Abstract
Background
"Real world" observational data on cardiovascular prognosis of patients with atrial fibrillation and active lung cancer are very limited.
Purpose
Our aim was to describe the ...incidence of major cardiovascular events in this population.
Methods
We used data from CANAC-FA Registry (Active Cancer and Atrial Fibrillation, in Spanish, CÁNcer ACtivo y Fibrilación Auricular), an observational, multicentre, retrospective study. The medical records of all subjects attended at the outpatient oncology clinics solely or mainly attending lung cancer patients from January 1st, 2017 to December 31st, 2019 in five tertiary university hospitals in the south of Spain were reviewed. The first visit to the oncology clinic with atrial fibrillation diagnosis (previous or at that moment), during the first year after the lung cancer diagnosis was considered the basal visit. Follow up period ended at December 31st, 2021. End points were stroke/systemic embolism, thrombotic events (stroke, systemic embolism, pulmonary embolism, deep vein thrombosis), major bleeding (International Society of Thrombosis and Haemostasis definition), and cardiovascular events (hospital admission for cardiovascular reasons or cardiovascular death). Death without the event of interest was considered a competing risk. Calculations were performed with R statistical software, cmprsk package.
Results
Among 6984 patients, 269 presented active lung cancer and atrial fibrillation (3.7%). Mean age was 71±8 years, and 91% were male. Cardiovascular risk factors were: hypertension 77%, dyslipidemia 49%, diabetes 37% and active smoking 30% (62% ex-smokers). Charlson, CHA2DS2VASc and HAS-BLED indexes were 6.7±2.9, 2.9±1.5 y 2.5±1.2, respectively. Tumor stage was I, II, III and IV in 11%, 11%, 34% and 45% of the study sample, respectively. Anticoagulants were prescribed to 84% of the patients: direct anticoagulants (44%), low molecular weight heparins (30%) and vitamin K antagonists (26%). After up to 46 months of maximum follow-up, 7 patients presented a stroke/systemic embolism, 18 had a thrombotic event, 16 presented a major bleeding, 33 had a cardiovascular event and 186 died. Cumulative incidences of major events at one, two and three years of follow-up were 2.4±1.0%, 3.3±1.3% and 3.3±1.3% for stroke/systemic embolism; 4.7±1.3%, 8.0±2.1% and 8.9±2.2% for thrombotic events; 2.7±1.0%, 6.7±1.9% and 9.9±2.6% for severe bleeding, and 9.5±1.8%, 13.4±2.5% and 15.9±3.0% for cardiovascular events (figure).
Conclusions
Cumulative incidence of cardiovascular events was 15.9% at three years in this "real world" population of patients with active lung cancer and atrial fibrillation. These data could suggest an unmet need for more effective preventive strategies in this population.Major events
Abstract
Background
Lung cancer has a poor prognosis for most patients, as it is frequently diagnosed in advanced tumour stages. Real world observational data on the impact of major cardiovascular ...events (MACE) and major bleedings (MB) in the prognosis of patients with atrial fibrillation (AF) and active lung cancer are very limited.
Purpose
Our aim was to investigate the impact of MACE and MB in mortality in this population.
Methods
We used data from CANAC-FA Registry (Active Cancer and AF, in Spanish, CÁNcer ACtivo y Fibrilación Auricular), an observational, multicentre, retrospective study. The medical records of all subjects attended at the outpatient oncology clinics solely or mainly attending lung cancer patients from January 1st, 2017 to December 31st, 2019 in five tertiary university hospitals in the south of Spain were reviewed. The first visit to the oncology clinic with AF diagnosis during the first year after the lung cancer detection was considered the basal visit. Follow up period ended at December 31st, 2021. MACE (hospital admission for cardiovascular causes) and MB (International Society of Thrombosis and Haemostasis definition) were registered, and impact on survival was assessed for the whole series and according to tumour stage.
