Publications

PwCF are at increased risk of adverse cardiac disease events. Future work should focus on defining determinants of cardiovascular risk such that appropriate risk stratification can be employed.

Within a community-based ED population of AF patients at high stroke risk, rates of appropriate stroke prevention action increased over the 7-year study period. Rates of AF thromboprophylaxis may be improved by addressing sex and age disparities, as females and those age ≥ 75 were less likely to receive indicated stroke prevention.

<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>

This paper is an executive summary of the full European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, published in <i>Europace</i>. It summarises developments in the field and provides recommendations for patient management, with particular emphasis on new advances since the previous European Society of Cardiology guidelines. The EHRA consensus document is available to read in full at http://europace.oxfordjournals.org.

Poor TTR control is associated with adverse clinical outcomes in patients with NVAF who were on warfarin. Efforts to ensure good TTR (≥65%) after initiation of warfarin are mandatory to minimize the risk of adverse clinical outcomes.

Frail patients with atrial fibrillation are often untreated with OAC in routine clinical care despite an indication for stroke prevention. The NCB balancing thromboembolic events and major bleeding was in favor of anticoagulation but decreased with advancing age and increasing frailty.

&lt;p&gt; &lt;/p&gt; &lt;p&gt;&lt;strong&gt;Objective:&lt;/strong&gt; We investigated the association between alterations in regular physical activity (PA) and the risk of developing AF in patients with type 2 diabetes mellitus (T2DM), and the optimal PA range based on energy expenditure.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Research Design and Methods:&lt;/strong&gt; In a nationwide database, subjects who underwent health examinations twice at a 2-year interval between 2009 and 2012 were studied. After identifying 1,815,330 type 2 DM patients without previous AF history, they were followed up until 2018. Based on regular PA alterations over time, individuals were divided into 4 groups: persistent non-exercisers (n=1,181,337), new exercisers (n=225,124), exercise dropouts (n=242,968), and exercise maintainers (n=165,401). &lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; During a mean follow-up period of 5.6±1.3 years, 46,589 cases (2.6%) of new-onset AF occurred. Compared to the persistent non-exercise group, both the exercise drop-outs group (adjusted hazard ratio [HR] 0.96, 95% confidence interval [CI] 0.94-0.99) and new exerciser group (HR 0.95, 95% CI 0.93-0.98) had lower risks of incident AF. The exercise maintainer group showed the lowest risk (HR 0.91, 95% CI 0.89-0.94). &lt;/p&gt; &lt;p&gt;When we stratified T2DM patients according to energy expenditure, undergoing regular PA with ≥1500 metabolic equivalents of task (MET)-min/week in new exercisers and ≥1000 MET-min/week in exercise maintainers were associated with lower risks of incident AF than non-exercisers, respectively.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusions&lt;/strong&gt;: In patients with T2DM, starting and maintaining regular PA were both associated with lower risk of incident AF. Optimal PA ranges based on energy expenditure which were associated with lower risks of incident AF can be defined. &lt;/p&gt; &lt;p&gt;&lt;strong&gt;Key words:&lt;/strong&gt; Type 2 diabetes mellitus, atrial fibrillation, physical activity, prognosis, energy expenditure&lt;/p&gt;

Abstract Background Catheter ablation is an effective treatment for symptomatic atrial fibrillation (AF) and has superiority over drug treatments. Emerging evidence suggests that exercise-based cardiac rehabilitation (ExCR) can improve the health outcomes of people with AF, but the long-term impact of ExCR on clinical endpoints for patients with AF following catheter ablation is unclear. We investigated 12-month all-cause mortality, hospitalisation, ischaemic stroke, and myocardial infarction in patients with AF receiving catheter ablation and ExCR versus matched controls receiving catheter ablation only. Methods and Results A propensity-matched cohort study was conducted using electronic medical records from a global federated health research network. Patients with AF who received catheter ablation and ExCR were propensity-score matched for age, sex, ethnicity, comorbidities, cardiovascular procedures, and cardiovascular medication with patients with AF who received catheter ablation only. Using logistic regression, 12-month incidence of all-cause mortality, hospitalisation, ischaemic stroke, and myocardial infarction were compared. In 6510 AF patients (mean age 66, SD; 11, 26.3% female) who had received catheter ablation, ExCR was associated with lower all-cause mortality (OR 0.73; 95% CI, 0.59-0.92) and hospitalisations (OR 0.77; 95% CI, 0.69-0.85) when compared with propensity-score matched controls. No significant associations were shown for ischaemic stroke (OR 0.88; 95% CI, 0.62-1.25) or myocardial infarction (OR 0.89; 95% CI, 0.67-1.20). Secondary analysis of AF progression from paroxysmal to sustained AF at 12-month follow-up demonstrated proportionally lower AF progression with 10% in the ExCR cohort compared to 15% in the catheter ablation cohort (OR 0.62, 95% CI: 0.56- 0.68). Conclusions ExCR in patients with AF who received catheter ablation associated with lower all-cause mortality and hospitalisation at 12-month follow-up compared to those who received catheter ablation alone, as well as less AF progression from paroxysmal to sustained AF at 12-month follow-up.