17 results on '"Saad, Marwan"'
Search Results
2. Meta-Analysis Assessing Efficacy and Safety of Vitamin K Antagonists Versus Direct Oral Anticoagulants for Atrial Fibrillation After Transcatheter Aortic Valve Implantation.
- Author
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Selvaraj V, Khan MS, Mufarrih SH, Kazimuddin M, Waheed MA, Tripathi A, Bavishi C, Hyder ON, Aronow HD, Saad M, and Abbott JD
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- Humans, Male, Aged, 80 and over, Female, Fibrinolytic Agents therapeutic use, Anticoagulants therapeutic use, Hemorrhage chemically induced, Hemorrhage epidemiology, Hemorrhage complications, Vitamin K, Administration, Oral, Randomized Controlled Trials as Topic, Atrial Fibrillation complications, Atrial Fibrillation drug therapy, Atrial Fibrillation surgery, Transcatheter Aortic Valve Replacement adverse effects, Stroke epidemiology, Stroke etiology, Stroke prevention & control
- Abstract
Patients who underwent transcatheter aortic valve implantation (TAVI) with concomitant atrial fibrillation (AF) are at a higher risk for thromboembolic and bleeding events. The optimal antithrombotic strategy for patients with AF after TAVI remains unclear. We sought to determine the comparative efficacy and safety of direct oral anticoagulants (DOAC) versus oral vitamin K antagonists (VKAs) in these patients. Electronic databases such as PubMed, Cochrane, and Embase databases were searched till January 31, 2023, for relevant studies evaluating clinical outcomes of VKA versus DOAC in patients with AF after TAVI. Outcomes assessed were (1) all-cause mortality, (2) stroke, (3) major/life-threatening bleeding, and (4) any bleeding. Hazard ratios (HRs) were pooled in meta-analysis using random effect model. Nine studies (2 randomized and 7 observational) were included in systematic review, and 8 studies with 25,769 patients were eligible to be included in the meta-analysis. The mean age of the patients was 82.1 years, and 48.3% were male. Pooled analysis using random-effects model showed no statistically significant difference in all-cause mortality (HR 0.91, 95% confidence interval [CI] 0.76 to 1.10, p = 0.33), stroke (HR 0.96, 95% CI 0.80 to 1.16, p = 0.70), and major/life-threatening bleeding (HR 1.05, 95% CI 0.82 to 1.35, p = 0.70) in patients that received DOAC compared with oral VKA. Risk of any bleeding was lower in the DOAC group compared with oral VKA (HR 0.83, 95% CI 0.76 to 0.91, p = 0.0001). In patients with AF, DOACs appear to be a safe alternative oral anticoagulation strategy to oral VKA after TAVI. Further randomized studies are required to confirm the role of DOACs in those patients., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to declare., (Copyright © 2023 Elsevier Inc. All rights reserved.)
- Published
- 2023
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3. Incidence and Predictors of New-Onset Atrial Fibrillation After Transcatheter Edge-to-Edge Repair of the Mitral Valve (from the Nationwide Readmissions Database).
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Lima FV, Berkowitz J, Kennedy KF, Kolte D, Saad M, Elmariah S, Palacios IF, Inglessis I, Khera S, Assa EB, Gordon P, and Chu AF
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- Electrolytes, Humans, Incidence, Mitral Valve surgery, Patient Readmission, Postoperative Complications etiology, Risk Factors, Aortic Valve Stenosis surgery, Atrial Fibrillation etiology, Heart Failure complications, Transcatheter Aortic Valve Replacement adverse effects
- Abstract
Patients who underwent transcatheter edge-to-edge repair (TEER) for mitral regurgitation with atrial fibrillation (AF) at baseline have higher mortality than those without AF. Data on new-onset AF (NOAF) after TEER are limited. Using the 2016 to 2018 Nationwide Readmissions Database, we identified a cohort of patients who underwent TEER and classified them into 3 groups based on AF presence during the study period. The primary end point was the incidence and timing of NOAF up to 6 months after TEER. Logistic regression modeling identified independent predictors of NOAF at readmission. Of the 6,861patients that underwent TEER, 4,134 (59.9%) had AF at baseline, and 239 (3.5%) developed NOAF. Median time-to-NOAF admission was 47 days (interquartile range 16 to 113), and 37% of patients with NOAF presented within 30 days after TEER. Patients with NOAF experienced costlier and longer index-TEER hospitalization and had more co-morbidities. Chronic kidney disease (odds ratio [OR] 1.51, 95% confidence interval [CI] 1.03 to 2.20), fluid and electrolyte disorders (OR 1.59, 95% CI 1.01 to 2.52), and heart failure (OR 1.86, 95% CI 1.01 to 3.44) were identified as independent predictors of NOAF. Hypertensive complications and heart failure were the leading causes of readmission. In conclusion, those patients that developed NOAF after TEER tended to be an overall sicker group at baseline compared with the remainder of the study cohort. These data, obtained from a nationally representative cohort, highlight a particular group of patients subject to developing NOAF and their association with increased rehospitalization in the post-TEER setting. Predictors of NOAF can be screened for during TEER workup to identify patients at increased risk., Competing Interests: Disclosures Dr. Khera is a consultant, speaker, and proctor for Medtronic; a consultant for Terumo, Abbott, and Boston Scientific; and a speaker for Zoll Medical. Dr. Elmariah received research grants from Edwards Lifesciences, Medtronic, and Abbott Vascular and is also a consultant for Edwards Lifesciences. The remaining authors have no conflicts of interest to declare., (Copyright © 2022 Elsevier Inc. All rights reserved.)
