145 results on '"Pallisgaard, Jannik"'
Search Results
102. Lower risk of myocardial infarction in atrial fibrillation patients treated with vitamin K antagonist than in combination with acetylsalicylic acid (ASA) or ASA alone
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Lee, C. J., Pallisgaard, Jannik Langtved, Gislason, Gunnar Hilmar, Torp-Pedersen, Christian Tobias, Brandes, Axel, Husted, S., Johnsen, S.P., and Hansen, M.L.
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- 2015
103. Non-vitamin K antagonist oral anticoagulation usage according to age among patients with atrial fibrillation:Temporal trends 2011-2015 in Denmark
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Staerk, Laila, Fosbøl, Emil Loldrup, Gadsbøll, Kasper, Sindet-Pedersen, Caroline, Pallisgaard, Jannik Langtved, Lamberts, Morten, Lip, Gregory Y H, Torp-Pedersen, Christian, Gislason, Gunnar Hilmar, Olesen, Jonas Bjerring, Staerk, Laila, Fosbøl, Emil Loldrup, Gadsbøll, Kasper, Sindet-Pedersen, Caroline, Pallisgaard, Jannik Langtved, Lamberts, Morten, Lip, Gregory Y H, Torp-Pedersen, Christian, Gislason, Gunnar Hilmar, and Olesen, Jonas Bjerring
- Abstract
Among atrial fibrillation (AF) patients, Danish nationwide registries (2011-2015) were used to examine temporal trends of initiation patterns of oral anticoagulation (OAC) treatment according to age. Overall, 43,299 AF patients initiating vitamin K antagonists (VKA) (42%), dabigatran (29%), rivaroxaban (13%), or apixaban (16%) were included with mean age (SD) 72.1 (11.3), 71.5 (11.0), 74.3 (11.1), and 75.3 (11.1) years, respectively. Patients aged ≥85 years comprised 15%. Trend tests showed increase in patients ≥85 years initiating OAC (p < 0.0001). VKA usage decreased from 92% to 24% (p < 0.0001). This decrease was independent of age. Dabigatran was the most common non-VKA OAC (NOAC) (40% users), but usage decreased from 2014 until study end (6%) (p < 0.0001). Apixaban was the most used OAC at study end (41%), in particular among those ≥85 years (44%). Compared with patients aged <65 years, the odds ratios associated with initiating VKA, dabigatran, rivaroxaban, or apixaban for patients aged ≥85 years were 0.81 (95% CI 0.75-0.86), 0.65 (95% CI 0.60-0.70), 1.52 (95% CI 1.38-1.67), and 2.09 (95% CI 1.89-2.30), respectively. In conclusion, substantial increase in NOAC usage has occurred. Increasing age was associated with upstart of rivaroxaban or apixaban with reference to age <65 within the specific agent.
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- 2016
104. Risk of Ischemic Stroke, Hemorrhagic Stroke, Bleeding, and Death in Patients Switching from Vitamin K Antagonist to Dabigatran after an Ablation
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Pallisgaard, Jannik Langtved, Gislason, Gunnar Hilmar, Torp-Pedersen, Christian, Lee, Christina Ji-Young, Sindet-Pedersen, Caroline, Staerk, Laila, Olesen, Jonas Bjerring, Lindhardt, Tommi Bo, Pallisgaard, Jannik Langtved, Gislason, Gunnar Hilmar, Torp-Pedersen, Christian, Lee, Christina Ji-Young, Sindet-Pedersen, Caroline, Staerk, Laila, Olesen, Jonas Bjerring, and Lindhardt, Tommi Bo
- Abstract
BACKGROUND: Safety regarding switching from vitamin K antagonist (VKA) to dabigatran therapy in post-ablation patients has never been investigated and safety data for this is urgently needed. The objective of this study was to examine if switch from VKA to dabigatran increased the risk of stroke, bleeding, and death in patients after ablation for atrial fibrillation.METHODS: Through the Danish nationwide registries, patients with non-valvular atrial fibrillation undergoing ablation were identified, in the period between August 22nd 2011 and December 31st 2015. The risk of ischemic stroke, hemorrhagic stroke, bleeding, and death, related to switching from VKA to dabigatran was examined using a multivariable Poisson regression model, where Incidence rate ratios (IRR) were estimated using VKA as reference.RESULTS: In total, 4,236 patients were included in the study cohort. The minority (n = 470, 11%) switched to dabigatran in the follow up period leaving the majority (n = 3,766, 89%) in VKA treatment. The patients in the dabigatran group were older, were more often males, and had higher CHA2DS2-VASc, and HAS-BLED scores. The incident rates of bleeding and death were almost twice as high in the dabigatran group compared with the VKA group. When adjusting for the individual components included in the CHA2DS2-VASc and HAS-BLED scores, the multivariable Poisson analyses yielded a non-significant IRR (95%CI) of 1.64 (0.72-3.75) for bleeding and of 1.41 (0.66-3.00) for death associated with the dabigatran group, compared to the VKA group. A significant increased risk of bleeding was found in the 110mg bid group with an IRR (95%CI) of 4.49(1.40-14.5).CONCLUSION: Shifting from VKA to dabigatran after ablation was associated with twice as high incidence of bleeding compared to the incidence in patients staying in VKA treatment. The only significant increased risk found in the adjusted analyses was for bleeding with 110mg bid dabigatran and not for 150mg
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- 2016
105. Familial Clustering of Venous Thromboembolism:A Danish Nationwide Cohort Study
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Sindet-Pedersen, Caroline, Oestergaard, Louise Bruun, Gundlund, Anna, Fosbøl, Emil Loldrup, Aasbjerg, Kristian, Pallisgaard, Jannik Langtved, Gislason, Gunnar, Torp-Pedersen, Christian, Olesen, Jonas Bjerring, Sindet-Pedersen, Caroline, Oestergaard, Louise Bruun, Gundlund, Anna, Fosbøl, Emil Loldrup, Aasbjerg, Kristian, Pallisgaard, Jannik Langtved, Gislason, Gunnar, Torp-Pedersen, Christian, and Olesen, Jonas Bjerring
- Abstract
BACKGROUND: Identification of risk factors for venous thromboembolism (VTE) is of utmost importance to improve current prophylactic regimes and treatment guidelines. The extent to which a family history contributes to the risk of VTE needs further exploration.OBJECTIVES: To examine the relative rate of VTE in first-degree relatives compared with the general population.METHODS: By crosslinking Danish nationwide registries we identified patients with VTE between 1978 and 2012, and their familial relations. The first member in a family to acquire VTE was defined as the proband. All first-degree relatives to probands were followed from the VTE date of the proband and until an event (VTE), death, emigration, 100 year birthday or end of study: 31st of December 2012, whichever came first. The relative rate of VTE was estimated by standardized incidence ratios (SIR) using time-dependent Poisson regression models, with the general population as a fixed reference.RESULTS: We identified 70,767 children of maternal probands, 66,065 children of paternal probands, and 29,183 siblings to sibling probands. Having a maternal proband or a paternal proband were associated with a significantly increased VTE rate of 2.15 (CI: 2.00-2.30) and 2.06 (CI: 1.92-2.21), respectively. The highest estimate of VTE was observed among siblings (adjusted SIR of 2.60 [CI: 2.38-2.83]). Noteworthy, the rate of VTE increased for all first-degree relatives when the proband was diagnosed with VTE in a young age (≤ 50 years).CONCLUSION: A family history of VTE was associated with a significantly increased rate of VTE among first-degree relatives compared with the general population.
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- 2016
106. Risk of atrial fibrillation in diabetes mellitus:A nationwide cohort study
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Pallisgaard, Jannik L, Schjerning, Anne-Marie, Lindhardt, Tommi B, Procida, Kristina, Hansen, Morten L, Torp-Pedersen, Christian, Gislason, Gunnar H, Pallisgaard, Jannik L, Schjerning, Anne-Marie, Lindhardt, Tommi B, Procida, Kristina, Hansen, Morten L, Torp-Pedersen, Christian, and Gislason, Gunnar H
- Abstract
AIM: Diabetes has been associated with atrial fibrillation but the current evidence is conflicting. In particular knowledge regarding young diabetes patients and the risk of developing atrial fibrillation is sparse. The aim of our study was to investigate the risk of atrial fibrillation in patients with diabetes compared to the background population in Denmark.METHODS AND RESULTS: Through Danish nationwide registries we included persons above 18 years of age and without prior atrial fibrillation and/or diabetes from 1996 to 2012. The study cohort was divided into a background population without diabetes and a diabetes group. The absolute risk of developing atrial fibrillation was calculated and Poisson regression models adjusted for sex, age and comorbidities were used to calculate incidence rate ratios of atrial fibrillation. The total study cohort included 5,081,087 persons, 4,827,713 (95%) in the background population and 253,374 (5%) in the diabetes group. Incidence rates of atrial fibrillation per 1000 person years were stratified in four age groups from 18 to 39, 40 to 64, 65 to 74 and 75 to 100 years giving incidence rates (95% confidence intervals) of 0.02 (0.02-0.02), 0.99 (0.98-1.01), 8.89 (8.81-8.98) and 20.0 (19.9-20.2) in the background population and 0.13 (0.09-0.20), 2.10 (2.00-2.20), 8.41 (8.10-8.74) and 20.1 (19.4-20.8) in the diabetes group, respectively. The adjusted incidence rate ratios in the diabetes group with the background population as reference were 2.34 (1.52-3.60), 1.52 (1.47-1.56), 1.20 (1.18-1.23) and 0.99 (0.97-1.01) in the four age groups, respectively.CONCLUSION: Diabetes is an independent risk factor for developing atrial fibrillation/flutter, most pronounced in young diabetes patients. Routine screening for atrial fibrillation/flutter in diabetes patients might be beneficial and have therapeutic implications, especially in younger diabetes patients.TRANSLATIONAL PERSPECTIVE: Diabetes increases the risk of
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- 2016
107. Risk of Ischemic Stroke, Hemorrhagic Stroke, Bleeding, and Death in Patients Switching from Vitamin K Antagonist to Dabigatran after an Ablation
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Pallisgaard, Jannik Langtved, primary, Gislason, Gunnar Hilmar, additional, Torp-Pedersen, Christian, additional, Lee, Christina Ji-Young, additional, Sindet-Pedersen, Caroline, additional, Staerk, Laila, additional, Olesen, Jonas Bjerring, additional, and Lindhardt, Tommi Bo, additional
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- 2016
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108. Non-vitamin K antagonist oral anticoagulation usage according to age among patients with atrial fibrillation: Temporal trends 2011–2015 in Denmark
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Staerk, Laila, primary, Fosbøl, Emil Loldrup, additional, Gadsbøll, Kasper, additional, Sindet-Pedersen, Caroline, additional, Pallisgaard, Jannik Langtved, additional, Lamberts, Morten, additional, Lip, Gregory Y. H., additional, Torp-Pedersen, Christian, additional, Gislason, Gunnar Hilmar, additional, and Olesen, Jonas Bjerring, additional
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- 2016
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109. Stroke and recurrent haemorrhage associated with antithrombotic treatment after gastrointestinal bleeding in patients with atrial fibrillation:nationwide cohort study
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Staerk, Laila, Lip, Gregory Y H, Olesen, Jonas B, Fosbøl, Emil L, Pallisgaard, Jannik L, Bonde, Anders N, Gundlund, Anna, Lindhardt, Tommi B, Hansen, Morten L, Torp-Pedersen, Christian, Gislason, Gunnar H, Staerk, Laila, Lip, Gregory Y H, Olesen, Jonas B, Fosbøl, Emil L, Pallisgaard, Jannik L, Bonde, Anders N, Gundlund, Anna, Lindhardt, Tommi B, Hansen, Morten L, Torp-Pedersen, Christian, and Gislason, Gunnar H
