Publications

<p> </p> <p><strong>Abstract</strong></p> <p><strong>Objective: </strong>To evaluate the association between pre-diabetes and HF and the association of HF with changes in glycaemic status. </p> <p><strong>Design and Methods: </strong>Patients newly diagnosed with AF between 2015 and 2018 were divided into 3 groups (normoglycaemia, pre-diabetes, and type 2 diabetes) according to their baseline glycaemic status. The primary outcome was incident HF. Fine and Gray model was applied, with death defined as the competing event. </p> <p><strong>Results</strong>: Among 17,943 AF patients (mean age 75.5 years, 47% female), 3,711 (20.7%) had pre-diabetes and 10,127 (56.4%) had diabetes at baseline. Over a median follow-up of 4.7 years, 518 (14%) normoglycaemic, 646 (15.7%) pre-diabetic, and 1,795 (17.7%) diabetic patients developed HF. Pre-diabetes was associated with an increased risk of HF compared with normoglycaemic patients (subdistribution Hazard Ratio (SHR) =1.12, 95% confidence interval (CI): 1.03-1.22). In patients with pre-diabetes at baseline, 403 (11.1%) progressed to diabetes and 311 (8.6%) reversed to normoglycaemia at 2 years. Compared to those who remained pre-diabetic, patients who progressed to diabetes were associated with an increased risk of HF (SHR=1.50, 95% CI: 1.13-1.97), whereas those who reversed to normoglycaemia were associated with decreased risk (SHR=0.61, 95% CI: 0.42-0.94). </p> <p><strong>Conclusions</strong>: Pre-diabetes was associated with an increased risk of HF in patients with AF. Compared with patients who remained pre-diabetic, those who progressed to diabetes at 2 years experienced an increased risk of HF, whereas those who reversed to normoglycaemia incurred a lower risk of HF. </p>

Two-year mortality after femoral angioplasty/stenting is higher in Asians, whereas risk of limb loss is higher in blacks compared with whites. Reasons of these ethnic differences in outcomes following femoral endovascular procedures for PAD merit further study.

Background Effective stroke prevention with oral anticoagulants (OAC) is recommended for some patients with atrial fibrillation (AF). We aimed to describe OAC use by geographical region and type of site in patients with recent-onset AF enrolled in a large global registry. Methods and Results Eligible participants were recruited into GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation), a prospective observational cohort study from 2014 to 2016 in 4 international regions: North America, Europe, Asia, and Latin America. Cumulative incidence functions were generated for direct OACs (DOAC), vitamin K antagonists, and antiplatelet drugs considering competing risks, stratified by region and type of site. Time-to-treatment initiation after AF diagnosis was analyzed with Fine-Gray subdistribution hazard models. A total of 21 237 patients eligible for analysis were identified. By 30 days after AF diagnosis, 40%, 16%, and 8.6% of patients had DOAC, vitamin K antagonists, and antiplatelet drugs initiated, respectively. Earlier initiation of DOACs was observed in Europe, with Asia and Latin America having lower hazard rates of DOAC time-to-treatment initiation than Europe (hazard ratio [HR], 0.66; 95% CI, 0.62-0.70 and HR, 0.79; 95% CI, 0.73-0.85, respectively). DOAC initiation was highest in community hospitals, vitamin K antagonists in outpatient health care centers/anticoagulation clinics, and antiplatelet drugs in primary care clinics. Conclusions Important geographic variability exists with the use of OACs for patients with AF. Differences in the time-to-treatment initiation of OAC by type of site suggests suboptimal implementation of guideline recommendations and could result in less benefit and more harm. Optimizing OAC use for patients with AF may improve outcomes and reduce health care costs. Registration URL: http://www.clinicaltrials.gov; Unique identifiers: NCT01468701, NCT01671007.

The increasing ageing of the general population has led to a significant burden of multimorbidity in the general population, requiring significant changes to healthcare and management, as well as clinical approaches. Hence, increasing attention to the progressively increasing burden of multimorbidity and the need for more integrated care management in patients with chronic long-term conditions. Even in the most common heart rhythm disorder, atrial fibrillation (AF), the presence of multimorbidity has proven to significantly influence clinical management and prognosis. The burden of multimorbidity in AF patients, similar to the overall general population, requires new strategies to manage patients and re- duce the risk of adverse outcomes. There is also a close relationship between AF and the concept of ‘frailty’, which is a clinical syndrome characterized by reduced physio-logical reserve and increased vulnerability. Given this background, the European Union through the Horizon 2020 research programme has funded the ‘Atrial fibrillation integrated approach in frail, multimorbid and polymedicated older people’ (AFFIRMO) Programme (grant agreement no. 899871). Central to the AFFIRMO Programme will be the inclusion of the comprehensive geriatric assessment (CGA) into the ABC pathway, to provide a comprehensive evaluation of health status in elderly multimorbid patients and to characterize each patient by the level of frailty and specifically manage functional status domains.

The prevalence and incident rates of cardiovascular outcomes were significantly higher in PWE. Targeting cardiovascular health could help reduce excess morbidity and mortality in PWE.

Abstract Background Sodium-glucose cotransporter-2 inhibitors (SGLT2I) have been suggested to have beneficial effects against infection. However, the comparative risks of new onset infective endocarditis between SGLT2Is, dipeptidyl peptidase-4 inhibitors (DPP4Is) and glucagon-like peptide-1 receptor agonist (GLP1a) remain unknown. Objective This real-world study aims to compare the risks of infective endocarditis upon exposure to SGLT2I and dipeptidyl peptidase-4 inhibitors (DPP4I). Methods This was a retrospective population-based cohort study of patients with type-2 diabetes mellitus (T2DM) on either SGLT2I or DPP4I between 1st January 2015 and 31st December 2020 using a territory-wide registry in Hong Kong. The primary outcome was new-onset infective endocarditis. The secondary outcome was cardiovascular-related mortality. Propensity score matching (1:1 ratio) using the nearest neighbour search was performed. Multivariable Cox regression was applied to identify significant associations. A three-arm sensitivity analysis including the GLP1a cohort was conducted. Results This cohort included 75638 T2DM patients (median age: 62.3 years old [SD: 12.8]; 55.79 % males). The SGLT2I and DPP4I groups consisted of 28774 patients and 46864 patients, respectively. After matching, 104 and 161 infective endocarditis in the SGLT2I and DPP4I groups occurred over a follow-up of 5.6 years. SGLT2I use was associated with lower risks of infective endocarditis (Hazard ratio [HR]: 0.58; 95% Confidence Interval [CI]: 0.41-0.81) and cardiovascular mortality (HR: 0.49; 95% CI: 0.33-0.72) compared to DPP4I use after adjustments for demographics, comorbidities, medications, renal function, and HbA1c levels. Similar associations were observed in subgroup analyses regardless of gender, hypertension, prior valvular disease, renal disease, or immunodeficiency. In the sensitivity analysis, SGLT2I was not associated with lower risks of infective endocarditis compared to GLP1a. The results remained consistent in the competing risk and the other sensitivity analyses. Conclusions SGLT2I use was associated with lower risks of new-onset infective endocarditis compared to DPP4I after adjustments. Illustrated abstract

In this contemporary AF cohort, diabetes was present in 1 in 4 patients and it served as an independent risk factor for reduced quality of life, greater healthcare resource utilisation and excess MACE, all-cause mortality and cardiovascular mortality. There was increased use of anticoagulation therapy in diabetes but with less rhythm control interventions.