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Association of kidney function and atrial fibrillation progression to clinical outcomes in patients with cardiac implantable electronic devices.
American Heart Journal ( IF 4.8 ) Pub Date : 2021-06-10 , DOI: 10.1016/j.ahj.2021.06.002
Karolina Szummer 1 , Krishna Pundi 2 , Alexander C Perino 2 , Jun Fan 3 , Mitra Kothari 3 , Mintu P Turakhia 2
Affiliation  

BACKGROUND Kidney function may promote progression of AF. OBJECTIVE We evaluated the association of kidney function to AF progression and resultant clinical outcomes in patients with cardiac implantable electronic devices (CIED). METHODS We performed a retrospective cohort study using national clinical data from the Veterans Health Administration linked to CIED data from the Carelink® remote monitoring data warehouse (Medtronic Inc, Mounds View, MN). All devices had atrial leads and at least 75% of remote monitoring transmission coverage. Patients were included at the date of the first AF episode lasting ≥6 minutes, and followed until the occurrence of persistent AF in the first year, defined as ≥7 consecutive days with continuous AF. We used Cox regression analyses with persistent AF as a time-varying covariate to examine the association to stroke, myocardial infarction, heart failure and death. RESULTS Of, 10,323 eligible patients, 1,771 had a first CIED-detected AF (mean age 69 ± 10 years, 1.2% female). In the first year 355 (20%) developed persistent AF. Kidney function was not associated with persistent AF after multivariable adjustment including CHA2DS2-VASc variables and prior medications. Only higher age increased the risk (HR: 1.37 per 10 years; 95% CI:1.22-1.54). Persistent AF was associated to higher risk of heart failure (HR: 2.27; 95% CI: 1.88-2.74) and death (HR: 1.60; 95% CI: 1.30-1.96), but not stroke (HR: 1.28; 95% CI: 0.62-2.62) or myocardial infarction (HR: 1.43; 95% CI: 0.91-2.25). CONCLUSION Kidney function was not associated to AF progression, whereas higher age was. Preventing AF progression could reduce the risk of heart failure and death.

中文翻译:

心脏植入式电子设备患者肾功能和心房颤动进展与临床结果的关联。

背景肾功能可促进AF的进展。目的 我们在心脏植入式电子设备 (CIED) 患者中评估了肾功能与 AF 进展和由此产生的临床结果的关联。方法 我们使用退伍军人健康管理局的国家临床数据进行了一项回顾性队列研究,这些数据与来自 Carelink® 远程监控数据仓库(美敦力公司,Mounds View,MN)的 CIED 数据相关联。所有设备都有心房导联和至少 75% 的远程监测传输覆盖。患者在第一次持续≥6 分钟的 AF 发作日期被纳入,并随访至第一年发生持续性 AF,定义为连续 AF ≥ 7 天。我们使用 Cox 回归分析和持续性 AF 作为时变协变量来检查与中风、心肌梗死、心力衰竭和死亡的关联。结果 在 10,323 名符合条件的患者中,1,771 名首次 CIED 检测到 AF(平均年龄 69 ± 10 岁,女性占 1.2%)。第一年 355 (20%) 发生持续性 AF。在包括 CHA2DS2-VASc 变量和既往药物在内的多变量调整后,肾功能与持续性 AF 无关。只有较高的年龄才会增加风险(HR:1.37 每 10 年;95% CI:1.22-1.54)。持续性房颤与更高的心力衰竭风险(HR:2.27;95% CI:1.88-2.74)和死亡(HR:1.60;95% CI:1.30-1.96)相关,但与中风无关(HR:1.28;95% CI) :0.62-2.62)或心肌梗塞(HR:1.43;95% CI:0.91-2.25)。结论肾功能与 AF 进展无关,而更高的年龄是。预防房颤进展可以降低心力衰竭和死亡的风险。
更新日期:2021-06-09
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