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  • Ovid Technologies (Wolters Kluwer Health)  (4)
  • Iguchi, Moritake  (4)
  • Ikeda, Syuhei  (4)
  • Wada, Hiromichi  (4)
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  • Ovid Technologies (Wolters Kluwer Health)  (4)
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  • 1
    Online Resource
    Online Resource
    Abstract 10705: Association Between Clinical Outcomes and Bleeding Risk Factors in Very Elderly Patients with Atrial Fibrillation at High Bleeding Risk: The Fushimi Af Registry
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Circulation Vol. 144, No. Suppl_1 ( 2021-11-16)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. Suppl_1 ( 2021-11-16)
    Abstract: Background: The ELDERCARE-AF trial demonstrated that low-dose edoxaban (15 mg once-daily) prevented stroke or systemic embolism (SE) in very elderly Japanese patients with nonvalvular atrial fibrillation (NVAF) who were inappropriate for standard oral anticoagulant therapy due to high bleeding risk. The association between clinical outcomes and bleeding risks in such patients in routine clinical practice are unclear. Methods: From the Fushimi AF registry, we obtained ELDERCARE-eligible patients with NVAF who aged ≥80 years, had CHADS 2 score ≥2, and had one or more bleeding risks as shown in the ELDERCARE-AF trial: low creatinine clearance (15 to 30 ml/min), a history of bleeding from a critical organ, low body weight (≤45 kg), or regular use of antiplatelet drugs. The association of the four bleeding risk factors with the outcomes was evaluated in eligible patients. Results: We obtained 549 ELDERCARE-eligible patients (12.8% of entire cohort, 52.8% of ≥80 years and CHADS 2 score ≥2). The median follow-up period was 1,823 (interquartile range: 809-2,900) days. The incidences (% per patient-year) of stroke/SE, major bleeding, all-cause mortality, and cardiovascular death were significantly higher in eligible patients than in non-eligible patients (stroke/SE: 4.6% vs. 2.0%, major bleeding: 3.5% vs. 1.8%, all-cause mortality: 15.5% vs. 3.9%, cardiovascular death: 2.9% vs. 0.6%, all log-rank P 〈 0.001). Among the four bleeding risk factors, low body weight and low creatinine clearance were significantly associated with the incidence of all-cause mortality (adjusted hazard ratio [95% confidence interval], low body weight: 1.56 [1.16-2.10] , P=0.003, low creatinine clearance: 1.70 [1.23-2.25], P 〈 0.001). Low creatinine clearance was also significantly associated with the incidence of cardiovascular death (2.55 [1.35-4.81], P=0.004). However, none of the four bleeding risk factors had associations with the incidences of stroke/SE or major bleeding after multivariate adjustment. Conclusion: Patients with NVAF who met the inclusion criteria of the ELDERCARE-AF trial had poor clinical outcomes, and low creatinine clearance was associated with the incidences of both all-cause and cardiovascular mortality.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.144.suppl_1.10705
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 1466401-X
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  • 2
    Online Resource
    Online Resource
    Abstract 14344: Prognostic Factors of Atrial Fibrillation Patients With Coronary Artery Disease: The Fushimi Af Registry
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Circulation Vol. 142, No. Suppl_3 ( 2020-11-17)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 142, No. Suppl_3 ( 2020-11-17)
    Abstract: Background: Atrial fibrillation (AF) patients are likely to have concomitant coronary artery disease (CAD). A new strategy of antithrombotic therapy in AF patients with stable CAD was demonstrated in recent randomized clinical trials. Now that antithrombotic therapy for AF patients with CAD has reached a major turning point, it is important to know the prognostic factors in those patients. Purpose: In this study, we investigated clinical characteristics, cardiovascular events and prognostic factors in AF patients with CAD. Methods: The Fushimi AF Registry, a community-based prospective survey, was designed to enroll all of the AF patients who visited the participating medical institutions in Fushimi-ku, Kyoto, Japan. Follow up data including prescription status were available in 4,441 patients from March 2011 to November 2019. Of 4,441 patients, 645 patients had a history of CAD at enrollment. Results: The mean age was 76.4±8.6 and 65.9% were male. Averages of CHA 2 DS 2 -VASc score and HAS-BLED score were 4.41 and 2.35, respectively. Oral anticoagulant (OAC) was prescribed in 52.9% of those patients and antiplatelet drug (APD) was prescribed in 70.4%. The combination of OAC and APD was prescribed in 36.0%. During follow-up period (median 1,495 days), cardiac death occurred in 51 patients, composite of cardiac death, myocardial infarction (MI) and stroke in 136, and major bleeding in 77 (1.8, 5.1 and 2.9 per 100 person-years, respectively). In multivariate analysis, factors associated with composite of cardiac death, MI and stroke in AF patients with CAD were low body weight ( 〈 =50kg) (hazard ratio [95% confidence interval]; 1.62 [1.07-2.47] ), previous stroke (1.69 [1.13-2.52]), heart failure (1.47 [1.02-2.11] ), hypertension (0.60 [0.41-0.87]) and diabetes mellitus (1.62 [1.13-2.32] ). Furthermore, factors associated with major bleeding in AF patients with CAD were anemia (male: hemoglobin 〈 12 g/dl, female: hemoglobin 〈 11 g/dl) (1.82 [1.09-3.04]) and thrombocytopenia ( 〈 150,000 /μL) (3.02 [1.29-7.03]). Conclusion: In Japanese AF patients with CAD, low body weight, previous stroke, heart failure, hypertension and diabetes mellitus were associated with cardiovascular events, and anemia and thrombocytopenia were associated with major bleeding.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.142.suppl_3.14344
