Atrial fibrillation burden, progression, and the risk of death: A case-crossover analysis in patients with cardiac implantable electronic devices

Jonathan P. Piccini, Rod S Passman, Mintu Turakhia, Allison T. Connolly, Yelena Nabutovsky, Niraj Varma

Research output: Contribution to journalReview article

Abstract

Aims Atrial fibrillation (AF) is associated with increased mortality, but the temporal relationship between AF burden (AFB) and death among patients with cardiac implanted electronic devices is unknown. We sought to characterize the timing and progression of AFB before death. Methods and results Using Merlin.net TM remote monitoring (RM) data, we analysed weekly AFB in patients age ≥55 years implanted with dual-chamber pacemaker, implantable cardioverter-defibrillator, or cardiac resynchronization therapy devices whose death was verified in the Social Security Death Index and who had continuous RM from 1 year to 4 weeks preceding death. Atrial fibrillation burden was defined as amount of time per week atrial rate exceeded a set threshold of 180 b.p.m. Case-crossover analysis was used to compare the AFB at every week to 6 control weeks at the start of the year before death. There were 3131 patients meeting analysis criteria (age at death 76 ± 8 years, 70% men). Weekly increase in AFB >6 h was associated with increased odds of death, which was greatest at 4 weeks before death [odds ratio (OR) 2.30, 95% confidence interval (CI) 2.09-2.53; P < 0.001]. Atrial fibrillation progression week-to-week >24 h was associated with the greatest odds of death (OR 12.95, 95% 8.72-19.22; P < 0.001). A combination of AFB >6 h per week and activity <0.5 h per day was associated with an increased odds of death. Conclusion In this large patient cohort, AFB progression accelerated in the weeks leading to death. Continuous monitoring of AFB may help identify device patients who may be at risk for adverse outcomes, including death.

Original languageEnglish (US)
Pages (from-to)404-413
Number of pages10
JournalEuropace
Volume21
Issue number3
DOIs
StatePublished - Mar 1 2019

Fingerprint

Atrial Fibrillation
Equipment and Supplies
Cardiac Resynchronization Therapy Devices
Neurofibromin 2
Odds Ratio
Implantable Defibrillators
Social Security
Confidence Intervals

Keywords

  • Activity
  • Atrial fibrillation
  • Atrial fibrillation burden
  • Case-crossover
  • Outcomes
  • Remote monitoring

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Piccini, Jonathan P. ; Passman, Rod S ; Turakhia, Mintu ; Connolly, Allison T. ; Nabutovsky, Yelena ; Varma, Niraj. / Atrial fibrillation burden, progression, and the risk of death : A case-crossover analysis in patients with cardiac implantable electronic devices. In: Europace. 2019 ; Vol. 21, No. 3. pp. 404-413.
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abstract = "Aims Atrial fibrillation (AF) is associated with increased mortality, but the temporal relationship between AF burden (AFB) and death among patients with cardiac implanted electronic devices is unknown. We sought to characterize the timing and progression of AFB before death. Methods and results Using Merlin.net TM remote monitoring (RM) data, we analysed weekly AFB in patients age ≥55 years implanted with dual-chamber pacemaker, implantable cardioverter-defibrillator, or cardiac resynchronization therapy devices whose death was verified in the Social Security Death Index and who had continuous RM from 1 year to 4 weeks preceding death. Atrial fibrillation burden was defined as amount of time per week atrial rate exceeded a set threshold of 180 b.p.m. Case-crossover analysis was used to compare the AFB at every week to 6 control weeks at the start of the year before death. There were 3131 patients meeting analysis criteria (age at death 76 ± 8 years, 70{\%} men). Weekly increase in AFB >6 h was associated with increased odds of death, which was greatest at 4 weeks before death [odds ratio (OR) 2.30, 95{\%} confidence interval (CI) 2.09-2.53; P < 0.001]. Atrial fibrillation progression week-to-week >24 h was associated with the greatest odds of death (OR 12.95, 95{\%} 8.72-19.22; P < 0.001). A combination of AFB >6 h per week and activity <0.5 h per day was associated with an increased odds of death. Conclusion In this large patient cohort, AFB progression accelerated in the weeks leading to death. Continuous monitoring of AFB may help identify device patients who may be at risk for adverse outcomes, including death.",
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Atrial fibrillation burden, progression, and the risk of death : A case-crossover analysis in patients with cardiac implantable electronic devices. / Piccini, Jonathan P.; Passman, Rod S; Turakhia, Mintu; Connolly, Allison T.; Nabutovsky, Yelena; Varma, Niraj.

