Clinical Relevance of Orthostatic Hypotension in Patients with Atrial Fibrillation and Suspected Transient Ischemic Attack

Mankoo, Alex; Minhas, Jatinder S.; Coles, Briana; Hussain, Shazia; Khunti, Kamlesh; Robinson, Thompson G.; Mistri, Amit; Eveson, David; SteeringCommittee, LeiSTAR

doi:10.1007/s40292-020-00363-4

Cited by 4 publications

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“…Prior studies suggest that pre-arrest comorbidity score may be a key determinant of survival after an in-hospital cardiac arrest [33][34][35]. A study by Mankoo et al noted that while higher blood pressure is generally considered detrimental to cardiovascular or cerebrovascular outcomes, chronic hypertension necessitates higher pressure for the cerebral autoregulation of blood pressure, thereby increasing the risk of ischemia at lower blood pressure [36]. As a result, they observed an inverse relationship between blood pressure and mortality outcomes with increased mortality risks among patients with pre-existing OH and AF presenting with a transient ischemic attack [36].…”

Section: Discussionmentioning

confidence: 99%

Atrial Fibrillation as a Prognostic Indicator in Patients With Orthostatic Hypotension: Nationwide Inpatient Sample Analysis

et al. 2022

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Background: Orthostatic hypotension and atrial fibrillation have common etiology and a bidirectional relationship with several cardiovascular conditions. Despite both conditions being highly prevalent in hospitalized patients, prior research has primarily evaluated adverse outcomes due to orthostatic hypotension and atrial fibrillation independent of each other. In this study, we aim to assess if the presence of atrial fibrillation exacerbates in-hospital outcomes of patients with orthostatic hypotension.Methods: Adult patients hospitalized in 2019 with a primary diagnosis of orthostatic hypotension with or without pre-existing atrial fibrillation were identified using the International Classification of Diseases, Tenth Revision (ICD-10) code. The primary outcome of interest was in-patient mortality and cardiac arrest. Secondary outcomes of interest were the length of stay and total hospital charges. Adjusted and unadjusted analysis was performed on appropriate variables of interest.Results: Among 10,630 hospitalizations with orthostatic hypotension, 2,987 (median (interquartile range (IQR)) age: 78.5 (68.5 -88.5) years; 1,197 women (40.1%)) comprised the atrial fibrillation cohort. Mean Charlson comorbidity index was noted to be significantly higher in orthostatic hypotension and atrial fibrillation patients (mean (standard deviation (SD)): 3.1 (2.1) vs. 2.5 (2.1), P < 0.001).Compared to orthostatic hypotension patients without atrial fibrillation, the prevalence of congestive heart failure (1,263 (42.3%) vs. 1,367 (17.9%)), coronary artery disease (1,432 (47.9%) vs. 2,481 (32.5%)), history of percutaneous coronary intervention or graft (443 (14.83%) vs. 860 (11.3%)), chronic obstructive pulmonary disease (644 (21.6%) vs. 1,131 (14.8%)) , chronic kidney disease (1,182 (39.6%) vs. 2,216 (29.0%)), and hyperlipidemia (1,828 (61.2%) vs. 4,087 (53.5%); all P < 0.05), were significantly higher in orthostatic hypotension patients with atrial fibrillation. Following multivariable analysis of orthostatic hypotension patients, atrial fibrillation was associated with 5.0 times greater odds for cardiac arrest (adjusted odds ratio (aOR) = 5.0 (95% confidence interval (CI): 1.4 -18.2), P = 0.014), without increased risk of in-hospital mortality (aOR = 2.1 (95% CI: 0.9 -5.0), P = 0.090).Conclusions: Atrial fibrillation is an independent predictor for cardiac arrest but not in-hospital mortality in patients with orthostatic hypotension. The short-and long-term prognostic value of atrial fibrillation in orthostatic hypotension patients must be confirmed in future prospective trials to improve patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Atrial Fibrillation as a Prognostic Indicator in Patients With Orthostatic Hypotension: Nationwide Inpatient Sample Analysis

et al. 2022

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“…The presence of systolic or diastolic OH increased mortality rates in both people with a CV diagnosis and non-CV diagnosis [18]. Meta-analysis data have shown that OH is associated with 40% higher risk of future all-cause mortality events [19].…”