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 1466401-X
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  • 3
    Online Resource
    Online Resource
    Progression From Paroxysmal to Sustained Atrial Fibrillation Is Associated With Increased Adverse Events
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Stroke Vol. 49, No. 10 ( 2018-10), p. 2301-2308
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 49, No. 10 ( 2018-10), p. 2301-2308
    Abstract: Atrial fibrillation (AF) is a common arrhythmic disorder among the elderly and sometimes progresses from paroxysmal to sustained (persistent or permanent) types. Clinical outcomes of patients with progression of AF were unknown. This study assessed the characteristics of patients with AF progression and the impact of AF progression on various clinical events. Methods— The Fushimi AF Registry is a community-based prospective survey of the patients with AF in Fushimi-ku, Kyoto. Analyses were performed on 4045 patients, which included 1974 paroxysmal AF (PAF; 48.8%) and 2071 sustained (persistent or permanent) AF (SAF; 51.2%) at baseline. Results— During the median follow-up period of 1105 days, progression of AF occurred in 252 patients with PAF (4.22 per 100 person-years). Multivariate Cox regression analysis demonstrated that progression of AF was significantly associated with an increased risk of ischemic stroke or systemic embolism (adjusted hazard ratio [HR], 4.10; 95% CI, 1.95–8.24; P 〈 0.001 [versus PAF without progression]; adjusted HR, 2.20; 95% CI, 1.11–4.00; P =0.025 [versus SAF]) during progression period from paroxysmal to sustained forms. The risk after the progression was equivalent to SAF (adjusted HR, 1.54; 95% CI, 0.78–2.75; P =0.201 [versus SAF]). AF progression was significantly associated with a higher risk of hospitalization for heart failure (adjusted HR, 2.70; 95% CI, 1.55–4.52; P 〈 0.001 [versus PAF without progression]; adjusted HR, 1.81; 95% CI, 1.08–2.88; P =0.026 [versus SAF]). Conclusions— Progression of AF was associated with increased risk of clinical adverse events during arrhythmia progression period from PAF to SAF among Japanese patients with AF. The risk of adverse events was transiently elevated during progression period from PAF to SAF and declined to the level equivalent to SAF after the progression. Clinical Trial Registration— URL: http://www.umin.ac.jp/ctr/ . Unique identifier: UMIN000005834.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.118.021396
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 1467823-8
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  • 4
    Online Resource
    Online Resource
    Abstract 10446: Prognostic Significance of Left Ventricular Ejection Fraction in Atrial Fibrillation Patients Without Pre-Existing Heart Failure
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Introduction: Atrial fibrillation (AF) increases the risk of heart failure (HF). However, little focus has been placed on the prevention of HF in patients with AF. Hypothesis: Left ventricular ejection fraction (LVEF) is an established echocardiographic parameters in patients with HF. We hypothesized that LVEF is a useful predictor for incident HF in AF patients even without HF. Methods: The Fushimi AF Registry is a community-based prospective survey of AF patients in Fushimi-ku, Kyoto, Japan. After excluding patients without pre-existing HF (defined as having one of the following; prior HF hospitalization, New York Heart Association class ≥2, or LVEF 〈 40%), we investigated 2,459 patients with the data of LVEF at enrollment. We divided the patients into 3 groups stratified by LVEF (mildly reduced LVEF [40-49%], below normal LVEF [50-59%] , and normal LVEF [≥60%]), and compared the backgrounds and incidence of HF hospitalization between the groups. Results: Of 2,459 patients (mean age: 72.4±10.5 years, female: 917 [37%], paroxysmal AF: 1,405 [57%] , and mean CHA 2 DS 2 -VASc score: 3.0±1.6), the mean LVEF was 66±8% (mildly reduced LVEF: 114 [5%], below normal LVEF: 300 [12%] and normal LVEF: 2,045 [83%], respectively). Patients with lower LVEF demonstrated lower prevalence of female and paroxysmal AF (both P 〈 0.01). During the median follow-up period of 6.0 years, 255 patients (10%) were hospitalized for HF (annual incidence: 1.9% per person-year). Kaplan-Meier curves revealed that LVEF at enrollment could stratify the incidence of HF hospitalization in AF patients without pre-existing HF ( Figure ). Multivariable Cox regression analysis demonstrated that lower LVEF strata were independently associated with the risk of HF after adjustment by age, sex, AF type and CHA 2 DS 2 -VASc score ( Figure ). Conclusion: LVEF at enrollment could stratify the incidence of HF hospitalization in patients with AF, suggesting the importance of measuring LVEF in all AF patients even without HF.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.10446
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1466401-X
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