Education level may modify the association between cardiac index and cognitive function among elders with normal ejection function.

Background: Lower cardiac index (CI) in elders has been associated with incident dementia, and higher CI has protectively effect with brain aging. In the present study, we investigated the modulating effects of education level and arterial stiffness on the association between CI and cognitive function among older adults. Methods: A total of 723 elders (≥60 years, 50.1% women) with normal left ventricular ejection fraction (≥50%) were identified from the Cardiovascular Diseases Risk Factor Two-Township Study. CI was calculated from the Doppler-derived stroke volume. We evaluated arterial stiffness by measuring carotid-femoral pulse wave velocity (CFPWV) and global cognitive function by using the Mini-Mental Short Examination (MMSE). Education level was determined by years of formal education. Results: In linear regression analysis adjusting for age, sex, formal years of education, and CFPWV, CI was significantly positively associated with MMSE (BETA=0.344±0.130, P = 0.0082). In logistic regression analysis adjusting for age, sex, formal years of education, and CFPWV, subjects with a CI≥75 percentile had a significantly lower risk of low MMSE (<26) (OR = 0.495, 95% CI = 0.274-0.896, P = 0.02). In subgroup analysis, higher CI was significantly associated with higher MMSE and lower risk of low MMSE only in elders with ≤ 9 years of formal education. Causal mediation analysis suggests that higher CI maintains higher MMSE in elders with lower education levels whereas higher CFPWV causes lower MMSE in all the elders. Conclusion: In elders with normal ejection fraction, a higher CI was associated with a lower risk of cognitive function impairment, independent of arterial stiffness, mainly in subjects with a lower education level and possibly a smaller cognitive reserve.

Molecular Identification and Selection of Probiotic Strains Able to Reduce the Serum TMAO Level in Mice Challenged with Choline.

Trimethylamine oxide (TMAO) originates from trimethylamine (TMA), which is oxidized in the liver by hepatic flavin-containing monooxygenases (FMO3). TMA is produced by its dietary precursors such as choline, carnitine, and phosphatidylcholine by gut microbiota. TMAO attracts attention, identified as a novel and independent risk factor for promoting obesity, atherosclerosis and cardiovascular disease (CVD), chronic kidney disease (CKD), insulin tolerance, and colon cancer. Probiotics have been considered as live microorganisms, providing benefits to their host when they are given in sufficient quantities and administered continuously. The objective of this study is to suggest a method to select potential probiotic strains to reduce the serum concentration of TMAO in mice fed with choline. In this work, we chose three lactobacilli with strong adherence capability, and fed multistrain formula (MF) to the mice challenged with choline. On days 7, 14, and day 28, it was found that the MF-containing L. amylovorus LAM1345, Lpb. plantarum LP1145, and Lim. fermentum LF33 showed a significant reduction in serum TMAO and TMA levels. For the single strains, LP1145 reduced TMAO on days 14 and 28, and strain LAM1345 reduced TMAO significantly on days 7 and day 14. For strain LF1143 from strain LF33, it showed no significant effect on TMAO and TMA. Thus, MF showed the best effect, which may be due to the additive and synergetic effect and the contribution of strain LP1145 and LAM1345. Finally, for the LAM1345 and LP1145 strains, we used molecular identification and typing methods to assure that these two strains are unique strains. The methods used for LAM 1345 were leader peptidase A (lepA) gene analysis and phylogenetic analysis, while for strain LP 1145and other strains of Lpb. plantarum subsp. plantarum sequences were compared using the whole-genome multilocus sequence typing (wgMLST) method.

The gene expression and bioinformatic analysis of choline trimethylamine-lyase (CutC) and its activating enzyme (CutD) for gut microbes and comparison with their TMA production levels.

