Atrial fibrillation, a contemporary sign of multimorbidity and irregular social inequity

Sagris, Dimitrios; Lip, Gregory Y. H.

doi:10.1016/j.lanepe.2022.100395

Cited by 5 publications

(4 citation statements)

References 10 publications

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“…This burden has direct implications regarding morbidity and mortality risk, as highlighted in the GARFIELD-AF study [49]. It was shown to be associated with lower socioeconomic status and older age [17,50]. Indeed, in our study, patients with comorbid conditions were more likely to be referred to EDs.…”

Section: Discussionmentioning

confidence: 60%

Trends in Atrial Fibrillation Management—Results from a National Multi-Center Urgent Care Network Registry

Lebovitz,

Estryk,

Zimmerman

et al. 2023

JCM

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Background: Atrial fibrillation (AF) is a common diagnosis in patients presenting to urgent care centers (UCCs), yet there is scant research regarding treatment in these centers. While some of these patients are managed within UCCs, some are referred for further care in an emergency department (ED). Objectives: We aimed to identify the rate of patients referred to an ED and define predictors for this outcome. We analyzed the rates of AF diagnosis and hospital referral over the years. Finally, we described trends in patient anticoagulation (AC) medication use. Methods: This retrospective study included 5873 visits of patients over age 18 visiting the TEREM UCC network with a diagnosis of AF over 11 years. Multivariate analysis was used to identify predictors for ED referral. Results: In a multivariate model, predictors of referral to an ED included vascular disease (OR 1.88 (95% CI 1.43–2.45), p < 0.001), evening or night shifts (OR 1.31 (95% CI 1.11–1.55), p < 0.001; OR 1.68 (95% CI 1.32–2.15), p < 0.001; respectively), previously diagnosed AF (OR 0.31 (95% CI 0.26–0.37), p < 0.001), prior treatment with AC (OR 0.56 (95% CI 0.46–0.67), p < 0.001), beta blockers (OR 0.63 (95% CI 0.52–0.76), p < 0.001), and antiarrhythmic medication (OR 0.58 (95% CI 0.48–0.69), p < 0.001). Visits diagnosed with AF increased over the years (p = 0.030), while referrals to an ED decreased over the years (p = 0.050). The rate of novel oral anticoagulant prescriptions increased over the years. Conclusions: The rate of referral to an ED from a UCC over the years is declining but remains high. Referrals may be predicted using simple clinical variables. This knowledge may help to reduce the burden of hospitalizations.

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Section: Discussionmentioning

confidence: 60%

Trends in Atrial Fibrillation Management—Results from a National Multi-Center Urgent Care Network Registry

Lebovitz,

Estryk,

Zimmerman

et al. 2023

JCM

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“…These interventions should also take into account and aim to minimise inequities. It has been demonstrated that implementing interventions during the early stages of the condition with effective strategies could yield significant benefits for healthcare systems 3 45–47…”

Section: Discussionmentioning

confidence: 99%

“…Numerous methods have been proposed for detecting undiagnosed AF. However, persistent barriers exist that go beyond individualised person-centred interventions and health promotion efforts 41–48…”

Section: Discussionmentioning

confidence: 99%

“…However, persistent barriers exist that go beyond individualised person-centred interventions and health promotion efforts. [41][42][43][44][45][46][47][48] The experts at the consensus conference recommend systematic screening for all individuals aged ≥75 years and suggest that systematic screening may also be considered for people aged 65-74 years who have additional risk factors, elevated biomarkers or a positive alert from digital devices. 43 44 49 Furthermore, the first practical guide on the use of digital devices for monitoring heart rhythm and frequency provides clarification on which technologies to employ and under what circumstances.…”

Section: Discussionmentioning

confidence: 99%

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Protocol for a multicentre and prospective follow-up cohort study of early detection of atrial fibrillation, silent stroke and cognitive impairment in high-risk primary care patients: the PREFA-TE study

Hernández-Pinilla,

Clua-Espuny,

Satué-Gracia

et al. 2024

BMJ Open

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BackgroundAtrial fibrillation (AF) is the most common type of cardiac arrhythmia. Future estimations suggest an increase in global burden of AF greater than 60% by 2050. Numerous studies provide growing evidence that AF is not only associated with stroke but also with cognitive impairment and dementia.AimThe main goal is to assess the impact of the combined use of cardiac rhythm monitoring devices, echocardiography, biomarkers and neuroimaging on the early diagnosis of AF, silent strokes and cognitive decline, in subjects at high risk of AF.Methods and analysisTwo-year follow-up of a cohort of individuals aged 65–85 years at high risk for AF, with no prior diagnosis of either stroke or dementia. The study involves baseline echocardiography, biomarkers, and neuroimaging, yearly cardiac monitoring, and semiannual clinical assessments. Different parameters from these tests will be analysed as independent variables. Throughout the study period, primary outcomes: new diagnoses of AF, stroke and cognitive impairment, along with any clinical and therapeutic changes, will be registered. A first descriptive and bivariate statistical analysis, appropriate to the types of variables, will be done. The information obtained from the data analysis will encompass adjusted risk estimates along with 95% confidence intervals. Event risk predictions will rely on multivariate Cox proportional hazards regression models. The predictive value of the model will be evaluated through the utilisation of receiver operating characteristic curves for area under the curve calculation. Additionally, time-to-event analysis will be performed using Kaplan-Meier curves.Ethics and disseminationThis study protocol has been reviewed and approved by the Independent Ethics Committee of the Foundation University Institute for Primary Health Care Research-IDIAP Jordi Gol (expedient file 22/090-P). The authors plan to disseminate the study results to the general public through various scientific events. Publication in open-access journals and presentations at scientific congresses, seminars and meetings is also foreseen.Trial registration numberNCT05772806.

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Stroke in Atrial Fibrillation and Other Atrial Dysrhythmias

et al. 2023

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Atrial fibrillation, a contemporary sign of multimorbidity and irregular social inequity

Cited by 5 publications

References 10 publications

Trends in Atrial Fibrillation Management—Results from a National Multi-Center Urgent Care Network Registry

Trends in Atrial Fibrillation Management—Results from a National Multi-Center Urgent Care Network Registry

Protocol for a multicentre and prospective follow-up cohort study of early detection of atrial fibrillation, silent stroke and cognitive impairment in high-risk primary care patients: the PREFA-TE study

Stroke in Atrial Fibrillation and Other Atrial Dysrhythmias

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