bluuebunny/crossref_metadata_2025_split huggingface dataset:
Episode-level characteristics of atrial fibrillation are associated with symptomatic events
Authors: Ahluwalia N , Schilling R J , Majumder S , Koehler J , Landman S , Sarkar S 
Published: November 2023

Abstract

Background
Symptoms related to Atrial Fibrillation (AF) can be debilitating are the main driver to seek hospital attention. However, many patients do not experience any symptoms and intra-subject variation is also seen. The reasons for this variability are unclear and a better understanding of the features associated with symptomatic AF episodes may improve stratification and personalisation of care.

Purpose
To evaluate the features associated with symptomatic versus asymptomatic AF episodes recorded using an insertable cardiac monitor (ICM).

Methods
We linked a deidentified database of aggregated electronic health records from 2007-2021 to a manufacturer’s device data warehouse with continuous diagnostic monitoring data. ICM-detected AF episodes of a minimum of one hour duration were retrospectively analysed. Symptomatic AF was defined as episodes temporally correlated with patient activation of a handheld symptom activator device. Episode- level comparison of mean heart rate at detection and during the entire AF episode, AF episode duration, activity index and AF evidence score (a linear scale based on episode irregularity) between symptomatic and asymptomatic patients was performed. Data was reported as mean ± standard deviation or median (inter-quartile range) if non-normally distributed. Wilcoxon Signed-Rank test was used for per-subject paired analysis. Multi-variate logistic regression model with binomial distribution and exchangeable correlation structure was used to identify factors associated with symptomatic episodes. A Generalized Estimating Equations model was used to account for multiple AF episodes within a subject.

Results
417,432 unique episodes were recorded in 11,436 patients. 6,190 (1.48%) episodes from 1776 patients were marked as symptomatic. These were longer (5.5 (12.1) hours vs 3.7 (9.3) hours), had a higher mean HR at onset (105.7±29.3bpm vs 89.1+-24.6bpm) and a greater AF evidence score (97.6+-26.9 vs 82.1+-24.4). On multi- variate logistic regression, AF evidence score, and mean HR was independently associated with symptomatic AF (table 1). Per subject analysis of 1589 patients with both symptomatic and asymptomatic episodes also suggested significantly higher AF evidence scores. (-3.64±22.0).
Discussion: This is the largest episode-level characterisation of AF episodes in patients with an ICM. The AF evidence score, a marker of ventricular rate variability, may be useful for the remote stratification of AF episodes. Prospective study of stratification based on this parameter would be of value.Regression model of symptomatic AF
Stroke, mortality, and major bleeding among patients with atrial fibrillation and chronic kidney disease; insights from a contemporary large-scale population study
Authors: Ben Baruch Golan Y , Tsaban G , Eisen A , Loewenberg Weisband Y , Iakobishvili Z , Henkin Y , Arnson Y , Haim M 
Published: November 2023

Abstract

Introduction
Chronic kidney disease (CKD) and atrial fibrillation (AF) frequently coexist, sharing a complex interplay. Although both conditions are prothrombotic, the prognostic role of CKD in AF remains uncertain, and anticoagulation effect on clinical outcomes is unclear.

Methods
A historical population-based study based on the "Clalit" health organization computerized database, including patients &gt;21 years first diagnosed with AF between January 1st, 2010, and January 1st, 2020. The study population was stratified according to the estimated glomerular filtration rate (eGFR) at baseline to: No or mild CKD (eGFR≥60mL/min/1.73m2), moderate-CKD (eGFR above 30 and below 60 mL/min/1.73m2) and advanced-CKD (eGFR≤30 mL/min/1.73m2). Multivariable Cox-regression analyses were performed to evaluate the association between CKD stages and the 5-year risk of death, stroke, intracranial hemorrhage (ICH), and gastrointestinal bleeding (GIB). The association of anticoagulation treatments and possible interaction with CKD with the risk for the study outcomes were also examined.

