bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of atrial fibrillation – a comprehensive nationwide analysis in Finland
Authors: Lehto M , Haukka J , Halminen O , Mustonen P , Putaala J , Linna M , Aro A , Hartikainen J , Airaksinen K E J 
Published: October 2022

Abstract

Introduction
Prevalence of atrial fibrillation (AF) is strongly associated with age, and with longer life-time expectancy number of AF patients is worldwide strongly increasing. However, nationwide prevalence of AF is not known when primary care data as well is accessible.

Purpose
The FinACAF-study is a nationwide registry study including of all AF patients searched from all available national health care registers. To our knowledge, this is the first nationwide AF study including both primary, secondary, and tertiary health care register data. The aim of this study was to assess the prevalence of AF in unselected nationwide population in Finland.

Methods
In the FinACAF study we gathered data of all AF patients (hospitalizations and outpatient specialist visits and primary health care, and National Reimbursement Register) from all national health care registers from 01st January 2004 to 31st December 2018. The annual prevalence on December 31st of each year 2007–2018 was calculated as the cumulative number of patients alive with AF divided by the number of Finnish population on the last day of that year. The prevalence is presented for population ≥20 years, and with the entire population as the background population, as well as for populations ≥65 years, and ≥75 years.

Results
In total, 411,387 patients with the diagnosis of AF were documented during 2004–2018 in Finland. The number of adult patients with AF at the end of the study period in 2018 was 226,847, corresponding to an AF prevalence of 5.2% in the age group ≥20 years. The prevalence in the total Finnish population was 4.1%. The prevalence rates increased remarkably with increasing age and were higher in men compared to women (5.9% vs. 4.6%, p&lt;0.001) in all age groups (Figure 1). The prevalence of AF in the adult population increased remarkably from 2.5% in 2007 to 5.2% in 2018 (p&lt;0.001) (Figure 2). Among the population ≥65 years the prevalence in 2018 was 15.3%, and in the elderly, ≥75 years the prevalence of AF was 23.4%.

Conclusions
Based on comprehensive, nationwide data – also including the primary care – we observed extremely increasing prevalence of AF in the older population, as well as remarkably increasing prevalence of AF over time.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Helsinki and Uusimaa Hospital District
Prevalence and distribution of non-pulmonary vein atrial fibrillation triggers in real-world clinical settings
Authors: Kawai S , Sakamoto K , Takase S , Noma A , Kisanuki H , Nakashima H , Watanabe T , Sakemi T , Okabe K , Okahara A , Tokutome M , Matsuura H , Matsukawa R , Masuda S , Mukai Y 
Published: October 2022

Abstract

Background
Epidemiology of non-pulmonary vein (PV) triggers of atrial fibrillation (AF) is not fully known.

Purpose
This study aimed to clarify the prevalence and distribution of non-PV triggers in real-world clinical settings of AF catheter ablation.

Methods
One-thousand and twenty patients undergoing AF ablations were retrospectively analyzed (mean age 65 years old, 702 males (69%), 506 paroxysmal and 514 non-paroxysmal). Induction and observation of AF triggers were attempted using intravenous isoproterenol/adenosine triphosphate and repeated direct current cardioversion during AF in each session. Documentable non-PV AF triggers were characterized in the studied population. Premature atrial contractions that did not initiate AF were excluded.

Results
A hundred and twenty-six non-PV triggers were documented in 108 patients (10.6%). Non-PV trigger was documented in 6.3% of 1st session cases, whereas 30.9% of recurrent cases undergoing multiple sessions (p&lt;0.0001). Left atrial (LA) posterior wall was the most prevalent site (N=34), followed by 30 intra-atrial septum (IAS), 29 superior vena cava (SVC), 13 crista terminalis, 7 right atrial (RA) free wall, 6 LA anterior wall, 3 coronary sinus (CS), 3 left atrial appendage, and 1 persistent left superior vena cava (LSVC). We classified those non-PV triggers into 4 groups; 43 LA, 33 thoracic veins (SVC, CS and LSVC), 30 IAS and 20 RA. Thoracic vein/RA origins were more prevalently detected in paroxysmal AF cases (57%) compared to non-paroxysmal AF (28%) (p&lt;0.01). Conversely, LA origin was more prevalently detected in non-paroxysmal AF cases (48%) compared to paroxysmal AF (20%) (p&lt;0.01).