- Published
- 2022
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4. Preadmission Oral Anticoagulation for Atrial Fibrillation/Flutter and Death or Thrombotic Events During COVID-19 Admission.
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Louis DW, Kennedy KF, Saad M, Salber G, Imran H, Wark T, Soares C, Ghosalkar D, Cherala R, Poppas A, Abbott JD, and Aronow HD
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- Administration, Oral, Anticoagulants therapeutic use, Hospital Mortality, Hospitalization, Humans, Risk Assessment, Risk Factors, Atrial Fibrillation complications, Atrial Fibrillation drug therapy, Atrial Fibrillation epidemiology, Atrial Flutter drug therapy, COVID-19 complications, COVID-19 epidemiology, Stroke epidemiology, Thrombosis epidemiology, Thrombosis etiology, Thrombosis prevention & control
- Abstract
Atrial fibrillation/flutter (AF) and COVID-19 are associated with an elevated risk of arterial and venous thrombosis. Whether preadmission oral anticoagulation (OAC) for AF reduces the incidence of in-hospital death or thrombotic events among patients with COVID-19 is unknown. We identified 630 patients with pre-existing AF and a hospitalization diagnosis of COVID-19 and stratified them according to preadmission OAC use. Multivariable logistic regression was employed to relate preadmission OAC to composite in-hospital mortality or thrombotic events. Unadjusted composite in-hospital mortality or thrombotic complications occurred less often in those on than not on preadmission OAC (27.1% vs 46.8%, p <0.001). After adjustment, the incidence of composite in-hospital all-cause mortality or thrombotic complications remained lower with preadmission OAC (odds ratio 0.37, confidence interval 0.25 to 0.53, p <0.0001). Secondary outcomes including all-cause mortality (16.3% vs 24.9%, p = 0.007), intensive care unit admission (14.7% vs 29.0%, p <0.001), intubation (6.4% vs 18.6%, p <0.001), and noninvasive ventilation (18.6% vs 27.5%, p = 0.007) occurred less frequently, and length of stay was shorter (6 vs 7 days, p <0.001) in patients on than those not on preadmission OAC. A higher CHA
2 DS2 -VASc score was associated with an increased risk of thrombotic events. In conclusion, among patients with baseline AF who were hospitalized with COVID-19, those on preadmission OAC had lower rates of death, arterial and venous thrombotic events, and less severe COVID-19., Competing Interests: Disclosures The authors have no conflicts of interest to declare., (Copyright © 2022 Elsevier Inc. All rights reserved.)- Published
- 2022
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5. Direct Oral Anticoagulants Versus Warfarin in Patients With Atrial Fibrillation and Valve Replacement or Repair.