Results
We identified 87,804 patients with incident AF. Of them, 3.2% had advanced CKD, and 25% had moderate CKD. 39,421 patients (45%) received anticoagulation. In multivariable models, moderate and advanced CKD were associated with increased risk for death in an incremental manner (moderate CKD: adjusted-hazard ratio (aHR) 1.17; 95% CI 1.14-1.20, p&lt;0.001) (advanced CKD: aHR 1.85; 95% CI 1.76 -1.96; p&lt;0.001). Both moderate CKD (aHR 1.1; 95% CI 1.00-1.20, p&lt;0.05) and advanced CKD (aHR 1.37; 95% CI 1.13-1.67; p=0.001) were associated with increased risk of stroke. Renal function was not associated with increased risk for ICH, yet it was associated with increased risk of GIB. DOAC therapy reduced the risk of stroke (aHR 0.7; 95% CI 0.57-0.86, p=0.001) and death (aHR 0.83; 95% CI 0.77-0.78, p&lt;0.001) while warfarin treatment did not. The association of anticoagulation treatment with reduced risk for stroke was consistent across CKD strata (p-for-interaction=0.19).

Conclusions
In this contemporary registry of AF patients, worse CKD was incrementally and independently associated with an increased risk of death, stroke and gastrointestinal bleeding among patients with AF. DOAC therapy was associated with a reduced risk for stroke and death without evident increase in ICH or GI bleeding. The inverse association between DOACs and stroke was consistent across all CKD categories. If confirmed by others, CKD ought to be added to stroke risk scores in AF.5 year stroke risk5 year death risk
Association of atrial fibrillation burden with rhythm control and stroke prevention interventions among patients with cardiac implantable electronic devices
Authors: Peigh G , Zhou J , Roberts A I , Rosemas S C , Longacre C , Schwab G , Soderlund D , Passman R S 
Published: November 2023

Abstract

Background
Prior analyses have demonstrated that persistent atrial fibrillation (PeAF) is associated with higher healthcare costs than paroxysmal AF (pAF) or permanent AF (PermAF). While clinical classification of AF is often inaccurate, assessing AF burden from cardiac implantable electronic devices (CIEDs) provides an opportunity to more accurately assess the mechanisms of cost differentials by type of AF.

Objective
To assess the rates of AF-specific healthcare interventions among patients with device detected pAF, PeAF and PermAF.

Methods
Using the de-identified Optum Clinformatics U.S. claims database (2015 to 2020) linked with the Medtronic CareLink database, we identified patients with newly implanted CIEDs that transmitted data 6 months post-implant (baseline period). Device monitoring data during baseline was utilized to stratify patients by AF burden category: pAF (at least one day with &gt;5m AF but &lt;7d with &gt;23h AF), PeAF (at least 7 consecutive days with &gt;23h AF) or PermAF (all days with &gt;23h AF or &gt;95% AF burden). Annualized rates of AF-specific interventions (cardioversions, ablations, hospitalizations for antiarrhythmic drug [AAD] loads, oral anticoagulation [OAC] prescription and AAD prescription) during follow-up were analyzed from insurance claims. Analyses were adjusted for geographical region, insurance type, CHA2DS2-VASc Score, and implant year.

Results
Of the 21,391 patients (72.9±10.9 yrs; 56.3% male) analyzed, 7,798 (36.5%) had device-detected AF. Among these, 5,966 (76.5%) were pAF (avg burden 2.9±8.6%), 1,145 (14.7%) were PeAF (avg burden 47.2±29.9%), and 687 (8.8%) were PermAF (avg burden 99.3±0.7%). Compared to patients with pAF, those with PeAF had a higher adjusted ratio of cardioversions, hospitalizations for new AAD initiation, OAC prescription and AAD prescription. Patients with PeAF also had higher adjusted rates of ablations, cardioversions, hospitalizations for new AAD initiation, and AAD prescriptions than those with PermAF. Compared to patients with pAF, those with PermAF had a lower adjusted rate of ablation, hospitalization for new AAD load and AAD prescription, but a higher rate of OAC prescription (fig).

Conclusion
In a real-world cohort, patients with CIED-detected PeAF had higher rates of cardioversions, hospitalizations for AAD initiation, and AAD prescriptions than those with CIED-detected pAF and PermAF. The higher intensity of observed physician-driven interventions may be a potential driver of the increased cost associated with PeAF.Figure
Clinical impact of type 1 and type 2 diabetes mellitus in atrial fibrillation and the effect of severe hypoglycaemia: a nationwide cohort study
Authors: Fauchier L , Bentounes S , Bisson A , Fauchier G , Bodin A , Vigny P , Pierre B , Angoulvant D , Ducluzeau P H , Lip G Y H 
Published: November 2023

Abstract

Background
Both atrial fibrillation (AF) and diabetes mellitus (DM) are common chronic conditions associated with a significant disease burden. Diabetes increases the risk of AF and the presence of both diseases is associated with higher risk of all-cause mortality and complications. We aimed to compare prognosis individuals with type 1 (T1DM) and type 2 (T2DM) diabetes, against those without DM, in a nationwide cohort of patients with AF and second, to study the outcomes in cases of severe hypoglycaemia amongst those with DM.

