Analysis of geographical variations in the epidemiology and management of non-valvular atrial fibrillation: results from the RAMSES registry.

OBJECTIVE: This study aimed to determine the differences in terms of demographic characteristics and preferred stroke prevention strategies for patients with non-valvular atrial fibrillation living in seven geographical regions of Turkey. METHODS: In total, 6273 patients were enrolled to this prospective, observational RAMSES study. The patients were divided into seven groups based on the geographical region of residence. RESULTS: In terms of the geographical distribution of the overall Turkish population, the highest number of patients were enrolled from Marmara (1677, 26.7%). All demographic characteristics were significantly different among regions. Preferred oral anticoagulants (OACs) also differed between geographical regions; non-vitamin K OACs were preceded by warfarin in East Anatolia, Aegean, Southeast Anatolia, and Black Sea. Nearly one-third of the patients (28%) did not receive any OAC therapy. However, the number of patients not receiving any OAC therapy was higher in Southeast Anatolia (51.1%) and East Anatolia (46.8%) compared with other geographical regions of Turkey. Inappropriate use of OACs was also more common in East and Southeast Anatolia. CONCLUSION: This study was the first to show that the demographic differences among the geographical regions may result in different preferences of stroke prevention strategies in Turkey. OACs are still under- or inappropriately utilized, particularly in the eastern provinces of Turkey.

Real-World Clinical Characteristics and Treatment Patterns of Individuals Aged 80 and Older with Nonvalvular Atrial Fibrillation: Results from the ReAl-life Multicenter Survey Evaluating Stroke Study.

OBJECTIVES: To compare the clinical characteristics of and use of oral anticoagulant (OAC) therapy in individuals aged 80 and older with atrial fibrillation (AF) with those of individuals younger than 80 with AF in clinical practice. DESIGN: Observational study. SETTING: The ReAl-life Multicenter Survey Evaluating Stroke prevention strategies in Turkey trial (NCT02344901), a national observational registry. PARTICIPANTS: Turkish adults with nonvalvular AF (NVAF). MEASUREMENTS: Age data were collected at the time of entry into the registry and the octogenarian subgroup included all patients aged ≥ 80 years. We compared background and management in octogenarian with non-octogenarian AF patients. RESULTS: Fifty-seven cardiology units enrolled 6,273 individuals in 3 months. Participants aged 80 and older (n = 1,170) were more likely to be female (60.7% vs 54.7%, P < .001) and had a higher prevalence of persistant or permanent AF, comorbidities, history of cerebral vascular accident, and major bleeding. As a consequence of having more comorbidities, Congestive heart failure; Hypertension; Aged 75 and older; Diabetes Mellitus; prior stroke, transient ischemic attack, or thromboembolism; Vascular disease; Aged 65 to 74; female Sex (CHA2 DS2 VASc) (4.32 ± 1.35 vs 3.04 ± 1.54, P < .001) and Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile international normalized ratio, Elderly, Drugs or alcohol (HAS-BLED) (2.14 ± 1.05 vs 1.54 ± 1.05, P < .001) scores were higher in those aged 80 and older. The mean time in therapeutic range of individuals who were taking warfarin was lower in those aged 80 and older (45.9 ± 27.9) than in those younger than 80 (54.7 ± 24.9%, P < .001). Anticoagulant therapy was prescribed for 74.8% of participants younger than 80% and 63% of those aged 80 and older (P < .001). Higher CHA2 DS2 VASc score and lower HAS-BLED score were independent predictors of OAC prescription in participants aged 80 and older. CONCLUSION: Nearly one-fifth of individuals with NVAF in this real-world sample were aged 80 and older. Participants aged 80 and older were more likely to be female and have more comorbidities than those who were younger than 80. Those aged 80 and older with AF were less likely to receive anticoagulants than those who were younger than 80, but having more comorbidities and other individual-level characteristics may explain this difference. When they were prescribed OACs, participants aged 80 and older had poorer quality of anticoagulation than those who were younger, suggesting opportunities for improvement.

Assessment of heart rate response to exercise and recovery during treadmill testing in arsenic-exposed workers.

