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  • 1.
    Andersson, Tommy
    et al.
    Dept Cardiology, Örebro Univ Hospital, Örebro, Sweden.
    Magnuson, Anders
    Unit Clinical Epidemiology & Biostatistics, Örebro Univ Hosp, Örebro, Sweden.
    Bryngelsson, Ing-Liss
    Dept. Occupational & Environmental Medicine, Örebro Univ Hospital, Örebro, Sweden.
    Fröbert, Ole
    Örebro University Hospital, Örebro, Sweden.
    Henriksson, Karin M.
    Dept. Laboratory Medicine, Lund Univ, Lund, Sweden; The Sahlgrenska Academy, Sahlgrenska Univ. Hospital, Gothenburg, Sweden.
    Edvardsson, Nils
    The Sahlgrenska Academy, Sahlgrenska Univ. Hospital, Gothenburg, Sweden.
    Poci, Dritan
    Örebro University Hospital.
    All-cause mortality in 272 186 patients hospitalized with incident atrial fibrillation 1995-2008: a Swedish nationwide long-term case-control study2013In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 34, no 14, p. 1061-1067Article in journal (Refereed)
    Abstract [en]

    Aims To evaluate long-term all-cause risk of mortality in women and men hospitalized for the first time with atrial fibrillation (AF) compared with matched controls. Methods and results A total of 272 186 patients (44% women) <= 85 years at the time of hospitalization with incidental AF 1995-2008 and 544 344 matched controls free of in-hospital diagnosis of AF were identified. Patients were followed via record linkage of the Swedish National Patient Registry and the Cause of Death Registry. Using Cox regression models, the long-term relative all-cause mortality risk, adjusted for concomitant diseases, in women vs. controls was 2.15, 1.72, and 1.44 (P < 0.001) in the age categories <= 65, 65-74, and 75-85 years, respectively. The corresponding figures for men were 1.76, 1.36, and 1.24 (P < 0.001). Among concomitant diseases, neoplasm, chronic renal failure, and chronic obstructive pulmonary disease contributed most to the increased all-cause mortality vs. controls. In patients with AF as the primary diagnosis, the relative risk of mortality was 1.63, 1.46, and 1.28 (P < 0.001) in women and 1.45, 1.17, and 1.10 (P < 0.001) in men. Conclusion Atrial fibrillation was an independent risk factor of all-cause mortality in patients with incident AF. The concomitant diseases that contributed most were found outside the thromboembolic risk scores. The highest relative risk of mortality was seen in women and in the youngest patients compared with controls, and the differences between genders in each age category were statistically significant.

  • 2.
    Andersson, Tommy
    et al.
    Dept Cardiol, Örebro Univ Hosp, Örebro, Sweden.
    Magnuson, Anders
    Clin Epidemiol & Biostat Unit, Örebro University Hospital, Örebro, Sweden.
    Bryngelsson, Ing-Liss
    Dept Occupat & Environm Med, Örebro University Hospital, Örebro, Sweden.
    Fröbert, Ole
    Örebro University Hospital. Dept Cardiol, Örebro University Hospital, Örebro, Sweden.
    Henriksson, Karin M.
    Dept Med Sci, Uppsala Univ, Uppsala, Sweden; AstraZeneca R&D, Mölndal, Sweden.
    Edvardsson, Nils
    Sahlgrenska Univ Hosp, Sahlgrenska Acad, Gothenburg, Sweden.
    Poci, Dritan
    Örebro University Hospital. Dept Cardiol, Örebro University Hospital, Örebro, Sweden.
    Gender-related differences in risk of cardiovascular morbidity and all-cause mortality in patients hospitalized with incident atrial fibrillation without concomitant diseases: A nationwide cohort study of 9519 patients2014In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 177, no 1, p. 91-99Article in journal (Refereed)
    Abstract [en]

    Background: Previous studies of patients with "lone" and "idiopathic" atrial fibrillation (AF) have provided conflicting evidence concerning the development, management and prognosis of this condition.