Methods
Based on the France nationwide administrative hospital-discharge database, we collected information for all AF patients seen in French hospitals between 2014 and 2022. Among 3,311,634 patients identified with AF, 694,610 (21.0%) had diabetes: 37,218 (1.1%) with T1DM and 657,392 (19.9%) with T2DM. History of severe hypoglycaemia was defined as a primary or secondary hospital ICD-10 diagnosis of E16.0, E16.1, E16.2, E10.0, E11.0, E12.0, E13.0, or E14.0 and was identified in 22,717 patients (3.1% of those with T1DM and 3.3% of those with T2DM). Adverse outcomes were investigated during follow-up until 31 December 2022. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox model and were adjusted for age, sex and comorbidities (hypertension, obesity, smoking, alcohol abuse, coronary artery disease, heart failure, valve disease, presence of pacemaker or implantable cardioverter defibrillator, peripheral artery disease, stroke, chronic lung disease, chronic kidney disease, dementia and history of cancer).

Results
Using individuals without diabetes as reference, the adjusted HRs indicated an increased risk in patients T1DM and in those with T2DM for all-cause death, cardiovascular death, HF, MI, ischemic stroke, dementia, VT/VF and cardiac arrest (HRs ranging from 1.19 to 1.69 in T1DM and from 1.10 to 1.41 in T2DM, all p &lt;0.0001, see Table 1).
Among patients with diabetes, those with a history of severe hypoglycaemia had increased risks of all-cause death, dementia and cardiac arrest in case of T1DM and an increased risk of all-cause death, cardiovascular death, HF, MI, dementia and cardiac arrest in case of T2DM (see Table 2).

Conclusion
Presence of diabetes (regardless of type) is associated with an increased risk of premature death, cardiovascular events and dementia in patients with AF. This increase seems more pronounced in T1DM than in T2DM. A history of severe hypoglycaemia is associated with a much worse prognosis in patients with T1DM or T2DM.
Cigarette smoking and structural brain deficits in patients with atrial fibrillation
Authors: Peter R , Aeschbacher S , Coslovsky M , Krisai P , Rodondi N , Mueller A , Haller M , Stauber A , Sinnecker T , Bonati L , Burkard T , Conen D , Osswald S , Kuehne M , Meyer-Zuern C 
Published: November 2023

Abstract

Background
Brain lesions are common in patients with atrial fibrillation (AF). Whether cigarette smoking is associated with an increased risk of brain lesions and reduced brain volume in patients with AF is currently unknown.

Purpose
In this analysis, we aimed to investigate the association of cigarette smoking habits with cerebral small vessel disease and overall brain volume.

Methods
For this cross-sectional analysis, we included AF patients from a multicentre cohort study. Smoking habits were defined by smoking status categories (never, former, current), duration (tertiles of years), cigarettes per day (CPD as obtained at baseline), packyears (PKY, tertiles) and time since smoking cessation (≤5 years, 6-10 years, 11-15 and ≥16 years). A standardized brain magnetic resonance imaging was done to assess the prevalence of small vessel disease white matter lesions (WML, graded according to the Fazekas scale) and small non-cortical infarcts (SNCI). Additionally, MRI was used to quantify the volumes of WML and SNCI; as well as to measure grey matter (GM) and white matter (WM) brain volumes. Multivariable adjusted logistic and linear regression analyses were applied.

