Asad, Zain Ul Abideen

Abstract Aims We aimed to perform a retrospective cohort study using the Centers for Disease Control and Prevention’s (CDC’s) Wide-Ranging Online Data for Epidemiologic Research (WONDER) database to analyse the trends in cardiovascular disease (CVD)–related mortality in patients with myeloproliferative neoplasms (MPNs) from 1999 to 2020. Methods and results We analysed the death certificate data from the CDC WONDER database from 1999 to 2020 for CVD with co-morbid myeloproliferative disorders in the US population. Age-adjusted mortality rates (AAMRs) and 95% confidence intervals (CIs) were computed per 1 million population by standardizing crude mortality rates to the 2000 US census population. To assess annual national mortality trends, we employed the Joinpoint regression model, calculating the annual per cent change in AAMR and corresponding 95% CIs. A total of 15 269 deaths related to CVD occurred in patients with co-morbid MPNs from 1999 to 2020. Overall, there was a decreasing trend in CVD-related AAMRs throughout these years. Males contributed to 51% of total deaths, and their AAMR was persistently higher than women throughout the study. Non-Hispanic (NH) Whites had the highest overall AAMR, followed by NH Blacks, NH American Indians or Alaska Natives, Hispanics or Latinos, and NH Asian or Pacific Islanders. Conclusion Our findings indicate a significant decline with notable gender, racial/ethnic, and regional differences in CVD-related mortality among patients with MPN over the past two decades. We emphasize the importance of a collaborative approach between oncologists and cardiologists in managing these patients, highlighting the potential benefits of integrating cardio-oncology services to enhance patient outcomes.

Background: Current clinical guidelines emphasize the significance of rhythm control with catheter ablation but lack guidance on the timing after diagnosing atrial fibrillation (AF). Purpose: We aim to investigate the latest evidence on the impact of diagnosis to ablation time (DAT) on AF recurrence, all-cause mortality, stroke, and heart failure (HF) after AF catheter ablation. Methods: We comprehensively searched PubMed, WOS, SCOPUS, EMBASE, and CENTRAL through February 2024. We conducted a pair-wise and prognostic systematic review and meta-analysis with a reconstructed time-to-event data meta-analysis. All analyses were performed using R V. 4.3.1. PROSPERO ID: CRD42024525542. Results: With the inclusion of 22 studies, our cohort comprised a total of 42,101 patients. Regarding pair-wise meta-analysis, shorter DAT was significantly associated with a decreased incidence of AF recurrence across paroxysmal and persistent AF subgroups. Moreover, DAT ≤ one year was significantly associated with a decreased incidence of all-cause mortality (RR: 0.73 with 95% CI [0.59, 0.92], P< 0.01) with a trend toward lowering the risk of stroke (RR: 0.80 with 95% CI [0.62, 1.03], P= 0.08). However, there was no significant difference between DAT ≤ one year and DAT > one year in HF. Regarding adjusted prognostic meta-analysis, longer DAT was significantly associated with an increased risk of AF recurrence (P < 0.01). Our reconstructed Kaplan Meier showed that DAT > one year was significantly associated with a 50% increase in the risk of AF recurrence compared to DAT ≤ one year (HR: 1.50 with 95% CI [1.42, 1.58], P< 0.00001) over 60 months follow-up. Conclusion: Our meta-analysis strongly underscores the critical importance of a short DAT in significantly reducing AF recurrence and all-cause mortality, with a trend toward lowering stroke risk, though no significant impact on HF was observed. Early ablation proves beneficial not only for patients with paroxysmal AF but also for those with persistent AF. These findings suggest that minimizing DAT can markedly improve AF outcomes, warranting further investigation to optimize treatment strategies.

