Ischemic stroke associated with AF was nearly twice as likely to be fatal as non-AF stroke. Recurrence was more frequent, and functional deficits were more likely to be severe among survivors. Since stroke is usually the initial manifestation of embolism in AF, prevention is critical to reducing disability and mortality.

ObjectiveTo determine AF prevalence and gaps in atrial fibrillation (AF) awareness and management in China.MethodsWe conducted a community-based survey of 47 841 adults (age ≥45 years) in seven geographic regions of China between 2014 and 2016. Participants underwent a structured questionnaire, a standard 12-lead ECG, physical examination and blood sampling. AF prevalence, defined by either ECG detection or self-report, was estimated according to sampling weights, non-response and age and sex distribution of the population. We used multivariable logistic regression to estimate associations among sociodemographic, clinical and geographic factors with the AF prevalence, awareness and treatment.ResultsThe weighted AF prevalence was 1.8% (95% CI 1.7% to 1.9%), but varied from 0.9% to 2.4% across geographical regions and equates to being present in an estimated 7.9 (95% CI 7.4 to 8.4) million people in China. Among men and women, the AF prevalence increased from 0.8% and 0.6% in the age group 45–54 years to 5.4% and 4.9% in the age group ≥75 years, respectively. Proportions of people who were aware of having AF decreased overall from 65.3% in 45–54 year-olds to 53.9% in ≥75 year-olds and varied between sex (men 58.5%, women 68.8%) and residency status (urban 78.3%, rural 35.3%). Only 6.0% of patients with high-risk AF received anticoagulation therapy.ConclusionsAF prevalence is higher than previously reported in China, with low awareness and large treatment gaps. Large-scale efforts are urgently needed to reduce AF adverse consequences.

Ninety-two percent (24/26) of subjects presenting with newly discovered AF at the time of acute stroke continued to have this rhythm disturbance in a chronic or paroxysmal form. In only 2 subjects (8%) was the arrhythmia short-lived and nonrecurrent. These follow-up data suggest that in most instances AF was probably the precipitant rather than the consequence of stroke.

Background Sympathetic nerve activity is important to cardiac arrhythmogenesis. Objectives (1) To develop a method for simultaneous noninvasive recording of skin sympathetic nerve activity (SKNA) and electrocardiogram (ECG) using conventional ECG electrodes. (2) This method (neuECG) can be used to adequately estimate the sympathetic tone. Methods We recorded neuECG signals from the skin in 56 human subjects. The signals were low pass filtered to show the ECG and high pass filtered to show nerve activity. Protocol (P)-1 included 12 healthy volunteers who underwent cold water pressor test (CPT) and Valsalva maneuver. P-2 included 19 inpatients with epilepsy but without known heart diseases monitored for 24 hours. P-3 included 22 patients admitted with electrical storm and monitored for 39.0±28.2 hours. P-4 included 3 patients who underwent bilateral stellate ganglion blockade with lidocaine injection. Results In patients without heart diseases, spontaneous nerve discharges were frequently observed at baseline and were associated with heart rate acceleration. The SKNA recorded from chest leads (V1–V6) during CPT and Valsalva maneuver (P-1) was invariably higher than during baseline and recovery periods (p<0.001). In P-2, the average SKNA correlated with the heart rate acceleration (r=0.73±0.14, p<0.05) and shortening of the QT interval (p<0.001). Among 146 spontaneous ventricular tachycardia episodes recorded in 9 patients of P-3, 106 episodes (73%) were preceded by SKNA within 30 s of onset. P4 showed that bilateral stellate ganglia blockade by lidocaine inhibited SKNA. Conclusions SKNA is detectable using conventional ECG electrodes in humans and may be useful in estimating the sympathetic tone.

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Stroke survivors have high likelihood of readmission within 1 year following discharge, with infections and recurrent vascular events being the most common reasons. Identification of high-risk subgroups might foster preventive interventions.

ObjectivesThe evolution of multimorbidity describes the continuum from a healthy status to the development of a single disease and further progression to multimorbidity with additional diseases. We investigated the evolution of cardiometabolic multimorbidity and risk for mortality in a Chinese population.DesignLongitudinal cohort study using data from the CHinese Electronic health Records Research in Yinzhou (CHERRY) study, with 5.43 million person–years follow-up (median 5.16 years).ParticipantsData for 1 038 704 adults (total 22 750 deaths) were analysed.ExposureCardiometabolic multimorbidity was defined as ever being diagnosed with two or more of three diseases: hypertension, diabetes and cardiovascular disease (CVD).Primary and secondary outcome measuresAge-adjusted and sex-adjusted HRs were calculated for all-cause mortality.ResultsThe cardiometabolic disease status of 105 209 (10.1%) individuals changed during the follow-up. The prevalence of cardiometabolic multimorbidity increased from 2.41% (95% CI: 2.38% to 2.44%) to 5.94% (95% CI: 5.90% to 5.99%). Baseline multimorbidity status showed the HR (95% CI) was 1.37 (1.33 to 1.42) in those with one disease, 1.71 (1.64 to 1.79) in those with two diseases and 2.22 (2.00 to 2.46) in those with three diseases. The highest HRs were observed for CVD only (3.31, 95% CI: 3.05 to 3.59) or diabetes and CVD (3.12, 95% CI: 2.37 to 4.11). Those with hypertension only had the lowest HR (1.26, 95% CI: 1.22 to 1.30). Longitudinal data showed the HRs (95% CI) in patients with one, two and three diseases were 1.36 (1.32 to 1.41), 2.03 (1.96 to 2.10) and 2.16 (2.05 to 2.29), respectively.ConclusionsThe prevalence of cardiometabolic multimorbidity in a general Chinese population increased more than doubled over 5 years, indicating rapid evolution of cardiometabolic multimorbidity. A history of CVD dominates the risk for mortality. A complementary strategy for primary and secondary prevention of cardiometabolic diseases is needed in China.

IntroductionData based on electronic health records (EHRs) are rich with individual-level longitudinal measurement information and are becoming an increasingly common data source for clinical risk prediction worldwide. However, few EHR-based cohort studies are available in China. Harnessing EHRs for research requires a full understanding of data linkages, management, and data quality in large data sets, which presents unique analytical opportunities and challenges. The purpose of this study is to provide a framework to establish a uniquely integrated EHR database in China for scientific research.Methods and analysisThe CHinese Electronic health Records Research in Yinzhou (CHERRY) Study will extract individual participant data within the regional health information system of an eastern coastal area of China to establish a longitudinal population-based ambispective cohort study for cardiovascular care and outcomes research. A total of 1 053 565 Chinese adults aged over 18 years were registered in the health information system in 2009, and there were 23 394 deaths from 1 January 2009 to 31 December 2015. The study will include information from multiple epidemiological surveys; EHRs for chronic disease management; and health administrative, clinical, laboratory, drug and electronic medical record (EMR) databases. Follow-up of fatal and non-fatal clinical events is achieved through records linkage to the regional system of disease surveillance, chronic disease management and EMRs (based on diagnostic codes from the International Classification of Diseases, tenth revision). The CHERRY Study will provide a unique platform and serve as a valuable big data resource for cardiovascular risk prediction and population management, for primary and secondary prevention of cardiovascular events in China.Ethics and disseminationThe CHERRY Study was approved by the Peking University Institutional Review Board (IRB00001052-16011) in April 2016. Results of the study will be disseminated through published journal articles, conferences and seminar presentations, and on the study website (http://www.cherry-study.org).