bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictive performance of different bleeding risk scores in patients with atrial fibrillation and acute coronary syndrome or undergoing percutaneous coronary intervention
Authors: Lyu S , Zhu J , Yu L , Yang Y 
Published: October 2021

Abstract

Background
Standard scoring system for bleeding risk assessment has not been developed in patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI). The study aims to evaluate the predictive value of the HAS-BLED, ORBIT, ARTIA, PARIS, and PRECISE-DEAPT score in patients with AF and ACS/PCI who received both anticoagulant and antiplatelet therapy.

Methods
A total of 930 patients with AF and ACS/PCI receiving both anticoagulant and antiplatelet therapy were consecutively recruited and followed up for 1 year. The primary endpoint was defined according to the bleeding academic research consortium (BARC) criteria as major (BARC 3a, 3b, 3c, and 5) and any bleeding (BARC 2, 3a, 3b, 3c, and 5). The secondary endpoints included major or minor bleeding according to TIMI criteria. Univariate and multivariate logistic regression were performed to evaluate the association between bleeding risk scores and outcomes. Receiver operating characteristic (ROC) curves were constructed and c-statistics were calculated to evaluate the predictive performance of different bleeding risk scores.

Results
BARC class ≥2 bleedings occurred in 36 patients (3.9%), while BARC class ≥3 bleedings were seen in 134 patients (14.4%). The HAS-BLED, ORBIT, ARTIA, PARIS, and PRECISE-DEAPT score were significantly associated with incidences of BARC class ≥2 and ≥3 bleedings during 1-year follow-up (all p&lt;0.05). The ROC analysis showed that the predictive performance of the five bleeding risk scores for BARC class ≥3 bleedings were low-to-moderate [c-statistic: HASBLED 0.584 (0.552–0.616), ATRIA 0.624 (0.592–0.655), ORBIT 0.623 (0.591–0.654), PARIS 0.633 (0.601–0.664), PRECISEDAPT 0.616 (0.584–0.647)]. Multivariable logistic regression indicated that previous bleeding history and hemoglobin were independent predictors of BARC class ≥3 bleedings. Compared to the HAS-BLED score, the model constructed by previous bleeding history and hemoglobin displays a significant improvement in bleeding risk prediction (0.704 vs. 0.584, p=0.013).

Conclusions
In patients with AF and ACS/PCI receiving both anticoagulant and antiplatelet therapy, the HAS-BLED, ORBIT, ARTIA, PARIS, and PRECISE-DEAPT score displayed low-to-moderate performance for predicting BARC class ≥3 bleedings during 1-year follow-up. More accurate scoring systems for bleeding risk evaluation should be developed for these patients in the future.

Funding Acknowledgement
Type of funding sources: None. Receiver operating characteristic curve
Effectiveness and safety of non-vitamin K antagonist oral anticoagulants versus warfarin among nonvalvular atrial fibrillation patients with prior bleeding events
Authors: Lip G.Y.H , Keshishian A , Kang A , Luo X , Atreja N , Zhang Y , Schuler P , Jiang J , Lovett K , Yuce H , Deitelzweig S 
Published: October 2021

Abstract

Background
Patients with non-valvular atrial fibrillation (NVAF) use oral anticoagulants such as warfarin or non-vitamin K antagonist oral anticoagulants (NOACs) for the prevention of stroke. However, the effectiveness and safety of warfarin and NOACs can be influenced by pre-existing patient comorbidities, such as a history of bleeding, and limited evidence are available to inform the choice of the most appropriate anticoagulant treatment for NVAF patients with bleeding history.

Purpose
This study used five United States insurance claims databases to evaluate the risk of stroke/systemic embolism (S/SE) and major bleeding (MB) among NVAF patients with prior bleeding events who were prescribed NOACs versus warfarin.