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Mentias A, Saad M, Michael M, Nakhla S, Menon V, Harb S, Chaudhury P, Johnston D, Saliba W, Wazni O, Svensson L, Desai MY, and Kapadia S
- Subjects
- Administration, Oral, Aged, Anticoagulants adverse effects, Dabigatran adverse effects, Hemorrhage chemically induced, Hemorrhage epidemiology, Humans, Medicare, Pyridones therapeutic use, Rivaroxaban therapeutic use, United States epidemiology, Warfarin adverse effects, Atrial Fibrillation complications, Atrial Fibrillation diagnosis, Atrial Fibrillation drug therapy, Ischemic Stroke, Stroke epidemiology, Stroke etiology, Stroke prevention & control
- Abstract
Background We sought to examine outcomes of direct oral anticoagulants (DOACs) versus warfarin in atrial fibrillation with valve repair/replacement. Methods and Results Two atrial fibrillation cohorts from Medicare were identified from 2015 to 2019. They comprised patients who underwent surgical or transcatheter mitral valve repair (MV repair cohort) and surgical aortic or mitral bioprosthetic or transcatheter aortic valve replacement (bioprosthetic cohort). Each cohort was divided into warfarin and DOACs (apixaban, rivaroxaban, and dabigatran) groups. Study outcomes included mortality, stroke, and major bleeding. Inverse probability weighting was used for adjustment between the 2 groups in each cohort. The MV repair cohort included 1178 patients. After a median of 468 days, DOACs were associated with lower risk of mortality (hazard ratio [HR], 0.67 [95% CI, 0.55-0.82], P <0.001), ischemic stroke (HR, 0.72 [95% CI, 0.52-1.00], P =0.05) and bleeding (HR, 0.79 [95% CI, 0.63-0.99], P =0.04) compared with warfarin. The bioprosthetic cohort included 8089 patients. After a median follow-up of 413 days, DOACs were associated with similar risk of mortality (adjusted HR, 0.93 [95% CI, 0.86-1.01], P =0.08), higher risk of ischemic stroke (adjusted HR, 1.27 [95% CI, 1.13-1.43], P <0.001), and lower risk of bleeding (adjusted HR, 0.86 [95% CI, 0.80-0.93], P <0.001) compared with warfarin. Conclusions In patients with atrial fibrillation, DOACs are associated with similar mortality, lower bleeding, but higher stroke with bioprosthetic valve replacement and lower risk of all 3 outcomes with MV repair compared with warfarin.
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- 2022
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6. Preoperative Atrial Fibrillation and Cardiovascular Outcomes After Noncardiac Surgery.
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Prasada S, Desai MY, Saad M, Smilowitz NR, Faulx M, Menon V, Moudgil R, Chaudhury P, Hussein AA, Taigen T, Nakhla S, and Mentias A
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- Aged, Female, Humans, Male, Medicare, Risk Assessment methods, Risk Factors, United States epidemiology, Atrial Fibrillation complications, Heart Failure, Myocardial Infarction complications, Stroke complications, Stroke etiology
- Abstract
Background: The impact of pre-existing atrial fibrillation (AF) on outcomes after noncardiac surgery is not clear., Objectives: We aimed to study the impact of AF on the risk of adverse outcomes after noncardiac surgery in a nationwide cohort., Methods: We identified Medicare beneficiaries admitted for noncardiac surgery from 2015 to 2019 and divided the study cohort into 2 groups: with and without AF. Noncardiac surgery was classified into vascular, thoracic, general, genitourinary, gynecological, orthopedics and neurosurgery, breast, head and neck, and transplant. We used propensity score matching on exact age, sex, race, urgency and type of surgery, revised cardiac risk index (RCRI) and CHA
2 DS2 -VASc score, and tight caliper on other comorbidities. The study outcomes were 30-day mortality, stroke, myocardial infarction, and heart failure. We examined the incremental utility of AF in addition to RCRI to predict adverse events after noncardiac surgery., Results: The study cohort included 8,635,758 patients who underwent noncardiac surgery (16.4% with AF). Patients with AF were older, more likely to be men, and had higher prevalence of comorbidities. After propensity score matching, AF was associated with higher risk of mortality (OR: 1.31; 95% CI: 1.30-1.32), heart failure (OR: 1.31; 95% CI: 1.30-1.33), and stroke (OR: 1.40; 95% CI: 1.37-1.43) and lower risk of myocardial infarction (OR: 0.81; 95% CI: 0.79-0.82). Results were consistent in subgroup analysis by sex, race, type of surgery, and all strata of RCRI and CHA2 DS2 -VASc score. AF improved the discriminative ability of RCRI (C-statistic 0.73 to 0.76)., Conclusion: Pre-existing AF is independently associated with postoperative adverse outcomes after NCS., Competing Interests: Funding Support and Author Disclosures The current research was partly funded by philanthropic gifts by the Haslam Family, Bailey Family, and Khouri family to the Cleveland Clinic for Dr Milind Desai's research. Dr Desai is a consultant for Medtronic and Bristol Myers Squibb; and is on the executive steering committee of a trial sponsored by Bristol Myers Squibb. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)- Published
- 2022
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7. In-hospital outcomes of transesophageal versus intracardiac echocardiography guided left atrial appendage closure.