    Methods: In this nation-wide, retrospective, cohort study, we studied patients diagnosed with incidental AF recorded in national Swedish registries between 1995 and 2008. Controls were matched for age, sex and calendar year of the diagnosis of AF in patients. All subjects were free of any in-hospital diagnosis from 1987 and until patients were diagnosed with AF and also free of any diagnosis within one year from the time of inclusion. Follow-up continued until 2009. We identified 9519 patients (31% women) and 12,468 matched controls.

    Results: Relative risks (RR) versus controls for stroke or transient ischemic attack (TIA) in women were 19.6, 4.4, 3.4 and 2.5 in the age categories <55, 55-64, 65-74 and 75-85, years respectively. Corresponding figures for men were 3.4, 2.5, 1.7 and 1.9. RR for heart failure were 6.6, 6.6, 6.3 and 3.8 in women and 7.8, 4.6, 4.9 and 2.9 in men. All RR were statistically significant with p < 0.01. RR for myocardial infarction and all-cause mortality were statistically significantly increased only in the two oldest age categories in women and 65-74 years in men.

    Conclusions: Patients with AF and no co-morbidities at inclusion had at least a doubled risk of stroke or TIA and a tripled risk of heart failure, through all age categories, as compared to controls. Women were at higher RR of stroke or TIA than men. (C) 2014 The Authors. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY-NC-SA license (http://creativecommons.org/licenses/by-nc-sa/3.0/).

  • 3.
    Andersson, Tommy
    et al.
    Örebro University, School of Medical Sciences. Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
    Magnuson, Anders
    Örebro University Hospital. Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Bryngelsson, Ing-Liss
    Örebro University Hospital. Department of Occupational and Environmental Medicine, Örebro University, Örebro, Sweden.
    Fröbert, Ole
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
    Henriksson, Karin M.
    Department of Medical Science, Uppsala University, Uppsala, Sweden.
    Edvardsson, Nils
    Sahlgrenska Academy at Sahlgrenska University Hospital, Göteborg, Sweden.
    Poci, Dritan
    Örebro University, School of Medical Sciences. Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
    Patients with atrial fibrillation and outcomes of cerebral infarction in those with treatment of warfarin versus no warfarin with references to CHA(2)DS(2)-VASc score, age and sex: A Swedish nationwide observational study with 48 433 patients2017In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 5, article id e0176846Article in journal (Refereed)
    Abstract [en]

    Aims: There is controversy in the guidelines as to whether patients with atrial fibrillation and a low risk of stroke should be treated with anticoagulation, especially those with a CHA(2)DS(2)-VASc score of 1 point.

    Methods: In a retrospective, nationwide cohort study, we used the Swedish National Patient Registry, the National Prescribed Drugs Registry, the Swedish Registry of Education and the Population and Housing Census Registry. 48 433 patients were identified between 1 January 2006 and 31 December 2008 with incident atrial fibrillation who were divided in age categories, sex and a CHA(2)DS(2)-VASc score of 0, 1, 2 and >= 3 and they were included in a time-varying analysis of warfarin treatment versus no treatment. The primary end-point was cerebral infarction and stroke, and patients were followed until 31 December 2009.

    Results: Patients with 1 point from the CHA(2)DS(2)-VASc score showed the following adjusted hazard ratios (HR) with a 95% confidence interval: men 65-74 years 0.46 (0.25-0.83), men < 65 years 1.11 (0.56-2.23) and women < 65 years 2.13 (0.94-4.82), where HR < 1 indicates protection with warfarin. In patients < 65 years and 2 points, HR in men was 0.35 (0.18-0.69) and in women 1.84 (0.86-3.94) while, in women with at least 3 points, HR was 0.31 (0.16-0.59). In patients 65-74 years and 2 points, HR in men was 0.37 (0.23-0.59) and in women 0.39 ( 0.21-0.73). Categories including age >= 65 years or >= 3 points showed a statistically significant protection from warfarin.

    Conclusions: Our results support that treatment with anticoagulation may be considered in all patients with an incident atrial fibrillation diagnosis and an age of 65 years and older, i.e. also when the CHA(2)DS(2)-VASc score is 1.