Methods
This retrospective observational study used data from 5 databases (CMS Medicare and four commercial databases, covering &gt;180 million beneficiaries) to select adult NVAF patients who were treated with apixaban, dabigatran, rivaroxaban, or warfarin (01JAN2013–30JUN2019). Patients were required to have a prior bleeding event, defined as a hospitalization with a diagnosis for intracranial hemorrhage (ICH), gastrointestinal (GI) bleeding or bleeding at other key sites prior to or during the index treatment episode. In each database, three 1:1 NOAC-warfarin propensity-score-matched (PSM) cohorts were created before pooling the results. Outcome measures were time to first stroke/SE, (ischemic stroke, hemorrhagic stroke, and SE), and time to first MB (gastrointestinal bleeding, intracranial hemorrhage, and MB at other key sites), and were measured from the index treatment episode to treatment discontinuation or switch, death, health plan disenrollment, or end of study period. Hazard ratios of S/SE and MB were calculated using Cox proportional hazards models.

Results
Among the eligible NVAF population, 8.2% of patients had a prior bleeding event (ICH: 12.3%; GI: 60.7%; Other: 27.0%). After PSM, a total of 43,092 apixaban-warfarin, 11,295 dabigatran-warfarin, and 32,723 rivaroxaban-warfarin patient pairs with prior bleeding were selected with a mean follow-up of 8–9 months. Apixaban and rivaroxaban were associated with a lower risk of S/SE, and dabigatran was associated with a similar risk of S/SE when compared to warfarin. Apixaban and dabigatran were associated with a lower risk of MB, and rivaroxaban was associated with a similar risk of MB, compared to warfarin (Figure).

Conclusion
Among NVAF patients with prior bleeding events, NOACs were associated with varying risks of S/SE and MB compared to warfarin. These results can help inform healthcare providers concerning the impact of OAC treatment in NVAF patients with history of bleeding.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Bristol-Myers Squibb Company and Pfizer, Inc.
The 30-day readmission of same-day discharge following pulmonary vein isolation for atrial fibrillation: a propensity score-matched analysis from National Readmission Database
Authors: Sahashi Y , Kuno T , Malik A.H , Briasoulis A 
Published: October 2021

Abstract

Introduction
The complication rate following pulmonary vein isolation (PVI) for atrial fibrillation (AF) has improved in recent decades with the increasing number of PVI worldwide. The effectiveness and safety of same-day discharge for PVI has not been elucidated well using a large nationwide database.

Purpose
The aim of our study was to evaluate the readmission rates within 30-days among patients receiving PVI for AF with the same-day discharge compared with the usual overnight observation protocol.

Methods
We performed a retrospective cohort study using the US Nationwide Readmission Database. Patients were divided into the two groups: the same-day discharge group and the overnight observation group (those who stayed at least one night following PVI). The primary outcome was an all-cause 30-day readmission rate following discharge in patients receiving PVI and a secondary outcome of total healthcare cost. A 1:3 propensity score matching was used to compare the safety within both protocols. Patients with peri-procedural complications such as pericardial, vascular, bleeding requiring transfusion, were excluded from the analysis.

Result
Among 30,776 patients (mean 67.2±11.4 years, 18,004 male (58.5%)) who received PVI from 2016 through 2018, 440 (1.42%) patients were discharged the same-day following PVI (same-day discharge group), and the remaining 30,336 patients stayed at least one night in the hospital (the overnight observation group). A propensity score analysis generated 1,751 matched pairs (440 in the same-day discharge group; 1311 in the observation overnight group). The 30-day readmission following discharge was not significantly higher in the same-day discharge group, compared to the overnight observation group (same-day discharge vs. overnight observation group: 12.7% vs. 9.7%, p=0.23; odds ratio [OR]:1.39, 95%confidence interval [CI]: 0.87–2.22) (Figure). Healthcare cost was significantly higher in the overnight observational group. ($25,237±14,036 vs. $30,749±16,383; p&lt;0.01).

Conclusion
In this large nationwide study using a propensity score matching analysis, there was no significant difference in 30-day readmission rates following the same-day discharge in patients receiving PVI for AF compared with the overnight observation protocol.