Results
Among 6984 patients, 269 presented active lung cancer and AF (3.9%). Mean age was 71±8 years, and 91% were male. Tumour stage was I, II, III and IV in 11%, 11%, 34% and 45% of the study sample, respectively. Anticoagulants were prescribed to 84% of the patients. After up to 46 months of maximum follow-up, 33 patients presented 40 MACE (13 heart failure admissions, 9 pulmonary embolisms, 5 strokes, 5 severe symptomatic arrhythmias, 4 deep vein thrombosis, 2 transient ischemic attacks, 2 systemic embolisms and 1 acute coronary syndrome), 16 patients had a MB and 186 died. However, two years’ mortality was similar in those patients with MACE or MB in follow-up versus those without them, in the whole of series (79% versus 73%, p=0.79, figure A), and in those with advanced cancer stages (III-IV, 89% versus 85%, p=0.39, figure B). In spite of that, in those patients with early tumour stages (I-II), two years’ mortality was significantly higher in those who suffered MACE or MB than in those free of both of them (85% versus 25%, p=0.01, figure C), and this difference remained after adjusting by other independent predictors of mortality (Hazard Ratio 11.08 2.69-45.58, p=0.001).
Conclusions
In patients with AF and active lung cancer, patients with MACE and MB in follow up had similar mortality than those without them in the subgroup with advanced cancer stages. However, mortality was significantly higher in patients with these complications versus those without them in the subgroup with early cancer stages. This information could be useful for individualizing therapeutic efforts in this population.Impact of events in survival
Abstract
Background
Older patients with atrial fibrillation (AF) have a higher thromboembolic and hemorrhagic risk, however oral anticoagulation (OAC) continues to be underutilized.
Purpose
To ...analyze the use of direct oral anticoagulant (DOAC) in patients older than 80 years.
Methods
The REFLEJA study is a single-centre prospective observational registry including 1039 consecutive outpatients with nonvalvular AF.
Results
Among ≥80 years patients (n=376) there were more women (57.7% vs 41.5%; p<0.001), permanent AF (66.5 vs 42%; <0.001), heart failure (HF) (29.8 vs 20.2%, p<0.001) and vascular disease (19.7 vs 12.8%, p=0.003), although without differences in bleeding (5.9 vs 3,8%, p=0.12) and previous strokes (9.3 vs 7.1%, p=0.20). Despite a higher CHA2DS2-VASc score (4.4±1.1 VS 2.9±1.6, p<0.001), HASBLED score >2 (34.6 vs. 23.7%; p<0.001) and chronic kidney disease (CKD) (51.5 vs. 22.6%, p<0.001), total use of OAC was higher among those older (94.9% vs 90%, p=0.005). There were no differences in the prescription of DOAC (64.1% vs 69.3%, p=0.08), although lower doses (45.8 vs. 12.2%, p<0.005) were more frecuent among older patients. In multivariate analysis, HF (OR 0.60, CI 0.40–0.90; p=0.013) and CKD (OR 0.55, CI 0.41–0.76; p<0.001) were independent risk factors for the prescription of DOAC, but not age ≥80 years (OR 1.16, CI 0.58–2.31, P=0.67).
Baseline characteristics
Total
<80 years
≥80 years
p value
Hypertension (%)
81.5
77.9
88
<0.001
Diabetes mellitus (%)
26.3
25.7
26.7
0.71
Malignancy (%)
6.6
6.5
6.9
0.78
Coronary artery disease (%)
12.1
10.8
14.4
0.08
Anemia (%)
16.3
12.5
23.2
<0.001
DOAC (%)
67.6
69.3
64.1
0.08
Low doses DOAC (%)
15.9
12.2
45.8
<0.001
CHA2DS2-VASc score
3.4±1.6
2.9±1.6
4.4±1.1
<0.001
HAS-BLED score
1.2±0.8
1.1±0.8
1.4±0.7
<0.001
Glomerular filtration rate (ml/min)
70.9±24.9
76.2±23.1
61.5±25
<0.001
Antiarrhythmic treatment (%)
7.3
9.6
3.1
0.005
Permanent AF
50.5
41.7
66.2
<0.001
DOAC: direct oral anticoagulants; HAS-BLED score: without INR lability; AF: atrial fibrillation.
Conclusion
The proportion of elderly anticoagulated patients in our environment is very high and advanced age was not associated with a lower use of DOAC.
Ultrasound has become an essential tool in assisting critically ill patients. His knowledge, use and instruction requires a statement by scientific societies involved in its development and ...implementation. Our aim are to determine the use of the technique in intensive care medicine, clinical situations where its application is recommended, levels of knowledge, associated responsibility and learning process also implement the ultrasound technique as a common tool in all intensive care units, similar to the rest of european countries. The SEMICYUC's Working Group Cardiac Intensive Care and CPR establishes after literature review and scientific evidence, a consensus document which sets out the requirements for accreditation in ultrasound applied to the critically ill patient and how to acquire the necessary skills. Training and learning requires a structured process within the specialty. The SEMICYUC must agree to disclose this document, build relationships with other scientific societies and give legal cover through accreditation of the training units, training courses and different levels of training.