Recent studies revealed that some intestinal microorganisms anaerobically convert choline to trimethylamine (TMA) by choline TMA-lyase (cutC). TMA is further oxidized to trimethylamine-N-oxide (TMAO), by the liver enzyme flavin-dependent monooxygenase 3 (FMO3). TMA in the serum is correlated with the risk of cardiovascular disease and some other diseases in human. The objective of this study is to study the expression levels of cutC and its activating enzyme (cutD) gene for these microorganisms and their association with TMA production. In this study, we collected 20 TMA producing bacteria strains representing 20 species, and designed primers to evaluate their gene expression levels by reverse transcription quantitative PCR (RT-qPCR). In addition, TMA production was analyzed by UPLC-MS/MS. Results showed that gene expression levels of most individual strains were different when compared with the gene expression level of their glyceraldehyde-3 phosphate dehydrogenase (GAPDH) gene and the TMA production level of gut bacteria may not correlate with their cutC/cutD gene expression levels. Bioinformatic analysis of the CutC protein showed conserved choline binding site residues; cutD showed conserved S-adenosylmethionine (SAM) and two CX2-CX2-CX3 motifs. The present study reports that the TMA production level may not only depend on cutC/cutD gene expression. Other factors may need to be investigated.

Deriving A Novel Health Index Using A Large-Scale Population Based Electronic Health Record With Deep Networks.

Health indexes are useful tools for monitoring the health condition of a population and can be used to guide healthcare policy of governments. However, most health indexes are constructed by using statistical methods to summarize recent adverse events (e.g., mortality). Information from these tools may reflect merely the impact of prior health policy holistically and can hardly indicate the most recent dynamics and its impact on future health conditions. As the advancements in medications and medical techniques rapidly evolve, there is a need of new health indexes that can reflect the most recent predictive health condition of a population and can easily be summarized with respect of any sub-population of interest. In this work, we develop a novel health index by using deep learning technique on a large-scale and longitudinal population based electronic health record (EHR). Three deep neural network (DNN) models were trained to predict 4-year event rates of mortality, hospitalization and cancer occurrence at an individual-level. Platt calibration approach was used to transform DNN output scores into estimated event risks. A novel health index is then constructed by weighted scoring these calibrated event risks. This individual-level health index not only provide a better predictive power but can also be flexibly summarized for different regions or sub-populations of interest - hence providing objective insights to develop precise personal or national policy beyond conventional health index.

Development of an intelligent decision support system for ischemic stroke risk assessment in a population-based electronic health record database.

BACKGROUND: Intelligent decision support systems (IDSS) have been applied to tasks of disease management. Deep neural networks (DNNs) are artificial intelligent techniques to achieve high modeling power. The application of DNNs to large-scale data for estimating stroke risk needs to be assessed and validated. This study aims to apply a DNN for deriving a stroke predictive model using a big electronic health record database. METHODS AND RESULTS: The Taiwan National Health Insurance Research Database was used to conduct a retrospective population-based study. The database was divided into one development dataset for model training (~70% of total patients for training and ~10% for parameter tuning) and two testing datasets (each ~10%). A total of 11,192,916 claim records from 840,487 patients were used. The primary outcome was defined as any ischemic stroke in inpatient records within 3 years after study enrollment. The DNN was evaluated using the area under the receiver operating characteristic curve (AUC or c-statistic). The development dataset included 672,214 patients (a total of 8,952,000 records) of whom 2,060 patients had stroke events. The mean age of the population was 35.5±20.2 years, with 48.5% men. The model achieved AUC values of 0.920 (95% confidence interval [CI], 0.908-0.932) in testing dataset 1 and 0.925 (95% CI, 0.914-0.937) in testing dataset 2. Under a high sensitivity operating point, the sensitivity and specificity were 92.5% and 79.8% for testing dataset 1; 91.8% and 79.9% for testing dataset 2. Under a high specificity operating point, the sensitivity and specificity were 80.3% and 87.5% for testing dataset 1; 83.7% and 87.5% for testing dataset 2. The DNN model maintained high predictability 5 years after being developed. The model achieved similar performance to other clinical risk assessment scores. CONCLUSIONS: Using a DNN algorithm on this large electronic health record database is capable of obtaining a high performing model for assessment of ischemic stroke risk. Further research is needed to determine whether such a DNN-based IDSS could lead to an improvement in clinical practice.

Predicting Gastrointestinal Bleeding Events from Multimodal In-Hospital Electronic Health Records Using Deep Fusion Networks.