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Morcos R, Megaly M, Saad M, Barakat AF, Rubens M, Saxena A, Elbadawi A, Kucharik M, Luna M, Garcia S, Veledar E, Maini B, and Khalili H
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- Cardiac Catheterization adverse effects, Cardiac Catheterization methods, Echocardiography, Transesophageal, Hospitals, Humans, Retrospective Studies, Treatment Outcome, Atrial Appendage, Atrial Fibrillation complications, Atrial Fibrillation diagnostic imaging, Atrial Fibrillation therapy, Pericardial Effusion complications, Pericardial Effusion etiology
- Abstract
Background: Transesophageal echocardiogram (TEE) is the preferred imaging modality to guide transcatheter left atrial appendage closure (LAAC). Intracardiac echocardiography (ICE) has evolved as a less invasive alternative to TEE. Several observational studies have shown similar success rates and perioperative complications between TEE and ICE for LAAC., Objectives: We sought to examine the temporal trends and patient characteristics of TEE versus ICE use in LAAC using a national database. We also evaluated hospital outcomes including periprocedural complications, mortality, and length of hospital stay., Methods: This is a retrospective analysis of data from the National Readmission Database, collected from 2016 to 2018. The primary outcome was major adverse events (MAE) defined as in-hospital mortality, cardiac arrest, pericardial effusion with or without tamponade, pericardiocentesis or window pericardiocentesis and pericardial window, pericardial effusion and tamponade, and hemorrhage requiring transfusion., Results: Trend analysis showed that TEE-guided LAAC increased from 96.6% in 2016 to 98.4% in 2018 (relative increase, 1.9%), while ICE-guided LAAC decreased from 3.4% to 1.6% during the same period (relative decrease, 53%, p for trend = 0.08). In the unmatched cohorts, the MAE was significantly lower in TEE-guided LAAC compared to ICE-guided LAAC (6.5% vs. 9.3%, p = 0.022). In the propensity score matching analysis, MAE remained significant (5.6% vs. 9.4%, p < 0.001). The incidence of pericardial effusion with or without tamponade remained significantly lower in the TEE group (2.3% vs. 5.8%, p < 0.001). Length of stay (3.4 vs. 1.9 days, p < 0.001) and hospitalization cost ($34,826 vs. $20,563, p < 0.001) remained significantly lower for TEE-guided LAAC., Conclusions: Compared to ICE, the incidence of MAE was significantly lower for TEE-guided LAAC, driven mainly by less pericardial effusion events. Large-scale randomized trials are needed to confirm the findings of the current and previous studies., (© 2022 Wiley Periodicals LLC.)
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- 2022
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8. Impact of Pre-Existing and New-Onset Atrial Fibrillation on Outcomes After Transcatheter Aortic Valve Replacement.
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Mentias A, Saad M, Girotra S, Desai M, Elbadawi A, Briasoulis A, Alvarez P, Alqasrawi M, Giudici M, Panaich S, Horwitz PA, Jneid H, Kapadia S, and Vaughan Sarrazin M
- Subjects
- Aged, Aged, 80 and over, Aortic Valve diagnostic imaging, Aortic Valve physiopathology, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis epidemiology, Aortic Valve Stenosis physiopathology, Atrial Fibrillation diagnosis, Atrial Fibrillation physiopathology, Databases, Factual, Female, Heart Failure epidemiology, Heart Rate, Hemorrhage epidemiology, Humans, Incidence, Male, Medicare, Patient Readmission, Retrospective Studies, Risk Assessment, Risk Factors, Stroke epidemiology, Time Factors, Treatment Outcome, United States epidemiology, Aortic Valve surgery, Aortic Valve Stenosis surgery, Atrial Fibrillation epidemiology, Transcatheter Aortic Valve Replacement adverse effects
- Abstract
Objectives: This study sought to evaluate impact of new-onset and pre-existing atrial fibrillation (AF) on transcatheter aortic valve replacement (TAVR) long-term outcomes compared with patients without AF., Background: Pre-existing and new-onset AF in patients undergoing TAVR are associated with poor outcomes., Methods: The study identified 72,660 patients ≥65 years of age who underwent nonapical TAVR between 2014 and 2016 using Medicare inpatient claims. History of AF was defined by diagnoses on claims during the 3 years preceding the TAVR, and new-onset AF was defined as occurrence of AF during the TAVR admission or within 30 days after TAVR in a patient without prior history of AF. Outcomes included all-cause mortality, and readmission for bleeding, stroke, and heart failure (HF)., Results: Overall, 40.7% had pre-existing AF (n = 29,563) and 6.8% experienced new-onset AF (n = 2,948) after TAVR. Mean age was 81.3, 82.4, and 83.8 years in patients with no AF, pre-existing, and new-onset AF, respectively. Pre-existing AF patients had the highest burden of comorbidities. After follow-up of 73,732 person-years, mortality was higher with new-onset AF compared with pre-existing and no AF (29.7, 22.6, and 12.8 per 100 person-years, respectively; p < 0.001). After adjusting for patient characteristics and hospital TAVR volume, new-onset AF remained associated with higher mortality compared with no AF (adjusted hazard ratio: 2.068, 95% confidence interval [CI]: 1.92 to 2.20; p < 0.01) and pre-existing AF (adjusted hazard ratio: 1.35; 95% CI: 1.26 to 1.45; p < 0.01). In competing risk analysis, new-onset AF was associated with higher risk of bleeding (subdistribution hazard ratio [sHR]: 1.66; 95% CI: 1.48 to 1.86; p < 0.01), stroke (sHR: 1.92; 95% CI: 1.63 to 2.26; p < 0.01), and HF (sHR: 1.98; 95% CI: 1.81 to 2.16; p < 0.01) compared with pre-existing AF., Conclusions: In patients undergoing TAVR, new-onset AF is associated with increased risk of mortality and bleeding, stroke, and HF hospitalizations compared with pre-existing AF or no AF., (Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
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9. Heart failure progression and mortality in atrial fibrillation patients with preserved or reduced left ventricular ejection fraction.
