bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends in clinical outcomes of patients with incident atrial fibrillation; results from a nationwide registry
Authors: Tsaban G , Golan Ben Baruch Y , Kazerle L , Alnsasra H , Barrett O , Henkin Y , Eisen A , Weisband Y , Schliamser J , Zahger D , Haim M 
Published: November 2023

Abstract

Background
Atrial fibrillation (AF) is associated with the risk of stroke and death. Advancements in patient care, such as direct oral anticoagulant (DOAC) use, are expected to improve AF patients' outcomes. However, real-world data examining this expectation are sparse.

Methods
We performed a historical population-based study among patients of Israel's largest health-maintenance-organization among patients aged&gt;21 years diagnosed with AF between 01/01/2010 and 01/01/2020. The study population was divided into early-era (2010-2014) and late-era (2015-2020). We compared the time-dependent 5-year risk of stroke, intracranial hemorrhage (ICH), gastrointestinal bleeding (GIB), or death.

Results
Of 98,241 patients (median-age:76, 51.3% women), 48,852 were in the early-era, and 49,389 were in the late-era. The late-era group had higher rates of OAC than the early-era group (51.3% vs. 33.5%, p&lt;0.001). The predominant OACs were warfarin (28.4%) in the early-era and DOACs (45.1%) in the late-era.
Five-year death rates were 17,226 (35.3%) and 14,702 (29.8%) in the early-era and late-era groups, respectively (p&lt;0.001), and 5-year stroke rates were 1,997 (4.1%) and 1,474 (3.0%) in the early-era and late-era groups, respectively (p&lt;0.001). In multivariate models, era-related death risk was mediated by between-group OAC changes (p-for-interaction&lt;0.001). OAC was associated with lower death risk (aHR 0.93, 95%CI(0.89,0.96),p&lt;0.001). The late-era group had a lower stroke risk (aHR 0.90 95%CI(0.82,0.99),p=0.037), which was associated with between-group OAC changes (p-for-interaction=0.002). OAC was associated with reduced stroke risk in the late-era only (aHR 0.87, 95%CI(0.78,0.97),p=0.012). The risk of ICH was similar across study groups (p=0.40). GIB risk was lower in the late-era (aHR 0.85 95%CI(0.78,0.93),p&lt;0.001). OAC was associated with increased GIB risk in the early-era (aHR 1.32, 95%CI(1.21,1.43),p&lt;0.001) but not in the late-era (aHR 1.06 95%CI(0.96,1.17),p=0.24).

Conclusions
Contemporary AF management is associated with lower stroke, death, and significant bleeding risks. The pendulum shift from warfarin to DOACs was associated with improved clinical benefits.Survival curves of the outcome
Impact of diabetes mellitus severity, treatment regimen and glycaemic control on atrial fibrillation prevalence. A report from the NOMED-AF prospective cross-sectional observational study
Authors: Gumprecht J , Lip G Y H , Sokal A , Sredniawa B , Stokwiszewski J , Zdrojewski T , Grodzicki T , Kazmierczak J , Opolski G , Kalarus Z 
Published: November 2023

Abstract

Introduction
Diabetes mellitus (DM) is a well-known risk factor for atrial fibrillation (AF), but the mechanism(s) by which DM affects AF prevalence remains unclear. The pathophysiological background underlying the frequent coexistence of diabetes and AF seems to be multifactorial, involving changes in left atrial size, abnormal proinflammatory mediators and endothelial dysfunction.

Purpose
This study aims to evaluate the impact of diabetes mellitus severity, expressed as its known duration, antihyperglycemic treatment regimen and glycaemic control reflected by HbA1c level on AF and its silent, asymptomatic form (SAF) prevalence.

Methods
The cross-sectional NOMED-AF trial schedule comprised multistage, stratified and clustered population sampling with subsequent clinical evaluation and long-term non-invasive AF screening. AF was screened using a telemonitoring vest for a mean of 21.9± 9.1 days. From the representative sample of 3014 participants (mean age 77.5, 49.1% female), 881 participants (mean age 77.6 ± 0.25, 46.4% female) with concomitant DM were involved in the analysis.

