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Influence of Different Treatment Strategies on New‐Onset Atrial Fibrillation Among Patients With Primary Aldosteronism: A Nationwide Longitudinal Cohort‐Based Study
- Source :
- Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
- Publication Year :
- 2020
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2020.
-
Abstract
- Background Primary aldosteronism ( PA ) is associated with higher atrial fibrillation prevalence and other cardiovascular complications. However, the effect of target treatment to prevent new‐onset atrial fibrillation ( NOAF ) remains unclear. This study investigated incidence of NOAF under different treatment strategies in patients with PA. Methods and Results We analyzed longitudinal data for patients with PA without atrial fibrillation history from 1997 to 2009 within the National Health Insurance Research Database in Taiwan. Patients with essential hypertension matched by propensity score were enrolled as controls. The primary outcome measurement was NOAF , and secondary outcome measurements were mortality, major cardiac and cardiac/cerebrovascular events, and a combined end point of NOAF and mortality. We identified 2202 patients with PA (534 adrenalectomy, 1668 mineralocorticoid receptor antagonist [MRA] therapy) and 8808 essential hypertension controls with mean follow‐up of 4.4 years. In primary outcome measurement, patients with PA who underwent adrenalectomy had a lower incidence of NOAF (adjusted hazard ratio; 0.28, P =0.011) than controls. In contrast, the patients with PA who received MRA therapy had comparable risk of NOAF (adjusted hazard ratio, 1.20; P =0.224). In secondary outcome measurement, patients with PA who underwent adrenalectomy had a lower rate of mortality and combined end point of NOAF and mortality than controls. Patients with PA who received MRA therapy had a higher risk of mortality, major cardiac and cardiac/cerebrovascular events, and combined NOAF with mortality than the essential hypertension controls. Conclusions Compared with patients with essential hypertension, patients with PA who underwent adrenalectomy had a lower incidence of NOAF . However, this finding was not observed in patients with PA who received MRA therapy with a lower dose. Differences between the 2 strategies may reduce with a higher dose of MRA therapy.
- Subjects :
- Male
medicine.medical_specialty
Databases, Factual
Epidemiology
medicine.medical_treatment
Taiwan
030209 endocrinology & metabolism
030204 cardiovascular system & hematology
ACE/Angiotension Receptors/Renin Angiotensin System
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Primary aldosteronism
Mineralocorticoid receptor
Risk Factors
Internal medicine
Atrial Fibrillation
Hyperaldosteronism
medicine
Humans
Longitudinal Studies
mineralocorticoid receptor antagonist
Aged
Mineralocorticoid Receptor Antagonists
Retrospective Studies
Original Research
aldosterone
Aldosterone
business.industry
Incidence
Adrenalectomy
adrenalectomy
Atrial fibrillation
Middle Aged
medicine.disease
New onset atrial fibrillation
Treatment
Treatment Outcome
spironolactone
chemistry
Hypertension
Spironolactone
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 20479980
- Volume :
- 9
- Database :
- OpenAIRE
- Journal :
- Journal of the American Heart Association
- Accession number :
- edsair.doi.dedup.....1eefb6dd4299fcd0256c4019321e58a2