In: Europace, Vol. 21, No. 3, 01.03.2019, p. 404-413.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Atrial fibrillation burden, progression, and the risk of death

T2 - A case-crossover analysis in patients with cardiac implantable electronic devices

AU - Piccini, Jonathan P.

AU - Passman, Rod S

AU - Turakhia, Mintu

AU - Connolly, Allison T.

AU - Nabutovsky, Yelena

AU - Varma, Niraj

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Aims Atrial fibrillation (AF) is associated with increased mortality, but the temporal relationship between AF burden (AFB) and death among patients with cardiac implanted electronic devices is unknown. We sought to characterize the timing and progression of AFB before death. Methods and results Using Merlin.net TM remote monitoring (RM) data, we analysed weekly AFB in patients age ≥55 years implanted with dual-chamber pacemaker, implantable cardioverter-defibrillator, or cardiac resynchronization therapy devices whose death was verified in the Social Security Death Index and who had continuous RM from 1 year to 4 weeks preceding death. Atrial fibrillation burden was defined as amount of time per week atrial rate exceeded a set threshold of 180 b.p.m. Case-crossover analysis was used to compare the AFB at every week to 6 control weeks at the start of the year before death. There were 3131 patients meeting analysis criteria (age at death 76 ± 8 years, 70% men). Weekly increase in AFB >6 h was associated with increased odds of death, which was greatest at 4 weeks before death [odds ratio (OR) 2.30, 95% confidence interval (CI) 2.09-2.53; P < 0.001]. Atrial fibrillation progression week-to-week >24 h was associated with the greatest odds of death (OR 12.95, 95% 8.72-19.22; P < 0.001). A combination of AFB >6 h per week and activity <0.5 h per day was associated with an increased odds of death. Conclusion In this large patient cohort, AFB progression accelerated in the weeks leading to death. Continuous monitoring of AFB may help identify device patients who may be at risk for adverse outcomes, including death.

AB - Aims Atrial fibrillation (AF) is associated with increased mortality, but the temporal relationship between AF burden (AFB) and death among patients with cardiac implanted electronic devices is unknown. We sought to characterize the timing and progression of AFB before death. Methods and results Using Merlin.net TM remote monitoring (RM) data, we analysed weekly AFB in patients age ≥55 years implanted with dual-chamber pacemaker, implantable cardioverter-defibrillator, or cardiac resynchronization therapy devices whose death was verified in the Social Security Death Index and who had continuous RM from 1 year to 4 weeks preceding death. Atrial fibrillation burden was defined as amount of time per week atrial rate exceeded a set threshold of 180 b.p.m. Case-crossover analysis was used to compare the AFB at every week to 6 control weeks at the start of the year before death. There were 3131 patients meeting analysis criteria (age at death 76 ± 8 years, 70% men). Weekly increase in AFB >6 h was associated with increased odds of death, which was greatest at 4 weeks before death [odds ratio (OR) 2.30, 95% confidence interval (CI) 2.09-2.53; P < 0.001]. Atrial fibrillation progression week-to-week >24 h was associated with the greatest odds of death (OR 12.95, 95% 8.72-19.22; P < 0.001). A combination of AFB >6 h per week and activity <0.5 h per day was associated with an increased odds of death. Conclusion In this large patient cohort, AFB progression accelerated in the weeks leading to death. Continuous monitoring of AFB may help identify device patients who may be at risk for adverse outcomes, including death.

KW - Activity

KW - Atrial fibrillation

KW - Atrial fibrillation burden

KW - Case-crossover

KW - Outcomes

KW - Remote monitoring

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