Abstract Background Catheter Ablation (CA) is an effective treatment for atrial fibrillation (AF). However, frail elderly patients have been understudied due to their exclusion from landmark trials. Objectives Our study aims to evaluate outcomes in this population. Methods The national readmission database (2016–2020) was queried, and frailty categories were defined based on hospital risk frailty scores ≦5 as low while >5 as intermediate/high frailty (IHF). We used multivariate regression and propensity‐matched analysis to compare outcomes in patients undergoing CA for atrial fibrillation based on frailty index. Results Among 55 936 CAs for AF, 33,248 patients had low frailty, while 22 688 had intermediate/high frailty (IHF). After propensity matching (N 12 448), IHF patients were found to have higher adverse events, including mortality (3% vs. 0.3%, p < .001), stroke (1.9% vs. 0.2%, p < .001), acute heart failure (53.8% vs. 42.2%, p < .001), AKI (42.5% vs. 6.8%, p < .001), pericardial complications (2.8 vs. 1.6%, p < .001), respiratory complications (27.8 vs. 7.2%, p < .001), major adverse cardiovascular events (21.2 vs. 9.4%, p < .001) and net adverse events (76.7 vs. 55%, p < .001). IHF patients had higher readmissions at 30 (15.5 vs. 12.6%, p < .001), 90 (31.9 vs. 25.1%, p < .001), and 180‐day (41 vs. 34.7%, p < .001) intervals. A higher median length of stay (LOS) (7 vs. 3 days, p < .001) and cost ($44 287 vs. $27 517, p < .001) at index admission and subsequent readmissions were also observed ( p < .001). Conclusion Intermediate/high frailty patients undergoing catheter ablation had worse clinical outcomes, higher healthcare burden, and readmission rates. LOS has decreased in both groups from 2016 to 2020; however, total cost has increased.

AbstractIntroductionWe performed a cross‐sectional study using the Centers for Disease Control and Prevention's (CDC's) Wide‐Ranging Online Data for Epidemiologic Research (WONDER) database to analyze the trends in cardiac implantable electronic device (CIED) infection‐related mortality from 1999 to 2020.MethodsWe analyzed the death certificate data from the CDC WONDER database from 1999 to 2020 for CIED infections in the US population aged ≥25 years using International Classification of Diseases, Tenth Revision (ICD‐10) codes, listed as the underlying or contributing cause of death. Age‐adjusted mortality rates (AAMR) and 95% confidence intervals (CIs) were computed per 1 million population by standardizing crude mortality rates to the 2000 US census population. To assess annual mortality trends, we employed the Joinpoint regression model, calculating the annual percent change (APC) in AAMR and corresponding 95% CIs.ResultsOverall, there was an observed declining trend in AAMRs related to CIED infection‐related mortality. Males accounted for 55% of the total deaths, with persistently higher AAMRs compared to females over the study duration. Both males and females had an overall decreasing trend in AAMRs throughout the study duration. On race/ethnicity stratified analysis, non‐Hispanic (NH) Blacks exhibited the highest overall AAMR, followed by NH American Indians or Alaska Natives, NH Whites, Hispanic or Latinos, and NH Asian or Pacific Islanders. On a stratified analysis based on region, the South region had the highest overall AAMR, followed by the Midwest, West, and Northeast regions.ConclusionOur study demonstrates a significant decline in CIED infection‐related mortality in patients over the last two decades. Notable gender, racial/ethnic, and regional differences exist in the rates of mortality related to CIED infections.

Introduction: Incident cardiac arrhythmias are common in hospitalized COVID-19 patients, but the impact of a second incident cardiac arrhythmia during hospitalization on clinical outcomes remain unclear. Hypothesis: The aim of this study was to assess the frequency and prognostic implications of a second incident arrhythmia in hospitalized COVID-19 patients over the pandemic course till vaccine availability. Methods: The multicenter COVID-RHYTHM Registry enrolled hospitalized COVID-19 patients from 3/8/2020 to 1/24/2021. Cardiac arrhythmia included documented atrial fibrillation (AF), atrial flutter (AFL), ventricular tachycardia (VT), severe sinus bradycardia (<40 bpm) or AV block. Outcomes were compared between patients with single vs. more than one incident arrhythmias adjusting for baseline variables. Results: Of 6299 hospitalized COVID-19 patients, 4398 had an had an incident cardiac arrhythmia during hospitalization, of which 822 (19%) had a second incident arrhythmia. Those with >1 incident arrhythmia had a higher baseline prevalence of heart failure, chronic kidney disease, coronary artery disease and sleep apnea (Table). Those with >1 incident arrhythmia had higher in-hospital mortality, need for ICU admission and need for rehab upon discharge. Length of stay was similar between the groups. Conclusions: In hospitalized COVID-19 patients with incident cardiac arrhythmias, a second incident arrhythmia during hospitalization was seen in 19%. Having >1 incident arrhythmia was associated with increased need for ICU admission and reduced survival.