Conclusions
Prevalence of non-PV trigger in cases undergoing multiple sessions is extremely high, suggesting a particular importance of non-PV trigger targeting in patients with recurrent AF undergoing 2nd or 3rd ablation sessions. Progressive nature of AF with newly generated AF triggers should be under consideration. Distributions of non-PV triggers are largely different between paroxysmal and non-paroxysmal AF. These findings may help ablation strategy regarding non-PV trigger targeting in practice.

Funding Acknowledgement
Type of funding sources: None.
New-onset atrial fibrillation in patients with community-acquired pneumonia: a systematic review and meta-analysis
Authors: Corica B , Tartaglia F , Oliva A , Raparelli V , Cangemi R , Basili S , Proietti M , Romiti G F 
Published: October 2022

Abstract

Background
Community-acquired pneumonia (CAP) is the commonest lower respiratory tract infection, often complicated by cardiovascular events and cardiac arrythmias, such as new-onset Atrial Fibrillation (noAF). NoAF, a new or first detactable episode of a chaotic and irregular atrial rhythm, has been associated with increased mortality in CAP patients, especially in critically-ill ones. However, the prevalence of noAF in patients with CAP is still unclear.

Purpose
We aimed to estimate the pooled prevalence of noAF in patients with CAP through a systematic review and meta-analysis of the literature.

Methods
PubMed and EMBASE were systematically searched from inception to 27th January 2022. All studies reporting the prevalence of noAF in CAP patients were included. The pooled prevalence of noAF, 95% Confidence Intervals (CI) and 95% Prediction Intervals (PI), were computed using generalized linear mixed models. The inconsistency index (I2) was calculated to measure heterogeneity. Subgroup analyses according to the study design and the geographical location were also performed. A protocol for this study was registered on PROSPERO (CRD42022307422).

Results
We retrieved 4,947 records from the literature search, with 11 studies were finally included, with a total of 346,192 CAP patients; 5 (45%) studies were conducted in Europe, while 4 (36%) were prospective studies. Pooled prevalence of noAF in CAP population was 6.6% (95% CI 4.1–10.6, 95% PI 1.0–33.6, I2=99%) [Figure 1]. No significant difference according to geographical location of the included studies or study design was found at subgroup analyses.

Conclusions
NoAF is common in CAP patients, being found in 1 out of 15 patients with CAP, with the 95% PI pointing towards potential higher prevalence in specific clinical scenarios. No significant subgroup differences were observed according to study design and geographical location.

Funding Acknowledgement
Type of funding sources: None.
External validation of the biomarker based ABCD score in atrial fibrillation patients with a non gender CHA2DS2 VASc score 0 to 1, A Korean multicenter retrospective cohort
Authors: Shin S Y , Jung M , Byeon K , Kang K , Park Y , Hwang Y , Lee S , Jin E , Roh S , Kim J , Ahn J , Lee S , Choi E , Ahn M , Lip G 
Published: October 2022

Abstract

Background
Patients with low to intermediate risk atrial fibrillation (AF), defined as non-gender CHA2DS2-VASc score of 0–1, are still at risk of stroke. This study verified the usefulness of ABCD score (Age [≥60 years], B-type natriuretic peptide [BNP] or N-terminal pro-BNP [≥300 pg/ml], Creatinine clearance [&lt;50 ml/min/1.73 m2], and Dimension of the left atrium [≥45 mm]) for stroke risk stratification in non-gender CHA2DS2-VASc score 0–1.

Methods
This multi-center cohort study retrospectively analyzed AF patients with non-gender CHA2DS2-VASc score 0–1. The primary endpoint was the incidence of stroke with or without anti-thrombotic treatment (ATT). An ABCD score was also validated.

Results
Overall, 2694 patients (56.3±9.5 years; female, 726 [26.9%]) were followed-up for 4.0±2.8 years. The overall stroke rate was 0.84/100 person-years (P-Y), stratified as follows: 0.46/100P-Y for an ABCD score 0; 1.02/100P-Y for an ABCD score≥1. The ABCD score was superior to the non-gender CHA2DS2-VASc score in stroke risk stratification (C-index=0.618, P=0.015; net reclassification improvement=0.576, P=0.040; integrated differential improvement=0.033, P=0.066). ATT was prescribed in 2353 patients (86.5%), and the stroke rate was significantly lower in patients receiving non-vitamin K antagonist oral anticoagulant (NOAC) therapy and an ABCD score≥1 than in those without ATT (0.44/100P-Y versus 1.55/100 P-Y; hazard ratio=0.26, 95% confidence interval 0.11–0.63, P=0.003).

