| Background:In recent years,clinical guidelines have emphasized comprehensive management for patients with atrial fibrillation,particularly for those with comorbidities.However,there is limited research on the effect of multimorbidity on patients with atrial fibrillation.Thus,this study aims to evaluate the impact of multimorbidity on the prognosis of patients with atrial fibrillation through the China Emergency Atrial Fibrillation Registry study.Methods:This study recruited a total of 2016 patients with atrial fibrillation from 20 emergency centers across China from September 2008 to April 2011.After excluding 26 patients with incomplete data,a total of 1990 patients were enrolled in statistical analysis.According to the 5 common comorbidities(coronary heart disease,heart failure,hypertension,diabetes,sleep apnea syndrome),the patients were divided into three groups:0 comorbidities group(n=361),1～2 comorbidities group(n=1215)and≥3 comorbidities group(n=414).The primary endpoints of this study were all-cause mortality,cardiovascular death,stroke,and systemic embolism.All patients were followed up for 1 year.Results:In this study,only 18.1%of patients with atrial fibrillation were without comorbidities,compared with 20.1%with≥3 comorbidities.Hypertension was the most common comorbidity in patients with atrial fibrillation.During the 1-year followup,a total of 276 all-cause deaths,177 cardiovascular deaths,147 strokes and 15 systemic embolism occurred.All-cause mortality(7.8%),cardiovascular mortality(3.9%),and the rate of systemic embolism(0.3%)were lowest in the 0 comorbidities group,and all-cause mortality(19.3%),cardiovascular mortality(14.0%)and the rate of systemic embolism(1.7%)were highest in the ≥3 comorbidities group.The Kaplan-Meier survival curve showed that the risk of all-cause mortality and cardiovascular death were lowest in the 0 comorbidities group and highest in the≥3 comorbidities group(all Log-rank P<0.001).The risk of systemic embolism was also lowest in the 0 comorbidities group and highest in the≥3 comorbidities group(Logrank P=0.039).The results of multivariate Cox regression analysis suggested that the risk of all-cause mortality in the≥3 comorbidities group was 1.622 times higher risk of the 0 comorbidity group[HR(Hazard ratio),1.622;95%CI(Confidence interval),1.031 to 2.551,P=0.036],and the risk of cardiovascular death was 2.488 times higher than that in the 0 comorbidity group(HR,2.488;95%CI,1.347 to 4.594,P=0.004).Conclusions:This study demonstrated that the proportion of patients with atrial fibrillation combined with comorbidities is higher than that without comorbidities in emergency departments across China.Besides,the most common comorbidity in patients with atrial fibrillation is hypertension.Patients with atrial fibrillation with multiple comorbidities(≥3 comorbidities)have a worse prognosis,and the risk of allcause mortality and cardiovascular death was significantly increased.This study suggested that the management of comorbidities in patients with atrial fibrillation needs more attention in clinical practice.Background:Studies on the relationship between sleep apnea syndrome and atrial fibrillation(AF)and its prognosis are limited.The purpose of this study was to explore the clinical characteristics of patients combined with AF and sleep apnea syndrome and to evaluate the impact of sleep apnea syndrome on the prognosis of AF.Methods:This multicenter study was from a national AF registry study in which 2016 patients with atrial fibrillation were enrolled from 20 emergency centers around China.After excluding 26 patients without detailed baseline data,1990 patients were included in the final statistical analysis.All of the patients were followed up for 1 year.Patients with AF were divided into two groups based on the presence or absence of sleep apnea.Eventually,there were 70 patients with sleep apnea and 1920 patients without sleep apnea.The primary endpoint of the study was all-cause death,cardiovascular death,stroke,and systemic embolism.Results:The median age of the 1990 patients with atrial fibrillation was 71 years,and 897(45.1%)were male.Compared to those without sleep apnea,patients with AF and sleep apnea were younger,more likely to be male and smokers,had higher BMIs,and tended to have histories of major bleeding(All P<0.05).Multivariate Logistic regression showed that male[OR(Odds ratio)3.02,95%CI(Confidence interval)1.565.85],BMI(OR 1.17,95%CI 1.09-1.25),smoking history(OR 2.71,95%CI 1.584.68),history of major bleeding(OR 3.07,95%CI 1.11-8.48)was an independent risk factor for sleep apnea in patients with AF.After 1-year follow-up,276 all-cause deaths occurred,including 177 cardiovascular deaths.There were 147 cases of stroke and 15 systemic embolism.There were no significant differences in the incidence of all-cause death(10.0%vs.14.0%,P=0.34),cardiovascular death(4.3%vs.8.5%,P=0.46),and stroke(5.7%vs.7.4%,P=0.58)between the two groups.However,the incidence of systemic embolism in patients with AF and sleep apnea was higher than those without sleep apnea(4.3%vs 