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To determine the prevalence and incidence of AF among HF subtypes in a biracial community-based cohort. We studied 6496 participants in the Atherosclerosis Risk in Community study (mean age, 75.8 ± 5.3, 59% women, 23% black) who attended the 2011–2013 visit. HF was identified from physician adjudicated diagnosis, hospital discharges, and self-report. HF subtypes were based on echocardiography. A left ventricular ejection fraction <40% represents HF with reduced ejection fraction (HFrEF), 40%–49% for HF with midrange ejection fraction (HFmEF), and ≥ 50% for HF with preserved ejection fraction (HFpEF). AF was ascertained through 2017 from study electrocardiograms, hospital discharges, and death certificates. Confounder-adjusted logistic regression and Cox models were used to estimate associations of HF subtype with prevalent and incident AF. Among eligible participants, 393 had HF (HFpEF = 232, HFmEF = 41, HFrEF = 35 and unclassified HF = 85) and 735 had AF. Compared to those without HF, all HF subtypes were more likely to have prevalent AF [odds ratio (95% confidence interval (CI)) 7.4 (5.6–9.9) for HFpEF, 8.1 (4.3–15.3) for HFmEF, 10.0 (5.0–20.2) for HFrEF, 8.8 (5.6–14.0) for unclassified HF]. Among participants without AF at baseline (n = 5761), 610 of them developed AF. Prevalent HF was associated with increased risk of AF [hazard ratio (95%CI) 2.3 (1.6–3.2) for HFpEF, 5.0 (2.7–9.3) for HFmEF, 3.5 (1.7–7.6) for HFrEF, 1.9 (0.9–3.7) for unclassified HF]. AF and HF frequently co-occur, with small differences by HF subtype, underscoring the importance of understanding the interplay of these two epidemics and evaluating shared preventive and therapeutic strategies. • The association of heart failure (HF) subtypes with atrial fibrillation (AF) risk in the community is unclear. • Prevalence of AF was 7-10 times higher and AF rates were 2-5 times higher across HF subtypes compared to no HF. • Prevalence and incidence of AF was highest among individuals with HF with reduced ejection (HFrEF) fraction. Risk of AF in HF with midrange EF was more comparable to HFrEF than HF with preserved EF. [ABSTRACT FROM AUTHOR]

The latest information regarding the awareness of atrial fibrillation (AF) remains limited in China. The present study aimed to understand the variation and disparity in awareness of AF in China. The cross-sectional study used data from the 2020 nationwide epidemiology survey on AF among adults aged 18 years or older in mainland China to assess the prevalence of AF awareness. The awareness of AF diagnostic methods and outcomes was also assessed using an interviewer-administered questionnaire. Of the 114,039 adults responding to the survey, 1463 (age-standardized prevalence, 55.3% (95% confidence interval [CI], 47.7–62.9%) and 10,202 (8.2%, 95%CI 5.4–10.9%) were aware of AF in participants with and without AF, respectively. Of these, 36.4% (95%CI 30.0–42.9%) and 6.3% (95%CI 3.6–9.1%) considered electrocardiogram as a method of diagnosing AF, and 30.0% (95% CI 3.2–8.2%) and 5.2% (95%CI 2.7–7.6%) considered stroke as an outcome of AF. The proportion of participants who being aware of AF varied significantly across sociodemographic and cardiovascular disease subgroups, and was almost consistently lower in rural areas than those in urban areas. Overall, lack of AF awareness was associated with rural areas, geographical region, lower education levels, and without history and had no risk factors of cardiovascular disease. Nearly half of adults with AF, and >90% non-AF population are unaware of AF in China, with significant variation and disparity. Focused public health initiatives are needed to improve awareness and knowledge of AF among high-risk populations. • Only 55.3% patients with AF and 8.2% adults without AF were aware of AF in China. • The prevalence of AF awareness was consistently lower in rural areas than those in urban areas. • Lack of AF awareness was associated with rural areas, geographical region, lower education levels, and without history and had no risk factors of cardiovascular disease. [ABSTRACT FROM AUTHOR]

Background: Timing and trajectories of cardiovascular risk factor (CVRF) development in relation to atrial fibrillation (AF) have not been described previously. We assessed trajectories of CVRF and incidence of AF over 25 years in the ARIC study (Atherosclerosis Risk in Communities).Methods: We assessed trajectories of CVRF in 2456 individuals with incident AF and 6414 matched control subjects. Subsequently, we determined the association of CVRF trajectories with the incidence of AF among 10 559 AF-free individuals (mean age, 67 years; 52% men; 20% blacks). Risk factors were measured during 5 examinations between 1987 and 2013. Cardiovascular events, including incident AF, were ascertained continuously. We modeled the prevalence of risk factors and cardiovascular outcomes in the period before and after AF diagnosis and the corresponding index date for control subjects using generalized estimating equations. Trajectories in risk factors were identified with latent mixture modeling. The risk of incident AF by trajectory group was examined with Cox models.Results: The prevalence of stroke, myocardial infarction, and heart failure increased steeply during the time close to AF diagnosis. All CVRFs were elevated in AF cases compared with controls >15 years before diagnosis. We identified distinct trajectories for all the assessed CVRFs. In general, individuals with trajectories denoting long-term exposure to CVRFs had increased AF risk even after adjustment for single measurements of the CVRFs.Conclusions: AF patients have increased prevalence of CVRF many years before disease diagnosis. This analysis identified diverse trajectories in the prevalence of these risk factors, highlighting their different roles in AF pathogenesis. [ABSTRACT FROM AUTHOR]