  • 4.
    Andersson, Tommy
    et al.
    Örebro University, School of Medical Sciences.
    Magnuson, Anders
    Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Bryngelsson, Ing-Liss
    Department of Occupational and Environmental Medicine, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Frøbert, Ole
    Örebro University, School of Medical Sciences. Department of Cardiology, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Henriksson, Karin M.
    Department of Medical Science, Uppsala University, Uppsala and AstraZeneca R&D, Mölndal, Sweden.
    Edvardsson, Nils
    Sahlgrenska Academy at Sahlgrenska University Hospital, Göteborg, Sweden.
    Poçi, Dritan
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiology.
    Patients without comorbidities at the time of diagnosis of atrial fibrillation: causes of death during long-term follow-up compared to matched controls2017In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 40, no 11, p. 1076-1082Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Little is known about the long-term, cause-specific mortality risk in patients without comorbidities at the time of diagnosis of atrial fibrillation (AF).

    METHODS: From a nation-wide registry of patients hospitalized with incident AF between 1995 and 2008 we identified 9 519 patients with a first diagnosed AF and no comorbidities at the time of AF diagnosis. They were matched with 12 468 controls. The follow-up continued until December 2008. Causes of death were classified according to the ICD-10 codes.

    RESULTS: During follow-up, 11.1% of patients with AF and 8.3% of controls died. Cardiovascular diseases were the most common causes of death and the only diagnoses which showed significantly higher relative risk in patients with AF than controls (HR 2.0, 95% CI 1.8-2.3), and the relative risk was significantly higher in women than in men. Stroke was a more common cause among patients with AF, 13.1% versus 9.7% (HR 2.7, 95% CI 1.8-4.0), while cerebral hemorrhage was more common among controls, 4.7% versus 10.2% (HR 0.9, 95% CI 0.6-1.5). The time from AF diagnosis to death was 6.0 ± 3.1 years.

    CONCLUSIONS: In patients with incident AF and no known comorbidities at the time of AF diagnosis, only cardiovascular diseases were more often causes of death as compared to controls. Women carried a significantly higher relative risk than men.

  • 5.
    Björkenheim, Anna
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
    Brandes, Axel
    Department of Cardiology, Odense University Hospital, Odense, Denmark.
    Andersson, Tommy
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
    Magnuson, Anders
    Clinical Epidemiology and Biostatistics Unit, Örebro University Hospital, Örebro, Sweden.
    Edvardsson, Nils
    Sahlgrenska Academy, Sahlgrenska University Hospital, Göteborg, Sweden.
    Wandt, Birger
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Pedersen, Henriette Sloth
    Department of Cardiology, Odense University Hospital, Odense, Denmark.
    Poci, Dritan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Dept Cardiol, Örebro University Hospital, Örebro, Sweden.
    Predictors of hospitalization for heart failure and of all-cause mortality after atrioventricular nodal ablation and right ventricular pacing for atrial fibrillation2014In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 16, no 12, p. 1772-1778Article in journal (Refereed)
    Abstract [en]

    Aims: Atrioventricular junction ablation (AVJA) is a highly effective treatment in patients with therapy refractory atrial fibrillation (AF) but renders the patient pacemaker dependent. We aimed to analyse the long-term incidence of hospitalization for heart failure (HF) and all-cause mortality in patients who underwent AVJA because of AF and to determine predictors for HF and mortality.

    Methods and results: We retrospectively enrolled 162 consecutive patients, mean age 67 +/- 9 years, 48% women, who underwent AVJA because of symptomatic AF refractory to pharmacological treatment (n = 117) or unsuccessful repeated pulmonary vein isolation (n = 45). Hospitalization for HF occurred in 32 (20%) patients and 35 (22%) patients died, representing a cumulative incidence for hospitalization for HF and mortality over the first 2 years after AVJA of 9.1 and 5.2%, respectively. Hospitalization for HF occurred to the same extent in patients who failed pharmacological treatment as in patients with repeated pulmonary vein isolation (PVI), although the mortality was slightly higher in the former group. QRS prolongation >= 120 ms and left atrial diameter were independent predictors of hospitalization for HF, while hypertension and previous HF were independent predictors of death.