- Abstract
STUDY QUESTION: What are the risks of all cause mortality, thromboembolism, major bleeding, and recurrent gastrointestinal bleeding associated with restarting antithrombotic treatment after gastrointestinal bleeding in patients with atrial fibrillation?METHODS: This Danish cohort study (1996-2012) included all patients with atrial fibrillation discharged from hospital after gastrointestinal bleeding while receiving antithrombotic treatment. Restarted treatment regimens were single or combined antithrombotic drugs with oral anticoagulation and antiplatelets. Follow-up started 90 days after discharge to avoid confounding from use of previously prescribed drugs on discharge. Risks of all cause mortality, thromboembolism, major bleeding, and recurrent gastrointestinal bleeding were estimated with competing risks models and time dependent multiple Cox regression models.STUDY ANSWER AND LIMITATIONS: 4602 patients (mean age 78 years) were included. Within two years, 39.9% (95% confidence interval 38.4% to 41.3%, n=1745) of the patients had died, 12.0% (11.0% to 13.0%, n=526) had experienced thromboembolism, 17.7% (16.5% to 18.8%, n=788) major bleeding, and 12.1% (11.1% to 13.1%, n=546) recurrent gastrointestinal bleeding. 27.1% (n=924) of patients did not resume antithrombotic treatment. Compared with non-resumption of treatment, a reduced risk of all cause mortality was found in association with restart of oral anticoagulation (hazard ratio 0.39, 95% confidence interval 0.34 to 0.46), an antiplatelet agent (0.76, 0.68 to 0.86), and oral anticoagulation plus an antiplatelet agent (0.41, 0.32 to 0.52), and a reduced risk of thromboembolism was found in association with restart of oral anticoagulation (0.41, 0.31 to 0.54), an antiplatelet agent (0.76, 0.61 to 0.95), and oral anticoagulation plus an antiplatelet agent (0.54, 0.36 to 0.82). Restarting oral anticoagulation alone was the only regimen with an increased risk of major bleeding (1.37, 1.06 to 1.77)
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- 2015
110. Cardioversion and Risk of Adverse Events with Dabigatran versus Warfarin-A Nationwide Cohort Study
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Pallisgaard, Jannik Langtved, Lindhardt, Tommi Bo, Hansen, Morten Lock, Schjerning, Anne-Marie, Olesen, Jonas Bjerring, Staerk, Laila, Torp-Pedersen, Christian, Gislason, Gunnar Hilmar, Pallisgaard, Jannik Langtved, Lindhardt, Tommi Bo, Hansen, Morten Lock, Schjerning, Anne-Marie, Olesen, Jonas Bjerring, Staerk, Laila, Torp-Pedersen, Christian, and Gislason, Gunnar Hilmar
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AIM: Cardioversion can rapidly and effectively restore sinus rhythm in patients with persistent atrial fibrillation. Since 2011 dabigatran has been available as an alternative to warfarin to prevent thromboembolic events in patients with non-valvular atrial fibrillation undergoing cardioversion. We studied time to cardioversion, risk of adverse events, and risk of readmission with atrial fibrillation after cardioversion according to anticoagulation therapy.METHODS AND RESULTS: Through the nationwide Danish registries we included 1,230 oral anticoagulation naïve patients with first time non-valvular atrial fibrillation and first time cardioversion from 2011 to 2012; 37% in the dabigatran group (n = 456), and 63% in the warfarin group (n = 774). Median time to cardioversion was 4.0 (interquartile range [IQR] 2.9 to 6.5) and 6.9 (IQR 3.9 to 12.1) weeks in the dabigatran and warfarin groups respectively, and the adjusted odds ratio of cardioversion within the first 4 weeks was 2.3 (95% confidence interval [CI] 1.7 to 3.1) in favor of dabigatran. The cumulative incidence of composite endpoint of stroke, bleeding or death were 2.0% and 1.0% at 30 weeks in the warfarin and dabigatran groups respectively, with an adjusted hazard ratio of 1.33 (95% CI 0.33 to 5.42). Cumulative incidence of readmission with atrial fibrillation after 30 weeks were 9% and 11% in the warfarin and dabigatran groups, respectively, and an adjusted hazard ratio of 0.66 (95% CI 0.41 to 1.08).CONCLUSION: Anticoagulation treatment with dabigatran allows shorter time to cardioversion for atrial fibrillation than warfarin, and appears to be an effective and safe alternative treatment strategy to warfarin.
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- 2015
111. Management and prognosis of atrial fibrillation in the diabetic patient
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Pallisgaard, Jannik Langtved, Lindhardt, Tommi Bo, Olesen, Jonas Bjerring, Hansen, Morten Lock, Carlson, Nicholas, Gislason, Gunnar Hilmar, Pallisgaard, Jannik Langtved, Lindhardt, Tommi Bo, Olesen, Jonas Bjerring, Hansen, Morten Lock, Carlson, Nicholas, and Gislason, Gunnar Hilmar
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The global burden of atrial fibrillation and diabetes mellitus (diabetes) is considerable, and prevalence rates are increasing. Diabetes is associated with an increased risk of developing atrial fibrillation; however, diabetes also influences the management and prognosis of atrial fibrillation. In the following article, the authors describe the association between diabetes and atrial fibrillation; specifically, the significance of diabetes on the risk of atrial fibrillation, ischemic stroke and bleeding complications associated with anticoagulation. In addition, the authors evaluate the risks and outcomes of heart failure and the success rates of both ablation and cardioversion in atrial fibrillation patients with diabetes. Finally, this article describes the association of HbA1c levels with the management and prognosis of atrial fibrillation patients., The global burden of atrial fibrillation and diabetes mellitus (diabetes) is considerable, and prevalence rates are increasing. Diabetes is associated with an increased risk of developing atrial fibrillation; however, diabetes also influences the management and prognosis of atrial fibrillation. In the following article, the authors describe the association between diabetes and atrial fibrillation; specifically, the significance of diabetes on the risk of atrial fibrillation, ischemic stroke and bleeding complications associated with anticoagulation. In addition, the authors evaluate the risks and outcomes of heart failure and the success rates of both ablation and cardioversion in atrial fibrillation patients with diabetes. Finally, this article describes the association of HbA1c levels with the management and prognosis of atrial fibrillation patients.
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- 2015
112. Comparison of antiplatelet regimens in secondary stroke prevention:a nationwide cohort study
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Christiansen, Christine Benn, Pallisgaard, Jannik, Gerds, Thomas Alexander, Olesen, Jonas Bjerring, Jørgensen, Mads Emil, Numé, Anna Karin, Carlson, Nicholas, Kristensen, Søren Lund, Gislason, Gunnar, Torp-Pedersen, Christian, Christiansen, Christine Benn, Pallisgaard, Jannik, Gerds, Thomas Alexander, Olesen, Jonas Bjerring, Jørgensen, Mads Emil, Numé, Anna Karin, Carlson, Nicholas, Kristensen, Søren Lund, Gislason, Gunnar, and Torp-Pedersen, Christian
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BACKGROUND: In patients with ischemic stroke of non-cardioembolic origin, acetylsalicylic acid, clopidogrel, or a combination of acetylsalicylic acid and dipyridamole are recommended for the prevention of a recurrent stroke. The purpose of this study was to examine the risk of bleeding or recurrent stroke associated with these three treatments.METHODS: Patients who were discharged with first-time ischemic stroke from 2007-2010, with no history of atrial fibrillation were identified from Danish nationwide registries. Hazard ratios (HRs) and 1-year risks of recurrent ischemic stroke and bleeding were calculated for each antiplatelet regimen.RESULTS: Among patients discharged after first-time ischemic stroke, 3043 patients were treated with acetylsalicylic acid, 12,295 with a combination of acetylsalicylic acid and dipyridamole, and 3885 with clopidogrel. Adjusted HRs for clopidogrel versus the combination of acetylsalicylic acid and dipyridamole were 1.02 (95% confidence interval [CI]: 0.89-1.17) for ischemic stroke and 1.06 (95% CI: 0.83-1.35) for bleeding. Adjusted HRs for acetylsalicylic acid versus the combination of acetylsalicylic acid and dipyridamole were 1.48 (95% CI: 1.31-1.67) for stroke and 1.47 (95% CI: 1.18-1.82) for bleeding. Clopidogrel versus acetylsalicylic acid yielded HRs of 0.69 (95% CI: 0.59-0.81) and 0.72 (95% CI: 0.55-0.96) for stroke and bleeding, respectively. The 1-year predicted risks associated with acetylsalicylic acid, the combination of acetylsalicylic acid and dipyridamole, and clopidogrel were 11.1 (95% CI: 10.2-12.2), 7.7 (95% CI: 7.3-8.3), and 8.0 (95% CI: 6.9-8.7) for ischemic stroke, respectively; while, the risks for bleeding were 3.4 (95% CI: 2.8-3.9), 2.4 (95% CI: 2.1-2.7), and 2.4 (95% CI: 1.9-2.9), respectively.CONCLUSION: Clopidogrel and the combination of acetylsalicylic acid and dipyridamole were associated with similar risks for recurrent ischemic stroke and bleeding; whereas acetylsalicylic acid w
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- 2015
113. Safety and efficacy of direct oral anticoagulants compared to warfarin for extended treatment of venous thromboembolism -a systematic review and meta-analysis
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Sindet-Pedersen, Caroline, Pallisgaard, Jannik Langtved, Olesen, Jonas Bjerring, Gislason, Gunnar Hilmar, Arevalo, Lourdes Cantarero, Sindet-Pedersen, Caroline, Pallisgaard, Jannik Langtved, Olesen, Jonas Bjerring, Gislason, Gunnar Hilmar, and Arevalo, Lourdes Cantarero
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OBJECTIVE: To examine and compare the safety and efficacy of extended treatment with dabigatran, apixaban, rivaroxaban and warfarin in patients with unprovoked venous thromboembolism.METHODS: PubMed and Embase were searched for randomized clinical trials reporting on the use of direct oral anticoagulants (DOACs) and warfarin for the extended treatment of VTE. Meta-analysis was performed on studies reporting similar study design and comparator.RESULTS: A total of 729 articles were identified and 5 studies covering 6 randomized clinical trials met the eligibility criteria and were included in the study. 5 studies were included in the meta-analysis. Results from the meta-analysis showed that the extended use of DOACs and warfarin significantly decreased the risk of recurrent VTE with 83 % when compared placebo. Warfarin (RR: 0.03, CI: 0.00-0.49) and dabigatran (RR: 0.08, CI: 0.03-0.27) showed the largest relative risk reduction followed by apixaban 2.5mg (RR: 0.19, CI: 0.11-0.33), rivaroxaban (RR:0.19, CI: 0.09-0.40) and apixaban 5mg (RR: 0.20, CI: 0.11-0.34). No significant increased risk of major bleeding was observed with the extended use of any DOACs and warfarin compared to placebo (1.15, CI: 0.40-3.31), but an overall increased risk of non-major clinically relevant bleeding (NMCRB) was observed (RR: 2.12, CI: 1.55-2.90). Apixaban 2.5mg and warfarin was not individually associated with an increased risk of NMCRB. Furthermore, it was found from a study not included in the meta-analysis that dabigatran was non-inferior to VKA for the prevention of recurrent VTE (HR: 1.44, CI: 0.78-2.64, p=0.01 for noninferiority) and decreased the risk of NMCRB compared to VKA (RR: 0.58, CI: 0.43-0.77).CONCLUSION: Extended treatment with both warfarin and DOACs are effective in preventing recurrent VTE and does not increase the risk of major bleeding, but increases the risk of NMCRB.