Background Little is known about the incidence of and risk factors for sick sinus syndrome (SSS), a common indication for pacemaker implantation. Objectives This study sought to describe the epidemiology of SSS. Methods This analysis included 20,572 participants (mean baseline age 59 years, 43% male) in the ARIC (Atherosclerosis Risk In Communities) study and the CHS (Cardiovascular Health Study), who at baseline were free of prevalent atrial fibrillation and pacemaker therapy, had a heart rate of ≥50 beats/min unless using beta blockers, and were identified as of white or black race. Incident SSS cases were identified by hospital discharge International Classification of Disease-revision 9-Clinical Modification code 427.81 and validated by medical record review. Results During an average 17 years of follow-up, 291 incident SSS cases were identified (unadjusted rate 0.8 per 1,000 person-years). Incidence increased with age (hazard ratio [HR]: 1.73; 95% confidence interval [CI]: 1.47 to 2.05 per 5-year increment), and blacks had a 41% lower risk of SSS than whites (HR: 0.59; 95% CI: 0.37 to 0.98). Incident SSS was associated with greater baseline body mass index, height, N-terminal pro-B-type natriuretic peptide, and cystatin C, with longer QRS interval, with lower heart rate, and with prevalent hypertension, right bundle branch block, and cardiovascular disease. We project that the annual number of new SSS cases in the United States will increase from 78,000 in 2012 to 172,000 in 2060. Conclusions Blacks have a lower risk of SSS than whites, and several cardiovascular risk factors were associated with incident SSS. With the aging of the population, the number of Americans with SSS will increase dramatically over the next 50 years. [ABSTRACT FROM AUTHOR]

Objective: Whether endogenous testosterone concentrations are associated with atrial fibrillation (AF) development is not well established. We assessed the association between plasma total testosterone concentrations and incident AF in a population-based longitudinal study.Study Design: Using data from the prospective Atherosclerosis Risk in Communities (ARIC) study, we identified incident AF among 9282 participants who had plasma total testosterone measured by liquid chromatography tandem mass spectrometry at Visit 4 (1996-1998).Main Outcome Measures: AF cases were identified by electrocardiograms performed during study visits, hospital records/discharge codes, and death certificates through 2013. We estimated hazard ratios (HRs) and 95% confidence intervals (95% CIs) for incident AF across quartiles of plasma total testosterone, stratified by sex, with multivariable Cox models.Results: The mean age of the participant sample at ARIC Visit 4 was 63 years (range 52-75); 54.5% were women. Mean (SD) plasma total testosterone levels were 537 ng/dL (213) for men and 27.6 ng/dL (34.7) for women. Over a mean of 13.7 years of follow-up, 1664 incident cases of AF were identified. Comparing those in the highest quartile of plasma total testosterone concentration to those in the lowest quartile and after adjustment for potential confounding variables, there was a positive association between plasma total testosterone and incident AF in men (HR 1.33, 95% CI 1.07, 1.66), but no such association in women (HR 0.99, 95% CI 0.80, 1.22). Conclusion A higher plasma total testosterone concentration was associated with a modestly greater incidence rate of AF in men. [ABSTRACT FROM AUTHOR]

Introduction: Atrial fibrillation (AF) is the most common clinically-significant cardiac arrhythmia and is strongly associated with increased risk of stroke and other cardiovascular diseases. Validated prediction models for AF using traditional risk factors have been developed, but the added predictive value of novel risk factors is uncertain. Hypothesis: Novel biomarkers and measurements identified via machine learning will improve prediction of 5-year AF risk, beyond variables included in the base Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) AF model. Methods: The Multi-Ethnic Study of Atherosclerosis (MESA) is a prospective cohort study comprised of men and women aged 45-84 years from six US communities; 3530 participants (mean age 61.3 years, 51.4% female) with complete data on all candidate variables were included in the analysis. Physician-adjudicated AF was defined based on ICD-9 codes, supplemented by Centers for Medicare and Medicaid Services inpatient and outpatient hospital claims. Novel candidate variables previously identified with the random survival forests machine learning method were evaluated for their ability to improve prediction performance in Cox regression models. A parsimonious model was selected using LASSO. Results: During an average 11.4-year follow-up, 436 participants had an AF event. Most novel candidate variables did not significantly improve prediction performance when added to the CHARGE-AF Enriched model (Table). The parsimonious LASSO model included age, weight, current smoking, NT-proBNP, and ln(CAC+1) score. The novel model achieved good discrimination (c-statistic: 0.781, 95% CI: 0.762-0.800) and calibration (χ2: 6.0, p=0.54). Conclusions: Compared with the CHARGE-AF Score, only CAC score added significantly to AF risk prediction. A parsimonious MESA score containing only five variables performed as well as CHARGE-AF and a 24-item score ("All Predictors") derived by machine learning. [ABSTRACT FROM AUTHOR]