Results
The mean DM duration was 12 ± 0.35 years, but no significant impact of DM timespan on AF and SAF prevalence was observed. There were also no differences in the course of DM treatment pattern (oral medication vs insulin vs both - oral + insulin) among the study population with and without concomitant AF (p=0.106). From the study population 72% (95% CI: 68.7-75.1) received only oral hypoglycaemic medication; 12.9% (95% CI: 10.7-15.5) was taking both oral treatment + insulin injections; and 15.1% (95% CI: 12.7-17.8) were administered with insulin only. Metabolic control reflected by HbA1c levels showed no significant association with AF prevalence (p=0.635; p=0.094).
On multivariate analyses, age (Odds Ratio (OR) 1.35, 95%CI: 1.18-1.53, p&lt;0.001), p=0.042), body mass index (BMI; OR 1.043, 95%CI: 1.01-1.08, p=0.027) and LDL&lt;100 mg/dl (OR 0.64, 95%CI: 0.42-0.97, p=0.037) were independent risk factors for AF prevalence, while age (OR 1.45, 95%CI: 1.20-1.75, p&lt;0.001), LDL&lt;100 mg/dl (OR 0.43, 95%CI 0.23-0.82, p=0.011), use of statins (OR 0.51, 95%CI: 0.28-0.94, p=0.031) and HbA1c ≤6.5 (OR 0.46, 95%CI: 0.25-0.85, p=0.013) were associated with silent AF prevalence.

Conclusions
Diabetes duration, diabetic treatment pattern or metabolic control per se did not significantly impact the prevalence of AF, including silent AF detected by prospective continuous monitoring. Independent predictors of AF were age, BMI and low LDL levels, with statins and HbA1c ≤6.5 being additional independent predictors for SAF.
Associations of adding salt to foods with incident atrial fibrillation in the UK biobank study
Authors: Park Y , Yang P S , Jang E S , Yu H T , Kim T H , Sung J H , Pak H N , Lee M H , Joung B Y 
Published: November 2023

Abstract

Background/Introduction
Recent studies documented that the frequency of adding salt to foods was significantly related with cardiovascular disease and premature death.

Purpose
We aimed to investigate the relationship between frequency of adding salt to food and incident atrial fibrillation (AF).

Methods
The UK Biobank cohort study enrolled more than 500 000 participants aged 40 to 70 years across the United Kingdom from 2006 to 2010. We excluded participants with AF, coronary artery disease, heart failure or stroke. This study included 395,682 participants who completed the questionnaire of the frequency of adding salt to foods at baseline.

Results
Compared with participants with a higher frequency of adding salt to foods, participants with a lower frequency were more women and had lower waist and Townsend deprivation index (TDI). During follow-up, 19212 (4.9%) developed AF. Compared with the group of always adding salt to foods, lower frequency of adding salt to foods was significantly associated with lower risk of incident AF after adjustment for age, sex, body mass index, TDI and other clinical variables (Hazard ratio[HR] 0.88 [95% confidence interval[CI] 0.82-0.95] in the group of usually, HR 0.85 [95% CI 0.80-0.91] in the group of sometimes and HR 0.82 [95% CI 0.77-0.88] in the group of never/rarely, respectively). In the multivariate Cox regression analysis, the lowest frequency of adding salt to food had lower risk of incident AF (HR 0.77 [95% CI 0.63-0.93]) compared with the highest frequency group after adjustment for total energy intake.

Conclusion
Our study indicates that lower frequency of adding salt to foods was associated with lower risk of incident AF.Baseline characteristicsRisk of incident atrial fibrillation
Validation of novel electrocardiographic classification for stroke prediction in patients with atrial fibrillation undergoing cardioversion
Authors: Relander A , Kaaria J , Jaakkola S , Vasankari T , Nuotio I , Airaksinen K E J , Kiviniemi T 
Published: November 2023

Abstract

Introduction
Atrial cardiomyopathy (aCM) is an electromechanical entity reflecting abnormal conduction, structure and function of the myocardium predisposing to stroke and atrial fibrillation (AF), however, its electrocardiographic (ECG) definition is poorly characterized. We systematically assessed potential ECG markers of aCM in an attempt to identify those at risk for stroke and systemic embolism (SSE) or a combination of SSE, heart failure and death (major adverse events, MAE).