- Author
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Slee A, Saad M, and Saksena S
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- Aged, Disease Progression, Female, Humans, Male, Ventricular Dysfunction, Left physiopathology, Ventricular Function, Left physiology, Atrial Fibrillation physiopathology, Heart Failure mortality, Heart Failure physiopathology, Stroke Volume
- Abstract
Background: Atrial fibrillation (AF) worsens cardiovascular (CV) outcomes of heart failure (HF) and vice versa. The impact of rate or rhythm control strategies on HF progression and survival remains unclear., Methods: We examined the risk of HF progression in AF patients (pts) with a prior HF event and minimal or no HF burden (NYHA class 0 or 1). They were stratified into HF with a preserved left ventricular ejection fraction (≥ 40%, pEF) or reduced EF (< 40%, rEF). HF subgroups from the Rate and Rhythm arm were compared for the primary outcome of worsening HF or death (WHFD), total mortality, cardiovascular mortality, and cardiovascular hospitalizations., Results: Four hundred ninety-two AF pts (HFpEF = 349, HFrEF = 143) were analyzed. Baseline characteristics were generally comparable in the Rate and Rhythm arms of the two subgroups. Over a median follow-up of 4 years, HF recurred and worsened in 66.6% and 41.2% of pts by ≥ 1 and ≥ 2 NYHA classes, respectively. HF progression by even 1 NYHA class increased the mortality risk in HFpEF (hazard ratio (HR) 2.06; 95% confidence intervals (CI) 1.25-3.4; p = 0.004) and HFrEF (HR 1.9; 95% CI 0.99-3.66; p = 0.054). Cardiovascular hospitalization (CVH) increased in HFpEF (HR 3.67; 95% CI 2.56, 5.25; p < 0.0001) and HFrEF (HR 2.8; 95% CI 1.53-5.14; p = 0.0009). HF progression by 2 or more NYHA classes or death was significantly worse in pts with HFrEF with the Rate control strategy compared with the Rhythm control (HR 1.62; 95% CI 1.03-2.53; p = 0.036) but similar in pts with HFpEF (HR 0.88; 95% CI 0.64-1.21; p = 0.440).The time to first AF recurrence was longer in the Rhythm arms of both HF subgroups as compared with Rate (Figure, p < 0.05)., Conclusions: (1) HF progression in AF pts with a prior HF event confers significant mortality and CVH risk in both HFrEF and HFpEF populations. (2) HF progression is more pronounced with a Rate control strategy in AF pts with HFrEF, but is comparable to Rhythm control in AF pts with HFpEF. (3) A Rhythm control strategy may be desirable to reduce HF progression in pts with HFrEF and AF. Prospective clinical trials appear warranted to examine HF progression by treatment strategy in HFpEF and HFrEF populations with AF.
- Published
- 2019
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10. Outcomes of Surgical Ablation in Patients With Atrial Fibrillation Undergoing Cardiac Surgeries.