Funding Acknowledgement
Type of funding sources: None.
Impact of atrial fibrillation in patients with colorectal cancer: a national inpatient sample database analysis
Authors: Patel N , Amgai B , Chakraborty S , Hajra A , Binit A , Patel Z , Ashish K , Reddy M , Aronow W , Khalid M 
Published: October 2021

Abstract

Background
Atrial fibrillation (AF) is the most common cardiac arrhythmia affecting approximately 1–2% overall population (1). Its causal relationship with colorectal cancer (CRC) is much for debate. According to one hypothesis, the presence of autoantibodies directed against ionic channels or acetylcholine receptors can predispose to the development of atrial fibrillation (2–3). Thus, AF may be regarded as an inflammatory complication in patients with colon cancer. Our study objective was to determine if AF impacts the outcome of patients with CRC.

Method
We analyzed the National Inpatient Sample (NIS) database from Oct-2015 to Dec 2018 using Stata 16.0. The NIS databases are released under the Healthcare Cost and Utilization Project, which includes inpatient admissions from the United States' participating hospitals. Total population with CRC were identified using their respective ICD-10 diagnostic codes then divided based on AF. To determine atrial fibrillation association with mortality and complications, we used multivariate logistic regression analysis using weights to generate nationally representative results. Later, a propensity-matched population analysis was done for the accuracy of the results.

Result
We found 245,305 patients admitted with CRC between Oct 2015 to Dec-2018 in the USA, out of which 28,170 (11.5%) were having AF. The mean age for the patients with AF was 77±10 compare to 65±14 years in those without AF. Patients with AF were associated with higher comorbidities and had a high population percentage with Carlson category three or above. There were 1,456 (5.2%) mortalities in the AF group compared to 5,689 (2.6%) in the other. The higher odds of mortality in patients with AF was present in multivariate logistic regression analysis in both non-propensity matched [1.71 (1.45–2.02), P-value: &lt;0.000] and propensity-matched [1.44 (1.18–1.75), P-value: &lt;0.001] cohorts. Patients with AF were hospitalized longer (9.20±7.8 vs. 6.85±7.0 days), leading to a high admission costs (US$ 25,875±22,875 vs. 20,087±19,314). Odds of complications such as need for blood transfusions [1.61 (1.05–1.29), P-value: 0.005], hemorrhage requiring blood transfusion [1.17 (1.05–1.29), P-value: 0.003], lower-GI bleed [1.31 (1.21–1.43), P-value: &lt;0.001], sepsis [1.45 (1.30–1.62), P-value: &lt;0.001], respiratory failure [1.39 (1.15–1.67), P-value: 0.001] etc. were also higher in group of patients with CRC and AF.

Conclusion
In our retrospective, propensity-matched national inpatient sample analyses of patients admitted with colorectal cancer, atrial fibrillation is associated with higher morbidity and mortality. AF was associated with a high burden of complications with prolonged hospital stay leading to increased health care expenditures.

Funding Acknowledgement
Type of funding sources: None.
Worsening renal function as an outcome predictor in patients with new onset atrial fibrillation on direct oral anticoagulant
Authors: Bartoli L , Angeli F , Stefanizzi A , Armillotta M , Sansonetti A , Magnani I , Fabrizio M , Paolisso P , Foa' A , Rinaldi A , Galie' N , Pizzi C 
Published: October 2021

Abstract

Background
In patients with atrial fibrillation (AF), baseline kidney function is used to guide oral anticoagulant (OA) selection and dosing, and chronic kidney disease (CKD) is a significant outcome predictor. However, the incidence of worsening renal function (WRF) and its prognostic role during treatment with direct oral anticoagulants (DOACS) has been poorly explored.

Purpose
To assess the prognostic role of WRF in terms of bleedings and major adverse cardiovascular events (MACEs) in a cohort of patients with newly diagnosed non-valvular AF (NVAF) treated with DOACs.

Methods
Between January 2017 and March 2019, we enrolled all the patients with newly diagnosed NVAF and OA indication, treated with DOACs. Renal function was assessed using the mean value of the estimated glomerular filtration rates (eGFR) calculated using Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas. CHA2DS2-VASc and HAS-BLED scores were used at baseline to estimate the ischemic and hemorrhagic risk, respectively. At follow-up, WRF was identified as a decrease in eGFR of at least 20% while bleedings were classified according to the international society of thrombosis and hemostasis (ISTH) criteria. Finally, we defined AF progression as the transition from paroxysmal to persistent or permanent AF or from persistent to permanent AF.