Methods and Results
We manually reviewed 1591 ECGs from patients with AF undergoing an acute cardioversion from the Finnish Cardioversion study (FIN-CV). Using post-CV 30d follow-up data as the derivation cohort, we determined the predictive performance of various P-wave indices including P-wave duration, morphology, and P-terminal force (PTF) for SSE prediction. The best predictive performance was found using a combination of prolonged P-wave (≥180ms), deflected P-wave morphology in lead II, biphasic P-waves in all inferior leads or increased PTF (≥80mm*ms) as markers for extensive aCM. We validated the findings using the long-term follow-up in patients with no anticoagulation of whom 219/874 (25.1%) had extensive aCM. During the median follow-up of 4.9 years, there was 51 (5.8%) new SSE and 152 (17.4%) MAE in total. At 3 years, 9 (4.1%), 4 (1.2%) and 1 (0.3%) patients with extensive, moderate or no aCM had suffered from SSE, respectively (p=0.002). At 5 years, the rates were 16 (7.3%), 8 (2.5%) and 5 (1.5%) (p&lt;0.001). Extensive aCM remained an independent predictor for SSE (HR 4.5, 95%CI 2.1-9.5, p&lt;0.001) and MAE (HR 1.7, 95%CI 1.1-2.6, p=0.01) after adjusting for CHA2DS2-VASc score (Figure 1).

Conclusion
Novel electrocardiographic markers of extensive aCM provided additional prognostic insight on risk for stroke in atrial fibrillation patients.Figure 1Graphical Abstract
Atrial fibrillation burden and timing of anticoagulation therapy in patients with screen-detected and clinically-diagnosed AF
Authors: Sun W , Tam T K , Yan B 
Published: November 2023

Abstract

Purpose
We evaluated the impact of atrial fibrillation (AF) burden and timing of oral anticoagulation (OAC) therapy initiation on stroke risk in patients with screen-detected and clinically-diagnosed AF.

Methods
Consecutive patients aged ≥65 years attending medical outpatient clinics with or without known AF were prospectively enrolled for AF-screening using handheld single-lead ECG (AliveCor) from 12/2014 to 12/2017 (NCT02409654). Repeated screening was performed in patients with &gt;1 visit during this period. Patients who participated in repeat screening were included in final analysis. Patients with previously known AF who were in AF in the initial screening and those with repeat screen-positivity were considered probably persistent AF, otherwise paroxysmal AF (single screen-positivity) or no AF (never screen-positive). Time from AF detection to initiation of OAC (Dx-to-Rx) was divided into two exposure levels, Dx-to-Rx ≤ 1 and &gt;1 month. Ischemic stroke risk was estimated using adjusted sub-distribution hazard ratios (aSHR) derived from Fine and Gray regression models, accounting for death as competing risk, adjusting for components of CHA2DS2VASC score and chronic renal disease, with no AF as reference and stratified according to AF burden and Dx-to-Rx.

Results
Of 11,972 patients enrolled, 3,853(32.2%) received repeated screening (mean age 76.7±7.3, female 47.5%), of which 3.7% (n=144) had screened-detected AF, 25.2% (n=972) previously known AF, 5.9% (n=226) clinically-diagnosed AF during follow-up, and 65.2% (n=2,511) no AF. Persistent AF was identified in 16.7% (n=644/3,853). Of patients with all AF categories, 55.1% (n=739/1,342) initiated OAC within 1 month after AF diagnosis. During a median follow-up period of 7.2(IQR: 6.1-7.5) years, compared to no AF, patients with paroxysmal AF and Dx-to-Rx ≤ 1m (aSHR=1.40, 95%CI:0.80-2.47) had similar low risk of ischemic stroke, while aSHR was highest for persistent AF and Dx-to-Rx &gt;1m (aSHR=2.42, 95%CI:1.38-4.26), followed by persistent AF with Dx-to-Rx≤ 1m (aSHR=2.19,95%:1.47-3.28), and paroxysmal AF with Dx-to-Rx &gt;1m (aSHR=2.00,95%CI:1.32-3.02) (Figure). Subgroup analysis revealed the effect of early initiation of OAC (P for interaction=0.936) and higher AF burden (P for interaction=0. 863) were consistent across screen-detected and clinically-diagnosed AF.

Conclusion
Among patients with screen-detected AF or clinically-diagnosed AF, lower AF burden and immediate initiation of OAC therapy were associated with reduction in risk of ischemic stroke. Early detection of AF by screening facilitating early OAC prophylaxis might improve clinical outcomes.Cumulative risk of ischemic stroke
Heart failure after left atrial appendage occlusion: insights from the LAAOS-III randomized trial
Authors: Krisai P , Belley-Cote E P , Mcintyre W F , Tsiplova K , Paparella D , Whitlock R P , Healey J S 
Published: November 2023

Abstract

Background
Left atrial appendage removal or occlusion (LAAO) might increase the risk for heart failure (HF) due to the loss of the LAA`s reservoir function, active contraction and neuroendocrine function.

Purpose
To investigate the incidence of HF hospitalizations and/or HF related death after LAAO in the Left Atrial Appendage Occlusion Study (LAAOS III).