BACKGROUND: Arsenic exposure is associated with various cardiovascular diseases. The aim of the present study was to assess cardiac autonomic function via heart rate response to exercise and recovery period of treadmill testing in arsenic-exposed workers. METHODS: Sixty-five (65) occupationally arsenic-exposed workers and 35 healthy controls were enrolled. Blood and urinary arsenic levels were analyzed and symptom limited maximal treadmill exercise test were performed. Chronotropic response to exercise including age-predicted maximal heart rate (APMHR), heart rate reserve (HRreserve ), age-predicted HRreserve (APHRreserve ) and adjusted HRreserve and 1st-, 2nd-and 3rd-min heart rate recovery (HRR) indices were calculated. RESULTS: Baseline clinical and echocardiographic parameters, exercise test duration, resting and maximal heart rate, peak exercise capacity, HRreserve , APMHR, APHRreserve , and adjusted HRreserve were found to be similar between groups. HRR1 (22.0 ± 4.3 vs. 24.3 ± 3.1 bpm, p = .003) and HRR2 (43.2 ± 6.2 vs. 46.7 ± 6.4 bpm, p = .012) were significantly lower in arsenic-exposed workers compared to controls. Blood and urinary arsenic levels negatively correlated with HRR1 (r = -.477, p < .001 and r = -.438, p < .001, respectively) and HRR2 (r = -.507, p < .001 and r = -.412, p < .001 respectively). CONCLUSIONS: Arsenic-exposed workers had lower HRR indices than normal subjects but chronotropic response were similar. Cardiac autonomic dysregulation may be one of the cardiovascular consequences of arsenic exposure.

Exercise heart rate recovery assessment of the cardiac autonomic nervous system in workers occupationally exposed to lead.

OBJECTIVE: The aim of the present study was to assess cardiac autonomic function via indices of exercise heart rate recovery (HRR) in workers occupationally exposed to lead. METHODS: A total of 98 lead-exposed workers and 98 healthy controls were enrolled. All underwent exercise testing and transthoracic echocardiography. HRR indices were calculated by subtracting 1st- (HRR1), 2nd- (HRR2), and 3rd-minute (HRR3) heart rates from maximal heart rate (HR). Exercise test parameters- HRR in particular- were compared between groups, and correlation analysis of blood, 24-hour urine lead levels, and test parameters was performed. RESULTS: Baseline demographic and clinical characteristics were found to be similar between groups. Mean HRR1 (26.2±3.6 vs 29.0±4.1 bpm, p<0.001), HRR2 (42.6±3.9 vs 46.9±3.7 bpm, p<0.001), and HRR3 (56.6±4.5 vs 61.8±4.3 bpm, p<0.001) values were significantly lower in the lead-exposed group than in the healthy controls. HRR1 was found to be significantly correlated with blood (r:-0.415; p<0.001) and 24-hour urine lead levels (r:-0.446; p<0.001). HRR2 and HRR3 were significantly correlated with 24-hour urine lead level (r:-0.396; p<0.001 and r:-0.233; p=0.021, respectively). CONCLUSION: Lead-exposed workers had lower HRR indices than normal subjects. Blood and 24-hour urine lead levels were significantly associated with HRR indices. Cardiac autonomic functions may be affected by exposure to lead, and those occupationally exposed should be closely followed for adverse cardiovascular outcome.

Assessment of the Cardiac Autonomic Nervous System in Mercury-Exposed Individuals via Post-Exercise Heart Rate Recovery.

OBJECTIVE: The aim of this study was to assess exercise heart rate recovery (HRR) indices in mercury-exposed individuals when evaluating their cardiac autonomic function. SUBJECTS AND METHODS: Twenty-eight mercury-exposed individuals and 28 healthy controls were enrolled. All the subjects underwent exercise testing and transthoracic echocardiography. The HRR indices were calculated by subtracting the first- (HRR1), second- (HRR2) and third-minute (HRR3) heart rates from the maximal heart rate. The two groups were evaluated in terms of exercise test parameters, especially HRR, and a correlation analysis was performed between blood, 24-hour urine and hair mercury levels and the test parameters. RESULTS: The mercury-exposed and control groups were similar in age (37.2 ± 6.6 vs. 36.9 ± 9.0 years), had an identical gender distribution (16 females and 12 males) and similar left ventricular ejection fractions (65.5 ± 3.1 vs. 65.4 ± 3.1%). The mean HRR1 [25.6 ± 6.5 vs. 30.3 ± 8.2 beats per min (bpm); p = 0.009], HRR2 (43.5 ± 5.3 vs. 47.8 ± 5.5 bpm; p = 0.010) and HRR3 (56.8 ± 5.1 vs. 59.4 ± 6.3 bpm; p = 0.016) values were significantly lower in the mercury-exposed group than in the healthy controls. However, there were no significant correlations between blood, urine and hair mercury levels and exercise test parameters. CONCLUSIONS: Mercury-exposed individuals had lower HRR indices than normal subjects. In these individuals, mercury exposure measurements did not show correlations with the exercise test parameters, but age did show a negative correlation with these parameters. Therefore, cardiac autonomic functions might be involved in cases of mercury exposure.