Section: Discussionmentioning

confidence: 99%

“…As such, further research into the sex and ethnic differences, and causes of death in this population is required. Furthermore, there should be a focus on understanding the mechanism by which OH may lead to increased mortality [18].…”

Section: Discussionmentioning

confidence: 99%

Mortality in a Multiethnic Population Attending a One-Stop TIA Clinic

et al. 2022

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Introduction: Studies indicate a 13–27% mortality rate following a transient ischaemic attack (TIA). However, outcomes following TIA/minor stroke since the introduction of rapid-access TIA clinics and prompt vascular risk factor intervention are not known. Specifically, there is paucity of data comparing outcomes between people who are diagnosed with an “acute cerebrovascular” (CV) event or an alternative non-cardiovascular diagnosis (non-CV) in a rapid-access TIA clinic. We aimed to assess the mortality in such a setting. Methods: A retrospective observational study was undertaken at the Leicester rapid-access secondary care TIA clinic. Data included information collected at the first clinic visit (including comorbidities, and primary diagnosis, categorized as CV and non-CV) and the date of death for people dying during follow-up. Results: 11,524 subjects were included with 33,164 years of follow-up data; 4,746 (41.2%) received a CV diagnosis. The median follow-up time was 2.75 years (interquartile range 1.36–4.32). The crude mortality rate was 37.3 (95% CI: 35.3–39.5) per 1,000 person-years (PTPY). The mortality rate was higher following a CV diagnosis (50.8 [47.2–54.7] PTPY) compared to a non-CV diagnosis (27.9 [25.7–30.4] PTPY), and for males, older people, those of white ethnicity, and people with orthostatic hypotension (OH). Discussion: This study identified possible risk factors associated with a higher mortality in TIA clinic attendees, who may benefit from specific intervention. Future research should explore the underlying causes and the effect of specific targeted management strategies.

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“…Es sollte eher eine leichte Hypertension toleriert werden, auch um neurologische Ereignisse wie bspw. eine hypotensive TIA zu verhindern [8][9][10][11]. Auf Medikamenteninteraktionen sollte ebenfalls ein hohes Augenmerk gerichtet werden.…”

Section: Synkopen In Geriatrischen Patientenunclassified

Synkopeneinheiten

Schick¹,

Napp²

2022

Nervenheilkunde

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ZUSAMMENFASSUNGDie Synkopenversorgung bei geriatrischen Patienten ist häufig aufgrund der höheren Wahrscheinlichkeit für schwerwiegende Grunderkrankungen sowie dem Vorliegen von Begleiterkrankungen und Polypharmazie anspruchsvoll. Häufig erfolgt eine stationäre Aufnahme zur weiteren Abklärung mit konsekutiv hohen Kosten für das Gesundheitssystem und ohne verbessertem Outcome für die Patienten. Zur spezifischen diagnostischen Abklärung, Risikostratifizierung und raschen Therapieinitiierung haben sich insbesondere für Intermediär- und Hochrisikosynkopen interdisziplinäre Synkopeneinheiten bewährt. Diese bestehen aus ärztlichen und pflegerischen Synkopenspezialisten sowie einem multidisziplinären Team und können anhand standardisierter Behandlungsalgorithmen eine rasche Diagnostik und ein optimiertes Management gewährleisten. Stationäre Aufnahmen, Aufenthaltsdauer sowie Behandlungskosten konnten hierdurch um 77 %, 50 % bzw. 29 % reduziert werden. Trotz einer klaren Empfehlung der European Society of Cardiology (ESC), haben 88 % der europäischen Krankenhäuser heute weiterhin keinen Zugriff auf eine Synkopeneinheit.

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Clinical Relevance of Orthostatic Hypotension in Patients with Atrial Fibrillation and Suspected Transient Ischemic Attack

Cited by 4 publications

References 24 publications

Atrial Fibrillation as a Prognostic Indicator in Patients With Orthostatic Hypotension: Nationwide Inpatient Sample Analysis

Atrial Fibrillation as a Prognostic Indicator in Patients With Orthostatic Hypotension: Nationwide Inpatient Sample Analysis

Mortality in a Multiethnic Population Attending a One-Stop TIA Clinic

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