Atrial fibrillation is the most common sustained arrhythmia and is associated with increased risk of stroke, possibly accounting for one in three incident ischaemic strokes.1 Acute ischaemic stroke ...can also be the first manifestation of atrial fibrillation. Because oral anticoagulation reduces stroke risk effectively in these patients, detection of atrial fibrillation is a fundamental component of secondary stroke prevention. The Impact of standardized MONitoring for Detection of Atrial Fibrillation in Ischemic Stroke (MonDAFIS) study, reported in The Lancet Neurology by Karl Haeusler and colleagues,4 is a multicentre randomised trial designed to assess the effect of systematic in-hospital ECG monitoring for up to 7 days compared with usual diagnostic procedures (consisting of a 12-lead ECG on admission and at least 24 h of inpatient ECG monitoring) in adults within 72 h of index stroke. ASV receives research funding from the US National Institutes of Health (NIH) Investigational New Drug Application (119127), NIH National Institute of Nursing Research (R01NR018443), and Novartis (CTQJ230A12001); has stock in Apple; is an MSD/Bayer Virtual Global Advisory Board Member, and is a member of the Bristol Myers Squibb Foundation Diverse Clinical Investigator Career Development Program National Advisory Committee.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
South Asians (from Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, and Sri Lanka) make up one quarter of the world’s population and are one of the fastest-growing ethnic groups in the ...United States. Although native South Asians share genetic and cultural risk factors with South Asians abroad, South Asians in the United States can differ in socioeconomic status, education, healthcare behaviors, attitudes, and health insurance, which can affect their risk and the treatment and outcomes of atherosclerotic cardiovascular disease (ASCVD). South Asians have higher proportional mortality rates from ASCVD compared with other Asian groups and non-Hispanic whites, in contrast to the finding that Asian Americans (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) aggregated as a group are at lower risk of ASCVD, largely because of the lower risk observed in East Asian populations. Literature relevant to South Asian populations regarding demographics and risk factors, health behaviors, and interventions, including physical activity, diet, medications, and community strategies, is summarized. The evidence to date is that the biology of ASCVD is complex but is no different in South Asians than in any other racial/ethnic group. A majority of the risk in South Asians can be explained by the increased prevalence of known risk factors, especially those related to insulin resistance, and no unique risk factors in this population have been found. This scientific statement focuses on how ASCVD risk factors affect the South Asian population in order to make recommendations for clinical strategies to reduce disease and for directions for future research to reduce ASCVD in this population.
In a recent issue of the Journal of Alzheimer's Disease, Zinman et al. investigated the role of sex in the risk of cognitive impairment in 5,969 patients with a stroke or transient ischemic attacks. ...Using a short validated clinical screening tool, they noted that men had a 34% higher risk of screening positive for post-stroke cognitive impairment after adjusting for age, education, and stroke severity compared to women. This study highlights that more large, prospective, and multicenter studies are needed to evaluate sex-specific changes after a stroke since sex differences exist in many aspects of stroke presentation and management.
COVID-19-associated myocardial injury is often mild and correlates with the viral load and severity of illness 1,3. ...its frequency and reported severity vary depending on the population studied. A ...recently published expert consensus document from the American College of Cardiology recommends triad testing with an ECG, cTn (preferably high sensitivity), and an echocardiogram when evaluating COVID-19 patients with cardiac symptoms or at least a moderate suspicion for cardiac involvement. ...if the initial triad testing raises suspicion of myocardial involvement with COVID-19, CMR is recommended for further evaluation if the patient is hemodynamically stable and the results are likely to impact the management plan 5. Potential mechanisms of CV manifestations of PASC remain under investigation. Because of the multifactorial nature of this condition, patients with PASC often require care by multidisciplinary teams, including primary care, cardiology, and other medical specialties.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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Women and atrial fibrillation Volgman, Annabelle Santos; Benjamin, Emelia J.; Curtis, Anne B. ...
Journal of cardiovascular electrophysiology,
October 2021, Volume:
32, Issue:
10
Journal Article
Peer reviewed
Open access
Atrial fibrillation (AF) remains a growing problem in the United States and worldwide, imposing a high individual and health system burden, including increased resource consumption due to repeated ...hospitalizations, stroke, dementia, heart failure, and death. This comprehensive review summarizes the most recent data on sex‐related differences in risks associated with AF. Women with AF have increased risk of stroke and death compared to men, and possible reasons for this disparity are explored. Women also continue to have worse symptoms and quality of life, and poorer outcomes with stroke prevention, as well as with rate and rhythm control management strategies. Many current rhythm control treatment strategies for AF, including cardioversion and ablation, are used less frequently in women as compared to men, whereas women are more likely to be treated with rate control strategies or antiarrhythmic drugs. Sex differences should be considered in treating women with AF to improve outcomes and women and men should be offered the same interventions for AF. We need to improve the evidence base to understand if variation in utilization of rate and rhythm control management between men and women represents health inequities or appropriate clinical judgement.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Pearls and Purple: The Dawn of a Modern Age Tracy, Melissa; Volgman, Annabelle Santos
Journal of the American Heart Association,
03/2021, Volume:
10, Issue:
5
Journal Article
Compared to conventional cardiac troponin (cTn), the high-sensitivity cardiac troponin (hs-cTn) assay is associated with improved detection of myocardial infarction (MI).