Background--It has recently been reported that atrial fibrillation (AF) is associated with an increased risk of myocardial infarction (MI). However, the mechanism underlying this association is currently unknown. Further study of the relationship of AF with the type of MI (ST-segment-elevation MI [STEMI] versus non-ST-segment-elevation MI [NSTEMI]) might shed light on the potential mechanisms. Methods and Results--We examined the association between AF and incident MI in 14 462 participants (mean age, 54 years; 56% women; 26% blacks) from the Atherosclerosis Risk in Communities (ARIC) study who were free of coronary heart disease at baseline (1987-1989) with follow-up through December 31, 2010. AF cases were identified from study visit ECGs and by review of hospital discharge records. Incident MI and its types were ascertained by an independent adjudication committee. Over a median follow-up of 21.6 years, 1374 MI events occurred (829 NSTEMIs, 249 STEMIs, 296 unclassifiable MIs). In a multivariable-adjusted model, AF (n=1545) as a time-varying variable was associated with a 63% increased risk of MI (hazard ratio,1.63; 95% confidence interval, 1.32-2.02). However, AF was associated with NSTEMI (hazard ratio, 1.80; 95% confidence interval, 1.39-2.31) but not STEMI (hazard ratio, 0.49; 95% confidence interval, 0.18-1.34; P for hazard ratio comparison=0.004). Combining the unclassifiable MI group with either STEMI or NSTEMI did not change this conclusion. The association between AF and MI, total and NSTEMI, was stronger in women than in men (P for interaction <0.01 for both).Conclusions--AF is associated with an increased risk of incident MI, especially in women. However, this association is limited to NSTEMI. [ABSTRACT FROM AUTHOR]

Objective: Advanced glycation end products (AGEs) may cause inflammation by binding to their cellular receptors (RAGE). Soluble RAGE (sRAGE) acts as a decoy receptor for AGEs and may prevent inflammation. Chronic low-grade inflammation is a risk factor for cardiovascular disease, including atrial fibrillation (AF). Methods: We studied 1,068 participants in a subsample of the Atherosclerosis Risk in Communities (ARIC) Study who had baseline measurements of sRAGE (mean age 56, 60% female, 21% Black). Inflammation was assessed using measurements of high sensitivity C-reactive protein (hsCRP), fibrinogen, gamma-glutamyl transferase (GGT) and white blood cell (WBC) count. AF events were identified using ECG data, hospitalization discharge codes, and linkage to the National Death Index. Results: Compared to the highest quartile (N1272.4 pg/mL), the lowest quartile of sRAGE (b714 pg/mL) was associated with higher baseline levels of inflammation (hsCRP=3 mg/L: OR = 2.21 [95% CI 1.41-3.49], fibrinogen =400 mg/dL: OR = 4.31 [95% CI 1.50-12.41], GGT =36 U/L in women and =61 U/L in men: OR = 5.22 [95% CI 2.66-10.22],WBC N6.2 × 109/L: OR = 2.38 [95% CI 1.52-3.72]). sRAGE was not prospectively associated with 6-year change in inflammatory markers (hsCRP or GGT). Therewas no significant association of sRAGE and risk of AF (HR 1.49 [95% CI: 0.80-2.78] for the 1st vs. 4th quartile of sRAGE). Conclusions: sRAGE was strongly inversely associated with markers of inflammation at baseline, but not prospectively. sRAGE was not significantly associated with incident AF. This supports a role for sRAGE in attenuating current inflammation, but it remains unclear whether sRAGE plays a role in the development of AF. [ABSTRACT FROM AUTHOR]