Introduction: There is a lack of data on the impact of sex on the outcomes of patients with heart failure (HF) undergoing atrial fibrillation (AF) ablation. Hypothesis: We hypothesized that outcomes of patients with HF undergoing AF ablation differ between males and females and tested this hypothesis using data from a nationally representative sample of the US population. Methods: The National Readmissions Database (NRD) was analyzed from 2016-2019 to identify patients ≥ 18 years old undergoing AF ablation. Patients were then divided into two cohorts based on their sex. A multivariable logistic regression model was used to adjust for confounders. Results: A total of 21,439 patients with HF underwent AF ablation between 2016-2019, of which 8,103 had heart failure with preserved ejection fraction (HFpEF) [64.8% were females], and 13,336 had heart failure with reduced ejection fraction (HFrEF) [38.4% were females]. Crude outcomes are shown in Figure 1. After multivariate adjustment, among patients with HFrEF, females had a longer length of stay (adjusted mean difference (aMD): 0.55 (0.16-0.93) days longer, p<0.01) along with lower odds of routine home discharge (adjusted odds ratio (aOR):0.62; 95% confidence interval (CI):0.55-0.70; p<0.01). Females had similar odds of in-hospital mortality, procedural complications, and 30-day/ 180-day all-cause, heart failure, and arrhythmia-related readmissions as compared to males. Among patients with HFpEF, females had higher odds of 30-day (aOR: 1.91; 95% CI: 1.24-2.93; p<0.01) and 180-day heart failure readmissions (aOR: 1.53; 95% CI: 1.04-2.28; p=0.03) along with lower odds of routine home discharge (aOR:0.67; 95% CI: 0.57-0.78; p<0.01), as compared to males. Conclusion: In conclusion, our results show that females with HFrEF undergoing AF ablation have similar odds of in-hospital/30-day/180-day outcomes whereas females with HFpEF have higher odds of 30-day/180-day HF readmissions, as compared to males.

Introduction: There is a lack of data on procedural safety and outcomes in patients with rheumatic mitral valve disease (RMVD) undergoing atrial fibrillation (AF) ablation. Hypothesis: We hypothesized that the presence of RMVD may affect the outcomes of patients undergoing AF ablation and tested this hypothesis using data from a large, nationally representative sample of the US population. Methods: The National Readmissions Database (NRD) was analyzed from 2016-2019 to identify patients ≥ 18 years old undergoing AF ablation. Patients with RMVD were then identified by using ICD-10 CM codes. A multivariable logistic regression model was used to adjust for confounders. Results: Our cohort included 50,728 weighted AF ablation procedures, of which 3,500 (6.9%) patients had RMVD. Patients with RMVD were older at the time of catheter ablation, with a significantly higher percentage of females, less likely to have paroxysmal AF, and had a higher burden of comorbidities including congestive heart failure, renal failure, and hypertension. On multivariable analysis, the presence of RMVD was associated with higher odds of cardiovascular complications (adjusted odds ratio [aOR] 1.28; 95% confidence interval [CI]: 1.12-1.47; p<0.01) with no difference in the odds of in-hospital mortality or other periprocedural outcomes. Also, RMVD was associated with longer length of stay (adjusted mean difference: +1.06; 95% CI: +0.67 - +1.45; p<0.01) days and lower odds of routine home discharge (aOR:0.77; 95% CI: 0.69-0.87; p<0.01). There was no difference in the odds of 30-day or 180-day all-cause, AF-related, or atrial flutter-related readmissions in patients with RMVD vs. no RMVD (Figure 1). Conclusion: In conclusion, patients with RMVD undergoing AF ablation have higher odds of periprocedural cardiovascular complications with similar odds of 30-day and 180-day all-cause and AF-related readmissions