    Conclusion: The long-term hospitalization rate for HF and all-cause mortality was low, which implies that long-term ventricular pacing was not harmful in this patient population, including patients with unsuccessful repeated PVI.

  • 6.
    Björkenheim, Anna
    et al.
    Örebro University, School of Medical Sciences. Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
    Brandes, Axel
    Department of Cardiology, Odense University Hospital, Odense, Denmark.
    Chemnitz, Alexander
    Department of Cardiology, Odense University Hospital, Odense, Denmark.
    Magnuson, Anders
    Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Edvardsson, Nils
    Sahlgrenska Academy, Sahlgrenska University Hospital, Göteborg, Sweden.
    Poçi, Dritan
    Örebro University, School of Medical Sciences. Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
    Rhythm Control and its Relation to Symptoms During the First Two Years After Radiofrequency Ablation for Atrial Fibrillation2016In: Pacing and Clinical Electrophysiology, ISSN 0147-8389, E-ISSN 1540-8159, Vol. 39, no 9, p. 914-925Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate rhythm control up to two years after AF ablation and its relation to reported symptoms.

    Background: The implantable loop recorder (ILR) continuously records the ECG, has an automatic AF detection algorithm and a possibility for patients to activate an ECG recording during symptoms.

    Methods: Fifty-seven patients (mean age 57±9 years, 60% male, 88% paroxysmal AF) underwent AF ablation following ILR implantation. Device data were downloaded at the ablation and three, six, 12, 18 and 24 months after ablation.

    Results: Fifty-four patients completed the two-year follow-up. Thirteen (24%) patients had no AF episodes detected by ILR during follow-up. Ten of 41 patients (24%) with AF recurrence were only detected by ILR and AF recurrences were detected earlier by ILR (P<0.001). The median AF burden in patients with AF recurrence was 5.7% (IQR 0.4-14.4) and was even lower in patients with AF only detected by ILR (P = 0.001). Forty-eight % of the patients indicated symptoms via the patient activator but 33% of those recordings were not due to AF. Early AF recurrence (within 3 months) was highly associated with later AF recurrence (P<0.001). AF burden >0.5% and longest >6h before the ablation were independent predictors of AF recurrence during intermittent but not continuous monitoring.

    Conclusions: After AF ablation, the AF burden was low throughout the 24 months follow-up. Nevertheless, symptoms were commonly indicated but one third of patient activated recordings did not show AF. Continuous monitoring was superior to intermittent follow-up in detecting AF episodes and assessing the AF burden.

    Clinical trial registration: URL: http://clinicaltrials.gov. Unique Identifier: NCT00697359.

  • 7.
    Björkenheim, Anna
    et al.
    Örebro University, School of Medical Sciences. Department of Cardiology.
    Brandes, Axel
    Department of Cardiology, Odense University Hospital, Odense, Denmark.
    Magnuson, Anders
    Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Chemnitz, Alexander
    Department of Cardiology, Odense University Hospital, Odense, Denmark.
    Edvardsson, Nils
    Sahlgrenska Academy at Sahlgrenska University Hospital, Göteborg, Sweden.
    Poçi, Dritan
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiology.
    Patient-Reported Outcomes in Relation to Continuously Monitored Rhythm Before and During 2 Years After Atrial Fibrillation Ablation Using a Disease-Specific and a Generic Instrument2018In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 7, no 5, article id e008362Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Atrial fibrillation (AF) ablation improves patient-reported outcomes, irrespective of mode of intermittent rhythm monitoring. We evaluated the use of an AF-specific and a generic patient-reported outcomes instrument during continuous rhythm monitoring 2 years after AF ablation.