Background: Sick sinus syndrome (SSS) is a common indication for pacemaker implantation. Limited information exists on the association of sick sinus syndrome (SSS) with mortality and cardiovascular disease (CVD) in the general population. Methods: We studied 19,893 men and women age 45 and older in the Atherosclerosis Risk in Communities (ARIC) study and the Cardiovascular Health Study (CHS), two community-based cohorts, who were without a pacemaker or atrial fibrillation (AF) at baseline. Incident SSS cases were validated by review of medical charts. Incident CVD and mortality were ascertained using standardized protocols. Multivariable Cox models were used to estimate the association of incident SSS with selected outcomes. Results: During a mean follow-up of 17 years, 213 incident SSS events were identified and validated (incidence, 0.6 events per 1,000 person-years). After adjustment for confounders, SSS incidence was associated with increased mortality (hazard ratio [HR] 1.39, 95% confidence interval [CI] 1.14–1.70), coronary heart disease (HR 1.72, 95%CI 1.11–2.66), heart failure (HR 2.87, 95%CI 2.17–3.80), stroke (HR 1.56, 95%CI 0.99–2.46), AF (HR 5.75, 95%CI 4.43–7.46), and pacemaker implantation (HR 53.7, 95%CI 42.9–67.2). After additional adjustment for other incident CVD during follow-up, SSS was no longer associated with increased mortality, coronary heart disease, or stroke, but remained associated with higher risk of heart failure (HR 2.00, 95%CI 1.51–2.66), AF (HR 4.25, 95%CI 3.28–5.51), and pacemaker implantation (HR 25.2, 95%CI 19.8–32.1). Conclusion: Individuals who develop SSS are at increased risk of death and CVD. The mechanisms underlying these associations warrant further investigation. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD) is associated with sudden cardiac death and some types of cardiac arrhythmias. However, the prevalence of various types of arrhythmias across CKD severity is not well-characterized. We therefore quantified the burden of arrhythmias across CKD severity in community-dwelling older adults in the ARIC study. Methods: In 2202 adults aged 71-94 years who underwent 2 weeks of non-invasive heart rhythm monitoring using the Zio XT Patch, we examined the associations of atrial fibrillation (AF), non-sustained ventricular tachycardia (NSVT), long pause (>3 sec), 2nd (Mobitz II) or 3rd degree atrioventricular block (AVB), ventricular ectopy (VE), and supraventricular tachycardia (SVT) and ectopy (SVE) with CKD severity categorized as no CKD (low risk) and CKD with moderate, high, and very high risk according to kidney function and albuminuria. Results: CKD participants (vs. no-CKD) had a higher prevalence of AF (9% vs. 5%), NSVT (33% vs. 26%), long pause (4% vs. 2%), and major arrhythmias comprising of the 3 types (39% vs. 28%), with significantly higher prevalence across CKD stages [ Table ]. Conversely, they had a similar prevalence of AVB (2% vs. 2%), and a lower prevalence of SVT (82% vs. 89%) and SVE (61% vs. 66%). After adjusting for potential confounders, CKD with higher risk remained significantly associated with major arrhythmias and AF [ Table ]. CKD with higher risk groups also remained associated with a lower prevalence of supraventricular arrhythmias. Conclusions: Based on 2-week monitoring, major arrhythmias are common in older adults with CKD particularly when severe. Of the major arrhythmias, AF is most robustly associated with CKD severity, highlighting the importance of CKD in the pathophysiology of AF. The lower prevalence of SVT in CKD warrants further studies on potential mechanisms and clinical implications. [ABSTRACT FROM AUTHOR]

Background Contemporary data on temporal trends in incidence and survival after atrial fibrillation are scarce. Methods Residents of Olmsted County, Minn., with a first-ever atrial fibrillation or atrial flutter event between 2000 and 2010 were identified. Age- and sex-adjusted incidence rates were standardized to the 2010 US population, and the relative risk of atrial fibrillation in 2010 versus 2000 was calculated using Poisson regression. Standardized mortality ratios of observed versus expected survival were calculated, and time trends in survival were examined using Cox regression. Results We identified 3344 patients with incident atrial fibrillation/atrial flutter events (52% were male, mean age 72.6 years, 95.7% were white). Incidence did not change over time (age- and sex-adjusted rate ratio, 1.01; 95% confidence interval [CI], 0.91-1.13 for 2010 vs 2000). Within the first 90 days, the risk of all-cause mortality was greatly elevated compared with individuals of a similar age and sex distribution in the general population (standardized mortality ratios 19.4 [95% CI, 17.3-21.7] and 4.2 [95% CI, 3.5-5.0] for the first 30 days and 31 to 90 days after diagnosis, respectively). Survival within the first 90 days did not improve over the study period (adjusted hazard ratio, 0.96; 95% CI, 0.71-1.32 for 2010 vs 2000); likewise, no difference in mortality between 2010 and 2000 was observed among 90-day survivors (hazard ratio, 1.05; 95% CI, 0.85-1.31). Conclusions In the community, atrial fibrillation incidence and survival have remained constant over the last decade. A dramatic and persistent excess risk of death was observed in the 90 days after atrial fibrillation diagnosis, underscoring the importance of early risk stratification. [ABSTRACT FROM AUTHOR]