Publications

Among adults with AF receiving OACs, the use of dabigatran had the lowest risk of diabetes when compared with warfarin use.

Abstract Introduction Climate change has led to more frequent, intense, and prolonged heatwaves. Although the effects of high temperatures on cardiovascular diseases (CVD) and premature mortality have been widely researched, their comprehensive impacts remain insufficiently studied. Purpose To assess the relationship between heatwave days and acute hospital admissions due to CVD, as well as premature mortality, at the county level, considering different age groups. Methods Geospatial analysis was conducted on the EP-PARTICLES cohort, comprising residents of Eastern Poland (N=8,077,671), with over 5 million CVD hospital admission records and deaths from 2011 to 2020, obtained from the National Health Fund. Heatwave events were indexed using the Excess Heat Factor (EHF) at the level of 709 counties (LAU–2). Additional covariates included air pollution, humidity, atmospheric pressure (as smoothed functions), weekdays, months, public holidays, and indicator varables. Negative binomial regression models were used at the municipal level. Results Total recorded deaths were 831,246 (total mortality, TM; median age: 78 years, IQR: 65–86, 52.8% male), including 377,344 cardiovascular-specific deaths (CVD mortality; median age: 82 years, IQR: 72–88, 46.2% male). In the non-adjusted model, TM increased by 4.8% (95% CI: 3.5–6.1), with a stronger effect in younger individuals (<65 years: 9.3%, 95% CI: 6.7–12.0) compared to older (≥65 years: 3.3%, 95% CI: 1.8–4.8), yielding a ratio of IR of 2.82 (P < 0.001). CVD mortality increased by 3.6% (95% CI: 1.8–5.6), with a higher effect in younger individuals (8.0%, 95% CI: 2.9–13.3) compared to older (3.0%, 95% CI: 1.0–5.0), ratio of IR: 2.67 (P=0.003). NSTEMI admissions decreased by −12.3% (95% CI: −15.9 to −8.5), with the largest reduction observed in the elderly (−16.8%, 95% CI: −21.1 to −12.2). No significant impact of heatwaves on the number of hospital admissions for ischemic stroke was observed. AKI admissions increased substantially by 15.9% (95% CI: 10.5–21.5), with stronger effects in younger individuals (35.9%, 95% CI: 24.1–48.8, P < 0.001) compared to older (11.2%, 95% CI: 5.2–17.5), resulting in a ratio of IR of 3.20 (P <0.001). Models adjusted for NO2, O3, and PM2.5 showed consistent effect directions for most outcomes, with adjustments for O3 yielding the highest estimates, particularly for TM and CVD mortality. Conclusion Heatwaves are significantly associated with increased mortality and cases of acute kidney injury but are linked to reductions in hospitalizations for acute coronary syndromes. The observed decrease in hospitalizations for myocardial infarction and no effect in IS could be indicative of increased pre-hospital mortality during heatwave events, as individuals experiencing severe cardiac events may succumb before reaching medical facilities. These findings highlight the importance of targeted public health strategies to address the diverse impacts of heatwaves on cardiovascular outcomes.

Given the positive correlations between the cumulative metabolic burdens and the risk of incident AF, maximal effort to detect and correct metabolic derangements even before MetS development might be important to prevent AF and related cardiovascular diseases.

Patients with cirrhosis are not only at an increased risk of bleeding but also at risk of venous thromboembolism (VTE). We sought to determine the clinical characteristics, management, and outcomes after VTE in patients with cirrhosis. We used the data from RIETE (Registro Informatizado de la Enfermedad TromboEmbolica), an international registry of patients with VTE, to compare the outcomes in patients with and without cirrhosis. Main outcomes included all-cause mortality, pulmonary embolism (PE)-related mortality, recurrent VTE, and bleeding. Among 43,611 patients with acute VTE, 187 (0.4%) had cirrhosis. Of these, 184 (98.4%) received anticoagulation for a median of 109 days (interquartile range [IQR]: 43-201 days), most commonly with enoxaparin (median dose: 1.77 [IQR: 1.38-2.00] mg/kg/day). Compared with patients without cirrhosis, those with cirrhosis had a higher rate of all-cause mortality (10.7 vs. 3.4%; odds ratio [OR]: 3.41; 95% confidence interval [CI]: 2.03-5.46) and fatal bleeding (2.1 vs. 0.2%; OR: 13.94; 95% CI: 3.65-37.90) but similar rates of fatal PE (0.5 vs. 0.5%; OR: 1.17; 95% CI: 0.03-6.70). Patients with cirrhosis had a higher rate of all-cause mortality per 100 patient-years of follow-up (58.9 vs. 16.0; hazard ratio [HR]: 3.70; 95% CI: 2.69-4.91). One-year hazard ratio of clinically relevant bleeding (HR: 2.86; 95% CI: 1.91-4.27), fatal bleeding (HR: 8.51; 95% CI: 3.5-20.7), or recurrent VTE (HR: 2.08; 95% CI: 1.00-4.36) was higher in patients with cirrhosis. Cirrhosis is a challenging comorbidity in patients with VTE. Most patients were treated with anticoagulation and had an elevated risk of recurrence, similar risk of fatal PE, and a very high risk of bleeding including fatal bleeds.