Applying machine learning (ML) methods on electronic health records (EHRs) that accurately predict the occurrence of a variety of diseases or complications related to medications can contribute to improve healthcare quality. EHRs by nature contain multiple modalities of clinical data from heterogeneous sources that require proper fusion strategy. The deep neural network (DNN) approach, which possesses the ability to learn classification and feature representation, is well-suited to be employed in this context. In this study, we collect a large in-hospital EHR database to develop analytics in predicting 1-year gastrointestinal (GI) bleeding hospitalizations for patients taking anticoagulants or antiplatelet drugs. A total of 815,499 records (16,757 unique patients) are used in this study with three different available EHR modalities (disease diagnoses, medications usage, and laboratory testing measurements). We compare the performances of 4 deep multimodal fusion models and other ML approaches. NNs result in higher prediction performances compare to random forest (RF), gradient boosting decision tree (GBDT), and logistic regression (LR) approaches. We further demonstrate that deep multimodal NNs with early fusion can obtain the best GI bleeding predictive power (area under the receiver operator curve [AUROC] 0.876), which is significantly better than the HAS-BLED score (AUROC 0.668).

Improving Young Stroke Prediction by Learning with Active Data Augmenter in a Large-Scale Electronic Medical Claims Database.

Electronic medical claims (EMC) database has been successfully used for predicting occurrences of stroke and a variety of other diseases. However, inadequate predictive performances have been observed in cases of rare occurrences due to both insufficient training samples and highly imbalanced class distribution. In this work, our aim is to improve stroke prediction, especially for young age group (25-45 year-old) in a large population-based EMC database (552,898 subjects). We learn a young stroke predictive deep neural network model using a novel active data augmenter. The augmenter selects the most informative EHR data samples from old age stroke patients. This approach achieves 9.3% and 8.2% area under the receiver operating characteristic curve (AUC) value improvements compared to training directly with only young age group data and training all age groups data, respectively. We further provide analyses on the AUC values obtained as a function of the training data size, and the amount and the type of augmented data samples.

Glitazones and alpha-glucosidase inhibitors as the second-line oral anti-diabetic agents added to metformin reduce cardiovascular risk in Type 2 diabetes patients: a nationwide cohort observational study.

OBJECTIVE: Metformin is the standard first-line drug for patients with Type 2 diabetes (T2DM). However, the optimal second-line oral anti-diabetic agent (ADA) remains unclear. We investigated the cardiovascular risk of various ADAs used as add-on medication to metformin in T2DM patients from a nationwide cohort. METHODS: T2DM patients using different add-on oral ADAs after an initial metformin therapy of > 90 days were identified from the Taiwan National Health Insurance Database. Five classes of ADAs, including sulphonylureas (SU), glinides, thiazolidinediones (TZD), alpha-glucosidase inhibitors (AGI), and dipeptidyl peptidase-4 inhibitors (DPP-4I) were selected for analysis. The reference group was the SU added to metformin. Patients were excluded if aged < 20 years, had a history of stroke or acute coronary syndrome (ACS), or were receiving insulin treatment. The primary outcomes included any major adverse cardiovascular event (MACE) including ACS, ischemic/hemorrhagic stroke, and death. A Cox regression model was used to estimate the hazard ratio (HR) for MACE. RESULTS: A total of 26,742 patients receiving their add-on drug to metformin of either SU (n = 24,277), glinides (n = 962), TZD (n = 581), AGI (n = 808), or DPP-4I (n = 114) were analyzed. After a mean follow-up duration of 6.6 ± 3.4 years, a total of 4775 MACEs occurred. Compared with the SU+metformin group (reference), the TZD+metformin (adjusted HR: 0.66; 95% CI 0.50-0.88, p = 0.004) and AGI+metformin (adjusted HR: 0.74; 95% CI 0.59-0.94, p = 0.01) groups showed a significantly lower risk of MACE. CONCLUSION: Both TZD and AGI, when used as an add-on drug to metformin were associated with lower MACE risk when compared with SU added to metformin in this retrospective cohort study. Trial registration CE13152B-3. Registered 7 Mar, 2013, retrospectively registered.