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Elbadawi A, Elgendy IY, Mahmoud AH, Ogunbayo GO, Saad M, Megaly M, Alotaki E, Mentias A, Barakat AF, and London B
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- Adolescent, Adult, Aged, Aged, 80 and over, Atrial Fibrillation complications, Atrial Fibrillation mortality, Female, Hospital Mortality, Hospitalization, Humans, Incidence, Male, Middle Aged, Propensity Score, Retrospective Studies, Treatment Outcome, Young Adult, Atrial Fibrillation surgery, Cardiac Surgical Procedures adverse effects, Catheter Ablation adverse effects, Postoperative Complications epidemiology
- Abstract
Background: Surgical ablation procedure is commonly performed in patients with atrial fibrillation (AF) undergoing cardiac surgeries; however, the evidence regarding its impact on in-hospital cardiovascular outcomes is controversial., Methods: We queried the Nationwide Inpatient Sample Database for patients with AF who underwent cardiac surgeries from 1998 to 2013. We performed a propensity-score matching including 21 various baseline characteristics to compare those who underwent surgical ablation with those who had not., Results: A total of 47,964 hospitalizations were included in our final analysis. On propensity matching, 23,975 were in the surgical ablation group and 23,990 in the control group. The primary outcome of in-hospital mortality was lower in the surgical ablation group compared with the control group (3.6% versus 4.2%, p < 0.001). The surgical ablation group was associated with lower in-hospital cerebrovascular accident (2.0% versus 2.8%, p < 0.001), cardiogenic shock (2.6% versus 3.6%, p < 0.001), use of intraaortic balloon pump (5.1% versus 5.8%, p = 0.001), and shorter length of hospital stay (12.3 ± 10.1 versus 12.5 ± 10.3 days, p = 0.008). There was no difference between the surgical ablation and control groups in the incidence of cardiac tamponade (0.4% versus 0.3%, p = 0.296). The surgical ablation group was associated with a higher rate of complete heart block (5.2% versus 4.3%, p < 0.001) and permanent pacemaker insertion (8.6% versus 8.0%, p = 0.01)., Conclusions: In this large analysis of almost 50,000 patients with AF undergoing cardiac surgery, surgical ablation appears to be safe in the short term. Future studies should focus on evaluating the long-term effectiveness of this procedure., (Copyright © 2019 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
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11. Atrial resynchronization therapy in patients with atrial fibrillation and heart failure with and without systolic left ventricular dysfunction: a pilot study.
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Saksena S, Slee A, and Saad M
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- Aged, Atrial Fibrillation diagnostic imaging, Cohort Studies, Comorbidity, Female, Heart Failure diagnostic imaging, Humans, Male, Middle Aged, Pacemaker, Artificial, Pilot Projects, Prognosis, Retrospective Studies, Risk Assessment, Severity of Illness Index, Stroke Volume physiology, Survival Rate, Treatment Outcome, Ventricular Dysfunction, Left diagnostic imaging, Ventricular Dysfunction, Left physiopathology, Atrial Fibrillation epidemiology, Atrial Fibrillation therapy, Cardiac Resynchronization Therapy methods, Heart Failure epidemiology, Heart Failure therapy, Ventricular Function, Left physiology
- Abstract
Background: We examined the long-term (≥ 5 years) outcomes of dual-site atrial pacing (DAP) when added to background antiarrhythmic drugs (AADs) and/or ablation in patients with refractory atrial fibrillation (AF) and heart failure (HF)., Methods: Seventy-three patients with HF (mean NYHA HF class of 2.5) and AF refractory to AADs and/or ablation were implanted with DAP systems to achieve biatrial electrical and mechanical resynchronization (ART) and rhythm control (RC)., Results: Thirty-eight patients with refractory AF and HF with preserved ejection fraction (HFpEF) and 35 with reduced ejection fraction (HFrEF) were enrolled. HFpEF patients had higher left ventricular ejection fraction compared to HFrEF (53 ± 5 vs. 31 ± 10% p < 0.001). Median follow-up for survival was 9.3 years (mean 9.0 years, SE 0.63) and was similar across subgroups (p = 0.127). After DAP, 87% maintained RC with improvement in NYHA HF class (mean 1.8) at 3 years. RC was similar in HFpEF compared with HFrEF patients (89 vs. 85% respectively, p = NS) and in paroxysmal versus persistent AF (90 vs. 85% respectively, p = NS). Total survival was superior in HFpEF compared HFrEF patients (75% in HFpEF vs. 45% in HFrEF at 5 years, and 60% in HFpEF vs. 34% in HFrEF at 10 years, p = 0.036). Survival trended to be better in patients with RC than those without RC (75 vs. 54% respectively at 5 years, p = .13)., Conclusions: ART using DAP as add on therapy improved HF and established long-term RC in many patients with HFrEF and HFpEF with refractory AF. Long-term survival rates were superior in HFpEF than HFrEF.
- Published
- 2018
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12. In-Hospital Cerebrovascular Outcomes of Patients With Atrial Fibrillation and Cancer (from the National Inpatient Sample Database).