Methods
In LAAOS III, 4811 patients with atrial fibrillation (AF) and a CHA2DS2-VASc score ≥2 were randomized to undergo or not undergo surgical LAAO during cardiac surgery for another indication. We compared the incidence of a composite endpoint of HF hospitalizations and HF related death between the two randomized groups (LAAO vs no-LAAO). We also pre-specified subgroups including: sex, age, BMI, surgery type, concomitant AF ablation, prior history of HF, history of hypertension, diabetes, prior myocardial infarction, left ventricular ejection fraction, sinus rhythm and occlusion method.

Results
We included 2379 patients in the LAAO and 2391 patients in the no-LAAO group. Overall, mean age was 71 years, 67% were male and 57% had prior HF. Baseline characteristics including drug treatment were balanced between the groups. Over a mean follow-up of 3.8 years, 395 (8.3%) patients met the primary HF endpoint: 209 (8.8%) in the LAAO group and 186 (7.8%) in the no-LAAO group. We did not find a significant difference for the primary endpoint between the randomized groups (Hazard ratio [95% confidence intervals] 1.13 [0.93-1.37], p=0.233) (Figure). The only significant subgroup interaction was for concomitant AF ablation (p for interaction = 0.004). Patients in the LAAO group without concomitant AF ablation had a higher risk for the primary endpoint (HR [95% CI] 1.37 [1.08-1.74], p=0.009) than patients with ablation (HR [95% CI] 0.74 [0.51-1.06], p=0.097).

Conclusion
LAAO did not increase the risk for a combined endpoint of HF hospitalizations and HF related death in patients with AF. Patients with concomitant AF ablation might have lower risk for the combined endpoint.Figure
Dementia risk among patients with atrial fibrillation treated with non-vitamin K vs. vitamin-K oral anticoagulants
Authors: Sagris D , Ntaios G , Harrison S , Buckley B , Underhill P , Lane D , Lip G Y H 
Published: November 2023

Abstract

Background
Atrial fibrillation (AF) is associated with increased risk of dementia. Whether the use of direct oral anticoagulats (DOAC) is associated with lower risk of dementia compared to vitamin-K antagonist (VKA) is unclear.

Purpose
The purpose of this study was to assess the risk of new all-cause dementia and vascular dementia in AF patients, treated with either DOAC or VKAs.

Methods
Anonymized electronic medical records from the TriNetX federated research network were used. AF patients treated with DOACs within 1 month of AF diagnosis, were 1:1 propensity score- matched with those treated with a VKA. Patients were followed up to 10 years for all-cause dementia and vascular dementia. Logistic regression and Cox proportional hazard models were used to calculate odds ratios (OR) and hazard ratios (HR), respectively with 95% confidence intervals (CIs).

Results
Among 321,282 patients included in the propensity-scored cohort [mean (SD) age 69.7 (±13.5) years; 138,593 (43.1%) female], dementia was diagnosed among 15,050 (4.7%) patients. Among patients treated with DOACs, all-cause dementia was diagnosed in 6,337 (3.9%) and 8,713 (5.4%) among those treated with VKA (OR:0.72, 95%CI:0.69-0.74). Vascular dementia was diagnosed in 1,188 (0.7%) patients treated with DOACs and 1,766 (1.1%) among the VKA-treated (OR:0.67, 95%CI:0.62-0.72). DOACs were associated with lower risk of all-cause dementia and vascular dementia compared to VKA (HR:0.85, 95%CI:0.82-0.88 and HR:0.82, 95%CI:0.76-0.88, respectively).

Conclusions
In this large propensity-score matched analysis, AF patients treated with a DOACs had significantly lower risk of all-cause dementia and vascular dementia compared to those treated with VKA. This finding requires confirmation in ongoing randomised controlled trials.
Age-dependent detection of Atrial Fibrillation with implantable cardiac monitors in patients with cryptogenic stroke
Authors: Uhe T , Keilitz J , Berrouschot J , Wacher R 
Published: November 2023

Abstract

Background
Prolonged and intensified rhythm monitoring is recommended to detect atrial fibrillation (AF) in patients with cryptogenic stroke (CS). Continuous monitoring using implantable cardiac monitors (ICM) results in AF detection rates of up to 30%. Although higher age has been identified as an independent risk factor for AF in patients post CS, there are no specific recommendations for the implantation of ICM in younger patients.
Furthermore, the temporal relationship between AF and recurrent stroke in patients with continuous monitoring is a relevant issue and scarcely investigated.