Angiotensin-Receptor Blocker, Angiotensin-Converting Enzyme Inhibitor, and Risks of Atrial Fibrillation: A Nationwide Cohort Study.

Both angiotensin-receptor blockers (ARB) and angiotensin-converting enzyme inhibitors (ACEI) have protective effects against atrial fibrillation (AF). The differences between ARB and ACEI in their effects on the primary prevention of AF remain unclear. This study compared ARB and ACEI in combined antihypertensive medications for reducing the risk of AF in patients with hypertension, and determined which was better for AF prevention in a nationwide cohort study.Patients aged ≥55 years and with a history of hypertension were identified from Taiwan National Health Insurance Research Database. Medical records of 25,075 patients were obtained, and included 6205 who used ARB, 8034 who used ACEI, and 10,836 nonusers (no ARB or ACEI) in their antihypertensive regimen. Cox regression models were applied to estimate the hazard ratio (HR) for new-onset AF.During an average of 7.7 years' follow-up, 1619 patients developed new-onset AF. Both ARB (adjusted HR: 0.51, 95% CI 0.44-0.58, P < 0.001) and ACEI (adjusted HR: 0.53, 95% CI 0.47-0.59, P < 0.001) reduced the risk of AF compared to nonusers. Subgroup analysis showed that ARB and ACEI were equally effective in preventing new-onset AF regardless of age, gender, the presence of heart failure, diabetes, and vascular disease, except for those with prior stroke or transient ischemic attack (TIA). ARB prevents new-onset AF better than ACEI in patients with a history of stroke or TIA (log-rank P = 0.012).Both ARB and ACEI reduce new-onset AF in patients with hypertension. ARB prevents AF better than ACEI in patients with a history of prior stroke or TIA.

Gap junction modifier rotigaptide decreases the susceptibility to ventricular arrhythmia by enhancing conduction velocity and suppressing discordant alternans during therapeutic hypothermia in isolated rabbit hearts.

BACKGROUND: Therapeutic hypothermia (TH) may increase the susceptibility to ventricular arrhythmias by decreasing ventricular conduction velocity (CV) and facilitating arrhythmogenic spatially discordant alternans (SDA). OBJECTIVE: The purpose of this study was to test the hypothesis that rotigaptide, a gap junction enhancer, can increase ventricular CV, delay the onset of SDA, and decrease the susceptibility to pacing-induced ventricular fibrillation (PIVF) during TH. METHODS: Langendorff-perfused isolated rabbit hearts were subjected to 30-minute moderate hypothermia (33°C) followed by 20-minute treatment with rotigaptide (300 nM, n = 8) or vehicle (n = 5). The same protocol was also performed at severe hypothermia (30°C; n = 8 for rotigaptide, n = 5 for vehicle). Using an optical mapping system, epicardial CV and SDA threshold were evaluated by S1 pacing. Ventricular fibrillation inducibility was evaluated by burst pacing for 30 seconds at the shortest pacing cycle length (PCL) that achieved 1:1 ventricular capture. RESULTS: Rotigaptide increased ventricular CV during 33°C (PCL 300 ms, from 76 ± 6 cm/s to 84 ± 7 cm/s, P = .039) and 30°C (PCL 300 ms, from 62 ± 6 cm/s to 68 ± 4 cm/s, P = .008). Rotigaptide decreased action potential duration dispersion at 33°C (P = .01) and 30°C (P = .035). During 30°C, SDA thresholds (P = .042) and incidence of premature ventricular complexes (P = .025) were decreased by rotigaptide. PIVF inducibility was decreased by rotigaptide at 33°C (P = .039) and 30°C (P = .042). Rotigaptide did not change connexin43 expressions and distributions during hypothermia. CONCLUSION: Rotigaptide protects the hearts against ventricular arrhythmias by increasing ventricular CV, delaying the onset of SDA, and reducing repolarization heterogeneity during TH. Enhancing cell-to-cell coupling by rotigaptide might be a novel approach to prevent ventricular arrhythmias during TH.

Age and CHADS2 Score Predict the Effectiveness of Renin-Angiotensin System Blockers on Primary Prevention of Atrial Fibrillation.

