Background: Differences in the impact of comorbid conditions on outcomes in atrial fibrillation (AF) patients compared to population controls have not been well documented. Methods: The prevalence of 19 chronic conditions and smoking status was obtained in 1430 patients with incident AF from 2000-2010 and 1430 controls matched 1:1 on sex and age (within 5 years) from Olmsted County, MN. Andersen-Gill models determined associations of each condition with all-cause hospitalizations in AF cases and controls after adjusting for all other conditions and accounting for the matching. Cox regression determined associations of each condition with death. Results: Among 1430 matched pairs (median age 76 years, 48.6% men), the prevalence of chronic conditions was higher in AF cases compared to controls for all conditions except asthma, dementia, depression, hepatitis, and osteoporosis. Over a mean follow-up of 6.3 years, 2678 hospitalizations and 812 deaths occurred. The rates of hospitalization were 59 and 26 per 100 person-years and the rates of death were 10 and 5 per 100 person-years in AF cases and controls, respectively. After adjusting for all other conditions, the risk of hospitalization was lower in AF patients compared to controls for those with coronary artery disease, arthritis, cancer, chronic obstructive pulmonary disease, and osteoporosis (figure). In contrast, the risk of hospitalization was higher in AF cases for those with diabetes and substance abuse. For deaths, the only comorbidity with different associations between AF cases and controls was depression. The hazard ratios (95% CI) for death were 2.02 (1.26-3.24) in AF cases and 0.90 (0.58-1.38) in controls (p-value for interaction=0.008). Conclusions: AF patients have a higher prevalence of chronic conditions compared to population controls. The associations of comorbidities with hospitalizations differed between AF cases and controls, suggesting that management of comorbidities in patients with AF may need to be tailored to this specific patient population.
The potential role of atrial natriuretic factor (ANF) in blood pressure (BP) drops during hemodialysis (HD) has been examined in 30 patients with end-stage chronic renal failure. Echocardiographic measurements and evaluation of cardiac parasympathetic function were performed prior to HD sessions, simultaneously with hormonal determinations. The plasma ANF level was correlated with the peak value of the E wave and the Doppler index of the left ventricular preload and was more elevated in ‘denervated’ than in intact patients. During the HD sessions, the BP fell in 18 patients (group 1) and remained stable in 12 others (group 2), despite similar weight losses. Both groups differed by the basal values of plasma ANF, greater in group 1 than in group 2 (100.0 ± 13.3 vs. 65.7 ± 3.4 fmol/ml; p < 0.05). The magnitude of plasma ANF decrease was identical in both groups despite the BP decrease in group 1 at the end of the session. These results suggest that the ANF release depends not only on hemodynamics but also on cardiac innervation in dialyzed patients and that high plasma ANF levels are implied in the BP drops during HD session.
Background Heart block in the young is uncommon and sometimes the etiology is not found. Several inflammatory rheumatic diseases can cause conduction disturbances. Some of them are well described, such as in patients with ankylosing spondylitis, but others are controversial. Ro autoantibodies have been traditionally associated with the development of neonatal lupus and congenital heart block. Recent research has demonstrated their physiopathological implication. Some investigators have tried to demonstrate the relationship between these autoantibodies and electrocardiographic abnormalities in adult patients with controversial results. Objectives To determine whether atrioventricular block (AVB) of unknown cause in young patients may be associated with an inflammatory rheumatism. Methods Retrospective observational study (1973-2011) at a university hospital with a referral area of 800000 inhabitants. The medical records of patients with pacemakers were reviewed from cardiology’s database: a total of 3359 patients. Patients under fifties with a heart block of unknown cause were selected: 24 patients. One was dead at the time of the study, and 3 refused to participate. The 20 remaining patients underwent an immunological study with antinuclear antibodies (AAN in HEp2 substrate) and extractable nuclear antigens (ENA) by immunoassay and immunoblot. A clinical interview was performed by a rheumatologist looking for signs and symptoms of inflammatory rheumatism. Results Twenty patients were included: 7 men (35%) and 13 women (65%). Mean age when they were reviewed was: 51 years ± 12 years (range: 28-70). Mean age at the time of pacemaker implantation was 37.5 ± 10 years (range: 17-49). The implantation causes were: complete AVB 14 patients (70%), advanced AVB 3 (15%), Wenckebach type 1 AVB (5%) and unknown AVB in 2 cases. Two patients had family history of autoimmune diseases: 1 rheumatoid arthritis and 1 autoimmune thyroiditis. A positive Ro52 patient without connective tissue disease and a Ro 60 positive patient diagnosed with systemic lupus erythematous were found; no other autoantibody was present. Another patient was diagnosed of ankylosing spondylitis (HLA B27 positive). The diagnosis of systemic lupus erythematous and ankylosing spondylitis were previous to the heart block. No signs or symptoms of inflammatory rheumatism were found in the other patients. The Schirmer test was abnormal in 5 (20%) patients. The 2 patients with systemic lupus erythematous and ankylosing spondylitis had sicca syndrome secondary to their underlying diseases. Conclusions Fifteen percent of patients had features of inflammatory rheumatic diseases: in 2 cases heart block occurred in a patient diagnosed with systemic lupus erythematous and another with ankylosing spondylitis. A third case with positive Ro52 antibodies was detected in a woman without connective tissue disease. Family history of autoimmune diseases was found in 2 patients. Anti Ro antibodies might be related to heart block in the young. It is recommended to purpose a cl...
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