Conclusion
The biomarker-based ABCD score demonstrated improved stroke risk stratification in AF patients with non-gender CHA2DS2-VASc score 0–1. Furthermore, NOAC with an ABCD score≥1 was associated with significantly lower stroke rate in AF patients with a non-gender CHA2DS2-VASc score 0–1.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Korean Disease Control and Prevention Agency
Outcomes in patients with ischaemic stroke undergoing endovascular thrombectomy: impact of atrial fibrillation
Authors: Alobaida M , Harrison S L , Lane D A , Hill A , Lip G Y H 
Published: October 2022

Abstract

Background/Introduction
Endovascular thrombectomy (EVT) has become the standard of care for the management of acute ischaemic stroke, but the risk of intracerebral haemorrhage and mortality still remains common following ischaemic stroke. The effect of concomitant atrial fibrillation (AF) on clinical outcomes in patients with acute ischaemic stroke after receiving EVT remains unclear.

Purpose
To investigate associations between AF and intracerebral haemorrhage (ICH) and all-cause mortality at 90 days in patients with ischaemic stroke undergoing EVT.

Methods
A retrospective cohort was conducted using TriNetX, a global health research network. The network was searched for people aged ≥18 years with ischaemic stroke, EVT and AF recorded in electronic medical records between 01/09/2018 and 01/09/2021. These patients were compared to controls with ischaemic stroke, EVT and no AF. Propensity score matching for age, sex, race, comorbidities, National Institutes of Health Stroke Scale (NIHSS) scores, and prior use of anticoagulation was used to balance the cohorts with and without AF.

Results
In total 1,388 patients were identified with history of ischaemic stroke treated by EVT. After propensity-score matching, 832 patients (mean age 68±13; 47% female) with ischaemic stroke, EVT and AF, were compared to 832 patients (mean age 67±12; 47% female) with ischaemic stroke, EVT and no history of AF. In the cohort with AF, 11.5% (n=96) experienced ICH within 90 days following EVT, compared with 12.3% (n=103 patients) in patients without AF (Odds Ratio (OR) 0.92, 95% confidence interval (CI) 0.68–1.24; p=0.59). In the patients with AF, mortality within 90 days following EVT was 18.7% (n=156), compared with 22.5% in patients without AF (n=187) (OR 0.79, 95% CI 0.63–1.01; p=0.06).

Conclusion
In patients with ischaemic stroke undergoing EVT, AF was not significantly associated with intracerebral haemorrhage or all-cause mortality at 90-day follow-up.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship.
Predicting new-onset heart failure hospitalization of patients with atrial fibrillation: development and external validations of a risk score
Authors: Ishii K , Matsue Y , Miyauchi K , Miyazaki S , Hidemori H , Nishizaki Y , Nojiri S , Saito Y , Nagashima K , Okumura Y , Daida H , Minamino T 
Published: October 2022

Abstract

Background
Atrial fibrillation (AF) is a well-known risk factor for heart failure (HF), and HF development as a complication of AF is associated with a decline in the quality of life and poor prognosis. However, unlike thrombotic events, incidence of HF in patients with AF has not changed for decades, and a preventive strategy has yet to be developed.

Purpose
We sought to develop a risk model for new-onset HF admission in patients with AF and without a history of HF. Additionally, we attempted to externally validate the developed risk model.

Methods
We utilized two multicenter, prospective, observational registries of AF and analyzed the patients without a history of AF. One of which is defined as a derivation cohort, which included 2,857 patients, and the other is defined as a validation cohort, which included 2,516 patients. We developed a risk model by selecting variables with regularized regression and weighing coefficients by Cox regression analysis with the derivation cohort. The external validity was tested in the validation cohort.