Renin-angiotensin system (RAS) blockers have potential protective effects against atrial fibrillation (AF). The purpose of this study was to determine if patient characteristics and underlying co-morbidities could predict the efficacy of RAS blockers in AF prevention. Patients aged ≥ 45 years with hypertension were identified from the Taiwan National Health Insurance Research Database. After propensity-score matching, a total of 22,324 patients were included in this study. Risk of new-onset AF in RAS blockers users and non-users was estimated. During up to 10 years of follow-up, 1,475 patients experienced new-onset AF. Overall, RAS blockers reduced the risk of AF by 36% (adjusted HR 0.64; 95% CI 0.58 to 0.71; p < 0.001). Subgroup analysis showed that RAS blockers use was beneficial for AF prevention in patients aged ≥ 55 years or with a CHADS2 score of 1, 2, or 3. The therapy provided no obvious beneficial effect for AF prevention in those aged less than 55 years or with a CHADS2 score ≥ 4. In conclusion, RAS blockers reduced the risk of new-onset AF in patients aged ≥ 55 years or with a CHADS2 score of 1, 2, or 3, but not in patients aged less than 55 years or with a CHADS2 score ≥ 4.

Statin Therapy for Primary Prevention of Atrial Fibrillation: Guided by CHADS2/CHA2DS2VASc Score.

Atrial fibrillation (AF) is the most common arrhythmia and is associated with increased cardiovascular morbidity and mortality. The anti-arrhythmic effect of statins on AF prevention appears to be highly significant in most clinical studies. However, some discrepancies do exist among different clinical studies. Different clinical settings and types of stains used may explain these differences between trials. The CHADS2 and CHA2DS2VASc scoring systems have been used for stroke risk stratification in AF patients. The recent study suggested that these scores can also be used to guide statin therapy for AF prevention. Patients with higher scores had a higher risk of developing AF and gained more benefits from statins therapy than those with lower scores. This review article focused on the ability of these scores to predict AF prevention by statins.

Resistant hypertension, patient characteristics, and risk of stroke.

BACKGROUND: Little is known about the prognosis of resistant hypertension (RH) in Asian population. This study aimed to evaluate the impacts of RH in Taiwanese patients with hypertension, and to ascertain whether patient characteristics influence the association of RH with adverse outcomes. METHODS AND RESULTS: Patients aged ≥45 years with hypertension were identified from the National Health Insurance Research Database. Medical records of 111,986 patients were reviewed in this study, and 16,402 (14.6%) patients were recognized as having RH (continuously concomitant use of ≥3 anti-hypertensive medications, including a diuretic, for ≥2 years). Risk of major adverse cardiovascular events (MACE, a composite of all-cause mortality, acute coronary syndrome, and stroke [included both fatal and nonfatal events]) in patients with RH and non-RH was analyzed. A total of 11,856 patients experienced MACE in the follow-up period (average 7.1±3.0 years). There was a higher proportion of females in the RH group, they were older than the non-RH (63.1 vs. 60.5 years) patients, and had a higher prevalence of cardiovascular co-morbidities. Overall, patients with RH had higher risks of MACE (adjusted HR 1.17; 95%CI 1.09-1.26; p<0.001). Significantly elevated risks of stroke (10,211 events; adjusted HR 1.17; 95%CI 1.08-1.27; p<0.001), especially ischemic stroke (6,235 events; adjusted HR 1.34; 95%CI 1.20-1.48; p<0.001), but not all-cause mortality (4,594 events; adjusted HR 1.06; 95%CI 0.95-1.19; p = 0.312) or acute coronary syndrome (2,145 events; adjusted HR 1.17; 95%CI 0.99-1.39; p = 0.070) were noted in patients with RH compared to those with non-RH. Subgroup analysis showed that RH increased the risks of stroke in female and elderly patients. However, no significant influence was noted in young or male patients. CONCLUSIONS: Patients with RH were associated with higher risks of MACE and stroke, especially ischemic stroke. The risks were greater in female and elderly patients than in male or young patients.

