Publications

Mobile health technology-supported atrial fibrillation screening and integrated care: A report from the mAFA-II trial Long-term Extension Cohort

Characteristics and 2-Year Outcomes of Dabigatran Treatment in Patients with Heart Failure and Atrial Fibrillation: GLORIA-AF

Patients with AF and history of HF may have greater disease burden at AF diagnosis and increased mortality rates vs. patients without HF. Stroke and major bleeding rates were roughly comparable between groups confirming the long-term safety and effectiveness of dabigatran in patients with HF.

Blood Pressure Control and Dementia Risk in Midlife Patients With Atrial Fibrillation

Atrial fibrillation (AF) is associated with increased risk of cognitive impairment and dementia, even with no overt stroke. Hypertension has been a potentially modifiable risk factor for dementia, especially in midlife (<70 years) individuals. We aimed to investigate the associations of blood pressure (BP) and hypertension burden with dementia risk among midlife AF patients. From the Korean National Health Insurance Service database, we enrolled 171 228 incident AF patients aged 50 to 69 years with no prior dementia from 2005 to 2016. During a mean of 6.6 years of follow-up, 9909 patients received a first-time diagnosis of dementia. U-shaped relationships were noted between systolic or diastolic BP and dementia risk: A 10 mm Hg increase or decrease in systolic BP starting from 120 mm Hg was associated with 4.4% (95% CI, 2.7%-6.0%) and 4.6% (95% CI, 0.1%-8.2%) higher dementia risk, respectively. An increase or decrease in diastolic BP starting from 80 mm Hg also increased dementia risk. In subtype analyses, Alzheimer disease increases with BP decrease whereas vascular dementia increases according to BP increase. When BP changes over time were accounted for in time-updated models, BP of 120 to 129/80 to 84 mm Hg was associated with the lowest dementia risk. Increasing hypertension burden (the proportion of days with increased BP during follow-up) was associated with higher dementia risk (hazard ratio, 1.10 per 10% increase [95% CI, 1.08-1.12]). Among midlife AF patients, there were a U-shaped association of BP and a log-linear association of hypertension burden with dementia risk. Minimizing the burden of hypertension in AF patients might help to prevent dementia.

Hs-CRP is associated with Heart Failure Hospitalization in Patients with MAFLD and Normal LVEF Undergoing Coronary Angiography

Abstract Background Systemic chronic inflammation plays a role in the pathophysiology of both heart failure with preserved ejection fraction (HFpEF) and metabolic dysfunction-associated fatty liver disease (MAFLD). Aim This study aimed to investigate whether serum high-sensitivity C-reactive protein (hs-CRP) levels were associated with the future risk of heart failure (HF) hospitalization in patients with MAFLD and a normal left ventricular ejection fraction (LVEF). Methods The study enrolled consecutive individuals with MAFLD and normal LVEF who underwent coronary angiography for suspected coronary heart disease. The study population was subdivided into non-HF, pre-HFpEF, and HFpEF groups at baseline. The study outcome was the first hospitalization for HF. Results In 10,019 middle-aged individuals (mean age 63.3±10.6 years; 38.5% female), the prevalence rates of HFpEF and pre-HFpEF were 34.2% and 34.5%, with a median serum hs-CRP level of 4.5 mg/L (IQR: 1.9-10 mg/L) and 5.0 mg/L (IQR: 2.1-10.1 mg/L), respectively. Serum hs-CRP levels were significantly higher in the pre-HFpEF and HFpEF groups than in the non-HF group. HF hospitalizations occurred in 1942 (19.4%) patients over a median of 3.2 years, with rates of 3.7% in non-HF, 20.8% in pre-HFpEF, and 32.1% in HFpEF, respectively. Cox regression analyses showed that patients in the highest hs-CRP level quartile had a ∼4.5-fold increased risk of being hospitalized for HF compared to those in the lowest hs-CRP level quartile (adjusted-Hazard Ratio 4.42, 95% CI 3.72-5.25). Conclusions There was a high prevalence of baseline pre-HFpEF and HFpEF in subjects with MAFLD. There was an increased risk of HF hospitalization in those with elevated hs-CRP levels.

The Atrial Fibrillation Better Care pathway for managing atrial fibrillation: a review

The 2020 European Society of Cardiology guidelines endorse the Atrial Fibrillation Better Care (ABC) pathway as a structured approach for the management of atrial fibrillation (AF), addressing three principal elements: 'A' - avoid stroke (with oral anticoagulation), 'B' - patient-focused better symptom management, and 'C' - cardiovascular and comorbidity risk factor reduction and management. This review summarizes the definitions used for the ABC criteria in different studies and the impact of adherence/non-adherence on clinical outcomes, from 12 studies on seven different cohorts. All studies consistently showed statistically significant reductions in the risk of stroke, myocardial infarction, and mortality among those with ABC pathway adherent treatment. The ABC pathway provides a simple decision-making framework to enable consistent equitable care from clinicians in primary and secondary/tertiary care. Further research examining the impact of ABC pathway implementation in prospective cohorts utilizing consistent inclusion criteria and definitions of 'A', 'B', and 'C' adherent care is warranted.