Results
1746 patients were enrolled (mean age 72.6 years, 27.5% females). 131 (7.5%) were current smokers, 846 (48.5%) former and 769 (44%) never smokers. Patients with a longer smoking duration, higher amount of CPD and PKY had reduced GM brain volume (p for linear trend 0.05, 0.005 and 0.02, respectively). Patient with higher CPD also had a reduced WM brain volume (p for linear trend 0.04). Compared to patients with a smoking duration in the lowest tertile (≤18 years), patients who had smoked for 19-34 years (second tertile) and more than 35 years (third tertile) had a higher risk for WML Fazekas ≥2 with an OR (95% CI) of 1.85 (1.29; 2.66, p=0.001) and 1.46 (1.01; 2.09, p=0.04) (Figure 1). Additionally, increasing smoking duration tertiles exhibited larger WML volumes, with a significant linear trend (p=0.05). AF patients who quit smoking ≥16 years ago had a lower odds for SNCI (OR 0.47 (0.24; 0.94, p= 0.03), less WML volume (β: -0.451 (-0.8; -0.11, p=0.01), and a higher WM brain volume (β: 16.9 (0.3; 33.6, p= 0.05) compared to patients who quit 5 years prior to the study enrolment (Figure 2). We found no significant difference in any structural brain deficit between current and former smokers compared to never smokers.

Conclusion
In a large AF population, we found that smoking duration and amount were associated with the loss of brain volumes. Smoking duration and time since smoking cessation were associated with small vessel disease.
AF in the AFternoon: The circadian pattern of incident atrial fibrillation in a loop recorder population
Authors: Chousou P A , Chattopadhyay R , Tsampasian V , Pugh P , Vassiliou V 
Published: November 2023

Abstract

Introduction
Loop recorders have provided the opportunity to systematically screen individuals for arrhythmias, and in doing so provide new appreciated mechanistic insights to arrhythmia pathophysiology. Atrial fibrillation (AF) is a complex arrhythmia with a multitude of precipitants and substrates. Previous studies looking at the circadian rhythm of AF, have required patient symptoms to define onset. All studies on the circadian rhythm of AF suggest that AF does not occur randomly. It has been suggested that the circadian variation in autonomic function may provide an underlying substrate for AF initiation.
This is the largest study to utilise loop recorder detected AF to explore the circadian pattern of AF.

Purpose
We sought to ascertain how the detection of incident AF varied throughout the day, in patients monitored with a loop recorder

Methods
This was a single-centre retrospective observational study. Consecutive adult patients referred for ILR implantation between March 2009 and November 2019, without prevalent AF or atrial flutter, were included. Demographic and anthropometric data was identified from the individuals medical notes. The time of incident AF episodes was identified from loop recorder reports.

Results
A total of 1168 AF episodes of any duration were identified by the ILR, of which onset time was available for 1118 episodes. Onset of AF episodes in our data for the entire population demonstrated a monophasic distribution (figure 1a). The OR for developing AF between 13.00-14.59 compared to 03.00-04.59 was 4.89 (95% CI 3.47-6.90).
Amongst the ESUS population time of onset distribution showed multiple daytime peaks (figure 1b). The OR for developing AF between 10.00-11.59 compared to 03.00-04.59 was 4.39 (95% CI 2.68-7.20).
Amongst the non- ESUS population time of onset distribution (figure 1c) shows a monophasic pattern with the peak at time blocks 12.00-14.59. The OR for developing AF between 13.00-14.59 compared to 02.00-03.59 was 6.75 (95% CI 4.17-10.93).

Conclusion(s)
Our study demonstrated that there is a diurnal variation for incident AF detection using a loop recorder. There is a general propensity for episodes to occur in the afternoon, with a nadir at night. This is in contrast to previous reports which have suggested that the nocturnal and morning peaks are more apparent. Moreover, different cohorts appear to show different temporal patterns, with ESUS patients having multiple time peaks, whereas the non-stroke cohort had a solitary peak period.
Understanding the diurnal variation of AF may help to shed more light on the complex pathogenesis of AF, and whether different AF phenotypes are associated with stroke risk. Moreover, the finding of a day-time propensity for AF, adds weight to the utilisation of consumer facing non-invasive monitoring tools during the day for AF identification in high-risk populations.
Screening for atrial fibrillation by village doctors in rural areas of china: the jiangsu province rural community atrial fibrillation project
Authors: Li M , Chu M , Zhang S M , Shen Y M , Sun X X , Gong J L , Yang G , Shi J J , Ding X W , Gu Z S , Li C Z , Zhang C Q , Wang Z R , Lip G Y H , Chen M L 
Published: November 2023

Abstract

Background
No study has systematically investigated the quality of long-term care delivered to the rural elderly with chronic diseases in China. Since atrial fibrillation (AF) is becoming an increasing burden on healthcare systems worldwide.