    METHODS AND RESULTS: Fifty-four patients completed the generic 36-Item Short-Form Health Survey and the AF-specific AF6 questionnaires before and 6, 12, and 24 months after AF ablation. All patients underwent continuous ECG monitoring via an implantable loop recorder. The generic patient-reported outcomes scores were compared with those of a Swedish age- and sex-matched population. After ablation, both summary scores reached normative levels at 24 months, while role-physical and vitality remained lower than norms. Responders to ablation (AF burden <0.5%) reached the norms in all individual 36-Item Short-Form Health Survey domains, while nonresponders (AF burden >0.5%) reached norms only in social functioning and mental component summary. All AF6 items and the sum score showed moderate to large improvement in both responders and nonresponders, although responders showed significantly greater improvement in all items except item 1 from before to 24 months after ablation. Higher AF burden was independently associated with poorer physical component summary and AF6 sum score.

    CONCLUSIONS: The AF-specific AF6 questionnaire was more sensitive to changes related to AF burden than the generic 36-Item Short-Form Health Survey. Patients improved as documented by both instruments, but a higher AF burden after ablation was associated with poorer AF-specific patient-reported outcomes and poorer generic physical but not mental health. Our results support the use of an AF-specific instrument, alone or in combination with a generic instrument, to assess the effect of ablation.

    CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00697359.

  • 8.
    Björkenheim, Anna
    et al.
    Örebro University, School of Medical Sciences.
    Brandes, Axel
    Odense University Hospital, Odense, Denmark.
    Magnuson, Anders
    Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Chemnitz, Alexander
    Odense University Hospital, Odense, Denmark.
    Svedberg, Lena
    Department of Cardiology, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Edvardsson, Nils
    Sahlgrenska Academy at Sahlgrenska University Hospital, Göteborg, Sweden.
    Poçi, Dritan
    Örebro University, School of Medical Sciences. Örebro University Hospital. Örebro University Hospital, Region Örebro Län, Örebro, Sweden.
    Assessment of Atrial Fibrillation–Specific Symptoms Before and 2 Years After Atrial Fibrillation Ablation: Do Patients and Physicians Differ in Their Perception of Symptom Relief?2017In: JACC: Clinical Electrophysiology, ISSN 2405-500X, Vol. 3, no 10, p. 1168-1176Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of this study was to evaluate patient-reported and physician-assessed atrial fibrillation (AF)–related symptoms after AF ablation.

    Background: Success of AF ablation is usually defined as freedom from AF, although symptom relief is often patients’ desire.

    Methods: Symptom relief was assessed as perceived by patients using the short, validated, AF-specific symptom questionnaire AF6 and as classified by physicians using the European Heart Rhythm Association (EHRA) classification at baseline and 6, 12, and 24 months after AF ablation. Recurrence of arrhythmia was documented by continuous electrocardiographic monitoring.

    Results: In total, 54 patients completed the 24-month follow-up. All 6 items on the AF6, AF6 sum score, and EHRA class improved significantly over time. The greatest improvement was seen during the first 6 months after ablation, but AF6 scores showed continued improvement up to 12 months, in contrast to EHRA class. There was a low correlation between AF6 score and EHRA class, but the predictive ability was low. Both AF6 scores and EHRA class were significantly correlated with AF burden at all times after ablation. A change of >9 points in AF6 sum score corresponded to a meaningful reduction in symptom severity.

    Conclusion: Patient-reported and physician-assessed outcomes were both useful in assessing symptom relief after AF ablation, although patient-reported outcomes were more sensitive tools. There was also a discrepancy between patient-reported and physician-assessed outcomes after ablation. Freedom from AF and a low AF burden most often resulted in a reduction of symptoms, but symptom relief also occurred despite little effect on the arrhythmia.

  • 9.
    Poci, Dritan
    et al.
    Örebro University Hospital. Dept Cardiol, Örebro University Hospital, Örebro, Sweden; Sahlgrenska Univ Hosp & Academy, Dept Mol & Clin Med Cardiol, Univ Gothenburg, Gothenburg, Sweden.
    Abrahamsson, Britt-Marie
    Sahlgrenska Univ Hosp &Sahlgrenska Academy, Dept Mol & Clin Med Cardiol, Univ Gothenburg, Gothenburg, Sweden.
    Edvardsson, Nils
    Sahlgrenska Univ Hosp, Sahlgrenska Acad, Dept Mol & Clin Med Cardiol, Univ Gothenburg, Gothenburg, Sweden.
    Bergfeldt, Lennart
    Sahlgrenska Univ Hosp, Sahlgrenska Acad, Dept Mol & Clin Med Cardiol, Univ Gothenburg, Gothenburg, Sweden.
    Sinus Bradycardia and Sinus Pauses Immediately after Electrical Cardioversion of Persistent Atrial FibrillationWhat Do They Mean?2013In: Annals of Noninvasive Electrocardiology, ISSN 1082-720X, E-ISSN 1542-474X, Vol. 18, no 3, p. 281-287Article in journal (Refereed)
    Abstract [en]

