Publications

<b>Objectives:</b> To investigate the effects of alcohol abstinence in preventing new-onset atrial fibrillation (AF) in patients with type 2 diabetes mellitus (T2DM). <p><b>Research Design and Methods:</b> A total of 1,112,682 patients newly diagnosed with T2DM between 2011–2014, were identified from the Korean National Health Insurance Service database. After excluding a previous history of AF, 175,100 subjects were included. The primary outcome was new-onset AF.</p> <p><b>Results:</b> During a mean follow-up of 4.0 years, AF occurred in 4,174 patients. Heavy alcohol consumption (alcohol intake ≥40 g/day) before a T2DM diagnosis had a higher risk of AF (adjusted hazard ratio [aHR] 1.22, 95% confidence interval [CI] 1.06–1.41) compared to no alcohol consumption. After a T2DM diagnosis, moderate-to-heavy alcohol consumption (alcohol intake ≥20 g/day) who abstained from alcohol had a lower risk of AF (aHR 0.81, 95% CI 0.68–0.97) than did constant drinkers. Alcohol abstinence showed consistent trends toward lower incident AF in all subgroups and was statistically significant in men (aHR 0.80, 95% CI 0.67–0.96), those aged >65 years (aHR 0.69, 95% CI 0.52–0.91), those with CHA<sub>2</sub>DS<sub>2</sub>-VASc score <3 points (aHR 0.71, 95% CI 0.59–0.86), non-insulin users (aHR 0.77, 95% CI 0.63–0.94), and body mass index < 25 mg/k<sup>2</sup> (aHR 0.68, 95% CI 0.53–0.88).</p> <p><b>Conclusions</b>: In patients with newly diagnosed T2DM, alcohol abstinence was associated with a low risk of AF development. Lifestyle modifications, such as alcohol abstinence, in patients newly diagnosed with T2DM should be recommended to reduce the risk of AF.</p>

Introduction: Previous research has demonstrated that patients with atrial fibrillation (AF) have limited knowledge of AF, stroke and oral anticoagulant (OAC) treatment. This analysis assessed the effect of educational level on stroke knowledge, AF perception, concern about stroke, OAC treatment preferences and adherence. Methods: This was a cross-sectional, prospective survey of 936 adult patients (mean (SD) age 54.3 (16.6) yrs; 37.2% female) with AF on OACs in the USA, Canada, Germany, France and Japan. Three groups were included: AF with recent stroke (≤ 6 m); new onset AF (≤ 6 [ ≤ 12 m in Japan]) without recent stroke; established AF (7-24m [1-3yrs in Japan]) without recent stroke. Open-ended questions determined stroke knowledge, assessed according to a predefined scoring system. Patients were grouped according to educational level: no school-leaving certificate (low), high school diploma, community college and university/technical college. Results: Stroke knowledge was similar in all patients regardless of educational level. A greater proportion of patients with college education were ‘always’ or ‘often concerned’ about stroke, whereas a greater proportion of those with low levels of education were ‘never concerned’ about stroke (or didn’t know). Educational level had no effect on self-reported OAC adherence or patient preference to be involved in OAC treatment decisions. Patients with no school leaving certificate perceived taking medication (all drugs) as a ‘major burden’ (25.9%), while significantly more patients with college/university education did not view taking medication as burdensome (38.5% and 50.4% versus 37.0%, respectively; Table). Conclusions: Education influenced patients’ perceptions of the seriousness of AF, frequency of concern about stroke and perceived burden of medication. Educational attainment did not affect level of stroke knowledge, OAC adherence and desire to be involved in OAC treatment decisions.

The purpose of this review is to describe the present evidence for exercise and nutritional interventions as potential contributors in the treatment of sarcopenia and frailty (i.e. muscle mass and physical function decline) and the risk of cardiorenal metabolic comorbidity in people with heart failure (HF). Evidence primarily from cross-sectional studies suggests that the prevalence of sarcopenia in people with HF is 37% for men and 33% for women, which contributes to cardiac cachexia, frailty, lower quality of life, and increased mortality rate. We explored the impact of resistance and aerobic exercise, and nutrition on measures of sarcopenia and frailty, and quality of life following the assessment of 35 systematic reviews and meta-analyses. The majority of clinical trials have focused on resistance, aerobic, and concurrent exercise to counteract the progressive loss of muscle mass and strength in people with HF, while promising effects have also been shown via utilization of vitamin D and iron supplementation by reducing tumour necrosis factor-alpha (TNF-a), c-reactive protein (CRP), and interleukin-6 (IL-6) levels. Experimental studies combining the concomitant effect of exercise and nutrition on measures of sarcopenia and frailty in people with HF are scarce. There is a pressing need for further research and well-designed clinical trials incorporating the anabolic and anti-catabolic effects of concurrent exercise and nutrition strategies in people with HF.

DM was independently associated with higher risks of all-cause death, CV death, MI, major bleeding and MACE in AF individuals. Individuals receiving insulin alone were associated with higher risks of all-cause death, CV death, MI, major bleeding and MACE.

Renal function, assessed by creatinine clearance (CrCl), affects the efficacy and safety of oral anticoagulant (OAC) therapy in patients with atrial fibrillation (AF). To investigate the association between CrCl and the risk of clinical adverse events and compare the safety profiles of vitamin K antagonists (VKA) and non-vitamin K antagonist oral anticoagulants (NOAC). Patients with newly diagnosed AF (< 3 months before baseline visit) were collected from the prospective Global Registry on Long-Term Oral Anti-Thrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF) registry Phase III. Clinical events assessed included the composite outcome (all-cause death, thromboembolism, and major bleeding), cardiovascular (CV) death, myocardial infarction (MI), and other single outcomes. 10,594 AF patients (mean age 70.35 ± 9.92 years; 55% male; 73% on NOAC) were included. Increasing CrCl was associated with decreased risks of all cause death, composite outcomes and CV-death with in patients with CrCl < 80 mL/min. Multivariate Cox models indicated that compared to VKA, NOAC was associated with lower risks of all cause death (adjusted hazard ratio [aHR] 0.68, 95% CI 0.58-0.78), composite outcomes (aHR 0.77, 95% CI 0.69-0.86), CV-death (aHR 0.70, 95% CI 0.56-0.87), and major bleeding (aHR 0.74, 95% CI 0.61-0.91) in AF patients. For CrCl < 30 mL/min, lower risks of all-cause death, composite outcomes and CV death were related to NOAC therapy. In this large prospective global registry, NOACs were associated with better outcomes compared with VKA for patients with normal or impaired renal function.

Anaemia was common in patients with AF and associated with major bleeding and lower TTR. Oral anticoagulation was associated with more major bleeding, but no reduction in risk of stroke/TE among AF patients with moderate/severe anaemia.

In the setting of an ICH, supportive care/measures are needed, and reversal of anticoagulation with specific agents (including administration of vitamin K, prothrombin complex concentrates, idarucizumab and andexanet alfa) should be considered. Most patients will likely benefit from restarting anticoagulation after an ICH and permanently withdrawn of OAC is associated with worse clinical outcomes. Although the timing of OAC resumption is still under debate, reintroduction after 4-8 weeks of the bleeding event may be possible, after a multidisciplinary approach to decision-making.