Purpose
We conducted an AF screening programme in rural elderly and evaluated healthcare efficiency led by the village doctors in China.

Methods
This cross-sectional study of the rural population aged ≥65 years was conducted from April to June 2019 in our towns of Jiangsu Province. AF was identified using 12-lead electrocardiography in the first-step (government-led health examination) and single-lead electrocardiography in the second-step (in-house AF screening). Questionnaire surveys were designed for the AF patients and their village doctors, respectively.

Results
Among the 31,342 registered subjects, 12,630 (40·3%) declined, 7,956 (25·3%) participated in the first-step and 10,756 (34·3%) in the second-step (Figure 1). The overall AF detection rate was 4·3% (810/18,712). Of the 810 patients with AF (mean age 76·1±5·9 years; 51·4% female), 51·5% had education level below primary school, 2·6% could use smartphone applications, and 8·1% lived with their children. Common risk factors were older age, men, hypertension, diabetes, prior stroke, vascular disease, and congestive heart failure. Among the 402 patients who were aware of AF, there were 367 were at high risk of stroke (CHA2DS2-VASc score ≥3 in women or ≥2 in men) and OAC was currently used in only 10·9% (40/367) of these (Figure 2). Only 17·6% (91/516) of patients with known hypertension had a resting blood pressure level &lt;140/90 mmHg, and 6·0% (8/132) of patients with known diabetes had a fasting blood glucose level ≤6·1 mmol/L. Our questionnaire survey for village doctors showed that only 7·3% (9/122) reported having the knowledge or ability for providing integrated care AF management.

Conclusions
This screening project in rural villages identified AF in 4·3%, but AF management was suboptimal with low use of oral anticoagulation. The current village doctor-dominant rural healthcare system is far from delivering optimal standardized AF management for older patients in rural China. There is a urgent need to support these rural clinics and empower the village doctors in optimising the care of AF patients.The flow chart of this studyThe use of oral anticoagulation
Pesticide exposure an unforseen trigger for atrial fibrillation
Authors: Kishore P , Aid J , Van Wijk S T A N W , Ramos K S , Van Schie M , Knops P , De Groot N A T A S A , Brundel B J J M 
Published: November 2023

Abstract

Background/Introduction
Over the last few decades, the use of pesticides for improving crop yield has continued to soar. Recent evidence shows the residuals of pesticides in many fruits and vegetables in the local supermarket. Although acute exposure to pesticides has been related to various severe illness, including cardiovascular dysfunction, chronic pesticide exposure has been poorly studied. Herein we study the cardiotoxic effect of commonly used pesticides to the most common cardiac arrhythmia, atrial fibrillation (AF).

Purpose
Whether exposure to commonly-used pesticides triggers AF if so, explore the underlying molecular mechanism.

Methods
Ten commonly used pesticides in the Netherlands, including glyphosate, MCPA and boscalid, were used to study cardiotoxicity using experimental Drosophila and rat model systems for AF. Drosophila were exposed to three varying pesticide concentrations, ranging from reported environment concentrations, LD50 and high dose, followed by survival and heart wall measurements (heart rate (HR) and arrhythmicity index). In addition, rats were exposed to four pesticides, paraquat, glyphosate, round-up and MCPA for 16 months followed by AF detection (ECG) and Westernblot and metabolomic analyses of the atrial tissue samples.

Results
A dose dependant survival curve was observed of Drosophila fed with pesticides compared to controls. In prepupae a significant reduction in HR and increase in arrhythmicity index was found for all? utilized pesticides. Furthermore, a significant increase in AF and atrial arrhythmic episodes was observed in rats treated with pesticides (15-70%) compared to non-treated control rats (0%). Metabolomic analyses in rats revealed a significant increase in mitochondrial supercomplexes and 6-phosphoglyconlactate levels in pesticide treated rats compared to controls, suggesting a role for mitochondrial and energy dysfunction to underlie pesticide-induced AF.

Conclusion(s)
This study provides evidence that chronic exposure to commonly-used pesticides in the Netherlands affects longevity, heart wall function in Drosophila and triggers atrial arrhythmia and AF in rats. Likely, the pesticides impair mitochondrial function and energy metabolism.