Results
During the follow-up period, 148 patients (5.2%) in the derivation cohort and 104 patients (4.1%) in the validation cohort developed HF during the median follow-up period of 1,396 (interquartile range [IQR]: 1,078–1,820) days and 1,168 (IQR: 844–1,309) days, respectively. In the derivation cohort, four predictors (age, hemoglobin, serum creatinine, and log-transformed brain natriuretic peptide) were identified as potential risk factors for HF development. The developed risk model showed good discrimination and calibration in both the derivation (area under the curve [AUC], 0.77 [95% confidence interval (CI) 0.73–0.81]; Hosmer-Lemeshow test, P=0.257) and validation cohorts (AUC: 0.76 [95% CI 0.72–0.81]; Hosmer-Lemeshow test, P=0.475). Considering death not due to HF as a competing risk, the cumulative incidence curves for HF admission stratified by the risk score were generated, which showed higher HF hospitalization rate for the higher risk score categories.

Conclusion
The newly developed risk model with four readily available clinical characteristics and biomarkers performed well in the prediction of new-onset HF admission of patients with AF in both derivation and validation cohort.

Funding Acknowledgement
Type of funding sources: None.
Echocardiographic parameters of left atrial structure and function in elderly patients with atrial fibrillation, and clinical outcomes at 2 years: the ANAFIE echocardiographic substudy
Authors: Hiasa K , Ikeda S , Tsutsui H 
Published: October 2022

Abstract

Background
Previous studies have shown an association between echocardiographic parameters of cardiac structure and function and prognosis in patients with atrial fibrillation (AF). However, only limited data are available for elderly patients (age, ≥75 years).

Purpose
The All Nippon Atrial Fibrillation In the Elderly (ANAFIE) Registry (UMIN000024006) was a prospective, multicenter, observational study which collected real-world data on the clinical status and prognosis of 33,062 Japanese patients aged ≥75 years and with non-valvular AF (NVAF). A prospective substudy of 1,474 patients who underwent transthoracic echocardiography at baseline was conducted to investigate relations between echocardiographic parameters of left atrial structure and function and clinical outcomes at 2 years.

Methods
Cumulative incidences and adjusted hazard ratios (HRs) of clinical outcomes were calculated using Kaplan–Meier analysis and the Cox proportional-hazards model, respectively. The data were analysed by left atrial volume index (LAVi) category, left atrial emptying fraction (LAEF) category, and direct oral anticoagulant (DOAC) use vs warfarin (WF) use. Cardiovascular (CV) events was a composite of stroke, myocardial infarction (MI), cardiac interventions, heart failure (HF) hospitalization, CV death. Cardiac events was a composite of MI, cardiac intervention, HF hospitalization, and CV death.

Results
Baseline characteristics were mean age of 80.7 years; male, 59.2%; paroxysmal AF, 45.9%; mean CHA2DS2-VASc score, 4.3; mean HAS-BLED score, 1.9; median LAVi, 48.7 mL/m2; median LAEF, 26.6%; comorbidity or history of HF, 32.2%; oral anticoagulant use, 92.7%; DOAC use, 68.7%; and WF use, 24.0%. Incidences (/100 patient-years) and HRs (95% CIs) for each clinical outcome according to LAVi and LAEF category are summarized in Table. Compared with patients with LAEF &gt;45.0% (n=224), those with LAEF ≤45.0% (n=1,213) were at higher risk of CV events (2.19 [1.13–4.27], p=0.021) and HF hospitalization (2.25 [1.02–4.96], p=0.045). Risk of all-cause death was higher in patients with LAVi &gt;48.0 mL/m2 (n=656) than in those with LAVi ≤48.0 mL/m2 (n=621) (1.69 [1.00–2.83], p=0.048). In the subgroups with LAEF ≤45.0% or LAVi &gt;48.0 mL/m2, patients receiving a DOAC had significantly lower risk of cardiac events, CV events, and HF hospitalization than patients receiving warfarin.

Conclusion
In elderly Japanese patients with NVAF, those with LAEF ≤45.0% are at higher risk of CV events and HF hospitalization, and those with LAVi &gt;48.0 mL/m2 are at higher risk of all-cause death. Thus, the higher risk differs between patients with LAEF ≤45.0% and those with LAVi &gt;48.0 mL/m2.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo Co., Ltd.
Artificial intelligence analysis of ECG signals to predict arrhythmia recurrence after cryoballoon ablation of atrial fibrillation
Authors: Warminski G , Kalinczuk L , Orczykowski M , Urbanek P , Bodalski R , Zielinski K , Gandor M , Palka F , Jaworski M , Mintz G S , Kowalik I , Hasiec A , Bilinska M , Plawiak P , Szumowski L 
Published: October 2022

Abstract

Introduction
Cryoballoon-based pulmonary vein isolation (CB) is an effective option for rhythm control in atrial fibrillation (AF). There have been multiple attempts to predict arrhythmia recurrence, but with moderate success.