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- 2015
114. Comparison of antiplatelet regimens in secondary stroke prevention: a nationwide cohort study
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Christiansen, Christine Benn, primary, Pallisgaard, Jannik, additional, Gerds, Thomas Alexander, additional, Olesen, Jonas Bjerring, additional, Jørgensen, Mads Emil, additional, Numé, Anna Karin, additional, Carlson, Nicholas, additional, Kristensen, Søren Lund, additional, Gislason, Gunnar, additional, and Torp-Pedersen, Christian, additional
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- 2015
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115. Thiazolidinediones and Risk of Atrial Fibrillation Among Patients with Diabetes and Coronary Disease.
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Bypass Angioplasty Revascularization Investigation 2 Diabetes Study Group, Pallisgaard, Jannik Langtved, Brooks, Maria Mori, Chaitman, Bernard R., Boothroyd, Derek B., Perez, Marco, and Hlatky, Mark A.
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THIAZOLIDINEDIONES , *ATRIAL fibrillation , *DIABETES , *CORONARY disease , *METFORMIN , *INSULIN , *CORONARY heart disease complications , *TYPE 2 diabetes complications , *CLINICAL trials , *COMPARATIVE studies , *HYPOGLYCEMIC agents , *RESEARCH methodology , *MEDICAL cooperation , *TYPE 2 diabetes , *PROBABILITY theory , *RESEARCH , *EVALUATION research , *TREATMENT effectiveness - Abstract
Background: We sought to determine whether insulin-sensitizing therapy (thiazolidinediones or metformin) decreased the risk of developing atrial fibrillation compared with insulin-providing therapy (insulin, sulfonylurea, or a meglitinide). Thiazolidinediones are insulin sensitizers that also decrease the inflammatory response. Because inflammation is a risk factor for atrial fibrillation, we hypothesized that treating diabetes with thiazolidinediones might decrease the risk of developing atrial fibrillation.Methods: The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial enrolled patients with type 2 diabetes and documented coronary artery disease. All patients were randomized to insulin-sensitizing therapy or insulin-providing therapy.Results: A total of 2319 patients entered the study, with 1160 assigned to the insulin-sensitization strategy and 1159 assigned to the insulin-provision strategy. Over a median follow-up of 4.2 years, 90 patients (3.9%) developed new-onset atrial fibrillation. In the intention-to-treat analysis, the incidence of atrial fibrillation was 8.7 per 1000 person-years in patients assigned to insulin sensitization compared with 9.5 in patients assigned to insulin provision with a hazard ratio (HR) of 0.91 (95% confidence interval [CI], 0.60-1.38, P = .66). In a time-varying exposure analysis, the incidence rate per 1000 person-years was 7.2 while exposed to thiazolidinediones and 9.7 while not exposed to thiazolidinediones with an adjusted HR of 0.80 (95% CI, 0.33-1.94, P = .62). In a subset of patients matched on propensity to receive a thiazolidinediones, the HR was 0.75 (95% CI, 0.43-1.30, P = .30).Conclusions: We did not find a significant reduction of atrial fibrillation incidence with use of thiazolidinediones. [ABSTRACT FROM AUTHOR]- Published
- 2018
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116. Temporal trends in atrial fibrillation recurrence rates after ablation between 2005 and 2014: a nationwide Danish cohort study.
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Pallisgaard, Jannik Langtved, Gislason, Gunnar Hilmar, Hansen, Jim, Johannessen, Arne, Torp-Pedersen, Christian, Rasmussen, Peter Vibe, and Hansen, Morten Lock
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Aims During the last decade, ablation has increasingly been used in rhythm control management of patients with atrial fibrillation (AF). Over time, experience and techniques have improved and indications for ablation have expanded. The purpose of this study was to investigate whether the recurrence rate of AF following ablation has improved during last decade. Methods and results Through Danish nationwide registers, all patients with first-time AF ablation, between 2005 and 2014 in Denmark were identified. Recurrent AF after ablation was identified with 1 year follow-up. A total of 5425 patients undergoing first-time ablation were included. While patient median age increased over time the median AF duration prior to ablation decreased. The rates of recurrent AF decreased from 45% in 2005-2006 to 31% 2013-2014 with the relative risk of recurrent AF almost halved with an odds ratio of 0.57 [95% confidence intervals (95% CI) 0.47-0.68] in 2013-2014 compared with patients undergoing ablation in 2005-2006. Female gender, hypertension, AF duration >2 years, and cardioversion within 1 year prior to ablation were all associated with an increased risk of recurrent AF. Conclusion One year risk of recurrent AF following first-time ablation has almost halved from 2006 to 2014. Hypertension, female sex, cardioversion 1 year prior to ablation, and AF duration for more than 2 years all increased the associated risk of recurrent AF. [ABSTRACT FROM AUTHOR]
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- 2018
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117. Cardioversion and Risk of Adverse Events with Dabigatran versus Warfarin—A Nationwide Cohort Study
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Pallisgaard, Jannik Langtved, primary, Lindhardt, Tommi Bo, additional, Hansen, Morten Lock, additional, Schjerning, Anne-Marie, additional, Olesen, Jonas Bjerring, additional, Staerk, Laila, additional, Torp-Pedersen, Christian, additional, and Gislason, Gunnar Hilmar, additional
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- 2015
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118. Safety and efficacy of direct oral anticoagulants compared to warfarin for extended treatment of venous thromboembolism -a systematic review and meta-analysis
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Sindet-Pedersen, Caroline, primary, Pallisgaard, Jannik Langtved, additional, Olesen, Jonas Bjerring, additional, Gislason, Gunnar Hilmar, additional, and Arevalo, Lourdes Cantarero, additional
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- 2015
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119. Risk of atrial fibrillation in diabetes mellitus: A nationwide cohort study
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Pallisgaard, Jannik L, primary, Schjerning, Anne-Marie, additional, Lindhardt, Tommi B, additional, Procida, Kristina, additional, Hansen, Morten L, additional, Torp-Pedersen, Christian, additional, and Gislason, Gunnar H, additional
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- 2015
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120. Management and prognosis of atrial fibrillation in the diabetic patient
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Pallisgaard, Jannik Langtved, primary, Lindhardt, Tommi Bo, additional, Olesen, Jonas Bjerring, additional, Hansen, Morten Lock, additional, Carlson, Nicholas, additional, and Gislason, Gunnar Hilmar, additional
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- 2015
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121. NSAIDs are associated with increased risk of atrial fibrillation in patients with prior myocardial infarction: a nationwide study
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Schjerning Olsen, Anne-Marie, primary, Fosbøl, Emil L., additional, Pallisgaard, Jannik, additional, Lindhardsen, Jesper, additional, Lock Hansen, Morten, additional, Køber, Lars, additional, Hansen, Peter R., additional, Torp-Pedersen, Christian, additional, and Gislason, Gunnar H., additional
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- 2015
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122. Massive Electrical Storm at Disease Onset in a Patient with Brugada Syndrome
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Pallisgaard, Jannik L, Gang, Uffe, Kanters, Jørgen K., Hansen, Peter R, Pallisgaard, Jannik L, Gang, Uffe, Kanters, Jørgen K., and Hansen, Peter R
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Background Brugada syndrome (BrS) is a genetic arrhythmogenic disease characterized by ST-segment elevations in the right precordial leads of the electrocardiogram (ECG). These ECG changes may be concealed and BrS may present with electrical storm characterized by recurrent ventricular tachycardia and fibrillation. Case Report A 49-year-old previously healthy man was admitted with electrical storm. The patient received direct current (DC) cardioversion shocks and only after intravenous lidocaine did the electrical storm slowly subside with a total of 255 DC shocks administered during the first 24 h after admission. He fully recovered and received an implantable cardioverter-defibrillator. Subsequent drug challenge with flecainide revealed type 1 BrS. Conclusions Massive electrical storm can be the first symptom of BrS and the diagnostic ECG changes may be concealed at presentation. Although hundreds of DC shocks may be required during initial treatment, full recovery can be achieved.
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- 2014
123. Thiazolidinediones are associated with a decreased risk of atrial fibrillation compared with other antidiabetic treatment: a nationwide cohort study.
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Pallisgaard, Jannik Langtved, Lindhardt, Tommi Bo, Staerk, Laila, Olesen, Jonas Bjerring, Torp-Pedersen, Christian, Hansen, Morten Lock, and Gislason, Gunnar Hilmar
- Abstract
The aim of this study was to investigate the association between thiazolidinediones (TZDs) vs. other antidiabetic drugs and risk of atrial fibrillation (AF) in diabetic patients.
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- 2017
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124. Abstract 11339: Socioeconomic Status Influences the Choice of Pacemaker Type in Atrial Fibrillation - Insights From Danish Nationwide Registries.
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Dalgaard, Frederik, Pallisgaard, Jannik, Gislason, Gunnar, Lindhardt, Tommi, and Ruwald, Martin
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ATRIAL fibrillation , *SOCIOECONOMIC factors , *CORONARY disease , *OBSTRUCTIVE lung diseases , *CARDIAC pacemakers - Abstract
Introduction and Hypothesis: Patients with low socioeconomic status (SES) experience more procedure complications. We hypothesized that atrial fibrillation (AF) patients with low SES are more likely to undergo less complicated permanent pacemaker (PPM) procedures, and thus may not receive optimal treatment. Methods: Using Danish nationwide registries, we identified all patients with AF and PPM from 2000 to 2014 and grouped them into quartiles by income; low (Q1), low-middle (Q2), middle-high (Q3), high (Q4) to categorize SES. We then identified pacemaker type: a 1-lead PPM (VVI), a 2-lead PPM (DDD), and a 3-lead PPM (CRT). We used adjusted logistic regression models to determine the odds ratio (OR) of having a VVI, DDD, or CRT by annual individualized income. Patients with missing PPM type were excluded from the analysis. Results: Among 17,553 patients 9,904 (56.4%) were men with a median age of 78 (interquartile range [IQR]: 70-84). The distribution between VVI, DDD, and CRT was 6,611 (37.7%), 7,265 (40.9%), and 1,381 (7.9%), respectively, leaving 2,296 (13.1%) with missing PPM type. AF patients in Q1 had a median age of 80 years (IQR: 74-85), and 49.8% were males. AF patients in Q4 were mostly males (67.5%) with a median age of 74 (IQR: 68-81). These two groups (Q1 vs. Q4) were different in the prevalence of ischemic heart disease (IHD) (30% vs. 26%), diabetes (14.3% vs. 11.6%), heart failure (36.3% vs. 30.7%), and educational level (primary education; 71.5% vs. 23.3%). Compared to AF patients in Q1, those in Q4 had an OR (95% CI) of 0.71 (0.65-0.71) for a VVI, 1.30 (1.18-1.43) for a DDD, and 1.75 (1.44-2.14) for a CRT (Figure). Conclusions: Low SES AF patients with PPMs are less likely to have CRT or a DDD, and more likely to have a VVI pacemaker compared to AF patients with high SES. Despite a healthcare system that is available to all inhabitants, free of charge in Denmark, this is a cause of concern as it may imply that a patient with low SES influence the clinical decision towards a less complicated PPM procedure that might not be the optimal treatment choice. Figure Legend Adjusted OR for PPM type by income of Q4 with Q1 as the reference. Events and total patients for Q1 and Q4 are shown. The model is adjusted for age, sex, AF duration, IHD, heart failure, and chronic obstructive pulmonary disease. [ABSTRACT FROM AUTHOR]