0.6%,P<0.01).In univariate Cox regression analysis,patients with sleep apnea and AF seemed not relate to the risk of all-cause death(HR 0.69,95%CI 0.33-1.46,P=0.33),cardiovascular death(HR 0.46,95%CI 0.15-1.42,P=0.18)and stroke(HR 0.77,95%CI 0.29-2.09,P=0.61),but related to the increased risk of systemic embolism(HR 6.90,95%CI 1.95-24.45,P<0.01).After adjusting for other covariates,the multivariate Cox regression analysis showed that sleep apnea syndrome was an independent risk factor for the risk of systemic embolism in patients with AF(HR 5.42,95%CI 1.34-22.01,P=0.02).Conclusions:Male gender,BMI,smoking history,and a history of major bleeding are independent risk factors for sleep apnea in patients with AF.Sleep apnea may not be associated with the risk of all-cause death,cardiovascular death,or stroke in patients with AF,but was associated with increased risk of systemic embolism significantly.Background:The studies on optimal target of blood pressure level for patients with atrial fibrillation is limited,and there is few Chinese own research data.Therefore,this study aims to evaluate the impact of baseline blood pressure in patients with atrial fibrillation on one-year all-cause mortality.Methods:This study was from a Chinese AF registry study which included 20 emergency centers across China and consecutively enrolled 2016 patients with AF from 2008 to 2011.After excluding 26 patients who lacked detailed data,1990 patients with atrial fibrillation were finally included in the statistical analysis.All participants were followed for 1 year±1 month.The primary endpoint was all-cause mortality.Results:During the follow-up,276(13.9%)all-cause deaths occurred.Kaplan-Meier curves showed that a systolic blood pressure(SBP)≤110 mmHg or>160 mmHg was associated with a higher risk of all-cause mortality(log-rank test,P=0.014),and a diastolic blood pressure(DBP)<70 mmHg was associated with the highest risk of allcause mortality(log-rank test,P=0.002).After adjusting for confounders,the multivariable Cox regression model suggested that the risk of all-cause mortality was statistically increased in the group with SBP≤110 mmHg[hazard ratio(HR),1.963;95%confidence interval(CI),1.306-2.951],and DBP<70 mmHg(HR,1.628;95%CI,1.163-2.281).In the restricted cubic splines,relations between baseline SBP or DBP and all-cause mortality showed inverse J-shaped associations(non-linear P<0.001 and P=0.029,respectively).The risk of all-cause mortality notably increased at a lower baseline SBP and DBP.The subgroup analyses were consistent with the main findings.Conclusions:The results of this study suggest an inverse J-curve relationship between baseline blood pressure levels and the risk of all-cause mortality in patients with atrial fibrillation.The risk of all-cause mortality significantly increased when SBP is less than 110 mmHg(≤110 mmHg)or DBP is less than 70 mmHg(<70 mmHg).The risk of allcause mortality is the lowest when systolic blood pressure is 120 mmHg or diastolic BP is 80 mmHg in patients with atrial fibrillation.Background:Renin-angiotensin-aldosterone-system inhibitors markedly play an active role in the primary prevention of atrial fibrillation(AF),and the effect of angiotensin-converting enzyme inhibitors(ACEIs)or angiotensin receptor blockers(ARBs)on improving prognosis in patients with heart failure has also been demonstrated.However,the impact of ACEI/ARB on the mortality of patients with AF remains unclear.This study aimed to examine the relationship between treatment with ACEIs or ARBs and mortality in emergency department(ED)patients with AF and hypertension.Methods:This multicenter study enrolled 2016 ED patients from September 2008 to April 2011;1110 patients with AF and hypertension were analyzed.Patients were grouped according to whether they were treated with ACEI/ARB or not and completed a 1-year follow-up to evaluate outcomes including all-cause death,cardiovascular death,stroke,and major adverse events(MAE).Results:Among the 1110 patients with AF and hypertension,574(51.7%)received ACEI/ARB treatment.During the 1-year follow-up,169 all-cause deaths(15.2%)and 100 cardiovascular deaths(9.0%)occurred,while 98 strokes(8.8%)and 255 MAE(23.0%)occurred.Kaplan-Meier survival analysis suggested that the ACEI/ARB group had a significantly lower risk of all-cause death(Log-rank P=0.007)and MAE(Logrank P=0.003).According to the multivariate Cox regression analysis,ACEI/ARB therapy was significantly associated with a reduced risk of all-cause death(HR,0.605;95%CI 0.431-0.849;P=0.004).Moreover,ACEI/ARB therapy was independently associated with a reduced risk of cardiovascular death(HR 0.585;95%CI 0.372-0.921;P=0.020)and MAE(HR 0.651,95%CI 0.496-0.855,P=0.002)after adjusting for other risk factors.Conclusions:Our results revealed that ACEI/ARB therapy was independently associated with a reduced risk of all-cause death,cardiovascular death,and MAE in ED patients with AF and hypertension.These results provide evidence for drug treatment for patients with AF and hypertension. |
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