    Background To determine the role of sinus bradyarrhythmia (SB) immediately after electrical cardioversion of persistent atrial fibrillation (AF) on the short-term recurrence rate and long-term pacemaker need and all-cause mortality. Methods SB defined as sinus bradycardia (sinus rate <40 bpm for 2 consecutive cycles) and/or sinus pauses (>2 s), were recorded during 5 minutes immediately after successful DC cardioversion in 140 consecutive patients with persistent AF. Results SB was observed during the first minute of SR in 31 patients (22%). Sinus bradycardia was present in 27 patients, sinus pauses in 16 (>3 s in 10) patients, and both in 12 patients. Compared to patients without SB, the mean heart rate during the first minute after cardioversion was lower, 57 +/- 13 versus 63 +/- 11 bpm; P < 0.05, while the mean heart rates during the subsequent 4 minutes were not statistically significantly different. The AF recurrence rates were not significantly different at 1 week (45% vs. 40%), or at 3 months (68% vs. 53%) in patients with or without SB. After a mean follow-up of 86 +/- 6 months the pacemaker implantation rate was 10% versus 11% (NS) and an all-cause mortality of 26 versus 18% (NS). Conclusions SB immediately after electrical cardioversion of persistent AF had no significant impact on the 3-month AF recurrence rate, the long-term need for pacemaker or all-cause mortality.

  • 10.
    Poci, Dritan
    et al.
    Department of Cardiology, University Hospital Örebro, Örebro, Sweden.
    Hartford, Marianne
    Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Karlsson, Thomas
    Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Edvardsson, Nils
    Caidahl, Kenneth
    Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden ; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden .
    Effect of New Versus Known Versus No Atrial Fibrillation on 30-Day and 10-Year Mortality in Patients With Acute Coronary Syndrome2012In: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 110, no 2, p. 217-221Article in journal (Refereed)
    Abstract [en]

    Coronary artery disease promotes the development of atrial fibrillation (AF). The aim of this study was to determine short- and long-term mortality in patients with acute coronary syndromes (ACS) and AF, depending on the AF presentation. A total of 2,335 consecutive patients with ACS were included. AF was classified as known persistent or permanent AF, known paroxysmal AF, new AF at admission, and new AF during hospitalization for ACS. Four hundred forty-two patients had any AF: 54 with known persistent or permanent AF, 150 with known paroxysmal AF, 54 with new AF at admission, and 184 with new AF during hospitalization. Statistically significant differences among subgroups related to previous heart failure (p <0.0001), stroke (p = 0.04), myocardial infarction (p <0.0001), angina pectoris (p <0.0001), hypercholesterolemia (p = 0.007), coronary artery bypass grafting (p <0.0001), and percutaneous coronary intervention (p = 0.03) were observed. Thirty-day mortality differed among the subgroups (p = 0.02) and was lowest in patients with known paroxysmal AF (7.3%). Ten-year mortality ranged from 53% to 78% among the subgroups. There were 5 predictors of long-term mortality across the subgroups: age (hazard ratio [HR] 1.06, 95% confidence interval [CI] 1.04 to 1.09, p <0.0001), previous myocardial infarction (HR 1.4, 95% CI 1.0 to 1.8, p = 0.04), heart failure (HR 1.8, 95% CI 1.3 to 2.4, p = 0.0002), diabetes (HR 1.7, 95% CI 1.2 to 2.2, p = 0.0005), and smoking (HR 1.7, 95% CI 1.2 to 2.3, p = 0.001). In conclusion, patient characteristics and 30-day mortality differed significantly among the subgroups, but long-term mortality did not. Any AF associated with ACS almost doubled the long-term mortality risk. AF in patients with ACS should therefore be regarded as an important risk factor irrespective of its presentation. (C) 2012 Elsevier Inc. All rights reserved. (Am J Cardiol 2012;110:217-221)