Moderate Hypothermia (33 °C) Decreases the Susceptibility to Pacing-Induced Ventricular Fibrillation Compared with Severe Hypothermia (30 °C) by Attenuating Spatially Discordant Alternans in Isolated Rabbit Hearts.

BACKGROUND: Severe hypothermia (SH, 30 °C) increases the risk of pacing-induced ventricular fibrillation (PIVF) by enhancing spatially discordant alternans (SDA). Whether moderate hypothermia (MH, 33 °C), which is clinically used for therapeutic hypothermia, also facilitates SDA remains unclear. We hypothesized that MH attenuates SDA occurrence compared with that achieved by SH, and decreases the susceptibility of PIVF. METHODS: Using an optical mapping system, action potential duration (APD)/conduction velocity restitutions and thresholds of APD alternans were determined by S1 pacing in Langendorff-perfused isolated rabbit hearts. In the MH group (n = 7), S1 pacing was performed at baseline (37 °C), after 5-min MH, and after 5-min rewarming (37 °C). In the SH group (n = 9), pacing was also performed at baseline (37 °C), after 5-min SH, and after 5-min rewarming (37 °C). The thresholds of APD alternans were defined as the longest S1 pacing cycle length at which APD alternans were detected. RESULTS: Although the thresholds of APD alternans were not different between the MH (273 ± 46 ms) and the SH (300 ± 35 ms) (p = 0.281) groups, SDA threshold was shorter (at a faster heart rate) during MH (228 ± 33 ms) than that during SH (289 ± 42 ms) (p = 0.028). At APD alternans threshold, SH hearts showed more SDA than that during MH (SH: 7 hearts, MH: 2 hearts, p = 0.049). SDA could be induced in all 9 SH hearts (100%), while only 4 MH hearts (57%) had SDA (p = 0.029). The PIVF inducibility during SH (44 ± 53%) was higher than that during MH (0%) (p = 0.043). CONCLUSIONS: Compared with SH, the MH group showed greater attenuation of SDA and decreased the susceptibility of PIVF. Therefore, MH is safer as a procedural guideline for use in clinical therapeutic hypothermia than SH. KEY WORDS: Cardiac alternans; Conduction velocity; Hypothermia; Optical mapping.

CHADS(2) score, statin therapy, and risks of atrial fibrillation.

OBJECTIVE: Little is known about the effectiveness of statins on primary prevention of atrial fibrillation in elderly patients. This study aimed to evaluate the efficacy of statin treatment for atrial fibrillation prevention in elderly patients with hypertension, and to determine if comorbidity or CHADS(2) (Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, prior Stroke or transient ischemic attack) score can predict the effectiveness of statin treatment. METHODS: Patients aged ≥65 years with hypertension were identified from a National Health Insurance research database (a systemic sampling from 2000 to 2009 with a total of 1,000,000 subjects). Medical records of 27,002 patients were used in this study, in which 2400 (8.9%) were receiving statin therapy. Risk of new-onset atrial fibrillation in statin users and nonusers was analyzed. RESULTS: During the 9-year follow-up period, 2241 patients experienced new-onset atrial fibrillation. Statin users were younger than nonusers (72.4 vs 73.4 years) but had a higher prevalence of ischemic heart disease, diabetes mellitus, stroke, and chronic renal disease. Overall, statin therapy reduced the risk of atrial fibrillation by 19% (adjusted hazard ratio 0.81; 95% confidence interval, 0.69-0.95; P=.009). Subgroup analysis showed that statin use was beneficial in patients with or without a particular comorbidity. The effectiveness of statins was significant in patients with CHADS(2) score ≥2 (adjusted hazard ratio 0.69; 95% confidence interval, 0.57-0.85; P <.001). However, statin therapy was not as beneficial in hypertensive patients without other cardiovascular comorbidities (CHADS(2) score =1). CONCLUSION: Statin therapy in elderly patients with hypertension reduces the risk of new-onset atrial fibrillation. Statins are more beneficial in patients with CHADS(2) score ≥2 than in those with score of 1.

Dosage of statin, cardiovascular comorbidities, and risk of atrial fibrillation: a nationwide population-based cohort study.