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- 2018
125. Serial troponin-I and long-term outcomes in subjects with suspected acute coronary syndrome.
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Pareek M, Kristensen AMD, Vaduganathan M, Byrne C, Biering-Sørensen T, Højbjerg Lassen MC, Johansen ND, Skaarup KG, Rosberg V, Pallisgaard JL, Mortensen MB, Maeng M, Polcwiartek CB, Frangeskos J, McCarthy CP, Bonde AN, Lee CJ, Fosbøl EL, Køber L, Olsen NT, Gislason GH, Torp-Pedersen C, Bhatt DL, and Kragholm KH
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- Humans, Troponin I, Biomarkers, Prognosis, Acute Coronary Syndrome diagnosis, Myocardial Infarction
- Abstract
Aims: It is unclear how serial high-sensitivity troponin-I (hsTnI) concentrations affect long-term prognosis in individuals with suspected acute coronary syndrome (ACS)., Methods and Results: Subjects who underwent two hsTnI measurements (Siemens TnI Flex® Reagent) separated by 1-7 h, during a first-time hospitalization for myocardial infarction, unstable angina, observation for suspected myocardial infarction, or chest pain from 2012 through 2019, were identified through Danish national registries. Individuals were stratified per their hsTnI concentration pattern (normal, rising, persistently elevated, or falling) and the magnitude of hsTnI concentration change (<20%, >20-50%, or >50% in either direction). We calculated absolute and relative mortality risks standardized to the distributions of risk factors for the entire study population. A total of 20 609 individuals were included of whom 2.3% had died at 30 days, and an additional 4.7% had died at 365 days. The standardized risk of death was highest among persons with a persistently elevated hsTnI concentration (0-30 days: 8.0%, 31-365 days: 11.1%) and lowest among those with two normal hsTnI concentrations (0-30 days: 0.5%, 31-365 days: 2.6%). In neither case did relative hsTnI concentration changes between measurements clearly affect mortality risk. Among persons with a rising hsTnI concentration pattern, 30-day mortality was higher in subjects with a >50% rise compared with those with a less pronounced rise (2.2% vs. <0.1%)., Conclusion: Among individuals with suspected ACS, those with a persistently elevated hsTnI concentration consistently had the highest risk of death. In subjects with two normal hsTnI concentrations, mortality was very low and not affected by the magnitude of change between measurements., Competing Interests: Conflict of interest: M.P. discloses the following relationships—advisory board: AstraZeneca, Janssen-Cilag, and Novo Nordisk; grant support: Danish Cardiovascular Academy funded by the Novo Nordisk Foundation and the Danish Heart Foundation (grant number CPD5Y-2022004-HF); and speaker honorarium: AstraZeneca, Bayer, Boehringer Ingelheim, and Janssen-Cilag. M.V. has received research grant support or served on advisory boards for American Regent, Amgen, AstraZeneca, Bayer AG, Baxter Healthcare, Boehringer Ingelheim, Cytokinetics, Lexicon Pharmaceuticals, Relypsa, and Roche Diagnostics; speaker engagements with Novartis and Roche Diagnostics; and participates on clinical endpoint committees for studies sponsored by Galmed and Novartis. C.B. discloses the following relationships—speaker honorarium: Bayer. T.B.-S. discloses the following relationships—steering committee member of the Amgen-financed GALACTIC-HF trial, chief investigator and steering committee chair of the Sanofi Pasteur–financed ‘NUDGE-FLU’ trial, chief investigator and steering committee chair of the Sanofi Pasteur–financed ‘DANFLU-1’ trial, chief investigator and steering committee chair of the Sanofi Pasteur–financed ‘DANFLU-2’ trial, and steering committee member of ‘LUX-Dx TRENDS Evaluates Diagnostics Sensors in Heart Failure Patients Receiving Boston Scientific’s Investigational ICM System’ trial; advisory board: Sanofi Pasteur, Amgen, and GSK; speaker honorarium: Novartis, Sanofi Pasteur, and GSK; and research grants: GE Healthcare and Sanofi Pasteur. M.M. is supported by a grant from the Novo Nordisk Foundation (grant number NNFOC0074083) and has received lecture and advisory board fees from Novo Nordisk. C.P.M. is supported by a grant from the National Institutes of Health (K23HL167659) and has received consulting fees/honorarium from Roche Diagnostics and Abbott Laboratories. L.K. discloses the following relationships—speaker honorarium from Novo Nordisk, Novartis, AstraZeneca, Boehringer, and Bayer. N.T.O. discloses the following relationships—research funding: Abbott and Shockwave. D.L.B. discloses the following relationships—advisory board: Angiowave, Bayer, Boehringer Ingelheim, Cardax, CellProthera, Cereno Scientific, Elsevier Practice Update Cardiology, High Enroll, Janssen, Level Ex, McKinsey, Medscape Cardiology, Merck, MyoKardia, NirvaMed, Novo Nordisk, PhaseBio, PLx Pharma, and Stasys; board of directors: American Heart Association New York City, Angiowave (stock options), Bristol Myers Squibb (stock), DRS.LINQ (stock options), and High Enroll (stock); consultant: Broadview Ventures and Hims; data monitoring committees: Acesion Pharma, Assistance Publique-Hôpitaux de Paris, Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO trial, funded by St. Jude Medical, now Abbott), Boston Scientific (chair, PEITHO trial), Cleveland Clinic, Contego Medical (chair, PERFORMANCE 2), Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine (for the ENVISAGE trial, funded by Daiichi Sankyo; for the ABILITY-DM trial, funded by Concept Medical), Novartis, Population Health Research Institute, and Rutgers University (for the NIH-funded MINT Trial); honoraria: American College of Cardiology (senior associate editor, Clinical Trials and News, ACC.org; chair, ACC Accreditation Oversight Committee), Arnold and Porter law firm (work related to Sanofi/Bristol-Myers Squibb clopidogrel litigation), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; RE-DUAL PCI clinical trial steering committee funded by Boehringer Ingelheim; AEGIS-II executive committee funded by CSL Behring), Belvoir Publications (editor in chief, Harvard Heart Letter), Canadian Medical and Surgical Knowledge Translation Research Group (clinical trial steering committees), CSL Behring (AHA lecture), Cowen and Company, Duke Clinical Research Institute (clinical trial steering committees, including for the PRONOUNCE trial, funded by Ferring Pharmaceuticals), HMP Global (editor in chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (guest editor, associate editor), K2P (co-chair, interdisciplinary curriculum), Level Ex, Medtelligence/ReachMD (CME steering committees), MJH Life Sciences, Oakstone CME (course director, Comprehensive Review of Interventional Cardiology), Piper Sandler, Population Health Research Institute (for the COMPASS operations committee, publications committee, steering committee, and US national co-leader, funded by Bayer), WebMD (CME steering committees), and Wiley (steering committee); other: Clinical Cardiology (deputy editor); patent: Sotagliflozin (named on a patent for sotagliflozin assigned to Brigham and Women’s Hospital who assigned to Lexicon; neither I nor Brigham and Women’s Hospital receive any income from this patent); research funding: Abbott, Acesion Pharma, Afimmune, Aker Biomarine, Alnylam, Amarin, Amgen, AstraZeneca, Bayer, Beren, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb, Cardax, CellProthera, Cereno Scientific, Chiesi, CinCor, Cleerly, CSL Behring, Eisai, Ethicon, Faraday Pharmaceuticals, Ferring Pharmaceuticals, Forest Laboratories, Fractyl, Garmin, HLS Therapeutics, Idorsia, Ironwood, Ischemix, Janssen, Javelin, Lexicon, Lilly, Medtronic, Merck, Moderna, MyoKardia, NirvaMed, Novartis, Novo Nordisk, Otsuka, Owkin, Pfizer, PhaseBio, PLx Pharma, Recardio, Regeneron, Reid Hoffman Foundation, Roche, Sanofi, Stasys, Synaptic, The Medicines Company, Youngene, and 89Bio; royalties: Elsevier (editor, Braunwald’s Heart Disease); site co-investigator: Abbott, Biotronik, Boston Scientific, CSI, Endotronix, St. Jude Medical (now Abbott), Philips, SpectraWAVE, Svelte, and Vascular Solutions; trustee: American College of Cardiology; and unfunded research: FlowCo and Takeda. The other authors report no relevant disclosures., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2024
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126. Short- and long-term risk of atrial fibrillation recurrence after first time ablation according to body mass index: a nationwide Danish cohort study.
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Tønnesen J, Pallisgaard J, Ruwald MH, Rasmussen PV, Johannessen A, Hansen J, Worck RH, Zörner CR, Riis-Vestergaard L, Middelfart C, Gislason G, and Hansen ML
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- Humans, Cohort Studies, Body Mass Index, Risk Factors, Overweight etiology, Overweight surgery, Recurrence, Denmark epidemiology, Treatment Outcome, Atrial Fibrillation diagnosis, Atrial Fibrillation epidemiology, Atrial Fibrillation surgery, Obesity, Morbid complications, Obesity, Morbid diagnosis, Obesity, Morbid epidemiology, Catheter Ablation adverse effects, Catheter Ablation methods
- Abstract
Aims: Overweight is associated with increased risk of atrial fibrillation (AF), but the impact of overweight and AF recurrence after ablation is less clear. Despite this, an increasing number of AF ablations are carried out in overweight patients. We investigated the impact of body mass index (BMI) on AF recurrence rates after ablation., Methods and Results: Through Danish nationwide registers, all patients undergoing first-time AF ablation between 2010 and 2018 were identified. Exposure of interest was BMI. The primary outcome was recurrent AF, defined from either any usage of antiarrhythmic medication, AF hospitalization, cardioversion, or re-ablation. A total of 9188 patients were included. Median age and interquartile range was 64 (60-75) in the normal-weight group and 60 (53-66) in the morbidly obese. There was an increase in comorbidity burden with increasing BMI, including a higher prevalence of heart failure, chronic obstructive pulmonary disease, diabetes, and hypertension. At 1- and 5-year follow ups, recurrence rates of AF increased incrementally by BMI categories. The hazard ratios and 95% confidence intervals of recurrent AF after ablation were 1.15 (1.07-1.23), 1.18 (1.09-1.28), and 1.26 (1.13-1.41) in overweight, obese, and morbidly obese, respectively, compared with normal-weight patients. Procedure duration and X-ray dose exposure also increased with increasing BMI., Conclusion: Following AF ablation, recurrence rates of AF increased incrementally with increasing BMI. Therefore, aggressive weight management pre ablation in overweight patients could potentially provide substantial benefits and improve short- and long-term outcomes after ablation., Competing Interests: Conflict of interest: JH has received consultant fees and speaker honoraria from Biosense Webster, Medtronic, and Boston Scientific, and research funding from Biosense Webster and Medtronic. R.H.W. has received consultant fees, speaker honoraria, and research funding from Biosense Webster. All remaining authors have declared no conflicts of interest., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2023
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127. Atrial fibrillation onset before heart failure or vice versa: what is worst? A nationwide register study.
