scholarly journals New‐Onset Postoperative Atrial Fibrillation After Total Arch Repair Is Associated With Increased In‐Hospital Mortality

2021 ◽  
Vol 10 (18) ◽  
Author(s):  
Rui Zhao ◽  
Zhao Wang ◽  
Fangfang Cao ◽  
Jian Song ◽  
Shuya Fan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Circulatory Arrest ◽  
The Elderly ◽  
Deep Hypothermic Circulatory Arrest ◽  
Postoperative Atrial Fibrillation ◽  
Inverse Probability ◽  
New Onset

Background It is well established that postoperative atrial fibrillation (POAF) is associated with adverse postoperative outcomes after major cardiac operations. The purpose of this study was to investigate the incidence of new‐onset POAF after successful total arch repair surgery and the association between POAF and in‐hospital mortality. Methods and Results All consecutive patients undergoing total arch repair from September 2012 to December 2019 in Fuwai hospital were enrolled (n=1280). Patients diagnosed with preoperative atrial fibrillation were excluded. POAF was diagnosed as the new‐onset atrial fibrillation or flutter for more than 5 minutes based on continuous electrocardiogram monitoring. A logistic regression model was used to determine predictors of in‐hospital mortality. Multivariable adjustment, inverse probability of treatment weighting, and propensity score matching were used to adjust for confounders. POAF was diagnosed in 32.3% (411/1271) of this cohort population. The occurrence of new‐onset POAF was associated with age (odds ratio [OR], 1.05; 95% CI, 1.04–1.06; P <0.001), male sex (OR, 0.72; 95% CI, 0.52–0.98; P =0.035), and surgery duration (OR, 1.2; 95% CI, 1.12–1.28; P <0.001). The in‐hospital mortality was significantly higher in patients with POAF than those without POAF (10.7% versus 2.4%, P <0.001). Inverse probability of treatment weighting and propensity score matching analyses confirmed the results. The increased in‐hospital mortality in POAF group still existed among subgroup analysis based on different age, sex, hypertension, smoking, and hypokalemia, combined with cardiac surgery, and deep hypothermic circulatory arrest. Conclusions More careful attention should be given to POAF after total arch repair surgery. The incidence of POAF after total arch repair surgery was 32.3% and associated with increased in‐hospital mortality. The elderly female patient who experienced longer operation duration was at highest risk for POAF.

Abstract 205: New Onset Heart Failure and Adverse Ischemic Events Associated with Amiodarone and Dronedarone Use among Atrial Fibrillation Patients

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Gosia Sylwestrzak ◽  
Jinan Liu ◽  
Alan Rosenberg ◽  
Jeffrey White ◽  
John Barron ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Incidence Rate ◽  
Statistical Significance ◽  
Administrative Claims ◽  
Risk Of Death ◽  
Observational Cohort ◽  
New Onset

