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BACKGROUND: Oral anti-coagulants (OAC) are the intervention for the prevention of stroke, which consistently improve clinical outcomes and survival among patients with atrial fibrillation (AF). The main purpose of this study is to identify problems in OAC utilization among hospitalized patients with AF in China. METHODS: Using data from the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation (CCC-AF) registry, guideline-recommended OAC use in eligible patients was assessed. RESULTS: A total of 52,530 patients with non-valvular AF were enrolled from February 2015 to December 2019, of whom 38,203 were at a high risk of stroke, 9717 were at a moderate risk, and 4610 were at a low risk. On admission, only 20.0% (6075/30,420) of patients with a diagnosed AF and a high risk of stroke were taking OAC. The use of pre-hospital OAC on admission was associated with a lower risk of new-onset ischemic stroke/transient ischemic attack among the diagnosed AF population (adjusted odds ratio: 0.54, 95% confidence interval: 0.43-0.68; P  70% of AF patients were at a high risk of stroke. Although poor performance on guideline-recommended OAC use was found in this study, over time the CCC-AF project has made progress in stroke prevention in the Chinese AF population.Registration:ClinicalTrials.gov, NCT02309398.

Copper, iron–chloride ionic liquids (ILs) were immobilized on SBA-15 via N-methylimidazole grafting with C–Cl in chloropropylsilane pre-anchored on SBA-15, followed by FeCl3 and CuCl2 coordination to imidazolium chloride to generate a double metal IL-supported mesoporous composite (SIL-CuFe). The prepared composite exhibited an effective catalytic performance for the solvent-free oxidation of styrene to benzaldehdye (BzH) with H2O2 oxidant, offering 51% conversion, a turnover number (TON) of 330.5 mol molFe+Cu−1, and a selectivity of 71% at a reaction temperature of 70 °C. The composite catalyst can be easily recovered and effectively reused without a significant loss in activity and selectivity. The quenching experiments by adding tert-butanol (TBA), 1,4-benzoquinone (p-BQ) and L -histidine (L -HIS) in the reaction system were conducted to identify the type of reactive O species, specifically ˙OH, ˙O2−, and 1O2, produced by catalyst activation with H2O2 and played a main role in the oxidation. The reaction mechanism of the oxidation process is also proposed. [ABSTRACT FROM AUTHOR]

Background: Effects of intensive blood pressure (BP) control on cognitive outcomes in patients with excess orthostatic BP changes are unclear. We aimed to evaluate whether orthostatic BP changes modified the effects of BP intervention on cognitive impairment. Methods: We analyzed 8547 participants from the Systolic Blood Pressure Intervention Trial Memory and cognition IN Decreased Hypertension. Associations between orthostatic BP changes and incident cognitive outcomes were evaluated by restricted cubic spline curves based on Cox models. The interactions between orthostatic BP changes and intensive BP intervention were assessed. Results: The U‐shaped associations were observed between baseline orthostatic systolic BP changes and cognitive outcomes. However, there were insignificant interactions between either change in orthostatic systolic BP (P for interaction = 0.81) or diastolic BP (P for interaction = 0.32) and intensive BP intervention for the composite outcome of probable dementia or mild cognitive impairment (MCI). The hazard ratio of intensive versus standard target for the composite cognitive outcome was 0.82 (95% CI 0.50–1.35) in those with an orthostatic systolic BP reduction of >20 mmHg and 0.41 (95% CI 0.21–0.80) in those with an orthostatic systolic BP increase of >20 mmHg. Results were similar for probable dementia and MCI. The annual changes in global cerebral blood flow (P for interaction = 0.86) consistently favored intensive BP treatment across orthostatic systolic BP changes. Conclusion: Intensive BP control did not have a deteriorating effect on cognitive outcomes among hypertensive patients experiencing significant postural BP changes. [ABSTRACT FROM AUTHOR]

Background: Wearable devices based on the PPG algorithm can detect atrial fibrillation (AF) effectively. However, further investigation of its application on long‐term, continuous monitoring of AF burden is warranted. Method: The performance of a smartwatch with continuous photoplethysmography (PPG) and PPG‐based algorithms for AF burden estimation was evaluated in a prospective study enrolling AF patients admitted to Beijing Anzhen Hospital for catheter ablation from September to November 2022. A continuous Electrocardiograph patch (ECG) was used as the reference device to validate algorithm performance for AF detection in 30‐s intervals. Results: A total of 578669 non‐overlapping 30‐s intervals for PPG and ECG each from 245 eligible patients were generated. An interval‐level sensitivity of PPG was 96.3% (95% CI 96.2%–96.4%), and specificity was 99.5% (95% CI 99.5%–99.6%) for the estimation of AF burden. AF burden estimation by PPG was highly correlated with AF burden calculated by ECG via Pearson correlation coefficient (R2 = 0.996) with a mean difference of ‐0.59 (95% limits of agreement, ‐7.9% to 6.7%). The subgroup study showed the robust performance of the algorithm in different subgroups, including heart rate and different hours of the day. Conclusion: Our results showed the smartwatch with an algorithm‐based PPG monitor has good accuracy and stability in continuously monitoring AF burden compared with ECG patch monitors, indicating its potential for diagnosing and managing AF. [ABSTRACT FROM AUTHOR]

Background: Evidence was lacking for the early choice of radiofrequency ablation (RFA) among patients with early‐onset atrial fibrillation (AF). Hypothesis: This study aimed to explore whether earlier RFA was associated with better clinical outcomes among early‐onset AF patients. Methods: Patients, who were diagnosed with AF before 45 years and underwent their first RFA procedures at baseline of the China Atrial Fibrillation registry, were enrolled and divided into four diagnosis‐to‐ablation time (DAT) groups: DAT ≤ 1 year, 1 year < DAT ≤ 3 years, 3 years < DAT ≤ 6 years, and DAT > 6 years. Another group of nonablation patients, who were newly diagnosed with AF and younger than 45 years, were also included. Adjusted associations of groups with composite cardiovascular events (cardiovascular death, embolism, major hemorrhages, or cardiac rehospitalization) or recurrent AF were analyzed using Cox proportional hazards models. Results: Among 1694 patients who underwent their first RFA at enrollment, incidences of composite cardiovascular outcomes were increasing with extension of DAT (DAT ≤ 1 year: 6.1/100 person‐years, 1 year < DAT ≤ 3 years: 7.9/100 person‐years, 3 years < DAT ≤ 6 years: 7.6/100 person‐years, DAT > 6 years: 10.5/100 person‐years; p <.001). In comparison with DAT > 6 years group, the DAT ≤ 1 year group was associated with reduced risk of cardiovascular events (adjusted hazard ratio, HR [95% confidence interval, CI] = 0.64 [0.47–0.87], p =.005) and AF recurrence (adjusted HR [95% CI] = 0.70 [0.57–0.88], p =.002). Associations remained similar after stratified by AF types. Compared to nonablation group (n = 413), DAT ≤ 1year patients tended to show lower cardiovascular risk (adjusted HR [95% CI] = 0.78 [0.58–1.05], p =.099) and lower risk of recurrent AF (adjusted HR [95% CI] = 0.46 [0.38–0.55], p <.001). Conclusions: A shorter DAT was associated with a lower risk of cardiovascular events and recurrent AF for early‐onset AF patients. [ABSTRACT FROM AUTHOR]