Prognostic factors of clinical endpoints in elderly patients with atrial fibrillation during a 2-year follow-up in China

Wang, Hao; Wang, Haijun; Chen, Yadong; Tao, Tao; Guo, Yutao; Zhao, Xiaojing; Liu, Hongbin; Wang, Yutang

doi:10.1097/md.0000000000007679

Cited by 4 publications

(4 citation statements)

References 49 publications

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“…Nevertheless, there exists a portion of the bibliography suggesting that BMI does not mediate the AF prognosis [18,35,36] and other researchers yielding results similar to ours, namely demonstrating that elevated BMI is linked to worse prognosis [22][23][24]37]. Specifically, in the latter studies, overweight and obese AF patients seemed to encounter increased thromboembolic risk (a 1 kg/m 2 BMI elevation was equivalent to a 9% enhancement of the thromboembolism rates) and even reduced survival rates compared to their thinner counterparts.…”

Section: Discussionsupporting

confidence: 72%

Prognostic Impact of Body Mass Index in Atrial Fibrillation

Nteli,

Moysidis

et al. 2024

JCM

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Background/Objectives: Contradictory results have been reported regarding the influence of obesity on the prognosis of atrial fibrillation (AF). The present study aimed to explore the potential association of body mass index (BMI) with the clinical outcomes of hospitalized patients with AF. Methods: In this retrospective, post hoc analysis of the MISOAC-AF randomized trial, 1113 AF patients were included and stratified as the following: underweight (BMI < 18 kg/m2), normal weight (BMI 18–24.9 kg/m2), overweight (BMI 25–29.9 kg/m2), and obese (BMI ≥ 30 kg/m2). The primary outcome was all-cause mortality; the secondary composite outcome was any hospitalization related to AF, heart failure (HF), or stroke. Cox regression analysis, survival analysis, and spline curve models were utilized. Results: Of the patients (median age: 76 years (IQR: 13), male: 54.6%), the majority were overweight (41.4%), followed by obese (33%), normal weight (24%), and underweight (1.6%). During a median 31-month follow-up, 436 (39.2%) patients died and 657 (59%) were hospitalized due to AF, HF, or stroke. Underweight, overweight, and obesity groups were significantly associated with an increased risk of all-cause mortality (p-values 0.02, 0.001, and <0.001, respectively), while overweight and obesity were significantly associated with the composite endpoint (p-values 0.01, <0.001, respectively) compared to normal weight. The spline curve analyses yielded that BMIs > 26.3 and > 25 were incrementally associated with all-cause mortality and the composite endpoint, respectively. A J-shaped relationship between BMI and AF prognosis was deduced. Conclusions: In conclusion, in recently hospitalized AF patients, BMI values outside the normal range were independently associated with poorer prognosis; therefore, it is essential that AF patients maintain a normal weight.

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Section: Discussionsupporting

confidence: 72%

Prognostic Impact of Body Mass Index in Atrial Fibrillation

Nteli,

Moysidis

et al. 2024

JCM

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“…(compared to 110 mg twice daily in Europe) 35 . Fifth, endpoints frequently differed from our outcomes of interest, as some studies 14,16‐18,24,28,32,33 examined the risk of ischemic stroke, stroke/SE/mortality, stroke/SE/myocardial infarction, or any (major or minor) bleeding. Lastly, results from observational studies 16‐18,20,22,24,30,33 on AF‐related outcomes in underweight versus normal BMI AF patients were all performed in an Asian setting potentially limiting generalizability.…”

Section: Discussionmentioning

confidence: 99%

“…27 Likewise, in a Chinese cohort study by Wang et al, the risk of stroke/SE/myocardial infarction was 9% higher per 1 kg/m 2 increase in BMI, although only 19% were OAC-treated and analyses were not adjusted for confounders. 28…”

Section: Thromboembolismmentioning

confidence: 99%

“…Fourth, NOAC dosages varied between studies, as rivaroxaban 15 and 10 mg once daily are the approved standard and reduced dosages in Japan 45 (as opposed to 20 and 15 mg in Europe) 35 and dabigatran 75 mg twice daily is the approved reduced dosage in the U.S. 12 (compared to 110 mg twice daily in Europe). 35 Fifth, endpoints frequently differed from our outcomes of interest, as some studies 14,[16][17][18]24,28,32,33 examined the risk of ischemic stroke, stroke/SE/mortality, stroke/SE/myocardial infarction, or any (major or minor) bleeding. Lastly, results from observational studies [16][17][18]20,22,24,30,33 on AF-related outcomes in underweight versus normal BMI AF patients were all performed in an Asian setting potentially limiting generalizability.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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The impact of underweight and obesity on outcomes in anticoagulated patients with atrial fibrillation: A systematic review and meta‐analysis on the obesity paradox