Results
1009 patients with newly diagnosed NVAF started on DOAC were enrolled. They were followed-up for 21.6±9.5 months. Overall, WRF was observed in 181 cases (18%). Patients with WRF had higher rates of progression of atrial fibrillation (18.5% vs 11.8%, p=0.02), MACEs (20.4% vs 12.9%, p=0.09) and major bleedings (MB) (9,4% vs 4,7%, p=0.013). WRF did not correlate with all bleedings, stroke, or acute coronary syndrome (ACS). However, those who presented WRF using CKD-EPI formula had higher ACS incidence (6.1% vs 2.5%, p=0.015), and generally better-predicted MACEs. At multivariate analysis adjusted for age, hypertension, baseline HAS-BLED score and WRF, the latter emerged as an independent predictor of MB (OR 1.9 95% C.I, 1,059–3,51).

Conclusion
In patients with newly diagnosed NVAF treated with DOACs, WRF is associated with atrial fibrillation progression and MACEs, and emerged as an independent predictor of major bleedings. WRF evaluated with CKD-EPI formula better predicted MACEs.

Funding Acknowledgement
Type of funding sources: None.
Lifetime prevalence of syncope: the HELIUS study
Authors: Brewster L , Van Den Born B.-J , Wieling W , Van Montfrans G 
Published: October 2021

Abstract

Background
Syncope is a common presentation to emergency departments. Cardiovascular risk differs markedly among ancestry groups, but data on syncope are scarce. Fundamental understanding of the determinants of syncope in the population might aid in the risk stratification of syncope in acute settings.

Purpose
To assess lifetime prevalence of syncope and its determinants in the general population.

Methods
We included 14937 adults (18–70 y) randomly sampled in the cross-sectional Healthy Life in an Urban Setting (HELIUS) population study, stratified by White-European, Asian, Turkish, Moroccan, and West-African ancestry. We assessed syncope history, body mass index (BMI), blood pressure (BP), supine stroke volume (SV), cardiac contractility (dP/dt), cardiac output (CO), systemic vascular resistance (SVR), and resting plasma activity of CK, an ATP-generating enzyme that facilitates cardiovascular contractility and sodium retention, counteracting hypotensive susceptibility.

Results
Mean age of the participants (39% men) was 43.3 y (SD 12.9). Lifetime prevalence of syncope was significantly higher in women (31%) vs. men (18%); and in White-European (34%) and other ancestries (25 to 28%), vs. West-African ancestry (19%) (Figure 1). Mean age at first syncope was 24 y (SD 13). Participants without syncope history had higher BP (systolic, +29% SD), BMI (+17% SD), CK (+31% SD) (Figure 1), modestly higher SV, dP/dt, and CO (+6 to 8% SD), and more diabetes (5.2 vs 3.6%). The main protective predictors of syncope were West-African ancestry (0.59 [0.54 to 0.65]), male sex (0.52 [0.48 to 0.57]), and CK (0.56 [0.46 to 0.69]/log CK increase), with high CK in men and West-African ancestry largely explaining the low syncope prevalence in these groups.

Conclusion
To our knowledge the first population study on syncope by ancestry indicates that the lifetime prevalence is high in White-European women, and low in person of African ancestry. The inverse association of syncope with the pressor enzyme CK needs further study.

Funding Acknowledgement
Type of funding sources: None. Figure 1. Syncope by Sex, Ancestry, and CK
Are there sex differences in patients with syncope and bundle branch block?
Authors: Francisco Pascual J , Rivas Gandara N , Badia Molins C , Maymi Ballesteros M , Perez Rodon J , Benito B , Santos Ortega A , Roca Luque I , Bach Oller M , Cantalapiedra Romero J , Maldonado J , Oristrell Santamaria G , Sambola Ayala A , Moya Mitjans A , Ferreira Gonzalez I 
Published: October 2021

Abstract

Background
In the last years a substantial effort has been made to improve the understanding of the sex-differences in cardiovascular disease. However, no studies have examined differences in presentation and outcomes between men and women presenting with syncope and bundle branch block (BBB).