Abstract Ultrasound has become an essential tool in assisting critically ill patients. Its knowledge, use and instruction require a statement by scientific societies involved in its development and ...implementation. Our aim is to determine the use of the technique in intensive care medicine, clinical situations where its application is recommended, levels of knowledge, associated responsibility and learning process also implement the ultrasound technique as a common tool in all intensive care units, similar to the rest of European countries. The SEMICYUC's Working Group Cardiac Intensive Care and CPR establishes after literature review and scientific evidence, a consensus document which sets out the requirements for accreditation in ultrasound applied to the critically ill patient and how to acquire the necessary skills. Training and learning module requires a structured process within the specialty. The SEMICYUC must agree to disclose this document, build relationships with other scientific societies and give legal cover through accreditation of the training units, training courses and different levels of training.
Lipoprotein(a) Lp(a) is a proatherogenic particle associated with increased cardiovascular risk. It is mainly genetically determined; so, the aim of our study is to evaluate the levels of Lp(a) in ...the relatives of a prospective cohort of patients who have suffered from an acute coronary syndrome (ACS) with Lp(a) ≥ 50 mg/dL.
: We conducted a multicenter prospective study, in which consecutive patients who had suffered from an ACS and presented Lp(a) ≥ 50 mg/dL and their first-degree relatives were included.
: We included 413 subjects, of which 56.4% were relatives of the patients. Family history of early ischemic heart disease was present in 57.5%, and only 20.6% were receiving statin treatment. The family cohort was younger (37.5 vs. 59.1 years;
< 0.001), and 4% had ischemic heart disease and fewer cardiovascular risk factors. Mean Lp(a) levels were 64.9 mg/dL, 59.4% had levels ≥ 50 mg/dL, and 16.1% had levels ≥ 100 mg/dL. When comparing the patients with respect to their relatives, the mean level of Lp(a) was lower but without significant differences regarding the levels of LDLc, ApoB, and non-HDL. However, relatives with Lp(a) ≥ 50 mg/dL, had values similar to the group of patients with ACS (96.8 vs. 103.8 mg/dL;
= 0.18). No differences were found in Lp(a) levels in relatives based on the other lipid parameters.
: Overall, 59.4% of the first-degree relatives of patients who suffered from an ACS with Lp(a) ≥ 50 mg/dL also had elevated levels. Relatives with elevated Lp(a) had similar levels as patients.
Lp Study Fernández-Olmo, M. Rosa; Bailen, Magdalena Carrillo; Martínez Quesada, Mar ...
Journal of clinical medicine,
04/2024, Letnik:
13, Številka:
8
Journal Article
Recenzirano
Background: Lipoprotein(a) Lp(a) is a proatherogenic particle associated with increased cardiovascular risk. It is mainly genetically determined; so, the aim of our study is to evaluate the levels of ...Lp(a) in the relatives of a prospective cohort of patients who have suffered from an acute coronary syndrome (ACS) with Lp(a) ≥ 50 mg/dL. Methods: We conducted a multicenter prospective study, in which consecutive patients who had suffered from an ACS and presented Lp(a) ≥ 50 mg/dL and their first-degree relatives were included. Results: We included 413 subjects, of which 56.4% were relatives of the patients. Family history of early ischemic heart disease was present in 57.5%, and only 20.6% were receiving statin treatment. The family cohort was younger (37.5 vs. 59.1 years; p < 0.001), and 4% had ischemic heart disease and fewer cardiovascular risk factors. Mean Lp(a) levels were 64.9 mg/dL, 59.4% had levels ≥ 50 mg/dL, and 16.1% had levels ≥ 100 mg/dL. When comparing the patients with respect to their relatives, the mean level of Lp(a) was lower but without significant differences regarding the levels of LDLc, ApoB, and non-HDL. However, relatives with Lp(a) ≥ 50 mg/dL, had values similar to the group of patients with ACS (96.8 vs. 103.8 mg/dL; p = 0.18). No differences were found in Lp(a) levels in relatives based on the other lipid parameters. Conclusions: Overall, 59.4% of the first-degree relatives of patients who suffered from an ACS with Lp(a) ≥ 50 mg/dL also had elevated levels. Relatives with elevated Lp(a) had similar levels as patients.