We performed a descriptive ...retrospective analysis of resource utilization at Rush University Medical Center over the transition period (July 1, 2021) from a cTn to a hs-cTn assay. Inclusion criteria included emergency department (ED) encounters between January 1 to December 31, 2021, with chief complaints of “chest pain” or “dyspnea” with associated troponin orders. The primary endpoint was the percentage of ED discharges. Secondary endpoints included the number of cardiac studies ordered. Univariable comparisons of these endpoints were performed using Student's t-test for continuous variables and Chi-square tests for binary/categorical variables.
A total of 5113 encounters were analyzed. Hs-cTn was associated with an overall increase in ED patient discharges with negative troponin tests (44.1% vs. 29.9%, P < 0.01). In terms of cardiac testing per encounter, hs-cTn was associated with significant increases in the number of troponin tests (1.9 vs. 1.6, P < 0.01), electrocardiograms (3.0 vs. 2.9, P = 0.01), and echocardiograms (0.5 vs. 0.4, P < 0.01). There was a significant decrease in the utilization of stress testing (0.21 vs. 0.26, P < 0.01). There was a significant increase in total coronary angiography use during the hs-cTn period compared to cTn (227/2471 (9.2%) vs. 195/2642 (7.4%), P = 0.02).
Transitioning from cTn to hs-cTn was associated with significantly increased ED discharges and an increase in troponin tests, ECG, echocardiograms, and coronary angiograms. There was a decrease in the number of stress tests.
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Individuals who present with STEMI without the standard cardiovascular risk factors (SMuRFs) of diabetes, hypercholesterolemia, hypertension, and smoking, coined SMuRF-less are not uncommon. Little ...is known about their outcomes as a cohort and how they differ by race.
We identified 431,615 admissions with STEMI in the National Inpatient Sample (NIS) database 2015–2018, including patients with ≥ 1 SMuRF (n = 369,870) and those who were SMuRF-less (n = 234,745). SMuRF-less patients presented at a similar age (median age 63y vs 63y), were less likely to be female (33.6 % vs 34.6 %) and were almost twice as likely to present as a cardiac arrest (13.7 % vs 7.0 %), than those with ≥ 1 SMuRFs. SMuRF-less patients were less frequently in receipt of ICA (71.3 % vs 83.8 %) and PCI (58.0 % vs 72.2 %) compared to those with ≥ 1 SMuRF. Our race disaggregated analysis showed ethnic minority SMuRF-less patients were less likely than White patients to receive ICA and PCI, which was most apparent in Black patients with reduced odds of ICA (OR: 0.47, 95 % CI: 0.43–0.52) and PCI (OR: 0.46, 95 % CI: 0.52–0.50). Similarly, in ethnic minority subgroups within the SMuRF-less cohort, mortality and MACCE were significantly higher than in White patients. This was most profound in Black patients with in-hospital mortality (OR: 1.90, 95 % CI: 1.72–2.09) and MACCE (OR: 1.63, 95 % CI: 1.49–1.78) compared to White patients.
Ethnic Minority SMuRF-less patients were less likely than White SMuRF-less patients to receive ICA and PCI and had worse mortality outcomes.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The impact of atrial fibrillation (AF) on the hospitalization outcomes in patients ≥ 60 years of age with implantable cardioverter defibrillators (ICD) is not well studied. We queried the National ...Inpatient Sample database for all patients aged ≥ 60 who had a history of ICD placement, and were admitted with a primary diagnosis of heart failure (HF) during the years 2016-2017. Patients were stratified into 2 groups based on their history of AF. The primary outcome of the study was all-cause in-hospital mortality. Secondary outcomes included cardiogenic shock, myocardial infarction (MI), ventricular fibrillation (VF), stroke and acute kidney injury (AKI). The association between different age strata and outcomes was investigated. The hospitalization outcomes were modeled using logistic regression. A total of 178,045 patients were included, of whom 56.2% had AF. AF correlated with increased mortality (A-OR 1.22 (95% CI: 1.06-1.4), p=0.005), cardiogenic shock (A-OR 1.21 (95%CI: 1.08-1.36), p<0.001), AKI (A-OR 1.12 (95%CI: 1.06-1.17), p<0.001 and lower risk for MI (A-OR 0.79 (95% CI: 0.68-0.9), p<0.001. There was no correlation between AF and risk for VF or stroke. A significant correlation between AF and higher risk for mortality, cardiogenic shock and AKI was demonstrated in ages ≤ 75, ≤ 75, and ≤ 80 years, respectively. In contrast, a significant correlation between AF and lower risk for MI is only demonstrated at age > 70 years. We conclude that AF is an independent predictor for increased all-cause in-hospital mortality and cardiogenic shock. Such risk is influenced by age.
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