BACKGROUND: Statin has potential protective effects against atrial fibrillation. Clinically, there is a need to predict the atrial fibrillation protective effects in statin-treated patients. The purpose of this study was to investigate if cardiovascular co-morbidities or cumulative defined daily doses (cDDDs) of statin use could predict statin efficacy in atrial fibrillation prevention. METHODS: Patients aged ≥ 50 years were identified from the Taiwan National Health Insurance Research Database. Medical records of 171,885 patients were used in this study, and 40,001 (23.3%) of the patients received statin therapy (≥ 28 cDDDs). Risk of new-onset atrial fibrillation in statin users and non-users (<28 cDDDs) was estimated. RESULTS: During the 9-year follow-up period, 6049 patients experienced new-onset atrial fibrillation. Overall, statin therapy reduced the risk of atrial fibrillation by 28% (adjusted hazard ratio [HR] 0.72; 95% CI 0.68 to 0.77). There was a dose-response relationship between statin use and the risk of atrial fibrillation. The adjusted HRs for atrial fibrillation were 1.04, 0.85, and 0.50 when cDDDs ranged from 28 to 90, 91 to 365, and more than 365, respectively. Subgroup analysis showed that statin use was more beneficial in patients with higher CHADS2 and CHA2DS2VASc scores than those with a score of 0 (P value for interaction<0.001). The therapy provided no obvious beneficial effect in those with a CHADS2 score of 0, a CHA2DS2VASc score of 0, or cDDDs less than 91. CONCLUSIONS: Statin therapy reduces the risk of new-onset atrial fibrillation in a dose-dependent manner, and is beneficial in patients with cardiovascular co-morbidities.

Falls and Atrial Fibrillation in Elderly Patients.

BACKGROUND: Atrial fibrillation is a common heart rhythm disorder in older adults, and its prevalence has increased rapidly in recent years. The health issues associated with atrial fibrillation are not limited to physiological problems, as it also contributes to an increased risk of falls, which may be related to cardiovascular co-morbidities and medication use. The aim of this study was to determine which cardiovascular co-morbidities and medication use are associated with falls in older adults with atrial fibrillation. METHODS: Four hundred and one patients 75 years of age or older (82.2 ± 0.2 years) were enrolled in a geriatric evaluation and management unit in Taiwan. Events associated with patient falls and medication use were recorded, and comprehensive geriatric assessment was conducted during admission. RESULTS: Among the study participants, 66 (16.5%) patients had atrial fibrillation and 234 (58.4%) patients had a history of fall. We found a significantly higher prevalence of falls in patients with atrial fibrillation [odds ration (OR) 1.98, 95% confidence interval (CI) 1.08-3.63, p = 0.026] compared with those without atrial fibrillation. Using multivariate logistic regression, we found that benzodiazepine use (OR 18.22, 95% CI 2.71-122.38, p = 0.003), a history of paroxysmal atrial fibrillation (OR 12.18, 95% CI 1.37-108.70, p = 0.025) and hypertension (OR 9.49, 95% CI 1.19-75.57, p = 0.034) were independent factors for falls in atrial fibrillation patients. CONCLUSIONS: A diagnosis of atrial fibrillation in elderly patients is associated with falls. Benzodiazepine use, history of paroxysmal atrial fibrillation, and hypertension were associated with a high falling prevalence among patients with atrial fibrillation. KEY WORDS: Atrial fibrillation; Benzodiazepine; Falls; Hypertension.

Acute massive pulmonary embolism after radiofrequency catheter ablation: a rare complication after a common procedure.

A 41-year-old man received an electrophysiological study (EPS) and radiofrequency catheter ablation (RFCA) for atrioventricular reentrant tachycardia (AVRT) in our hospital. Massive pulmonary embolism (PE) with hypotension developed 9 hours after these procedures. After emergent pulmonary angiography and catheter-directed intrathrombus urokinase infusion and clot breaking, the patient recovered well. This case suggests that life-threatening PE may occur in patients who receive EPS, RFCA, or both. An adequate observation time after RFCA and clinical alertness are necessary for immediate diagnosis and treatment. Emergent catheter-directed therapy may be of benefit in some patients with acute massive PE.