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Pallisgaard J, Greve AM, Lock-Hansen M, Thune JJ, Fosboel EL, Devereux RB, Okin PM, Gislason GH, Torp-Pedersen C, and Bang CN
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- Humans, Antihypertensive Agents, Anticoagulants therapeutic use, Atrial Fibrillation diagnosis, Atrial Fibrillation epidemiology, Atrial Fibrillation therapy, Brain Ischemia, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Stroke diagnosis, Stroke epidemiology, Stroke prevention & control, Heart Failure diagnosis, Heart Failure epidemiology, Heart Failure therapy, Amiodarone
- Abstract
Aims: Atrial fibrillation (AF) and heart failure (HF) often coexist. However, whether AF onset before HF or vice versa is associated with the worst outcome remains unclear. A consensus of large studies can guide future research and preventive strategies to better target high-risk patients., Methods and Results: We included all Danish cases with the coexistence of AF and HF (2005-17) using nationwide registries. Patients were divided into three separate groups (i) AF before HF, (ii) HF before AF, or (iii) AF and HF diagnosed concurrently (±30 days). Adjusting landmark Cox analyses (index date was the time of the latter diagnosis of AF or HF) were used for evaluating the association of the three groups with a composite outcome of ischaemic stroke or death. Among a total of 49 042 patients included, 40% had AF before HF, 27% had HF before AF, and 33% had AF and HF diagnosed concurrently. The composite endpoint accrued more often in patients with HF before AF compared to the two other groups (<0.001), and this remained significant in the adjusted analyses with hazard ratios (95% confidence intervals) of 1.26 (1.22-1.30) compared to AF before HF. Finally, antihypertensive treatment, oral anticoagulants, amiodarone, statins, and AF ablation were associated with a lower hazard ratio of the composite endpoint (all < 0.001)., Conclusions: In this large Danish national cohort, diagnosis of HF before AF was associated with an increased absolute risk of death compared to AF before HF and AF and HF diagnosed concurrently. Antihypertensive treatment, oral anticoagulants, amiodarone, statins, and AF ablation may improve prognosis., Competing Interests: Conflict of interest: P.M.O. acts as an advisor to Prolaio Inc. All remaining authors have declared no conflicts of interest.., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2023
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128. Serial troponin-T and long-term outcomes in suspected acute coronary syndrome.
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Pareek M, Kragholm KH, Kristensen AMD, Vaduganathan M, Pallisgaard JL, Byrne C, Biering-Sørensen T, Lee CJ, Bonde AN, Mortensen MB, Maeng M, Fosbøl EL, Køber L, Olsen NT, Gislason GH, Bhatt DL, and Torp-Pedersen C
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- Humans, Biomarkers, Logistic Models, Acute Coronary Syndrome diagnosis, Myocardial Infarction diagnosis, Myocardial Infarction therapy, Troponin T
- Abstract
Background: Long-term prognostic implications of serial high-sensitivity troponin concentrations in subjects with suspected acute coronary syndrome are unknown., Methods and Results: Individuals with a first diagnosis of myocardial infarction, unstable angina, observation for suspected myocardial infarction, or chest pain from 2012 through 2019 who underwent two high-sensitivity troponin-T (hsTnT) measurements 1-7 h apart were identified through Danish national registries. Absolute and relative risks for death at days 0-30 and 31-365, stratified for whether subjects had normal or elevated hsTnT concentrations, and whether these concentrations changed by <20%, > 20 to 50%, or >50% in either direction from first to second measurement, were calculated through multivariable logistic regression with average treatment effect modeling. Of the 28 902 individuals included, 2.8% had died at 30 days, whereas 4.9% of those who had survived the first 30 days died between days 31-365. The standardized risk of death was highest among subjects with two elevated hsTnT concentrations (0-30 days: 4.3%, 31-365 days: 7.2%). In this group, mortality was significantly higher in those with a > 20 to 50% or >50% rise from first to second measurement, though only at 30 days. The risk of death was very low in subjects with two normal hsTnT concentrations (0-30 days: 0.1%, 31-365 days: 0.9%) and did not depend on relative or absolute changes between measurements., Conclusions: Individuals with suspected acute coronary syndrome and two consecutively elevated hsTnT concentrations consistently had the highest risk of death. Mortality was very low in subjects with two normal hsTnT concentrations, irrespective of changes between measurements., Competing Interests: Conflict of interest: M.P. discloses the following relationships—Advisory Board: AstraZeneca, Janssen-Cilag; Grant Support: Danish Cardiovascular Academy funded by the Novo Nordisk Foundation and the Danish Heart Foundation (grant number: CPD5Y-2022004-HF); Speaker Honorarium: AstraZeneca, Bayer, Boehringer Ingelheim, Janssen-Cilag. M.V. has received research grant support or served on advisory boards for American Regent, Amgen, AstraZeneca, Bayer AG, Baxter Healthcare, Boehringer Ingelheim, Cytokinetics, Lexicon Pharmaceuticals, Novartis, Pharmacosmos, Relypsa, Roche Diagnostics, Sanofi, and Tricog Health, speaker engagements with AstraZeneca, Novartis, and Roche Diagnostics, and participates on clinical trial committees for studies sponsored by Galmed, Novartis, Bayer AG, Occlutech, and Impulse Dynamics. C.B. discloses the following relationships—speaker honorarium: Bayer. M.M. is supported by a grant from the Novo Nordisk Foundation (grant number NNFOC0074083) and has received lecture and advisory board fees from Novo Nordisk. T.B.-S. discloses the following relationships—Steering Committee member of the Amgen financed GALACTIC-HF trial, Chief investigator and steering committee chair of the Sanofi Pasteur financed ‘NUDGE-FLU’ trial, Chief investigator and steering committee chair of the Sanofi Pasteur financed ‘DANFLU-1’ trial, Chief investigator and steering committee chair of the Sanofi Pasteur financed ‘DANFLU-2’ trial, Steering Committee member of ‘LUX-Dx TRENDS Evaluates Diagnostics Sensors in Heart Failure Patients Receiving Boston Scientific’s Investigational ICM System’ trial, Advisory Board: Sanofi Pasteur, Amgen and GSK, speaker honorarium: Novartis, Sanofi Pasteur and GSK, Research grants: GE Healthcare and Sanofi Pasteur. L.K. discloses the following relationships—speaker honorarium from Novo Nordisk, Novartis, AstraZeneca, Boehringer, and Bayer. N.T.O. discloses the following relationships—research funding: Abbott, Shockwave. D.L.B. discloses the following relationships—advisory board: AngioWave, Bayer, Boehringer Ingelheim, Cardax, CellProthera, Cereno Scientific, Elsevier Practice Update Cardiology, Janssen, Level Ex, Medscape Cardiology, Merck, MyoKardia, NirvaMed, Novo Nordisk, PhaseBio, PLx Pharma, Regado Biosciences, Stasys; Board of Directors: AngioWave (stock options), Boston VA Research Institute, Bristol Myers Squibb (stock), DRS.LINQ (stock options), Society of Cardiovascular Patient Care, TobeSoft; Chair: Inaugural Chair, American Heart Association Quality Oversight Committee; Data Monitoring Committees: Acesion Pharma, Assistance Publique-Hôpitaux de Paris, Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO trial, funded by St. Jude Medical, now Abbott), Boston Scientific (Chair, PEITHO trial), Cleveland Clinic (including for the ExCEED trial, funded by Edwards), Contego Medical (Chair, PERFORMANCE 2), Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine (for the ENVISAGE trial, funded by Daiichi Sankyo; for the ABILITY-DM trial, funded by Concept Medical), Novartis, Population Health Research Institute; Rutgers University (for the NIH-funded MINT Trial); Honoraria: American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org; Chair, ACC Accreditation Oversight Committee), Arnold and Porter law firm (work related to Sanofi/Bristol-Myers Squibb clopidogrel litigation), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; RE-DUAL PCI clinical trial steering committee funded by Boehringer Ingelheim; AEGIS-II executive committee funded by CSL Behring), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Canadian Medical and Surgical Knowledge Translation Research Group (clinical trial steering committees), Cowen and Company, Duke Clinical Research Institute (clinical trial steering committees, including for the PRONOUNCE trial, funded by Ferring Pharmaceuticals), HMP Global (Editor in Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), K2P (Co-Chair, interdisciplinary curriculum), Level Ex, Medtelligence/ReachMD (CME steering committees), MJH Life Sciences, Oakstone CME (Course Director, Comprehensive Review of Interventional Cardiology), Piper Sandler, Population Health Research Institute (for the COMPASS operations committee, publications committee, steering committee, and USA national co-leader, funded by Bayer), Slack Publications (Chief Medical Editor, Cardiology Today’s Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), WebMD (CME steering committees), Wiley (steering committee); Other: Clinical Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Chair), VA CART Research and Publications Committee (Chair); Research Funding: Abbott, Acesion Pharma, Afimmune, Aker Biomarine, Amarin, Amgen, AstraZeneca, Bayer, Beren, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb, Cardax, CellProthera, Cereno Scientific, Chiesi, CSL Behring, Eisai, Ethicon, Faraday Pharmaceuticals, Ferring Pharmaceuticals, Forest Laboratories, Fractyl, Garmin, HLS Therapeutics, Idorsia, Ironwood, Ischemix, Janssen, Javelin, Lexicon, Lilly, Medtronic, Merck, Moderna, MyoKardia, NirvaMed, Novartis, Novo Nordisk, Owkin, Pfizer, PhaseBio, PLx Pharma, Recardio, Regeneron, Reid Hoffman Foundation, Roche, Sanofi, Stasys, Synaptic, The Medicines Company, 89Bio; Royalties: Elsevier (Editor, Braunwald’s Heart Disease); Site Co-Investigator: Abbott, Biotronik, Boston Scientific, CSI, Endotronix, St. Jude Medical (now Abbott), Philips, Svelte, Vascular Solutions; Trustee: American College of Cardiology; Unfunded Research: FlowCo, Takeda. The other authors report no relevant disclosures., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2023
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129. Glycated haemoglobin levels among 3295 hospitalized COVID-19 patients, with and without diabetes, and risk of severe infection, admission to an intensive care unit and all-cause mortality.
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Alhakak A, Butt JH, Gerds TA, Fosbøl EL, Mogensen UM, Krøll J, Pallisgaard JL, Gislason GH, Torp-Pedersen C, Køber L, and Weeke PE
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- Aged, Female, Glycated Hemoglobin analysis, Humans, Intensive Care Units, Male, SARS-CoV-2, COVID-19, Diabetes Mellitus, Type 2 complications, Diabetes Mellitus, Type 2 epidemiology
- Abstract
Aim: To determine the risk of adverse outcomes across the spectrum of glycated haemoglobin (HbA1c) levels among hospitalized COVID-19 patients with and without diabetes., Materials and Methods: Danish nationwide registries were used to study the association between HbA1c levels and 30-day risk of all-cause mortality and the composite of severe COVID-19 infection, intensive care unit (ICU) admission and all-cause mortality. The study population comprised patients hospitalized with COVID-19 (3 March 2020 to 31 December 2020) with a positive polymerase chain reaction (PCR) test and an available HbA1c ≤ 6 months before the first positive PCR test. All patients had at least 30 days of follow-up. Among patients with diabetes, HbA1c was categorized as <48 mmol/mol, 48 to 53 mmol/mol, 54 to 58 mmol/mol, 59 to 64 mmol/mol (reference) and >64 mmol/mol. Among patients without diabetes, HbA1c was stratified into <31 mmol/mol, 31 to 36 mmol/mol (reference), 37 to 41 mmol/mol and 42 to 47 mmol/mol. Thirty-day standardized absolute risks and standardized absolute risk differences are reported., Results: We identified 3295 hospitalized COVID-19 patients with an available HbA1c (56.2% male, median age 73.9 years), of whom 35.8% had diabetes. The median HbA1c was 54 and 37 mmol/mol among patients with and without diabetes, respectively. Among patients with diabetes, the standardized absolute risk difference of the composite outcome was higher with HbA1c < 48 mmol/mol (12.0% [95% confidence interval {CI} 3.3% to 20.8%]) and HbA1c > 64 mmol/mol (15.1% [95% CI 6.2% to 24.0%]), compared with HbA1c 59 to 64 mmol/mol (reference). Among patients without diabetes, the standardized absolute risk difference of the composite outcome was greater with HbA1c < 31 mmol/mol (8.5% [95% CI 0.5% to 16.5%]) and HbA1c 42 to 47 mmol/mol (6.7% [95% CI 1.3% to 12.1%]), compared with HbA1c 31 to 36 mmol/mol (reference)., Conclusions: Patients with COVID-19 and HbA1c < 48 mmol/mol or HbA1c > 64 mmol/mol had a higher associated risk of the composite outcome. Similarly, among patients without diabetes, varying HbA1c levels were associated with higher risk of the composite outcome., (© 2021 John Wiley & Sons Ltd.)