Introduction: There is limited data on how psychosocial risk factors (PSRFs) affect the outcomes of patients undergoing atrial fibrillation (AF) ablation. Hypothesis: We hypothesized that the presence of PSRFs affects the outcomes of AF ablation and tested this hypothesis using a nationally representative sample of the US population. Methods: The National Readmissions Database (NRD) was analyzed from 2016-2019 to identify patients ≥ 18 years old undergoing AF ablation. Patients were divided into two cohorts based on the presence or absence of ≥1 PSRF. PSRFs were divided into 5 domains including limited cognitive understanding, substance use, psychiatric disease, low socioeconomic status, and uninsured status. A multivariable logistic regression model was utilized to adjust for confounders. Results: Our cohort included 50,623 AF ablation procedures, of which 21,363 (42.2%) had ≥ 1 PSRF. On multivariable analysis, the presence of ≥ 1 PSRF was associated with higher odds of cardiovascular complications (adjusted odds ratio [aOR] 1.11; 95% confidence interval [CI]: 1.02-1.22; p=0.02), peripheral vascular complications (aOR:1.18; 95% CI: 1.01-1.38; p=0.04), pulmonary complications (aOR:1.16; 95% CI: 1.05-1.29; p<0.01) and neurological complications (aOR:1.42; 95% CI: 1.12-1.78; p<0.01), along with higher odds of 30-day all-cause readmissions (aOR:1.30; 95% CI: 1.19-1.43; p<0.01) and atrial fibrillation/flutter related readmissions (aOR:1.27; 95% CI: 1.08-1.50; p<0.01), 90-day all-cause readmissions (aOR:1.30; 95% CI: 1.20-1.40; p<0.01) and atrial fibrillation/flutter related readmissions (aOR:1.22; 95% CI: 1.06-1.41; p<0.01), and 180-day all-cause readmissions (aOR:1.35; 95% CI: 1.24-1.45; p<0.01) (Figure 1). Conclusion: In conclusion, our data suggest an association between PSRFs and worse in-hospital outcomes along with increased all-cause and arrhythmia-related readmissions in patients undergoing AF ablation.

Abstract Background Obesity is associated with an increased risk of developing recurrent atrial fibrillation (AF) after catheter ablation (CA). However, the current data on weight loss interventions show inconsistent results in preventing the recurrence of AF after CA. Methods We conducted a systematic search in MEDLINE and EMBASE to identify studies that reported the outcome of recurrence of AF after CA in obese patients undergoing weight interventions. The subgroup analysis included: (1) Weight loss versus no weight loss, (2) >10% weight loss versus <10% weight loss, (3) <10% weight loss versus no weight loss, (4) Follow‐up <12 months, and (5) Follow‐up >12 months after CA. Mantel–Haenszel risk ratios with a 95% confidence interval (CI) were calculated using a random effects model and for heterogeneity, I 2 statistics were reported. Results A total of 10 studies (one randomized controlled trial and nine observational studies) comprising 1851 patients were included. The recurrence of AF was numerically reduced in the weight loss group (34.5%) versus no weight loss group (58.2%), but no statistically significant difference was observed (risk ratio [RR] = 0.76; 95% CI: 0.49–1.18, p = .22). However, there was a statistically significant reduction in recurrence of AF with weight loss versus no weight loss at follow‐up >12 months after CA (RR = 0.47; 95% CI: 0.32–0.68, p < .0001). At follow‐up >12 months after CA, both >10% weight loss versus <10% weight loss (RR = 0.49; 95% CI: 0.31–0.80, p = .004) and <10% weight loss versus no weight loss (RR = 0.39; 95% CI: 0.31–0.49, p < .00001) were associated with a statistically significant reduction in recurrent AF. Conclusion In patients with AF undergoing CA, weight loss is associated with reducing recurrent AF at > 12 months after ablation and these benefits are consistently seen with both >10% and <10% weight loss. The benefits of weight loss in preventing recurrent AF after CA should be examined in larger studies with extended follow‐up duration.