Impact of anemia on clinical outcomes of patients with atrial fibrillation: The COOL-AF registry.

BACKGROUND: To determine whether anemia is an independent risk factor for ischemic stroke and major bleeding in patients with non-valvular atrial fibrillation (NVAF). HYPOTHESIS: Anemia in patients with NVAF increase risk of clinical complications related to atrial fibrillation. METHODS: We conducted a prospective multicenter registry of patients with NVAF in Thailand. Demographic data, medical history, comorbid conditions, laboratory data, and medications were collected and recorded, and patients were followed-up every 6 months. The outcome measurements were ischemic stroke or transient ischemic attack (TIA), major bleeding, heart failure (HF), and death. All events were adjudicated by the study team. We analyzed whether anemia is a risk factor for clinical outcomes with and without adjusting for confounders. RESULTS: There were a total of 1562 patients. The average age of subjects was 68.3 ± 11.5 years, and 57.7% were male. The mean hemoglobin level was 13.2 ± 1.8 g/dL. Anemia was demonstrated in 518 (33.16%) patients. The average follow-up duration was 25.8 ± 10.5 months. The rate of ischemic stroke/TIA, major bleeding, HF, and death was 2.9%, 4.9%, 1.8%, 8.6%, and 9.2%, respectively. Anemia significantly increased the risk of these outcomes with a hazard ratio of 2.2, 3.2, 2.9, 1.9, and 2.8, respectively. Oral anticoagulants (OAC) was prescribed in 74.8%; warfarin accounts for 89.9% of OAC. After adjusting for potential confounders, anemia remained a significant predictor of major bleeding, heart failure, and death, but not for ischemic stroke/TIA. CONCLUSION: Anemia was found to be an independent risk factor for major bleeding, heart failure, and death in patients with NVAF.

Factors associated with low health-related quality of life among younger and older Thai patients with non-valvular atrial fibrillation.

PURPOSE: The aim of this study was to investigate the factors associated with low health-related quality of life (HRQoL) compared between younger and older Thai patients with non-valvular atrial fibrillation (NVAF). METHODS: This is a cross-sectional analysis of baseline data from a prospective NVAF registry from 24 hospitals located across Thailand. Patient demographic, clinical, lifestyle, and medication data were collected at baseline. EuroQOL/EQ-5D-3L was used to assess HRQoL. Health utility was calculated for the entire study population, and low HRQoL was defined as the lowest quartile. Multivariate logistic regression was used to identify factors that significantly predict low HRQoL among younger and older (≥ 65 years) patients with NVAF. RESULTS: Among the 3218 participants that were enrolled, 61.0% were aged older than 65 years. Mean HRQoL was lower in older than in younger patients (0.72 ± 0.26 vs. 0.84 ± 0.20; p < 0.001). Factors associated with low HRQoL among younger NVAF patients were the treatment-related factors bleeding history (p = 0.006) and taking warfarin (p = 0.001). Among older patients, the NVAF-related complications ischemic stroke or TIA, heart failure (HF), and dementia (all p < 0.001) were all significantly associated with low HRQoL. Dementia is the factor that most adversely influences low HRQoL among older NVAF. Interestingly, symptomatic NVAF was found to be a protective factor for low HRQoL (p < 0.001). CONCLUSIONS: Bleeding history and taking warfarin among younger patients, and ischemic stroke/TIA, HF, and dementia among older patients are significant predictors of low HRQoL. These factors should be taken into consideration when selecting treatment options for patients with NVAF.

Correlation between inferior vena cava diameter and central venous pressure in critically ill patients.

BACKGROUND: The inferior vena cava (IVC) diameter is often used to estimate central venous pressure (CVP); however, the correlation and the cutoff of IVC compared with CVP have not yet been described in a Thai-population. MATERIAL AND METHOD: A cross-sectional study evaluated the critically ill patients in the medical intensive care unit who had a central venous catheter inserted. The correlation between CVP and IVC diameter measured by a 2-dimensional, long-axis subxiphoid view at the end-expiratory phase with bedside ultrasonography were evaluated. RESULTS: Forty-seven patients with a mean age of 60 +/- 16 years (range, 18 to 91) were studied. Correlation (r) between end-expiration IVC diameter and CVP was 0.75 (95% CI 0.59-0.85; p < 0.0001). An IVC diameter of < or = 10 mm predicted CVP of 10 cmH2O (sensitivity 77% and specificity 91%) and IVC diameter of > or = 15 mm predicted CVP of 15 cmH2O (sensitivity 90% and specificity 89%). CONCLUSION: The present study indicate that the measurement of the IVC diameter has a good correlation with CVP in Thai-population and useful for assessment of the volume status. The measurement of the IVC by ultrasonography may be an important additional evaluation of critically ill patients.

Non-O1/non-O139 Vibrio cholerae septicemia with peritonitis.

A 67-year-old Thai female with alcoholic cirrhosis presented with fever and abdominal pain for 5 days. On examination, there was marked ascites with generalized abdominal tenderness. The result of ascitic fluid analysis showed yellow turbid fluid, a WBC count of 6,100 cells/mm3 with polymorphonucleocytes predominant. Blood cultures yielded non-O1/ non-O139 Vibrio cholerae. The patient improved gradually and recovered fully after 1 week of parenteral antibiotic.