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- 2022
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130. Gastrointestinal bleeding and the risk of colorectal cancer in anticoagulated patients with atrial fibrillation.
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Rasmussen PV, Dalgaard F, Gislason GH, Brandes A, Johnsen SP, Grove EL, Torp-Pedersen C, Dybro L, Harboe L, Münster AB, Pedersen L, Blanche P, Pallisgaard JL, and Hansen ML
- Abstract
Aims: Gastrointestinal bleeding (GI-bleeding) is frequent in patients with atrial fibrillation (AF) treated with oral anticoagulation (OAC) therapy. We sought to investigate to what extent lower GI-bleeding represents the unmasking of an occult colorectal cancer., Methods and Results: A total of 125 418 Danish AF patients initiating OAC therapy were identified using Danish administrative registers. Non-parametric estimation and semi-parametric absolute risk regression were used to estimate the absolute risks of colorectal cancer in patients with and without lower GI-bleeding. During a maximum of 3 years of follow-up, we identified 2576 patients with lower GI-bleeding of whom 140 patients were subsequently diagnosed with colorectal cancer within the first year of lower GI-bleeding. In all age groups, we observed high risks of colorectal cancer after lower GI-bleeding. The absolute 1-year risk ranged from 3.7% [95% confidence interval (CI) 2.2-6.2] to 8.1% (95% CI 6.1-10.6) in the age groups ≤65 and 76-80 years of age, respectively. When comparing patients with and without lower GI-bleeding, we found increased risk ratios of colorectal cancer across all age groups with a risk ratio of 24.2 (95% CI 14.5-40.4) and 12.3 (95% CI 7.9-19.0) for the youngest and oldest age group of ≤65 and >85 years, respectively., Conclusion: In anticoagulated AF patients, lower GI-bleeding conferred high absolute risks of incident colorectal cancer. Lower GI-bleeding should not be dismissed as a benign consequence of OAC therapy but always examined for a potential underlying malignant cause., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.)
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- 2022
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131. Treatment of older patients with atrial fibrillation by morbidity burden.
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Rasmussen PV, Pallisgaard JL, Hansen ML, Gislason GH, Torp-Pedersen C, Ruwald M, Alexander KP, Lopes RD, Al-Khatib SM, and Dalgaard F
- Subjects
- Administration, Oral, Aged, Aged, 80 and over, Anticoagulants therapeutic use, Female, Humans, Morbidity, Atrial Fibrillation complications, Atrial Fibrillation epidemiology, Atrial Fibrillation therapy, Catheter Ablation
- Abstract
Aims: Older patients with atrial fibrillation (AF) are at risk of adverse outcomes, which is accentuated by comorbidities. We sought to examine the association between morbidity burden and the treatment of older AF patients., Methods and Results: Using Danish nationwide registers we included patients ≥70 years of age between 2010 and 2017 at their first hospitalization due to AF. Using multiple logistic regression models we examined the association between morbidity burden and the odds of receiving oral anticoagulants (OACs), anti-arrhythmic drugs (AADs), and rhythm-control procedures (direct current cardioversions and catheter ablations). A total of 48 995 patients were included with a majority of women (54%), with a median age of 80 years [interquartile range (IQR) 75-85], and a median morbidity burden of 2 comorbidities (IQR 1-3). Increasing morbidity burden was associated with decreasing odds of OAC treatment with patients having >5 comorbidities having the lowest odds [odds ratio (OR) 0.38, 95% confidence interval (CI) 0.35-0.42] compared to patients with low morbidity burden (0-1 comorbidities). Having >5 comorbidities were associated with increased odds of AAD treatment (OR 1.90, 95% CI 1.64-2.21) and decreased odds of AF procedures (OR 0.39, 95% CI 0.31-0.48), compared to patients with a low morbidity burden (0-1 comorbidities). Examining morbidity burden continuously revealed similar results., Conclusions: In older AF patients, multimorbidity was associated with lower odds of receiving OACs and rhythm-control procedures but increased odds of AADs. This presents a clinical conundrum as multimorbid patients potentially benefit the most from treatment with OACs., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2022
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132. Haematuria and urinary tract cancers in patients with atrial fibrillation treated with oral anticoagulants.
- Author
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Rasmussen PV, Dalgaard F, Gislason GH, Brandes A, Johnsen SP, Grove EL, Torp-Pedersen C, Münster AB, Erikson MS, Pallisgaard JL, Blanche P, and Hansen ML
- Subjects
- Administration, Oral, Aged, Aged, 80 and over, Anticoagulants, Hematuria chemically induced, Hematuria diagnosis, Hematuria epidemiology, Humans, Male, Risk Factors, Atrial Fibrillation complications, Atrial Fibrillation diagnosis, Atrial Fibrillation drug therapy, Stroke epidemiology, Urologic Neoplasms chemically induced, Urologic Neoplasms complications, Urologic Neoplasms drug therapy
- Abstract
Aims: Patients with atrial fibrillation (AF) treated with oral anticoagulants (OACs) have an increased risk of bleeding including haematuria. In the general population, gross haematuria is associated with urinary tract cancer. Consequently, we aimed to investigate the potential association between gross haematuria and urinary tract cancer in anticoagulated patients with AF., Methods and Results: Using Danish nationwide registers, we included Danish AF patients treated with OACs between 2001 and 2015. Non-parametric estimation and semi-parametric absolute risk regression were used to estimate the absolute risk of urinary tract cancer in patients with and without gross haematuria. We included 125 063 AF patients with a median age of 74 years (interquartile range 65-80) and a majority of males (57%). The absolute risk of gross haematuria 12 months after treatment initiation increased with age ranging from 0.37% [95% confidence interval (CI) 0.31-0.42] to 0.85% (95% CI 0.75-0.96) in the youngest and oldest age groups of ≤70 and >80 years of age, respectively. The 1-year risk of urinary tract cancer after haematuria ranged from 4.2% (95% CI 2.6-6.6) to 6.5% (95% CI 4.6-9.0) for patients in age group >80 and 71-80 years, respectively. Gross haematuria conferred large risk ratios of urinary tract cancer when comparing patients with and without haematuria across all age groups., Conclusion: Gross haematuria was associated with clinically relevant risks of urinary tract cancer in anticoagulated patients with AF. These findings underline the importance of meticulously examining anticoagulated patients with haematuria., (Published on behalf of the European Society of Cardiology. © The Author(s) 2020.)
- Published
- 2021
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133. Risk of gastrointestinal bleeding associated with oral anticoagulation and non-steroidal anti-inflammatory drugs in patients with atrial fibrillation: a nationwide study.
- Author
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Olsen AS, McGettigan P, Gerds TA, Fosbøl EL, Olesen JB, Sindet-Pedersen C, Staerk L, Lock Hansen M, Pallisgaard JL, Køber L, Torp-Pedersen C, Gislason GH, and Lamberts M
- Subjects
- Administration, Oral, Adult, Aged, Aged, 80 and over, Anti-Inflammatory Agents, Non-Steroidal administration & dosage, Anticoagulants administration & dosage, Atrial Fibrillation epidemiology, Denmark epidemiology, Drug Interactions, Female, Humans, Male, Middle Aged, Polypharmacy, Registries, Risk Assessment, Risk Factors, Stroke epidemiology, Treatment Outcome, Anti-Inflammatory Agents, Non-Steroidal adverse effects, Anticoagulants adverse effects, Atrial Fibrillation drug therapy, Gastrointestinal Hemorrhage chemically induced, Stroke prevention & control
- Abstract
Aims: Non-vitamin K antagonist oral anticoagulants (NOACs) are displacing vitamin K antagonists (VKAs) for stroke prophylaxis in patients with atrial fibrillation (AF). Concomitant use of non-steroidal anti-inflammatory drugs (NSAIDs) could increase gastrointestinal bleeding (GIB) risks among these patients. The aim of this study was to examine the risk of GIB among Danish AF patients taking oral anticoagulants (OACs) and NSAIDs., Methods and Results: Using nationwide administrative registries, we determined concomitant NSAID use among anticoagulant-naïve patients with AF initiating OACs between August 2011 and June 2017. We calculated short-term absolute risks differences and hazard ratios (HRs) for GIB based on multiple adjusted cause-specific Cox regressions with time-dependent NSAID treatment. Among 41 183 patients [median age 70 years (interquartile range 64-78); 55% men], 21% of patients on NOACs and 18% on VKA were co-prescribed NSAIDs. The differences in absolute risk [95% confidence interval (CI)] of GIB within 14 days of commencing concomitant NSAID therapy (vs. no concomitant NSAID therapy) were 0.10% (0.04-0.18%) for NOACs and 0.13% (0.03-0.24%) for VKA. NOACs overall were associated with less GIB than VKA [HR 0.77 (95% CI 0.69-0.85)]. Compared with OACs alone, concomitant NSAIDs doubled the GIB risk associated with NOACs overall [HR 2.01 (95% CI 1.40-2.61)] and with VKA [HR 1.95 (95% CI 1.21-2.69)]., Conclusion: Among this nationwide AF population taking OACs, concomitant NSAID therapy increased the short-term absolute risk of GIB. Non-vitamin K antagonist oral anticoagulants alone were associated with lower GIB risks than VKA but concomitant NSAIDs abolished this advantage. The findings align with post hoc analyses from randomized studies. Physicians should exercise appropriate caution when prescribing NSAIDs for patients with AF taking NOACs or VKA., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2020
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134. [Fatal outcome of coronavirus disease 2019 in a previously healthy 50-year-old man].
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Wissenberg M, Andersen LPK, Pallisgaard JL, and Lawson-Smith P
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- Betacoronavirus, COVID-19, Fatal Outcome, Humans, Hypoxia etiology, Male, Middle Aged, Multiple Organ Failure etiology, SARS-CoV-2, Shock, Septic etiology, Coronavirus Infections complications, Coronavirus Infections diagnosis, Heart Arrest etiology, Pandemics, Pneumonia, Viral complications, Pneumonia, Viral diagnosis, Respiratory Insufficiency etiology
- Abstract
In this case report, a 50-year-old man who had no medical history, presented with multiple cardiac arrests following a week with progressing symptoms of pneumonia. After achieving return of spontaneous circulation he presented with respiratory failure with severe hypoxia, septic shock, and multiple organ failure. A chest X-ray showed signs of acute respiratory distress syndrome. Despite aggressive intensive care management, the patient died 7.5 hours after admission. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was later confirmed, and the presumed cause of death was SARS-CoV-2 pneumonia. In conclusion: coronavirus disease 2019 (COVID-19) can lead to a fatal outcome in younger healthy residents, who are not treated timely in case of severe symptoms like dyspnoea.
