Body mass index and the risk of all-cause mortality among patients with nonvalvular atrial fibrillation: a multicenter prospective observational study in China

Wan, Huaibin; Wu, Sinan; Wang, J; Yang, Yanmin; Zhu, Jun; Shao, Xing‐hui; Huang, Bi; Zhang, H

doi:10.1038/ejcn.2016.183

Cited by 12 publications

(7 citation statements)

References 35 publications

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“…Moreover, previous meta‐analyses only compared high and low effect sizes using the semiparametric method, and an exposure‐effect association between increasing BMI and AF prognosis has not yet been investigated. Furthermore, because several new high‐quality studies have been published, we conducted an up‐to‐date meta‐analysis of BMI and AF outcomes using only prospective studies to further investigate the exposure‐effect relationship.…”

Section: Introductionmentioning

confidence: 99%

The obesity paradox for outcomes in atrial fibrillation: Evidence from an exposure‐effect analysis of prospective studies

et al. 2019

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The impact of obesity on the prognosis of atrial fibrillation (AF) remains controversial. We conducted an exposure-effect meta-analysis of prospective studies to clarify the relationship between body mass index (BMI) and outcomes in patients with AF. The Cochrane Library, PubMed, and Embase databases were searched through May 1, 2019. Summary relative risks (RRs) were calculated using random-effects models. Nonlinear associations were explored using restricted cubic spline models. Twenty publications involving 161,922 individuals were included. Categorical variable analysis showed that underweight was associated with an increased risk of all-cause mortality (RR: 2.6), cardiovascular death (RR: 2.91), major bleeding (RR: 1.57), stroke or systemic embolism (RR: 1.62), and a composite endpoint (RR: 2.23). In exposure-effect analysis, the risk per 5 BMI increase was reduced for adverse outcomes (RR=0.86, 95% CI: 0.80-0.92 for all-cause death; RR=0.82, 95% CI: 0.71-0.95 for cardiovascular death; RR=0.89, 95% CI: 0.84-0.95 for stroke or systemic embolism; and RR=0.78, 95% CI: 0.67-0.92 for a composite endpoint).There was a significant "U"-shaped exposure-effect relationship with all-cause death, and the nadir of the curve was observed at a BMI of approximately 28.Our results showed that underweight is associated with a worse prognosis, but that overweight and obesity are associated with improved adverse outcomes in patients with AF. KEYWORDSatrial fibrillation, body mass index, meta-analysis, obesity paradox

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Section: Introductionmentioning

confidence: 99%

The obesity paradox for outcomes in atrial fibrillation: Evidence from an exposure‐effect analysis of prospective studies

et al. 2019

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“…First, we did not assess the stroke risk factors. Some patient lacked the well documented past histories such as the atrial fibrillation [ 28 ] or comorbid diabetes mellitus, [ 29 ] especially the spontaneous ICH patients. Second, this retrograde review did not include the economic burden analyses in ICS between these 2 stroke group, nor the daily cost, the 3rd-party or out-of-pocket cost.…”

Section: Discussionmentioning

confidence: 99%

Different utilization of intensive care services (ICSs) for patients dying of hemorrhagic and ischemic stroke, a hospital-based survey

et al. 2018

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The intensive care service (ICS) saves lives and rescues the neurological function of stroke patients. We wondered the different utilization of ICS for patients with ischemic and hemorrhagic stroke, especially those who died within 30 days after stroke.Sixty-seven patients died during 2011 to 2015 due to acute stroke (42 due to intracranial hemorrhage [ICH]; 25 due to cerebral infarct [CI]). The durations of hospital stay (hospital staying days [HSDs]) and ICS staying days (ISDs) and codes of the do-not-resuscitate (DNR) were surveyed among these medical records. Statistics included chi-square and descriptive analyses.In this study, CI patients had a longer HSD (mean 14.3 days), as compared with ICH patients (mean 8.3 days); however, the ICH patients had a higher percentage of early entry within the first 24 hours of admission into ICS than CI group (95.1% vs 60.0%, P = .003). A higher rate of CI patients died in holidays or weekends than those with ICH (44.0% vs 21.4%, P = .051). DNR, requested mainly from direct descendants (children or grandchildren), was coded in all 25 CI patients (100.0%) and 38 ICH patients (90.5%). More cases with early DNR coded within 24 hours after admission occurred in ICH group (47%, 12% in CI patients, P = .003). None of the stroke patient had living wills. Withhold of endotracheal intubation (ETI) occurred among CI patients, more than for ICH patients (76.0% vs 18.4%, P < .005).In conclusion, CI patients longer HSD, ISD, higher mortality within holidays or weekends, and higher ETI withhold; but less percentage of ICS utilization expressed by a lower ISD/HSD ratio. This ICS utilization is a key issue of medical quality for stroke care.