Altered fibrin clot structure in patients with atrial fibrillation and worsening renal function

Note: The review process for this manuscript was fully handled by Christian Weber, Editor in Chief.

One-year clinical outcome of patients with nonvalvular atrial fibrillation: Insights from KERALA-AF registry

Despite high risk profile of patients in this registry, use of OAC was suboptimal, whereas antiplatelets were used in nearly half of patients. A relatively high rate of annual mortality and hospitalization was observed in patients with NVAF in Kerala AF Registry.

Association between metabolically healthy obesity and atrial fibrillation: A systematic review and meta-analysis of longitudinal studies

Supermarket/hypermarket opportunistic screening for atrial fibrillation (SHOPS-AF) using sensors embedded in the handles of supermarket trolleys: A feasibility study

The study demonstrates that the public will engage with AF screening undertaken as part of their daily routines using hand-held devices. Sensors can play a key role in identifying asymptomatic patients in this way, but the technology must be further developed to reduce the quantity of non-diagnostic ECGs.

Association between brachial-ankle pulse wave velocity and the risk of new-onset atrial fibrillation: A report from Kailuan prospective cohort study

One marker of arterial stiffness (AS) is the brachial-ankle pulse wave velocity (baPWV). We aim to investigate the predictive value of baPWV with regard to new-onset atrial fibrillation (AF). All participants without AF from 2010 to 2020 in the Kailuan cohort were included. The primary endpoint was new-onset AF. Participants were categorized into three study groups based on baPWV, with a normal baPWV group as a reference. The predictive value of baPWV was analyzed as a continuous variable. Multivariable Cox proportional hazard regression models were used to investigate the association. A total of 49,872 subjects (mean age: 47.57 years old, 74.2% male) were included with a mean follow-up of 6.17 (3.95-8.46) years. The risk of AF increased as the baseline baPWV increased, whereby the adjusted hazard ratio (aHR) of the borderline AS group and the elevated AS group were 1.82 (95% confidence interval [CI]: 1.18-2.80) and 2.08 (95% CI: 1.31-3.30), respectively. When considered as a continuous variable, each 361 cm/s increase in baseline baPWV, increased the risk of AF by 21.7% (aHR: 1.22; 95% CI: 1.08-1.37). In the subgroup analysis of non-hypertensive patients, the risks of AF were significantly higher in the borderline AS group (aHR: 3.16, 95% CI: 1.74-5.74) and elevated AS group (aHR: 2.26, 95% CI: 1.02-5.05). For patients with elevated BMI, the risk of AF in the elevated AS group was significantly higher (aHR: 1.69, 95% CI: 1.00-2.83). Baseline baPWV was associated with new-onset AF after adjustments. (Trial registration site and registration number are, respectively, http://www.chictr.org.cn/index.aspx and ChiCTR-TNRC-11001489).

Drug Interactions Affecting Oral Anticoagulant Use

Oral anticoagulants (OACs) are medications commonly used in patients with atrial fibrillation and other cardiovascular conditions. Both warfarin and direct oral anticoagulants are susceptible to drug-drug interactions (DDIs). DDIs are an important cause of adverse drug reactions and exact a large toll on the health care system. DDI for warfarin mainly involve moderate to strong inhibitors/inducers of cytochrome P450 (CYP) 2C9, which is responsible for the elimination of the more potent S-isomer of warfarin. However, inhibitor/inducers of CYP3A4 and CYP1A2 may also cause DDI with warfarin. Recognition of these precipitating agents along with increased frequency of monitoring when these agents are initiated or discontinued will minimize the impact of warfarin DDI. Direct oral anticoagulants are mainly affected by medications strongly affecting the permeability glycoprotein (P-gp), and to a lesser extent, strong CYP3A4 inhibitors/inducers. Dabigatran and edoxaban are affected by P-gp modulation. Strong inducers of CYP3A4 or P-gp should be avoided in all patients taking direct oral anticoagulant unless previously proven to be otherwise safe. Simultaneous strong CYP3A4 and P-gp inhibitors should be avoided in patients taking apixaban and rivaroxaban. Concomitant antiplatelet/anticoagulant use confers additive risk for bleeding, but their combination is unavoidable in many cases. Minimizing duration of concomitant anticoagulant/antiplatelet therapy as indicated by evidence-based clinical guidelines is the best way to reduce the risk of bleeding.

