Background There are limited data on the association of diabetes mellitus (DM) and levels of glycated hemoglobin (HbA1c) with outcomes in patients with atrial fibrillation (AF). Methods This retrospective cohort study included patients who were recently hospitalized with a primary or secondary diagnosis of AF from December 2015 through June 2018. Kaplan–Meier curves and Cox-regression adjusted hazard ratios (aHR) were calculated for the primary outcome of all-cause mortality and for the secondary outcomes of cardiovascular (CV) mortality and the composite outcome of CV death or hospitalization. Competing-risk regression analyses were performed to calculate the cumulative risk of stroke, major bleeding, AF- or HF-hospitalizations adjusted for the competing risk of all-cause death. Spline curve models were fitted to investigate associations of HbA1c values and mortality among patients with AF and DM. Results In total 1109 AF patients were included, of whom 373 (33.6%) had DM. During a median follow-up of 2.6 years, 414 (37.3%) patients died. The presence of DM was associated with a higher risk of all-cause mortality (aHR = 1.40 95% confidence intervals [CI] 1.11–1.75), CV mortality (aHR = 1.39, 95% CI 1.07–1.81), sudden cardiac death (aHR = 1.73, 95% CI 1.19–2.52), stroke (aHR = 1.87, 95% CI 1.01–3.45) and the composite outcome of hospitalization or CV death (aHR = 1.27, 95% CI 1.06–1.53). In AF patients with comorbid DM, the spline curves showed a positive linear association between HbA1c levels and outcomes, with values 7.6–8.2% being independent predictors of increased all-cause mortality, and values < 6.2% predicting significantly decreased all-cause and CV mortality. Conclusions The presence of DM on top of AF was associated with substantially increased risk for all-cause or CV mortality, sudden cardiac death and excess morbidity. HbA1c levels lower than 6.2% were independently related to better survival rates suggesting that optimal DM control could be associated with better clinical outcomes in AF patients with DM.

Atrial fibrillation (AF) and diabetes mellitus (DM) constitute two major closely inter-related chronic cardiovascular disorders whose concurrent prevalence rates are steadily increasing. Although, the pathogenic mechanisms behind the AF and DM comorbidity are still vague, it is now clear that DM precipitates AF occurrence. DM also affects the clinical course of established AF; it is associated with significant increase in the incidence of stroke, AF recurrence, and cardiovascular mortality. The impact of DM on AF management and prognosis has been adequately investigated. However, evidence on the relative impact of glycemic control using glycated hemoglobin levels is scarce. This review assesses up-to-date literature on the association between DM and AF. It also highlights the usefulness of glycated hemoglobin measurement for the prediction of AF and AF-related adverse events. Additionally, this review evaluates current anti-hyperglycemic treatment in the context of AF, and discusses AF-related decision-making in comorbid DM. Finally, it quotes significant remaining questions and sets some future strategies with the potential to effectively deal with this prevalent comorbidity.

The impact of the COVID-19 pandemic on multiple aspects of physical and social health, including spiritual and religious dimensions, has been discussed not only by numerous theologians, scientists, and politicians, but also by millions of believers of all faiths worldwide. The pandemic seems to have exerted a significant impact on religious practices. Massive gatherings of devoted and faithful people have been strongly discouraged and even openly banned. Prominent religious festivals and pilgrimages that have been conflated by the media with other "mega-spreader events" are incessantly canceled to mitigate the pandemic and alleviate the burden of COVID-19 on the healthcare system. The impact of the pandemic on Catholic or Muslim religious tourism has been extensively described in peer-reviewed and gray literature. However, observant members of the Orthodox Christianity faith have also experienced the constrictive prohibitions for gathering at and worshiping in shrines, churches, and monasteries. Among the manifestations of devotion that the pandemic has interfered with are the attendance to public worship spaces for the celebration of rites and ceremonies, like the celebration of Orthodox Easter. Expressions of reverent devotion including the kissing of crosses and icons as well as the sacrament of Holy Communion may have also been considered a motive of concern as these holy objects and the spoon used might act as fomites in the dissemination of the virus. Visitation of holy places has been also hampered by the pandemic. The most important centers of pilgrimage for Orthodox Christianity are Mount Athos and Jerusalem, as well as the Shrine of Panagia Evangelistria in the Island of Tinos, Greece. Authorities have halted almost completely the arrival of visitors to these sites. This paper aims at elaborating on the impact that the COVID-19 pandemic has had on social manifestations of religiosity and therefore taking a toll on the spiritual health of believers who have deeply rooted religious convictions and are strongly attached to Church tradition. This analysis closes with the provision of specific suggestions for the care, support, and healing of the impacted or splintered spiritual health of the believers who cannot participate in expressions of devotion, such as pilgrimages and religious tourism because of personal and public health concern, such as the COVID-19 pandemic.