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“…1 Nos últimos anos, com o envelhecimento da população na China, a incidência dessa doença aumentou. 2 Portanto, essa doença representa uma séria ameaça à vida e à saúde das pessoas. Quando a FA ocorre, o átrio cardíaco não pode se contrair regularmente e efetivamente e o fluxo sanguíneo diminui, o que aumenta muito o risco de trombose atrial esquerda/ trombose de apêndice atrial esquerdo, 3 e a trombose atrial esquerda/trombose de apêndice atrial esquerdo aumenta ainda mais o risco de episódios de tromboembolismo.…”

Section: Introductionunclassified

Valor do Diâmetro do Átrio Esquerdo com Escore CHA2DS2-Vasc na Predição da Trombose Atrial Esquerda/Trombose de Apêndice Atrial Esquerdo na Fibrilação Atrial Não Valvar

Zhang

Yang

2021

Arquivos Brasileiros De Cardiologia

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Fundamentos: A fibrilação atrial é a arritmia persistente mais comum e é o principal fator que leva ao tromboembolismo. Objetivo: Investigar o valor do diâmetro do átrio esquerdo combinado com o escore CHA2DS2-VASc na predição da trombose atrial esquerda/trombose de apêndice atrial esquerdo na fibrilação atrial não valvar. Métodos: Trata-se de estudo retrospectivo. 238 pacientes com fibrilação atrial não valvar foram selecionados e divididos em dois grupos: trombose e não trombose. Determinou-se o escore CHA2DS2-VASc. Valores de p<0,05 foram considerados estatisticamente significativos. Resultados: A análise de regressão logística multivariada revelou que histórico de acidente vascular cerebral/ataque isquêmico transitório, doença vascular, escore CHA2DS2-VASc, DAE, DDFVE e FEVE foram fatores de risco independentes para trombose atrial esquerda/trombose de apêndice atrial esquerdo (p<0,05). A análise da curva ROC (Receiver Operating Characteristic) revelou que a área sob a curva para o escore CHA2DS2-VASc na predição de trombose atrial esquerda/trombose de apêndice atrial esquerdo foi de 0,593 quando o escore CHA2DS2-VASc foi ≥3 pontos, e a sensibilidade e especificidade foram 86,5% e 32,6%, respectivamente, enquanto a área sob a curva para o DAE na predição de trombose atrial esquerda/trombose de apêndice atrial esquerdo foi 0,786 quando o DAE foi ≥44,17 mm, e a sensibilidade e especificidade foram 89,6% e 60,9%, respectivamente. Entre os diferentes grupos CHA2DS2-VASc, a taxa de incidência de trombose atrial esquerda/trombose de apêndice atrial esquerdo em pacientes com DAE ≥44,17 mm foi maior do que em pacientes com DAE <44,17 mm (p <0,05). Conclusão: O escore CHA2DS2-VASc e o DAE estão correlacionados com a trombose atrial esquerda/trombose de apêndice atrial esquerdo na fibrilação atrial não valvar. Para pacientes com escore CHA2DS2-VASc de 0 ou 1, quando o DAE é ≥44,17 mm, o risco de trombose atrial esquerda/trombose de apêndice atrial esquerdo permaneceu alto.

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Body mass index and the risk of all-cause mortality among patients with nonvalvular atrial fibrillation: a multicenter prospective observational study in China

Abstract: A paradoxical BMI-all-cause mortality risk association was observed in Chinese patients with NVAF, and this association was pronounced among patients at high stroke risk rather than in those at low stroke risk.

Cited by 12 publications

References 35 publications

The obesity paradox for outcomes in atrial fibrillation: Evidence from an exposure‐effect analysis of prospective studies

The obesity paradox for outcomes in atrial fibrillation: Evidence from an exposure‐effect analysis of prospective studies

Different utilization of intensive care services (ICSs) for patients dying of hemorrhagic and ischemic stroke, a hospital-based survey

Valor do Diâmetro do Átrio Esquerdo com Escore CHA2DS2-Vasc na Predição da Trombose Atrial Esquerda/Trombose de Apêndice Atrial Esquerdo na Fibrilação Atrial Não Valvar

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