  • 11.
    Själander, Sara
    et al.
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Holmqvist, Fredrik
    Arrhythmia Clinic, Skåne University Hospital, Lund, Sweden; Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden .
    Smith, J. Gustav
    Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden; Department of Heart Failure and Valvular Disease, Skåne University Hospital, Lund, Sweden .
    Platonov, Pyotr G.
    Arrhythmia Clinic, Skåne University Hospital, Lund, Sweden; Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden .
    Kesek, Milos
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Svensson, Peter J.
    Department for Coagulation Disorders, Lund University, Malmö, Sweden.
    Blomström-Lundqvist, Carina
    Department of Cardiology, Institution of Medical Science, Uppsala University, Uppsala, Sweden.
    Tabrizi, Fariborz
    Department of Clinical Sciences, South Hospital, Karolinska Institute, Stockholm, Sweden; Arrhythmia Center Stockholm, Stockholm, Sweden.
    Tapanainen, Jari
    Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
    Poci, Dritan
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiology.
    Jönsson, Anders
    Department of Cardiology, Linköping University Hospital, Linköping, Sweden.
    Själander, Anders
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Assessment of Use vs Discontinuation of Oral Anticoagulation After Pulmonary Vein Isolation in Patients With Atrial Fibrillation2017In: JAMA cardiology, ISSN 2380-6583, E-ISSN 2380-6591, Vol. 2, no 2, p. 146-152Article in journal (Refereed)
    Abstract [en]

    IMPORTANCE: Pulmonary vein isolation (PVI) is a recommended treatment for patients with atrial fibrillation, but it is unclear whether it results in a lower risk of stroke.

    OBJECTIVES: To investigate the proportion of patients discontinuing anticoagulation treatment after PVI in association with the CHA(2)DS(2)-VASc (congestive heart failure, hypertension, age >= 75 years [doubled], diabetes, stroke [doubled], vascular disease, age 65-74 years, sex category [female]) score, identify factors predicting stroke after PVI, and explore the risk of cardiovascular events after PVI in patients with and without guideline-recommended anticoagulation treatment.

    DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort studywas conducted using Swedish national health registries from January 1, 2006, to December 31, 2012, with a mean-follow up of 2.6 years. A total of 1585 patients with atrial fibrillation undergoing PVI from the Swedish Catheter Ablation Register were included, with information about exposure to warfarin in the national quality register Auricula. Data analysis was performed from January 1, 2015, to April 30, 2016.

    EXPOSURES: Warfarin treatment.

    MAIN OUTCOMES AND MEASURES: Ischemic stroke, intracranial hemorrhage, and death.

    RESULTS: In this cohort of 1585 patients, 73.0% were male, the mean (SD) age was 59.0 (9.4) years, and the mean (SD) CHA(2)DS(2)-VASc score was 1.5 (1.4). Of the 1585 patients, 1175 were followed up for more than 1 year after PVI. Of these, 360 (30.6%) discontinued warfarin treatment during the first year. In patients with a CHA(2)DS(2)-VASc score of 2 or more, patients discontinuing warfarin treatment had a higher rate of ischemic stroke (5 events in 312 years at risk [1.6% per year]) compared with those continuing warfarin treatment (4 events in 1192 years at risk [0.3% per year]) (P = .046). Patients with a CHA(2)DS(2)-VASc score of 2 or more or those who had previously experienced an ischemic stroke displayed a higher risk of stroke if warfarin treatment was discontinued (hazard ratio, 4.6; 95% CI, 1.2-17.2; P = .02 and hazard ratio, 13.7; 95% CI, 2.0-91.9; P = .007, respectively).

    CONCLUSIONS AND RELEVANCE: These findings indicate that discontinuation ofwarfarin treatment after PVI is not safe in high-risk patients, especially those who have previously experienced an ischemic stroke.

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