Language matters: representations of ‘heart failure’ in English discourse—a large-scale linguistic study

AIMS: Heart failure (HF) has a lower public profile compared with other serious health conditions, notably cancer. This discourse analysis study investigates the extent to which HF is discussed in general contemporary English, UK parliamentary debates and the ways in which HF is framed in discussions, when compared with two other serious health conditions, cancer and dementia. METHODS: The Oxford English Corpus (OEC) of 21st century English-language texts (2 billion words) and the UK Hansard Reports of parliamentary debates from 1945 to early 2021 were used to investigate the relative frequencies, contexts and use of the terms 'heart failure', 'cancer' and 'dementia'. RESULTS: In the OEC, the term 'heart failure' occurs 4.26 times per million words (pmw), 'dementia' occurs 3.68 times pmw and 'cancer' occurs 81.96 times pmw. Cancer is talked about 19 times more often than HF and 22 times more often than dementia. These are disproportionately high in relation to actual incidence: annual cancer incidence is 1.8 times that of the other conditions; annual cancer mortality is two times that caused by coronary heart disease (including HF) or dementia.'Heart failure' is used much less than 'cancer' in UK parliamentary debates (House of Commons and House of Lords) between 1945 and early 2021, and less than 'dementia' from 1990 onwards. Moreover, HF is even mentioned much less than pot-holes in UK roads and pavements. In 2018, for example, 'pot-hole/s' were mentioned over 10 times pmw, 37 times more often than 'heart failure', mentioned 0.28 times pmw. Discussions of HF are comparatively technical and formulaic, lacking survivor narratives that occur in discussions of cancer. CONCLUSIONS: HF is underdiscussed in contemporary English compared with cancer and dementia and underdiscussed in UK parliamentary debates, even compared with the less-obviously life-threatening topic of pot-holes in roads and pavements.

Novel Echocardiographic Biomarkers in the Management of Atrial Fibrillation

Abstract Purpose of Review Atrial fibrillation (AF) is the most common arrhythmia in adults. The number of patients with AF is anticipated to increase annually, mainly due to the aging population alongside improved arrhythmia detection. AF is associated with a significantly elevated risk of hospitalization, stroke, thromboembolism, heart failure, and all-cause mortality. Echocardiography is one of the key components of routine assessment and management of AF. Therefore, the aim of this review is to briefly summarize current knowledge on “novel” echocardiographic parameters that may be of value in the management of AF patients. Recent Findings Novel echocardiographic biomarkers and their clinical application related to the management of AF have been taken into consideration. Both standard parameters such as atrial size and volume but also novels like atrial strain and tissue Doppler techniques have been analyzed. Summary A number of novel echocardiographic parameters have been proven to enable early detection of left atrial dysfunction along with increased diagnosis accuracy. This concerns particularly experienced echocardiographers. Hence, these techniques might improve the prediction of stroke and thromboembolic events among AF patients and need to be further developed and disseminated. Nonetheless, even the standard imaging parameters could be of significant value and should not be discontinued in everyday clinical practice.

Real-world applicability and impact of early rhythm control for European patients with atrial fibrillation: a report from the ESC-EHRA EORP-AF Long-Term General Registry

Among the 10,707 patients evaluated for eligibility to EAST-AFNET 4, a total of 3774 (34.0%) were included. Early rhythm control was associated with better quality of life, but with greater use of health-care resources. During follow-up, the primary outcome occurred less often in early rhythm control patients than in those with no rhythm control (13.6% vs. 18.5%, p < 0.001). In the multivariate adjusted Cox regression model, no significant difference was found between no rhythm control and early rhythm control, for the primary outcome. No difference in the primary outcome between early rhythm control and 'no rhythm control patients' adherent to Atrial fibrillation Better Care (ABC) pathway' was evident (p = 0.753) CONCLUSIONS: Use of an early rhythm control strategy was associated with a lower rate of major adverse events, but this difference was non-significant on multivariate analysis, being mediated by differences in baseline characteristics and clinical risk profile. Early rhythm control was associated with a higher use of health-care resources and risk of hospital admission, despite showing better quality of life.

Association between changes in renal function and clinical outcomes in anticoagulated atrial fibrillation patients with marginal renal function. A nationwide observational cohort study

In anticoagulated AF patients with marginal renal function, a substantial proportion of patients experienced renal function decline below eGFR 45 ml/min/1.73 m² within 2 years. Renal function decline was associated with higher risks of major bleeding, ESRD, all-cause death, and the composite outcome compared to those who maintained their baseline renal function.

Non-drug management

Impact of Physical Activity on All-Cause Mortality According to Specific Cardiovascular Disease

PA was associated with a reduced risk of all-cause mortality in older adults with and without CVD. The benefits of PA in patients with CVD, especially patients with stroke or heart failure, were greater than those without.

Comparative Effectiveness and Safety Between Apixaban, Dabigatran, Edoxaban, and Rivaroxaban Among Patients With Atrial Fibrillation

None.