Background: Dronedarone is a non-iodinated form of amiodarone that may not cause some of serious adverse effects associated with amiodarone. However, it is less effective than amiodarone in maintaining normal sinus rhythm, and it does not improve success of electrical cardioversion. Additionally, dronedarone use has been associated with new onset or worsening of heart failure (HF), including a doubling of the risk of death in patients with symptomatic heart failure. We aimed to compare the incidence of newly diagnosed HF and HF hospitalizations among dronedarone and amiodarone users. Secondary outcomes of interest included rates of acute ischemic stroke (IS) and transient ischemic attack (TIA). Methods: This retrospective study utilized administrative claims data between 1/1/2007-9/30/2011 from the HealthCore Integrated Research Environment (HIRE ® ). Patients were required to have at least one claim for atrial fibrillation. Propensity score matching was employed to adjust for differences between the cohorts. Incidence rate of HF, HF hospitalizations, IS and TIA events were compared between matched cohorts using Poisson time-to-event model. Results: The cohort consisted of 6,013 amiodarone and 1,534 dronedarone patients. Dronedarone patients were younger, healthier per Deyo-Charlson Index (DCI) and CHADS2 score, and less likely to have underlying heart disease (all p-values<0.05). In the propensity score matching process 838 patients with comparable baseline characteristics were selected in each group. Median follow up was 552 days in the amiodarone cohort and 412 days in the dronedarone cohort. Among patients without HF history, new onset HF incidence rate was 34.6 per 100 person-year in amiodarone cohort and 19.1 per 100 person-year in dronedarone cohort (IRR=1.61, 95% CI: 1.30-2.01, p<0.01). The incidence rate for HF hospitalization was also higher in amiodarone patients-- 10.7 per 100 person-year against 7.8 per 100 person-year for dronedarone (IRR=1.39, 95% CI: 1.02-1.85, p=0.03). For IS, the incidence rate was 1.68 per 100 person-year in amiodarone vs. 0.84 in dronedarone but results did not reach statistical significance (IRR=1.91, 95% CI: 0.84-4.30, p=0.12); for TIA, it was 3.67 vs. 2.35 for amiodarone and dronedarone respectively (IRR=2.01, 95% CI: 1.14-3.57, p=0.02). Conclusions: In a propensity score matched observational cohort study, amiodarone use was associated with higher incidence rate of new onset HF, HF hospitalizations, and TIA as identified from claims. This finding differs from other clinical studies. Future observational cohort studies should incorporate medical record review for validation since information from claims might be insufficient to fully account for underlying patient risk status, or accurately determine if HF was new onset. Key words: amiodarone; dronedarone; atrial fibrillation; heart failure.

scholarly journals Propensity score matching and inverse probability of treatment weighting to address confounding by indication in comparative effectiveness research of oral anticoagulants

2020 ◽  
Vol 9 (9) ◽  
pp. 603-614
Author(s):  
Victoria Allan ◽  
Sreeram V Ramagopalan ◽  
Jack Mardekian ◽  
Aaron Jenkins ◽  
Xiaoyan Li ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Comparative Effectiveness Research ◽  
Comparative Effectiveness ◽  
Controlled Trials ◽  
Effectiveness Research ◽  
Confounding By Indication ◽  
Inverse Probability ◽  
Randomized Controlled

After decades of warfarin being the only oral anticoagulant (OAC) widely available for stroke prevention in atrial fibrillation, four direct OACs (apixaban, dabigatran, edoxaban and rivaroxaban) were approved after demonstrating noninferior efficacy and safety versus warfarin in randomized controlled trials. Comparative effectiveness research of OACs based on real-world data provides complementary information to randomized controlled trials. Propensity score matching and inverse probability of treatment weighting are increasingly popular methods used to address confounding by indication potentially arising in comparative effectiveness research due to a lack of randomization in treatment assignment. This review describes the fundamentals of propensity score matching and inverse probability of treatment weighting, appraises differences between them and presents applied examples to elevate understanding of these methods within the atrial fibrillation field.

scholarly journals Statin Use and In‐Hospital Mortality in Patients With Diabetes Mellitus and COVID‐19

2020 ◽  
Vol 9 (24) ◽  
Author(s):  
Omar Saeed ◽  
Francesco Castagna ◽  
Ilir Agalliu ◽  
Xiaonan Xue ◽  
Snehal R. Patel ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Interquartile Range ◽  
Survival Models ◽  
Inverse Probability ◽  
Risk Of Death ◽  
Patients With Diabetes ◽  
Statin Use