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Elbadawi A, Elgendy IY, Ha LD, Baig B, Saad M, Adly H, Ogunbayo GO, Olorunfemi O, Mckillop MS, and Maffett SA
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- Aged, Female, Hospital Mortality, Hospitalization, Humans, Length of Stay statistics & numerical data, Male, Propensity Score, Risk Factors, Survival Rate, United States, Atrial Fibrillation complications, Neoplasms complications, Stroke mortality
- Abstract
Limited data are available regarding the impact of cancer on cerebrovascular accidents in patients with atrial fibrillation (AF). We queried the Nationwide Inpatient Survey Database to identify patients who have diagnostic code for AF. We performed a 1:1 propensity matching based on the CHA
2 DS2 VASc score and other risk factors between patients with AF who had lung, breast, colon, and esophageal cancer, and those who did not (control). The final cohort included a total of 31,604 patients. The primary outcome of in-hospital cerebrovascular accidents (CVA) was lower in the cancer group than in the control group (4% vs 7%, p < 0.001), but with only a weak association (ф = -0.067). In-hospital mortality was higher in the cancer group than in the control group (18% vs 11%, p < 0.001; ф = -0.099). A subgroup analysis according to cancer type showed similar results with a weak association with lower CVA in breast cancer (4% vs 7%; ф = -0.066, p < 0.001), lung cancer (4% vs 6%; ф = -0.062, p < 0.001), colon cancer (4% vs 6%; ф = -0.062, p < 0.001), and esophageal cancer (3% vs 7%; ф = -0.095, p < 0.001) compared with the control groups. A weak association with higher in-hospital mortality was demonstrated in lung cancer (20% vs 11%; ф = -0.127, p < 0.001), colon cancer (16% vs 11%; ф = -0.076, p < 0.001), and esophageal cancer (20% vs 12%; ф = -0.111, p < 0.001) compared with the control groups, but no significant difference between breast cancer and control groups in mortality (11% vs 11%; ф = -0.002, p = 0.888). In conclusion, in patients with AF, cancer diagnosis may not add a predictive role for in-hospital CVA beyond the CHADS2VASc score., (Copyright © 2017 Elsevier Inc. All rights reserved.)- Published
- 2018
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13. Impact of Left Atrial Appendage Exclusion on Cardiovascular Outcomes in Patients With Atrial Fibrillation Undergoing Coronary Artery Bypass Grafting (From the National Inpatient Sample Database).
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Elbadawi A, Ogunbayo GO, Elgendy IY, Olorunfemi O, Saad M, Ha LD, Alotaki E, Baig B, Abuzaid AS, Shahin HI, Shah A, and Rao M
- Subjects
- Aged, Atrial Fibrillation complications, Coronary Artery Disease complications, Female, Hospital Mortality trends, Humans, Incidence, Male, Registries, Survival Rate trends, Treatment Outcome, United States epidemiology, Atrial Appendage surgery, Atrial Fibrillation surgery, Cardiac Surgical Procedures methods, Coronary Artery Bypass, Coronary Artery Disease surgery, Inpatients statistics & numerical data, Postoperative Complications epidemiology
- Abstract
Left atrial appendage (LAA) exclusion is performed by some surgeons in patients with atrial fibrillation (AF) who undergo coronary artery bypass grafting (CABG). However, the available evidence regarding the efficacy and safety of this procedure remains mixed. We queried the Nationwide Inpatient Survey Database for the 10-year period from 2004 to 2013. Using International Classification of Diseases, Ninth Edition, Clinical Modification diagnosis codes, we identified patients who had a diagnosis of AF and underwent a primary procedure of CABG with or without LAA exclusion. We then performed a 1:5 matching based on the CHA
2 DS2 VASc score between patients who got LAA exclusion and those who did not (control group). The primary outcome was the incidence of in-hospital cerebrovascular events, whereas the secondary outcomes included in-hospital bleeding events, pericardial effusion, cardiac tamponade, postoperative shock, and mortality. Our analysis included a total of 15,114 patients. Patients who underwent LAA exclusion had significantly less incidence of cerebrovascular events (2.0% vs 3.1%, p = 0.002). However, LAA exclusion group had higher incidences of bleeding events (36.4% vs 21.3%, p <0.001), pericardial effusion (2.7% vs 1.2%, p <0.001), cardiac tamponade (0.6% vs 0.2%, p <0.001), and postoperative shock (1.2% vs 0.4%, p <0.001). LAA exclusion was associated with higher in-hospital mortality (1.6% vs 0.3%, p <0.001). Multivariate regression analysis showed that LAA exclusion was significantly associated with lower cerebrovascular accident events and higher in-hospital mortality. In conclusion, LAA exclusion in patients with AF undergoing CABG might be associated with a lower incidence of in-hospital cerebrovascular events. This benefit is offset by a higher incidence of higher bleeding events, pericardial effusion, cardiac tamponade, postoperative shock, and in-hospital mortality., (Copyright © 2017 Elsevier Inc. All rights reserved.)- Published
- 2017
- Full Text
- View/download PDF
14. Cardiovascular Outcomes With Surgical Left Atrial Appendage Exclusion in Patients With Atrial Fibrillation Who Underwent Valvular Heart Surgery (from the National Inpatient Sample Database).