Grymonprez

Capiau

Backer

et al. 2021

Clinical Cardiology

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Although obesity is associated with the development and progression of atrial fibrillation (AF), an obesity paradox may be present, illustrated by seemingly protective effects of obesity on AF‐related outcomes. Body mass index (BMI) has an impact on outcomes in AF patients using oral anticoagulants. After searching Medline and Embase, meta‐analysis of results of four randomized and five observational studies demonstrated significantly lower risks of stroke or systemic embolism (RR 0.80, 95%CI [0.73–0.87]; RR 0.63, 95%CI [0.57–0.70]; and RR 0.42, 95%CI [0.31–0.57], respectively) and all‐cause mortality (RR 0.73, 95%CI [0.64–0.83]; RR 0.61, 95%CI [0.52–0.71]; and RR 0.56, 95%CI [0.47–0.66], respectively) in overweight, obese and morbidly obese anticoagulated AF patients (BMI 25 to <30, ≥30 and ≥40 kg/m2, respectively) compared to normal BMI anticoagulated AF patients (BMI 18.5 to <25 kg/m2). In contrast, thromboembolic (RR 1.92, 95%CI [1.28–2.90]) and mortality (RR 3.57, 95%CI [2.50–5.11]) risks were significantly increased in underweight anticoagulated AF patients (BMI <18.5 kg/m2). In overweight and obese anticoagulated AF patients, the risks of major bleeding (RR 0.86, 95%CI [0.76–0.99]; and RR 0.88, 95%CI [0.79–0.98], respectively) and intracranial bleeding (RR 0.75, 95%CI [0.58–0.97]; and RR 0.57, 95%CI [0.40–0.80], respectively) were also significantly lower compared to normal BMI patients, while similar risks were observed in underweight and morbidly obese patients. This meta‐analysis demonstrated lower thromboembolic and mortality risks with increasing BMI. However, as this paradox was driven by results from randomized studies, while observational studies rendered more conflicting results, these seemingly protective effects should still be interpreted with caution.

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The Role of Intralipid Emulsion in the Rat Model of Digoxin Intoxication

et al. 2018

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Although the mechanism of action is not well known, intravenous lipid emulsion (ILE) has been shown to be effective in the treatment of lipophilic drug intoxications. It is thought that, ILE probably separates the lipophilic drugs from target tissue by creating a lipid-rich compartment in the plasma. The second theory is that ILE provides energy to myocardium with high-dose free fatty acids activating the voltage-gated calcium channels in the myocytes. In this study, effects of ILE treatment on digoxin overdose were searched in an animal model in terms of cardiac side effects and survival. Forty Sprague-Dawley rats were divided into five groups. As the pre-treatment, the groups were administered saline, ILE, DigiFab and DigiFab and ILE. Following that, digoxin was infused to all groups until death except the control group. First arrhythmia and cardiac arrest observation times were recorded. According to the results, there was no statistically significant difference among the group in terms of first arrhythmia time and cardiac arrest times. However, when the saline group compared with ILE-treated group separately, significant difference was observed. DigiFab, ILE or ILE-DigiFab treatment make no significant difference in terms of the first arrhythmia and cardiac arrest duration in digoxin-intoxicated rats. However, it is not possible to say that at the given doses, ILE treatment might be successful at least as a known antidote. The fact that the statistical significance between the two groups is not observed in the subgroup analysis, the study should be repeated with larger groups.

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Prognostic factors of clinical endpoints in elderly patients with atrial fibrillation during a 2-year follow-up in China

Cited by 4 publications

References 49 publications

Prognostic Impact of Body Mass Index in Atrial Fibrillation

Prognostic Impact of Body Mass Index in Atrial Fibrillation

The impact of underweight and obesity on outcomes in anticoagulated patients with atrial fibrillation: A systematic review and meta‐analysis on the obesity paradox

The Role of Intralipid Emulsion in the Rat Model of Digoxin Intoxication

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