Background Severe coronavirus disease 2019 (COVID‐19) is characterized by a proinflammatory state with high mortality. Statins have anti‐inflammatory effects and may attenuate the severity of COVID‐19. Methods and Results An observational study of all consecutive adult patients with COVID‐19 admitted to a single center located in Bronx, New York, was conducted from March 1, 2020, to May 2, 2020. Patients were grouped as those who did and those who did not receive a statin, and in‐hospital mortality was compared by competing events regression. In addition, propensity score matching and inverse probability treatment weighting were used in survival models to examine the association between statin use and death during hospitalization. A total of 4252 patients were admitted with COVID‐19. Diabetes mellitus modified the association between statin use and in‐hospital mortality. Patients with diabetes mellitus on a statin (n=983) were older (69±11 versus 67±14 years; P <0.01), had lower inflammatory markers (C‐reactive protein, 10.2; interquartile range, 4.5–18.4 versus 12.9; interquartile range, 5.9–21.4 mg/dL; P <0.01) and reduced cumulative in‐hospital mortality (24% versus 39%; P <0.01) than those not on a statin (n=1283). No difference in hospital mortality was noted in patients without diabetes mellitus on or off statin (20% versus 21%; P =0.82). Propensity score matching (hazard ratio, 0.88; 95% CI, 0.83–0.94; P <0.01) and inverse probability treatment weighting (HR, 0.88; 95% CI, 0.84–0.92; P <0.01) showed a 12% lower risk of death during hospitalization for statin users than for nonusers. Conclusions Statin use was associated with reduced in‐hospital mortality from COVID‐19 in patients with diabetes mellitus. These findings, if validated, may further reemphasize administration of statins to patients with diabetes mellitus during the COVID‐19 era.

scholarly journals Risks of Pneumonia in COPD Patients with New-Onset Atrial Fibrillation

2018 ◽  
Vol 7 (9) ◽  
pp. 229 ◽  
Author(s):  
Ya-Hui Wang ◽  
Chih-Cheng Lai ◽  
Cheng-Yi Wang ◽  
Hao-Chien Wang ◽  
Chong-Jen Yu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
International Classification Of Diseases ◽  
Competing Risk ◽  
Chronic Obstructive ◽  
National Health Research Institute ◽  
Copd Patients ◽  
The Impact ◽  
New Onset

The association between Atrial Fibrillation (AF) and pneumonia remains unclear. This study aims to assess the impact of AF on high pneumonia risk group—chronic obstructive pulmonary disease (COPD)—In order to find the association between AF and the risk of pneumonia. The COPD cohort was extracted from National Health Research Institute of Taiwan. The AF cohort comprised all COPD patients with new-onset AF (International Classification of Diseases (ICD)-9 code 427.31) after COPD diagnosis. We further sampled non-AF cohort and performed 1:1 propensity score matched analysis to improve the balance of baseline characteristics between AF and non-AF cohort. The outcomes were pneumonia and pneumonia requiring mechanical ventilation (MV). From 2000–2011, a total of 6228 patients with COPD and AF, and matched 84,106 control subjects were enrolled. After propensity score matching, we identified 6219 patients, each with AF, and matched controls without AF. After propensity score matching, the AF cohorts had higher risk of mortality (adjusted hazard ratio (aHR), 1.24; 95% confidence interval (CI), 1.15–1.34), pneumonia (aHR, 1.17; 95% CI, 1.07–1.27), and pneumonia requiring MV (aHR, 1.33; 95% CI, 1.18–1.50) in comparison with the matched non-AF cohort. After adjusting for mortality from causes other than outcomes of interest as a competing risk, AF remains significantly associated with pneumonia and pneumonia requiring MV. The risks of pneumonia were higher in this population with AF than in those without AF, and the risk was still significant after the adjustment for the competing risk of all-cause mortality.

Abstract 13351: Association of Atrial Fibrillation With In-hospital Mortality Among Patients With Takotsubo Cardiomyopathy

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Qiying Dai ◽  
Abhishek Bose ◽  
Pengyang Li ◽  
PENG CAI ◽  
Douglas Laidlaw
Keyword(s):  
Atrial Fibrillation ◽  
Logistic Regression ◽  
Mortality Rate ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Mortality Rates ◽  
Primary Diagnosis ◽  
Propensity Score Matching Analysis ◽  
Significant Difference