Aim
To determinate if there are sex-specific differences in the characteristics and outcomes of syncope in patients with BBB

Methods
Cohort study carried out in a tertiary hospital that is a reference center for syncope from January 2008 to February 2021. Patients (p.) with BBB and syncope of unknown origin after the initial evaluation without direct indication of an ICD were included. They were managed according to the current ESC guidelines. All patients underwent to an EPS and an ILR was implanted if it was not diagnostic.

Results
374p. were included (75±1 y. o; 135 (36%) female). Mean follow up was 2.3±1.6 y.o. No differences in baseline characteristics where found comparing both groups, except that LBBB was more prevalent in female and RBBB in male (Figure 1A). EPS and ILR diagnostic yield was 44%/44% respectively in females and 50% /40% in males (p=ns). However, basal HV interval in EPS was significant shorter in females (Figure 2A). In the multivariate analyses female sex was associated with a significant lower risk of AV block (Figure 1B), and with a trend of less need of a pacemaker implantation (PM) (53% in females, 60% in males) (Log-rank 0.1) (Figure 2B). No significant differences in recurrences neither in mortality rate were found.

Conclusions
Female patients with syncope and BBB have lower risk of AV block compared to males, and only half of them required a pacemaker implantation. A strategy of direct PM implantation should be avoided, specially in woman.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
Utility of telemetry in syncope admissions
Authors: Saha T , Bagel P , Toole J , Coplan N 
Published: October 2021

Abstract

Introduction
Syncope is a major cause of emergency room visits and admission to telemetry units however, prior studies have shown conflicting evidence for the necessity for a telemetry admission. Our current 2017 ACC/AHA/HRS guidelines recommend telemetry admissions for syncope evaluation when cardiac etiology is suspected.

Purpose
The purpose of this study is to investigate whether there are any differences in telemetry events in patients with a cardiac syncope versus non-cardiac/unspecified and to determine any correlation between the number of cardiac risk factors in patients with cardiac syncope versus non-cardiac etiology to predict those who would benefit most from telemetry.

Methods
Our retrospective study included 574 patients admitted to the cardiac telemetry unit between February 2017 and February 2020 at our metropolitan tertiary care centre, further grouped into: cardiac, non-cardiac, or unspecified syncope. Cardiac syncope included aetiologies such as arrhythmias, pulmonary hypertension, Long QTc, device malfunction etc. The non-cardiac syncope group included aetiologies such as orthostatic and reflex mediated. Thirteen cardiac risk factors were summed from the 2009 ESC syncope guidelines. These included HFrEF, elevated BNP, anemia, abnormal ECG, family history of sudden cardiac death or MI, age above 65, male gender, structural heart disease, abnormal vitals on presentation, history of sudden cardiac death, no prodrome prior to syncope and chest pain.

Results
Of the 574 patients, 102 patients (17.7%) had a cardiac etiology, 405 patients (70.5%) had a non-cardiac etiology and 67 patients (11.6%) had unspecified etiology for syncope. Overall, 47% of the cardiac group, 16% of the non-cardiac group, and 12% of the unspecified group had telemetry events. There was a statistically significant difference in the number of patients with telemetry events among the three syncope groups, p&lt;0.0001. The odds of patients with cardiac syncope having telemetry events were 4.0 times greater than those with non-cardiac syncope and 6.3 time higher than those with unspecified syncope.
The average number of risk factors were: 4 (±1.7) (cardiac), 3±1.6 (non-cardiac), and 3±1.7 (unspecified). Linear regression model showed the number of risk factors to be 19% and 15% lower in the non-cardiac and unspecified groups compared to the cardiac group. There was no association between any of the individual risk factors and the presence of telemetry event.

Conclusions
Our study demonstrates that those with cardiac syncope tend to have more cardiac risk factors and more telemetry events relative to their non-cardiac syncope counterparts. While patients with cardiac risk factors have on average a higher cardiac risk factor profile, it is not clinically significant enough to determine who would benefit from telemetry versus who would not.

Funding Acknowledgement
Type of funding sources: None.