Objectives
(1)To analyze age-related AF rates in patients with CS and continuous rhythm monitoring using ICM.
(2)To determine the rates of oral anticoagulation and recurrent strokes in patients with ICM-detected AF after CS.
(3)To describe the temporal relationship of AF detection and recurrent stroke in these patients.

Methods
From 02/2014 to 11/2021, patients with CS provided with ICMs were systematically followed. All patients underwent 72-h ECG monitoring, transcranial doppler ultrasound and transthoracic echocardiography according to current guidelines prior to ICM insertion. Follow-up was performed by means of a regular outpatient presentation every three months and included medical history, physical examination, and interrogation of the ICM. AF was defined as any episode of absolute arrhythmia &gt;30 seconds.

Results
One hundred and eighty-six patients (mean age 65 ± 12 years) were included in this analysis. AF was detected in 62 patients (33 %) during a mean follow-up of 36 ± 23 months. AF was found in 6 % (3/52), 27 % (17/62), 56 % (31/55) and 65 % (11/17) (p &lt; 0.001) in patients aged &lt; 60 years, 60-69 years, 70-79 years and ≥ 80 years, respectively (see Figure 1). All patients with AF under 60 years had an impaired systolic left ventricular function (left ventricular ejection fraction &lt; 50 %). Oral anticoagulation was initiated in 85% of the patients with AF. Recurrent stroke occurred in 34 patients (18.3%) of whom fifteen had a diagnosis of AF. In nine patients, AF was diagnosed before the occurrence of a recurrent stroke. In four patients, AF was diagnosed after recurrent stroke and in one patient, AF and recurrent stroke occurred simultaneously (see Figure 2).

Conclusion
AF was absent in cryptogenic stroke patients with preserved ejection fraction and younger than 60 years. AF prevalence increased with age. The temporal relationship of AF and recurrent stroke was weak. Further research is needed to better identify stroke patients at risk of AF and recurrent stroke.
Figure 1: Time to first detection of Atrial fibrillation in patients aged &lt; 60 years, 60-69 years, 70-79 years and ≥80 years, respectively.
Figure 2: Temporal relationship of first detected atrial fibrillation (AF) and recurrent stroke in patients with cryptogenic stroke.Figure 1Figure 2
Atrial fibrillation high power radiofrequency ablation: efficiency and safety
Authors: Martinho M , Grade Santos J , Almeida S , Miranda R , Ferreira B , Santos Cunha D , Baltazar O , Ilchyshyn N , Mirinha Luz J , Budzak K , Cale R , Briosa A , Sebaiti D , Brandao Alves L , Pereira H 
Published: November 2023

Abstract

Introduction
High power-ablation index (HP-AI) guided radiofrequency (RF) ablation of atrial fibrillation (AF) is increasingly being used as an alternative to conventional power (CP) ablation due to its better procedural performance and similar safety profile. Some evidence suggests that the lower RF time used in HP-AI may also have a protective effect in contact related complications. Despite this evidence, this strategy is still not widely used.

Purpose
Compare procedural efficiency and safety between HP-AI vs CP-AI-guided ablation in AF patients (pts).

Methods
Retrospective single-center study of consecutive pts submitted to AI-guided ablation, between 05/2018 and 10/2022. RF power and AI were 25W/500 and 45W/500 for the anterior wall and 20W/380 and 35W/380 for the posterior wall in CP-AI and HP-AI, respectively. Procedure related complications incidence were checked at 1 month.

Results
Of a total of 83 pts included in the study, mean age was 62±10y and 57.8% were males. HP-AI was performed in 61.4% (n=51). 39.2% had persistent AF (vs 25% in CP-AP, p=0.235). HP-AI was associated with significantly lower median procedure duration (150.0[140.0-180.0]min vs 192.0[180.0-235.0]min, p&lt;0.001), fluoroscopy time (9.2[7.3-11.3]min vs 12.2[9.7-14.3]min, p=0.003) and RF time (26.3[20.4-28.4]min vs 34.3[30.1-39.6]min, p&lt;0.001). These times were significantly reduced for both paroxysmal and persistent AF (figure 1). Electrical isolation of all the pulmonary veins was achieved in all patients. There were no early complications related to the procedure in either CP-AI or HP-AI groups.

Conclusion
HP-AI guided AF ablation significantly reduced procedure duration without impairing safety. It was also associated with lower RF application time, which may potentially lead to a reduction in procedure related complications. Data regarding long-term effectiveness will eventually support HP-AI as the best option for RF AF ablation.Comparison of median procedural times