Incident AF was associated with an increased risk of dementia, independent of clinical stroke in an elderly population. Oral anticoagulant use was linked with a decreased incidence of dementia.

Hypertension is a risk factor for both progression of atrial fibrillation (AF) and development of AF-related complications, that is major adverse cardiac and cerebrovascular events (MACCE). It is unknown whether left ventricular hypertrophy (LVH) as a consequence of hypertension is also a risk factor for both these end points. We aimed to assess this in low-risk AF patients, also assessing gender-related differences. We included 799 patients from the Euro Heart Survey with nonvalvular AF and a baseline echocardiogram. Patients with and without hypertension were included. End points after 1 year were occurrence of AF progression, that is paroxysmal AF becoming persistent and/or permanent AF, and MACCE. Echocardiographic LVH was present in 33% of 379 hypertensive patients. AF progression after 1 year occurred in 10.2% of 373 patients with rhythm follow-up. In hypertensive patients with LVH, AF progression occurred more frequently as compared with hypertensive patients without LVH (23.3% vs 8.8%, p = 0.011). In hypertensive AF patients, LVH was the most important multivariably adjusted determinant of AF progression on multivariable logistic regression (odds ratio 4.84, 95% confidence interval 1.70 to 13.78, p = 0.003). This effect was only seen in male patients (27.5% vs 5.8%, p = 0.002), while in female hypertensive patients, no differences were found in AF progression rates regarding the presence or absence of LVH (15.2% vs 15.0%, p = 0.999). No differences were seen in MACCE for hypertensive patients with and without LVH. In conclusion, in men with hypertension, LVH is associated with AF progression. This association seems to be absent in hypertensive women.

The Ministry of Health and Welfare and the Ministry of Food and Drug Safety, Republic of Korea.

AF patients have an increased risk of dementia, independent of stroke, with highest risk of VaD. Management and prevention of the identified risk factors could be crucial to reduce the increasing burden of dementia.

Persistent moderate to heavy drinking and higher cumulative alcohol consumption burden might increase the risk of atrial fibrillation even in young adults aged 20 to 39 years.

<h3>Background</h3> Cancer Antigen 125 (CA125) is a large transmembrane protein. Previous studies in heart failure have demonstrated that CA125 is associated with measures of vascular congestion, inflammation, and long-term outcome, especially regarding monitoring therapy. The short-term prognostic significance of an increased CA125 in patients presenting with signs and symptoms of heart failure (HF) remains to be elucidated. <h3>Aim</h3> To determine the short-term prognosis of an increased CA125 in patients presenting with signs and symptoms of HF. <h3>Methods</h3> A retrospective cohort study was performed using electronic medical records from a global federated research network from the US. The network was searched on 28th December 2023. NTproBNP and CA125 results were the first reported within 30 days of presentation with shortness of breath, or fatigue or ankle oedema. Cohorts were grouped according to biomarker-specific thresholds and 1:1 propensity-score matched for age, gender and co-morbidities (hypertension, diabetes mellitus, hyperlipidaemia, CV procedures and medications, eGFR and smoking status) Patients with ovarian cancer were excluded. Logistical regression produced odds ratios with 95%CI for 30-day and 6 month incident HF and all-cause mortality. All statistical analysis was performed on the network’s online platform. <h3>Results</h3> The results are shown in table 1 (30-day outcome) and table 2 (6 month outcome). <h3>Conclusion</h3> In our large cohort elevated levels of CA125 do provide prognostic information, especially all-cause mortality. Further validation of CA125 may focus on its use in guiding treatment response, or dynamic modelling to evaluate the prognostic significance of changes in CA125. <h3>Conflict of Interest</h3> None