Purpose
To use artificial intelligence (AI) deep electrocardiogram (ECG) analysis to predict arrythmia recurrence after CB.

Methods
In a single-center study of 250 consecutive pts (58.2±12.6 years, 30% female) treated with CB for AF (05.2017–04.2019), 60% had paroxysmal AF (PAF), 66.5% had hypertension, and 27.2% had a redo CB. Analyses included left atrial volume (LA vol: indexed for BSA and assed by angio-MSCT in 76% and the rest with echo), left ventricle ejection fraction (LVEF) and hypertrophy (LVH: septal/posterior wall thickness ≥11mm in ♂ and ≥10mm in ♀) along with 30s arrhythmia recurrence at 2-yr follow-up. Baseline 500Hz raw 12-lead digital ECG signals were analyzed by means of convolutional neural network (CNN) architecture that was taught to process the 12-channel ECG signal (XML). The transfer learning method of CNN parameters learned on a very large number of coded consecutive training ECG samples (n=1,000) was adopted to analyze current sample of ECG signals.

Results
Arrhythmia recurrence at 2-yrs was 46.0% (n=115). There was gradual increase in predictive performance being the lowest if only baseline clinical data were analyzed and the highest combing all baseline clinical data plus anatomical and functional parameters (Table 1: #1–#3). AI baseline ECG analysis alone offered predictive performance similar to that made upon analysis of all baseline clinical data or joint analysis of LA vol, LVH, and LVEF (Table 1: #4). AI results added substantially to predictive performance of models using baseline clinical data alone (#1 vs #5, p&lt;0.001) and joint analysis of baseline clinical plus LA vol, LVH and LVEF (#3 vs #6, p=0.0130) (Fig. 1).

Conclusions
Prediction of recurrence after CB using raw ECG data with deep AI analysis is feasible. Joint analysis of results of AI of baseline ECG and basic clinical data offers predictive performance similar to that made upon analysis of clinical data including advanced information on LA volume and LVH and function. AI analysis of baseline ECG adds significantly to models aimed at recurrent AF prediction.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): National Institute of Cardiology, Warsaw, Poland
Sex differences in the use of rhythm control strategies in patients with atrial fibrillation in FinACAF study
Authors: Kalatsova K , Lehto M , Inkovaara J , Aro A L , Halminen O , Jaakkola J , Penttila T , Salmela B , Airaksinen K E J 
Published: October 2022

Abstract

Aim
Women with atrial fibrillation (AF) have been reported to receive less antiarrhythmic therapies (AAT) than men. We assessed sex differences in AAT use in Finland.

Methods
The FinACAF registry linked data from several nationwide registries covering all levels of care in addition to drug purchases and included records on all patients diagnosed with incident AF in Finland during 2007–2018. The outcomes of interest (use of antiarrhythmic drugs (AAD), cardioversions (CV), catheter ablation procedures and any AAT including all aforementioned rhythm control modalities) were identified based on procedure-specific codes and drug purchases. Sex differences in AAT use were analyzed in the entire cohort and separately in three age groups: &lt;65 years, 65–74 years and ≥75 years using Fine-Gray subdistribution hazard regression with death as a competing risk and adjustments made for comorbidities, age and levels of income and education.

Results
Altogether, 229565 patients (50.0% female; mean age 68.90±13.44 in men and 76.57±11.79 in women) with incident AF were identified. In the entire patient population, female sex was associated a higher incidence of AAD use and lower incidence of CVs and ablation procedures contributing to an overall slightly lower incidence of any AAT compared to men (Table 1). In the age group specific analyses, the lower incidence of CVs and higher incidence of AAD use in females were observed only in patients &lt;65 years and &lt;75 years, respectively, whereas the association of female sex with lower incidence of catheter ablation procedures was observed only in the age group ≥75 years.

Conclusion
Our nationwide data showed no considerable sex difference in overall use of AAT in Finland. Despite a lower number of CVs in women, ablation procedures were performed almost equally and AADs were used more frequently in women compared to men.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Sydäntutkimussäätiö