- Published
- 2020
135. Catheter ablation for atrial fibrillation is associated with lower incidence of heart failure and death.
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Modin D, Claggett B, Gislason G, Hansen ML, Worck R, Johannessen A, Hansen J, Svendsen JH, Pallisgaard JL, Schou M, Køber L, Solomon SD, Torp-Pedersen C, and Biering-Sørensen T
- Subjects
- Cohort Studies, Humans, Incidence, Atrial Fibrillation diagnosis, Atrial Fibrillation epidemiology, Atrial Fibrillation surgery, Catheter Ablation, Heart Failure diagnosis, Heart Failure epidemiology
- Abstract
Aims: Catheter ablation for atrial fibrillation (CAF) improves symptoms, but whether CAF improves outcome is less clear. The purpose of this study was to investigate whether CAF is associated with improved outcome in atrial fibrillation (AF) patients with previous direct current (DC) cardioversion., Methods and Results: We performed a nationwide cohort study including all patients who underwent their 1st direct current cardioversion for AF in the period 2003-15 (N = 25 439). End points were all-cause death, cardiovascular death, stroke/thromboembolism, and incident heart failure (HF). Catheter ablation for AF was treated as a time-varying covariate and the association with outcome was assessed using Cox regression. We also constructed a propensity-matched cohort and assessed the association between CAF and outcome. Median follow-up was 5.3 years (inter-quartile range 3.0-8.7 years). A total of 3509 patients (13.8%) underwent CAF during the study period. Following adjustment for age, gender, comorbidities, medications, educational level, household income, and CHA2DS2VASc score, CAF was associated with reduced risks of all-cause death, cardiovascular death, and incident HF [all-cause death: hazard ratio (HR) 0.69, P < 0.001; cardiovascular death: HR 0.68, P = 0.003; incident HF: HR 0.76, P = 0.011]. Catheter ablation for AF was not associated with a reduced risk of stroke/thromboembolism. These results were replicated in a propensity-matched cohort., Conclusion: In AF patients with a prior DC cardioversion, CAF was associated with a reduced risk of all-cause and cardiovascular death. This may be due to a reduced risk of HF., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2020
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136. Safety and effectiveness of rivaroxaban and apixaban in patients with venous thromboembolism: a nationwide study.
- Author
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Sindet-Pedersen C, Staerk L, Pallisgaard JL, Gerds TA, Berger JS, Torp-Pedersen C, Gislason GH, and Olesen JB
- Subjects
- Aged, Aged, 80 and over, Denmark epidemiology, Factor Xa Inhibitors adverse effects, Female, Fibrinolytic Agents adverse effects, Hemorrhage chemically induced, Hemorrhage mortality, Hospitalization, Humans, Male, Middle Aged, Pyrazoles adverse effects, Pyridones adverse effects, Recurrence, Registries, Retrospective Studies, Risk Factors, Rivaroxaban adverse effects, Time Factors, Treatment Outcome, Venous Thromboembolism diagnosis, Venous Thromboembolism mortality, Factor Xa Inhibitors therapeutic use, Fibrinolytic Agents therapeutic use, Pyrazoles therapeutic use, Pyridones therapeutic use, Rivaroxaban therapeutic use, Venous Thromboembolism drug therapy
- Abstract
Aims: To investigate the risk of all-cause mortality, recurrent venous thromboembolism (VTE), and hospitalized bleeding in patients with VTE treated with either rivaroxaban or apixaban., Methods and Results: Using Danish nationwide registries, patients with VTE treated with rivaroxaban or apixaban in the period from 1 January 2015 to 30 June 2017 were identified. Standardized absolute risks were estimated based on outcome-specific Cox regression models, adjusted for potential confounders. A total of 8187 patients were included in the study, of which 1504 (18%) were treated with apixaban [50% males, median age 70 years; interquartile range (IQR) 56-80] and 6683 (82%) were treated with rivaroxaban (55% males, median age 67 years; IQR 53-76). The 180 days risk of all-cause mortality was 5.08% [95% confidence interval (95% CI) 4.08% to 6.08%)] in the apixaban group and 4.60% (95% CI 4.13% to 5.18%) in the rivaroxaban group [absolute risk difference: -0.48% (95% CI -1.49% to 0.72%)]. The 180 days risk of recurrent VTE was 2.16% (95% CI 1.49% to 2.88%) in the apixaban group and 2.22% (95% CI 1.89% to 2.52%) in the rivaroxaban group [absolute risk difference of 0.06% (95% CI -0.72% to 0.79%)]. The 180 days risk of hospitalized bleeding was 1.73% (95% CI 1.22% to 2.35%) for patients in the apixaban group and 1.89% (95% CI 1.56% to 2.20%) in the rivaroxaban group [absolute risk difference: 0.16% (95% CI -0.59% to 0.81%)]., Conclusion: In a nationwide cohort of 8187 patients with VTE treated with rivaroxaban or apixaban, there were no significant differences in the risks of all-cause mortality, recurrent VTE, or hospitalized bleeding.
- Published
- 2018
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137. Use of oral anticoagulants in combination with antiplatelet(s) in atrial fibrillation.
- Author
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Sindet-Pedersen C, Staerk L, Lamberts M, Gerds TA, Berger JS, Nissen Bonde A, Langtved Pallisgaard J, Hansen ML, Torp-Pedersen C, Gislason GH, and Bjerring Olesen J
- Subjects
- Administration, Oral, Aged, Aged, 80 and over, Atrial Fibrillation mortality, Denmark epidemiology, Drug Therapy, Combination, Female, Humans, Male, Myocardial Infarction mortality, Percutaneous Coronary Intervention mortality, Practice Patterns, Physicians' statistics & numerical data, Retrospective Studies, Treatment Outcome, Vitamin K antagonists & inhibitors, Anticoagulants administration & dosage, Aspirin administration & dosage, Atrial Fibrillation drug therapy, Clopidogrel administration & dosage, Platelet Aggregation Inhibitors administration & dosage
- Abstract
Objectives: To investigate temporal trends in the use of non-vitamin K oral anticoagulants (NOACs) and vitamin K antagonists (VKAs) in combination with aspirin and/or clopidogrel in patients with atrial fibrillation (AF) following acute myocardial infarction (MI) and/or percutaneous coronary intervention (PCI)., Methods: Using Danish nationwide registries, all patients with AF who survived 30 days after discharge from MI and/or PCI between 22 August 2011 and 30 September 2016 were identified., Results: A total of 2946 patients were included in the study population, of whom 1967 (66.8%) patients were treated with VKA in combination with antiplatelet(s) (VKA+aspirin n=477, VKA+clopidogrel n=439, VKA+aspirin+clopidogrel n=1051) and 979 (33.2%) patients were treated with NOAC in combination with antiplatelet(s) (NOAC+aspirin n=252, NOAC+clopidogrel n=218, NOAC+aspirin+clopidogrel n=509). The overall study population had a median age of 76 years [IQR: 69-82] and consisted of 1995 (67.7%) men. Patients with MI as inclusion event accounted for 1613 patients (54.8%). Patients with high CHA
2 DS2 -VASc score(congestive heart failure, hypertension, age ≥75 years (2 points), diabetes mellitus, history of stroke/transient ischemic attack/systemic thromboembolism (2 points), vascular disease, age 65-75 years, and female sex) accounted for 132 2814 (95.5%) of patients, and patients with high HAS-BLED score (hypertension, abnormal renal/liver function, history of stroke, history of bleeding, age >65 years, non-steroidal anti-inflammatory drug usages, or alcohol abuse, leaving out labile international normalized ratio (not available), and use of antiplatelets (exposure variable)) accounted for 934 (31.7%) of patients. There was an increase from 10% in 2011 to 52% in 2016 in the use of NOACs in combination with antiplatelet(s)., Conclusion: From 2011 to 2016, the use of NOAC in combination with antiplatelet(s) increased in patients with AF following MI/PCI and exceeded the use of VKA in combination with antiplatelet(s) by 2016., Competing Interests: Competing interests: CS-P has nothing to declare. TAG has nothing to declare. LS has received funding for research from Boehringer Ingelheim. JLP has received funding for research from Boehringer Ingelheim and Bayer. CT-P declares research contracts with Bayer and Biotronic and speaker fees for Bayer and BMS. GHG has received funding for research from Boehringer Ingelheim, Pfizer, BMS, AstraZeneca and Bayer, and declares ownership of stocks in Lundbeck A/S, Novo Nordisk A/S and ALK Abello Pharmaceuticals. JBO has received speaker fees from Bristol-Myers Squibb, Boehringer Ingelheim, Bayer and AstraZeneca, previous funding for research from the Lundbeck Foundation, and current funding for research from the Bristol-Myers Squibb and the Capital Region of Denmark, Foundation for Health Research. ML has received speaker fees from Bristol-Meyer Squibb and Bayer. JSB has received research support from AstraZeneca and is a consultant for Merck, AstraZeneca and Janssen. ANB has nothing to declare. MLH has received speaker fees from Bristol-Meyer Squibb., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)- Published
- 2018
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138. Thiazolidinediones are associated with a decreased risk of atrial fibrillation compared with other antidiabetic treatment: a nationwide cohort study.
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Pallisgaard JL, Lindhardt TB, Staerk L, Olesen JB, Torp-Pedersen C, Hansen ML, and Gislason GH
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Atrial Fibrillation epidemiology, Atrial Fibrillation etiology, Denmark epidemiology, Diabetes Mellitus blood, Diabetes Mellitus epidemiology, Female, Follow-Up Studies, Humans, Incidence, Male, Middle Aged, Prevalence, Retrospective Studies, Risk Factors, Time Factors, Young Adult, Atrial Fibrillation prevention & control, Diabetes Mellitus drug therapy, Population Surveillance methods, Registries, Thiazolidinediones therapeutic use
- Abstract
Aim: The aim of this study was to investigate the association between thiazolidinediones (TZDs) vs. other antidiabetic drugs and risk of atrial fibrillation (AF) in diabetic patients., Method and Results: Diabetes mellitus (diabetes) increases the risk of AF by approximately 34%. TZD is an insulin sensitizer that also has anti-inflammatory effects, which might decrease the risk of AF compared with other antidiabetic drugs. We used data from the Danish nationwide registries to study 108 624 patients with diabetes and without prior AF who were treated with metformin or sulfonylurea as first-line drugs. The incidence of AF was significantly lower with TZD as the second-line antidiabetic treatment compared with other second-line antidiabetic drugs (P < 0.001). The 10 year cumulative incidence [95% confidence interval (95% CI)] of AF was 6.2% (3.1-9.3%) with TZD vs. 10.2% (9.8-10.6%) with other antidiabetic drugs. The decreased risk of AF remained significant after adjusting for age, sex, and comorbidities with a hazard ratio (95% CI) of 0.76 (0.57-1.00), P = 0.047 associated with TZD treatment compared with other antidiabetic drugs., Conclusion: Use of a TZD to treat diabetes was associated with reduced risk of developing AF compared with other antidiabetic drugs as second-line treatment., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For Permissions, please email: journals.permissions@oup.com.)
- Published
- 2017
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139. Adherence with oral anticoagulation in non-valvular atrial fibrillation: a comparison of vitamin K antagonists and non-vitamin K antagonists.
- Author
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Sørensen R, Jamie Nielsen B, Langtved Pallisgaard J, Ji-Young Lee C, and Torp-Pedersen C
- Subjects
- Administration, Oral, Adolescent, Adult, Aged, Atrial Fibrillation complications, Atrial Fibrillation epidemiology, Denmark epidemiology, Female, Humans, Incidence, Male, Middle Aged, Stroke epidemiology, Stroke etiology, Young Adult, Anticoagulants administration & dosage, Atrial Fibrillation drug therapy, Registries, Stroke prevention & control, Thrombolytic Therapy methods, Vitamin K antagonists & inhibitors
- Abstract
Aims: The purpose of this study was to describe adherence with non-vitamin K antagonists (NOACs) and vitamin K antagonists (VKA) in patients with non-valvular atrial fibrillation (NVAF)., Methods and Results: By linkage of Danish nationwide registers, we identified patients with NVAF who claimed a prescription of a NOAC (dabigatran, rivaroxaban, and apixaban), or a VKA. Adherence was evaluated according to Proportions of Days Covered, refill gaps, and switch in treatment. Adjusted analyses were calculated with logistic regression and Cox proportional hazard models. Between 2011 and 2014, 46 675 patients with NVAF claimed a prescription of anticoagulation (OAC): 57.3% used VKA, 29.8% dabigatran, 8.5% rivaroxaban, and 4.4% apixaban. During the first 180 days, PDC >80% was the highest among users of rivaroxaban. Compared with rivaroxaban, OR was 0.79 with apixaban (95% CI 0.69-0.92), 0.72 with dabigatran (95% CI 0.66-0.80), and 0.76 with VKAs (95% CI 0.69-0.83). HR for refill gaps between 7 and 89 days of length were (rivaroxaban as reference): apixaban 1.52(95% CI 1.36-1.69), dabigatran 1.72 (95% CI 1.60-1.85), and VKA 2.36(95% CI 2.20-2.52). Refill gaps of more than 89 days occurred in 11.5% of VKA recipients, with substantially lower rates for patients treated with NOAC. Switch between OACs was the highest in users of dabigatran (21.0%) and the lowest in users of apixaban (8.6%)., Conclusion: Among NVAF patients treated with OAC, 42.7% received a NOAC. PDC > 80%, and periods without refill gaps were the highest among users of rivaroxaban. Refill gaps occurred most often with VKA, switch was most common with dabigatran use., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2017
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140. Stroke and recurrent haemorrhage associated with antithrombotic treatment after gastrointestinal bleeding in patients with atrial fibrillation: nationwide cohort study.