- Author
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Elbadawi A, Olorunfemi O, Ogunbayo GO, Saad M, Elgendy IY, Arif Z, Badran H, Saheed D, Ahmed HMA, and Rao M
- Subjects
- Adolescent, Adult, Aged, Atrial Appendage diagnostic imaging, Atrial Fibrillation complications, Atrial Fibrillation mortality, Child, Child, Preschool, Echocardiography, Transesophageal, Female, Follow-Up Studies, Heart Valve Diseases complications, Heart Valve Diseases mortality, Heart Valve Prosthesis Implantation, Humans, Incidence, Infant, Infant, Newborn, Male, Middle Aged, Retrospective Studies, Stroke epidemiology, Stroke etiology, Survival Rate trends, United States epidemiology, Young Adult, Atrial Appendage surgery, Atrial Fibrillation surgery, Cardiac Surgical Procedures methods, Heart Valve Diseases surgery, Inpatients, Stroke prevention & control
- Abstract
Left atrial appendage (LAA) exclusion is a commonly performed procedure to reduce the embolic events in patients with atrial fibrillation (AF) who underwent cardiac surgeries. Our study aimed to evaluate the in-hospital outcomes of LAA exclusion in patients with AF who underwent valvular heart surgeries. We queried the Nationwide Inpatient Sample Database from 1998 to 2013 for patients with the International Classification of Diseases, Ninth Edition, Clinical Modification, diagnosis codes for AF and underwent any valvular heart surgery. We then performed a case-control matching based on the CHA
2 DS2 VASc score for those who underwent LAA exclusion versus those who did not. Primary outcome was the incidence of in-hospital cerebrovascular events, whereas the secondary outcomes included all-cause mortality, length of hospital stay, and bleeding. Our analysis included 1,304 patients. Patients who underwent LAA exclusion had significantly less incidence of cerebrovascular events (2.5% vs 4.6%, p = 0.04), in-hospital death (1.5% vs 4.9%, p = 0.001), and shorter hospital stay (10.5 vs 12.9 days, p <0.01). The LAA exclusion cohort had more incidence of pericardial effusion (1.3% vs 0.5%, p = 0.04) but no difference in bleeding events (p = 0.55). In conclusion, in patients with AF who underwent valvular surgeries, LAA exclusion may be associated with lower in-hospital cerebrovascular events and mortality and shorter hospital stay., (Copyright © 2017 Elsevier Inc. All rights reserved.)- Published
- 2017
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- View/download PDF
15. ATRIAL FIBRILLATION “BURDEN” RATHER THAN A SINGLE ARRHYTHMIA RECURRENCE IDENTIFIES RISK OF ADVERSE CARDIOVASCULAR EVENTS ON ANTIARRHYTHMIC DRUGS: FURTHER INSIGHTS FROM THE AFFIRM TRIAL.
- Author
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Saksena, Sanjeev, Slee, April, Saad, Marwan, and Nagarakanti, Rangadham
- Subjects
- *
ARRHYTHMIA , *ATRIAL fibrillation , *ADVERSE health care events , *CARDIOVASCULAR agents , *MYOCARDIAL depressants - Published
- 2015
- Full Text
- View/download PDF
16. EFFICACY AND SAFETY OF VITAMIN K ANTAGONISTS VERSUS DIRECT ORAL ANTICOAGULANTS FOR ATRIAL FIBRILLATION AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT: A META-ANALYSIS.
- Author
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Selvaraj, Vijairam, Khan, Mohammad Saud, Contos, Alexis, Jindal, Atin, Kazimuddin, Mohammed, Abdul-Waheed, Mohammad, Saad, Marwan, Hyder, Omar, Aronow, Herbert D., and Abbott, J. Dawn
- Subjects
- *
HEART valve prosthesis implantation , *ANTICOAGULANTS , *ATRIAL fibrillation - Published
- 2022
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17. TCT-415 Predictors of New-Onset Atrial Fibrillation Following Transcatheter Mitral Valve Repair: Insights From the Nationwide Readmissions Database.
- Author
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Berkowitz, Julia, Lima, Fabio, Kennedy, Kevin, Kolte, Dhaval, Saad, Marwan, Ben-Assa, Eyal, Palacios, Igor, Gordon, Paul, and Chu, Antony
- Subjects
- *
ATRIAL fibrillation , *MITRAL valve , *PATIENT readmissions , *DATABASES , *MITRAL valve insufficiency , *ATRIAL flutter - Published
- 2021
- Full Text
- View/download PDF
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