Introduction: Takotsubo cardiomyopathy (TC), characterized by transient left ventricular dysfunction, is known to be precipitated by sudden physical or emotional stress. Atrial fibrillation (AF) is a common arrhythmia and its presence increases mortality in patients with chronic underlying diseases. Furthermore, multiple studies have suggested that in TC patients, underlying AF correlates with a higher in-hospital mortality. However, these studies were constrained by either a disproportionate percentage of AF patients or lack of risk factor matching. To systematically explore the association between TC and AF, we decided to perform a propensity score matching analysis. Methods: We performed a retrospective cohort analysis using the ICD-10 codes for a primary diagnosis of TC from the 2016 National Inpatient Sample. To adjust for underlying risk factors a multivariable logistic regression model was employed followed by a propensity score matching analysis for the AF group and the non-AF group. A similar analysis method was followed for the subset of patients with paroxysmal AF. In-hospital mortality rates were compared between the two groups. Results: Out of the total 3139 patients with a primary diagnosis of TC, 433 (13.7%) had AF and 243 (7.7%) had paroxysmal AF. In the unmatched group, patients with AF appeared to be older (74.7 vs. 65.3 years, P<0.001) and more likely to have comorbidities like diabetes mellitus (24.0% vs 19.2%, P=0.024), chronic kidney disease (15.7% vs 7.6%, P<0.001) and obstructive sleep apnea (8.8% vs 4.9%, P=0.002). On multivariable logistic regression, in-hospital mortality was higher in the AF group (3.9% vs 1.3%, P< 0.001). However, after propensity score matching, there was no significant difference in the mortality rate between the two groups (3.7% vs 1.9%, P=0.082). Similarly, on logistic regression followed by propensity matching for patients with paroxysmal AF, no significant difference was noted for in-hospital mortality rates (3.3% vs 1.3%, P=0.112). Conclusions: In patients with TC, the presence of underlying AF had no effect on the in-hospital mortality rate.

scholarly journals Comparative effects of sodium glucose cotransporter 2 (SGLT2) inhibitors and dipeptidyl peptidase-4 (DPP4) inhibitors on new-onset atrial fibrillation and stroke outcomes

2021 ◽  
Author(s):  
Sharen Lee ◽  
Jiandong Zhou ◽  
Carlin Chang ◽  
Tong Liu ◽  
Dong Chang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Propensity Score ◽  
Lower Risk ◽  
Sglt2 Inhibitors ◽  
All Cause Mortality ◽  
New Onset

AbstractBackgroundSGLT2I and DPP4I are medications prescribed for type 2 diabetes mellitus patients. However, there are few population-based studies comparing their effects on incident atrial fibrillation or ischemic stroke.MethodsThis was a territory-wide cohort study of type 2 diabetes mellitus patients prescribed SGLT2I or DPP4I between January 1st, 2015 to December 31st, 2019 in Hong Kong. Patients with both DPP4I and SGLT2I use and patients with drug discontinuation were excluded. Patients with prior AF or stroke were excluded for the respective analysis. 1:2 propensity-score matching was conducted for demographics, past comorbidities and medications using nearest-neighbor matching method. Cox models were used to identify significant predictors for new onset heart failure (HF) or myocardial infarction (MI), cardiovascular and all-cause mortality.ResultsThe AF-free cohort included 49108 patients (mean age: 66.48 years old [SD: 12.89], 55.32% males) and the stroke-free cohort included 49563 patients (27244 males [54.96%], mean baseline age: 66.7 years old [SD: 12.97, max: 104.6 years old]). After propensity score matching, SGLT2i use was associated with a lower risk of new onset AF (HR: 0.43[0.28, 0.66]), cardiovascular mortality (HR: 0.79[0.58, 1.09]) and all-cause mortality (HR: 0.69[0.60, 0.79]) in the AF-free cohort. It was also associated with a lower risk of new onset stroke (0.46[0.33, 0.64]), cardiovascular mortality (HR: 0.74[0.55, 1.00]) and all-cause mortality (HR: 0.64[0.56, 0.74]) in the stroke-free cohort.ConclusionsThe novelty of our work si that SGLT2 inhibitors are protective against atrial fibrillation and stroke development for the first time. These findings should be validated in other cohorts.

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