- Author
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Staerk L, Lip GY, Olesen JB, Fosbøl EL, Pallisgaard JL, Bonde AN, Gundlund A, Lindhardt TB, Hansen ML, Torp-Pedersen C, and Gislason GH
- Subjects
- Aged, Denmark epidemiology, Female, Fibrinolytic Agents therapeutic use, Gastrointestinal Hemorrhage epidemiology, Humans, Incidence, Male, Proportional Hazards Models, Recurrence, Risk Factors, Stroke etiology, Survival Rate trends, Atrial Fibrillation complications, Fibrinolytic Agents adverse effects, Gastrointestinal Hemorrhage chemically induced, Registries, Stroke prevention & control
- Abstract
Study Question: What are the risks of all cause mortality, thromboembolism, major bleeding, and recurrent gastrointestinal bleeding associated with restarting antithrombotic treatment after gastrointestinal bleeding in patients with atrial fibrillation?, Methods: This Danish cohort study (1996-2012) included all patients with atrial fibrillation discharged from hospital after gastrointestinal bleeding while receiving antithrombotic treatment. Restarted treatment regimens were single or combined antithrombotic drugs with oral anticoagulation and antiplatelets. Follow-up started 90 days after discharge to avoid confounding from use of previously prescribed drugs on discharge. Risks of all cause mortality, thromboembolism, major bleeding, and recurrent gastrointestinal bleeding were estimated with competing risks models and time dependent multiple Cox regression models., Study Answer and Limitations: 4602 patients (mean age 78 years) were included. Within two years, 39.9% (95% confidence interval 38.4% to 41.3%, n=1745) of the patients had died, 12.0% (11.0% to 13.0%, n=526) had experienced thromboembolism, 17.7% (16.5% to 18.8%, n=788) major bleeding, and 12.1% (11.1% to 13.1%, n=546) recurrent gastrointestinal bleeding. 27.1% (n=924) of patients did not resume antithrombotic treatment. Compared with non-resumption of treatment, a reduced risk of all cause mortality was found in association with restart of oral anticoagulation (hazard ratio 0.39, 95% confidence interval 0.34 to 0.46), an antiplatelet agent (0.76, 0.68 to 0.86), and oral anticoagulation plus an antiplatelet agent (0.41, 0.32 to 0.52), and a reduced risk of thromboembolism was found in association with restart of oral anticoagulation (0.41, 0.31 to 0.54), an antiplatelet agent (0.76, 0.61 to 0.95), and oral anticoagulation plus an antiplatelet agent (0.54, 0.36 to 0.82). Restarting oral anticoagulation alone was the only regimen with an increased risk of major bleeding (1.37, 1.06 to 1.77) compared with non-resumption of treatment; however, the difference in risk of recurrent gastrointestinal bleeding was not significant between patients who restarted an antithrombotic treatment regimen and those who did not resume treatment., What This Study Adds: Among patients with atrial fibrillation who experience gastrointestinal bleeding while receiving antithrombotic treatment; subsequent restart of oral anticoagulation alone was associated with better outcomes for all cause mortality and thromboembolism compared with patients who did not resume treatment. This was despite an increased longitudinal associated risk of bleeding., Funding, Competing Interests, Data Sharing: This study was supported by a grant from Boehringer-Ingelheim. Competing interests are available in the full paper on bmj.com. The authors have no additional data to share., (© Staerk et al 2015.)
- Published
- 2015
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141. NSAIDs are associated with increased risk of atrial fibrillation in patients with prior myocardial infarction: a nationwide study.
- Author
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Schjerning Olsen AM, Fosbøl EL, Pallisgaard J, Lindhardsen J, Lock Hansen M, Køber L, Hansen PR, Torp-Pedersen C, and Gislason GH
- Subjects
- Aged, Anti-Inflammatory Agents, Non-Steroidal administration & dosage, Atrial Fibrillation epidemiology, Denmark epidemiology, Dose-Response Relationship, Drug, Female, Follow-Up Studies, Humans, Incidence, Male, Middle Aged, Recurrence, Retrospective Studies, Risk Factors, Survival Rate trends, Time Factors, Anti-Inflammatory Agents, Non-Steroidal adverse effects, Atrial Fibrillation chemically induced, Myocardial Infarction therapy, Registries, Risk Assessment methods
- Abstract
Aims: Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with increased risk of cardiovascular disease. Yet, the risk of atrial fibrillation (AF) associated with NSAIDs among patients with prior myocardial infarction (MI) has not been examined, and such data could contribute considerably to the risk-benefit assessment of NSAID use in this clinical context., Methods and Results: Using nationwide administrative registries in Denmark, we studied patients aged ≥30 years admitted with first-time MI and without prior AF in the period of 1997-2011. Risk of AF associated with NSAID use vs. no NSAID use was analysed by multivariable time-dependent Cox proportional hazard models. Of the 86 496 patients [mean age 66 (SD 13) years; 64% men] included in this study, 44.1% filled at least one NSAID prescription after discharge from MI. During a mean follow-up of 5.3 years, 7831 (8.9%) developed AF. The confidence intervals rate (95% CI) of AF per 100 person-years with NSAID treatment was 2.2 (2.0-2.4) compared with 1.7 (1.6-1.7) without NSAIDs. In the adjusted model, the risk of AF after NSAID treatment increased [Hazard ratio (HR) 1.27 (1.14-1.40)]. An increased risk of AF was seen regardless of the type of NSAID or with short-term (0-14 days) treatment [HR 1.45 (1.24-1.69)]. When the risk of death in patients exposed [crude rate 23.3 (19.7-27.5)] vs. not exposed [crude rate 17.4 (95% CI 16.8-18.1)] to NSAIDs at the time of AF was compared, NSAID use was associated with a poorer prognosis [HR 1.35 (1.14-1.60)]., Conclusion: Our study suggests that the use of NSAIDs might be associated with the increased risk of AF in post-MI patients., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.)
- Published
- 2015
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142. Massive electrical storm at disease onset in a patient with Brugada syndrome.
- Author
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Pallisgaard JL, Gang U, Kanters JK, and Hansen PR
- Subjects
- Brugada Syndrome therapy, Electric Countershock, Electrocardiography, Humans, Male, Middle Aged, Tachycardia, Ventricular diagnosis, Tachycardia, Ventricular therapy, Ventricular Fibrillation diagnosis, Ventricular Fibrillation therapy, Brugada Syndrome complications, Brugada Syndrome diagnosis, Tachycardia, Ventricular etiology, Ventricular Fibrillation etiology
- Abstract
Background: Brugada syndrome (BrS) is a genetic arrhythmogenic disease characterized by ST-segment elevations in the right precordial leads of the electrocardiogram (ECG). These ECG changes may be concealed and BrS may present with electrical storm characterized by recurrent ventricular tachycardia and fibrillation., Case Report: A 49-year-old previously healthy man was admitted with electrical storm. The patient received direct current (DC) cardioversion shocks and only after intravenous lidocaine did the electrical storm slowly subside with a total of 255 DC shocks administered during the first 24 h after admission. He fully recovered and received an implantable cardioverter-defibrillator. Subsequent drug challenge with flecainide revealed type 1 BrS., Conclusions: Massive electrical storm can be the first symptom of BrS and the diagnostic ECG changes may be concealed at presentation. Although hundreds of DC shocks may be required during initial treatment, full recovery can be achieved.
- Published
- 2014
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143. [Fistula-producing giant coronary aneurysm in a 62-year-old woman].
- Author
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Pallisgaard JL, Stride NO, San Myschetzky P, and Bech J
- Subjects
- Arterio-Arterial Fistula diagnostic imaging, Arterio-Arterial Fistula drug therapy, Coronary Aneurysm diagnostic imaging, Coronary Aneurysm drug therapy, Coronary Angiography, Coronary Vessels diagnostic imaging, Female, Humans, Middle Aged, Pulmonary Artery diagnostic imaging, Tomography, X-Ray Computed, Arterio-Arterial Fistula etiology, Coronary Aneurysm complications
- Abstract
Giant coronary aneurysms (GCA with a diameter > 20 mm) are rare with a prevalence < 0.02%. A 62-year-old woman with no history of ischaemic heart disease was admitted to hospital with acute chest pain. A coronary angiography revealed a left an-terior descendent-associated GCA. A cardiac computed tomo-g-raphy demonstrated a "snake-pit"-like fistula connecting the GCA and the pulmonary artery. Atherosclerosis, connective tissue dis-orders, and previous coronary intervention will predispose to GCA. No evidence-based treatment regimen exists, but coiling, excision or a conservative approach, as in this case, is possible strategies.
- Published
- 2014
144. [Viral myocarditis in a man with scleroderma].
- Author
-
Pallisgaard JL, Alhede C, Olsen NT, and Skøtt P
- Subjects
- Electrocardiography, Humans, Male, Middle Aged, Myocarditis diagnosis, Scleroderma, Systemic diagnostic imaging, Myocarditis virology, Scleroderma, Systemic complications
- Abstract
Scleroderma is a rare cause of myocarditis. We present a case of myocarditis due to scleroderma in a 48-year-old man. The patient was eventually diagnosed with viral myocarditis, as his scleroderma was well controlled, and the clinical presentation did not match prior examples of myocarditis due to scleroderma. When treating scleroderma patients with myocarditis, scleroderma should always be considered as a possible cause, as the treatment differs from other types of myocarditis.
- Published
- 2014
145. [Calcified amorpheus tumour of the heart as the cause of near syncope].
- Author
-
Pallisgaard JL, Buch TN, Søndergaard EB, and Tønder N
- Subjects
- Calcinosis diagnostic imaging, Calcinosis surgery, Cardiomyopathies diagnostic imaging, Cardiomyopathies surgery, Female, Heart Atria diagnostic imaging, Heart Atria pathology, Heart Atria surgery, Heart Neoplasms diagnostic imaging, Heart Neoplasms surgery, Humans, Middle Aged, Treatment Outcome, Ultrasonography, Calcinosis complications, Cardiomyopathies complications, Heart Neoplasms complications, Syncope etiology
- Abstract
Calcified amorphoeus tumour of the heart (cardiac CAT) is a rare non-neoplastic tumour of the heart. To the best of our knowledge, this is the first case report of cardiac CAT in Scandinavia. The patient was a 55-year-old woman with obesity, hypertension, hyperlipidaemia, a history of smoking, and a family history of ischaemic heart disease. She presented with dyspnoea and near syncope. The tumour was resected, and cytopathology was preformed on its content. Based on the cytopathology, the pathologist concluded that the tumour most likely was cardiac CAT, though a calcified myxoma could not be excluded with certainty.
- Published
- 2012
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