Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: systematic review and meta-analysis

AimTo clarify the features of stroke mimics.MethodsWe retrospectively investigated stroke mimic cases among the suspected stroke cases examined at our emergency department, over the past 9 years, during the tissue‐type plasminogen activator treatment time window.ResultsOf 1,557 suspected acute stroke cases examined at the emergency department, 137 (8.8%) were stroke mimics. The most common causes were symptomatic epilepsy (28 cases, 20.4%), neuropathy‐like symptoms (21 cases, 15.3%), and hypoglycemia (15 cases, 10.9%). Outcomes were survival to hospital discharge for 91.2% and death for 8.8% of the cases. Clinical results were significantly different between stroke mimics and the stroke group for low systolic blood pressure, low National Institutes of Health Stroke Scale score on initial treatment, history of diabetes, and no history of arrhythmia. On multivariate analysis, distinguishing factors for stroke mimics include systolic blood pressure ≤ 140 mmHg, National Institutes of Health Stroke Scale score ≤ 5 points, history of diabetes, and no history of arrhythmia.ConclusionsFrequency of stroke mimics in cases of acute stroke suspected cases is 8.8%, and the most common cause is epilepsy. In order to distinguish stroke mimics, it is useful to understand common diseases presenting as stroke mimics and evaluate clinical features different from stroke by medical interview or nerve examination.

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“…Odutayo et al 20. reported that the risk of ischemic stroke was 2.33 times than that in people without atrial fibrillation in their cohort study.…”

Section: Discussionmentioning

confidence: 92%

Clinical features of stroke mimics in the emergency department

Okano

Ishimatsu

Kato

et al. 2018

Acute Medicine & Surgery

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“…Studies that accounted for the largest share of heterogeneity were sequentially and cumulatively excluded until I 2 was <50%. We then examined whether the OR estimates were consistent [36]. Evidence of publication bias was examined using funnel plots.…”

Section: Resultsmentioning

confidence: 99%

“…and S.G.) independently used the Newcastle-Ottawa quality assessment scale for case-control studies to assess the risk of bias [31][32][33][34][35]. Subsequently, the studies were considered at a low risk of bias if they achieved a full rating in at least two categories of selection, comparability, or outcome assessment [36].…”

Section: Data Extraction and Quality Assessmentmentioning

confidence: 99%

Association between antidepressant medication use and epithelial ovarian cancer risk: a systematic review and meta‐analysis of observational studies

Huo

Qiao

Gao

2018

Brit J Clinical Pharma

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AIMThe aim of this paper is to clarify the inconsistent findings in the association between antidepressant use and the risk of epithelial ovarian cancer (EOC). METHODSThis study is a meta-analysis of observational studies retrieved from the PubMed, EMBASE, and Web of Science databases prior to August 15, 2017. Two researchers independently screened studies and extracted study characteristics and risk estimates. The odds ratios (OR) and 95% confidence intervals (CI) of EOC risk were summarized using an inverse variance weighted randomeffects model. Heterogeneity between studies was assessed with the I 2 statistic. RESULTSEight case-control studies involving 7878 EOC cases and 73 913 controls were identified. Compared with non-use, use of antidepressants was not significantly associated with EOC risk (summarized OR = 1.10, 95% CI: 0.91-1.32, I 2 = 74.4%). Similar null results were also observed in the use of selective serotonin reuptake inhibitors (OR = 1.04, 95% CI = 0.80-1.35), tricyclic antidepressants (OR = 1.01, 95% CI = 0.79-1.30), and other antidepressant drugs (OR = 0.91, 95% CI = 0.74-1.12). Subgroup analyses of study characteristics, stratified by the type of control subjects, geographic location, exposure assessment, number of cases, and adjustment for potential confounders, showed that the ORs were broadly consistent across strata. The OR per 1 yearincrement of duration was 0.99 (95% CI = 0.94-1.05, I 2 = 40.0%, P = 0.154). Additionally, the OR for the greatest intensity of antidepressant use compared with never use was 0.82 (95% CI = 0.70-0.98, I 2 = 0%, P = 0.489). Furthermore, no evidence of publication bias was detected through Funnel plots as well as Egger's and Begg's tests. CONCLUSIONSThere is no association between antidepressant use and EOC risk. Further prospective studies are warranted to confirm these findings. British Journal of Clinical PharmacologyBr J Clin Pharmacol (2018) 84 649-658 649

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“…(8) A large meta-analysis involving over half a million patients with AF over a median follow-up period ranging from 3 -6 years, highlights that this arrhythmia is associated with increased absolute risk of heart failure (11.1 events/1 000 person-years), chronic kidney disease (6.6/1 000), stroke (3.6/1 000) and ischaemic heart disease (1.4/1 000) as well as excess cardiovascular (2.6/1 000) and all-cause mortality (3.8/1 000). (9) Certainly this association does not imply direct causality but it does question why a correlation with excess mortality and morbidity from both cardiovascular and non-cardiovascular causes exists.…”

Section: Atrial Fibrillation As a Vascular Diseasementioning

confidence: 99%

Approach to device-detected subclinical atrial fibrillation

Zyl

McLeod²,

Gersh³

2017

SAHJ

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INTRODUCTIONCardiac implantable electronic devices (CIEDs) are becoming more and more common due to an aging global population and expanded criteria for implantation. During 2009, over 1.3 million new or replaced implantable cardiac devices were implanted worldwide, with around a quarter of these occurring in the United States (US) alone.(1,2) South Africa has experienced substantial growth with an almost 25% rise in CIEDs implanted between 2005 and 2009, as opposed to only 8% in the US.(1) In addition, there is a greater availability of external surface monitoring and implantable loop recorders (ILR). Out of this vast increase in continuous arrhythmia monitoring arises the challenge of how to approach the abundance of data that identifies subclinical arrhythmia, and germane to this discussion, atrial fibrillation (AF).As the most pervasive sustained arrhythmia encountered in clinical practice, AF has risen in age-adjusted incidence over the last half century -a trend which may be plateauing over the last decade.(3,4) After age 40 the lifetime risk of developing AF is almost 1 in 4.(2) As many as 40% of patients are entirely asymptomatic -also termed subclinical AF -and the arrhythmia may only come to the attention of the patient and provider as an incidental finding.(5) Population screening of those over 65 years of age would detect subclinical AF in an estimated 1.4% of patients -of whom, more than two thirds would be at high risk for stroke based on clinical risk prediction models.(6) AF shares many risk factors -including age, male gender, heart failure and coronary disease -with indications for a permanent pacemaker or implantable cardioverter defibrillator (ICD) and, as such, the detection of clinically silent paroxysms of AF by device interrogation is not uncommon. In patients with CIEDs placed for unrelated indications, without a prior history of permanent AF, 43% had 5 minutes or more of AF detected over 2 years of follow-up in a pooled analysis of 5 large prospective trials (n=10 016).(7) Therefore, adoption of a strategy for dealing with device-detected subclinical AF is vital for clinicians.In the midst of several studies which demonstrate the con-

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Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: systematic review and meta-analysis

Abstract: ObjeCtiveTo quantify the association between atrial fibrillation and cardiovascular disease, renal disease, and death.Design Systematic review and meta-analysis.

Cited by 627 publications

References 126 publications

Clinical features of stroke mimics in the emergency department

Clinical features of stroke mimics in the emergency department

Association between antidepressant medication use and epithelial ovarian cancer risk: a systematic review and meta‐analysis of observational studies

Approach to device-detected subclinical atrial fibrillation

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