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Frontiers in Endocrinology 2023Hypoglycaemia has been linked to an increased risk of cardiac arrhythmias by causing autonomic and metabolic alterations, which may be associated with detrimental... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Hypoglycaemia has been linked to an increased risk of cardiac arrhythmias by causing autonomic and metabolic alterations, which may be associated with detrimental outcomes in individuals with diabetes(IWD), such as cardiovascular diseases (CVDs) and mortality, especially in multimorbid or frail people. However, such relationships in this population have not been thoroughly investigated. For this reason, we conducted a systematic review and meta-analysis.
METHODS
Relevant papers published on PubMed, Embase, Cochrane, Web of Knowledge, Scopus, and CINHAL complete from inception to December 22, 2022 were routinely searched without regard for language. All of the selected articles included odds ratio, hazard ratio, or relative risk statistics, as well as data for estimating the connection of hypoglycaemia with cardiac arrhythmia, CVD-induced death, or total death in IWD. Regardless of the heterogeneity assessed by the I statistic, pooled relative risks (RRs) and 95% confidence intervals (CI) were obtained using random-effects models.
RESULTS
After deleting duplicates and closely evaluating all screened citations, we chose 60 studies with totally 5,960,224 participants for this analysis. Fourteen studies were included in the arrhythmia risk analysis, and 50 in the analysis of all-cause mortality. Hypoglycaemic patients had significantly higher risks of arrhythmia occurrence (RR 1.42, 95%CI 1.21-1.68), CVD-induced death (RR 1.59, 95% CI 1.24-2.04), and all-cause mortality (RR 1.68, 95% CI 1.49-1.90) compared to euglycaemic patients with significant heterogeneity.
CONCLUSION
Hypoglycaemic individuals are more susceptible to develop cardiac arrhythmias and die, but evidence of potential causal linkages beyond statistical associations must await proof by additional specifically well planned research that controls for all potential remaining confounding factors.
Topics: Humans; Diabetes Mellitus; Hypoglycemia; Arrhythmias, Cardiac; Hypoglycemic Agents; Cardiovascular Diseases
PubMed: 37645418
DOI: 10.3389/fendo.2023.1222409 -
Current Cardiology Reports Jul 2023This study aims to evaluate the sensitivity and specificity of wearable devices for AF detection in older adults, as well as examine the incidence of AF across various... (Review)
Review
PURPOSE OF REVIEW
This study aims to evaluate the sensitivity and specificity of wearable devices for AF detection in older adults, as well as examine the incidence of AF across various studies, contextual factors impacting AF detection, and safety and adverse events associated with wearable use.
RECENT FINDINGS
A systematic search of three databases identified 30 studies on wearables for AF detection in older adults, encompassing 111,798 participants. Both PPG-based and single-lead electrocardiography-based wearables show scalable potential for screening and managing AF. The results of this systematic review demonstrate that wearable devices, such as smartwatches, can effectively identify arrhythmias like AF in older adults, with scalable potential in PPG-based and single-lead electrocardiography-based wearables. As wearable technologies continue to gain prominence in healthcare, it is crucial to understand their challenges and incorporate them as preventative and monitoring tools for AF detection in elderly populations to improve patient care and prevention techniques.
Topics: Humans; Aged; Atrial Fibrillation; Sensitivity and Specificity; Electrocardiography; Wearable Electronic Devices; Incidence
PubMed: 37222916
DOI: 10.1007/s11886-023-01898-3 -
BMJ Clinical Evidence May 2008Risk factors for acute atrial fibrillation include increasing age, cardiovascular disease, alcohol, diabetes, and lung disease. Acute atrial fibrillation increases the... (Review)
Review
INTRODUCTION
Risk factors for acute atrial fibrillation include increasing age, cardiovascular disease, alcohol, diabetes, and lung disease. Acute atrial fibrillation increases the risk of stroke and heart failure. Acute atrial fibrillation resolves spontaneously within 24-48 hours in over 50% of people, however many people will require interventions to control heart rate or restore sinus rhythm.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions: to prevent embolism; for conversion to sinus rhythm; and to control heart rate in people with recent onset atrial fibrillation (within 7 days) who are haemodynamically stable? We searched: Medline, Embase, The Cochrane Library and other important databases up to October 2007 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 28 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: amiodarone, antithrombotic treatment before cardioversion, digoxin, diltiazem, direct current cardioversion, flecainide, propafenone, quinidine, sotalol, timolol, and verapamil.
Topics: Acute Disease; Amiodarone; Anti-Arrhythmia Agents; Atrial Fibrillation; Humans; Propafenone; Sotalol
PubMed: 19450312
DOI: No ID Found -
The Cochrane Database of Systematic... Apr 2005Hyperkalaemia occurs in outpatients and in between 1% and 10% of hospitalised patients. When severe, consequences include arrhythmia and death. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Hyperkalaemia occurs in outpatients and in between 1% and 10% of hospitalised patients. When severe, consequences include arrhythmia and death.
OBJECTIVES
To review randomised evidence informing the emergency (i.e. acute, rather than chronic) management of hyperkalaemia
SEARCH STRATEGY
We searched MEDLINE (1966-2003), EMBASE (1980-2003), The Cochrane Library (issue 4, 2003), and SciSearch using the text words hyperkal* or hyperpotass* (* indicates truncation). We also searched selected journals and abstracts of meetings. The reference lists of recent review articles, textbooks, and relevant papers were reviewed for additional potentially relevant titles.
SELECTION CRITERIA
All selection was performed in duplicate. Articles were considered relevant if they were randomised, quasi-randomised or cross-over randomised studies of pharmacological or other interventions to treat non-neonatal humans with hyperkalaemia, reporting on clinically-important outcomes, or serum potassium levels within the first six hours of administration.
DATA COLLECTION AND ANALYSIS
All data extraction was performed in duplicate. We extracted quality information, and details of the patient population, intervention, baseline and follow-up potassium values. We extracted information about arrhythmias, mortality and adverse effects. Where possible, meta-analysis was performed using random effects models.
MAIN RESULTS
None of the studies of clinically-relevant hyperkalaemia reported mortality or cardiac arrhythmias. Reports focussed on serum potassium levels. Many studies were small, and not all intervention groups had sufficient data for meta-analysis to be performed. On the basis of small studies, inhaled beta-agonists, nebulised beta-agonists, and intravenous (IV) insulin-and-glucose were all effective, and the combination of nebulised beta agonists with IV insulin-and-glucose was more effective than either alone. Dialysis is effective. Results were equivocal for IV bicarbonate. K-absorbing resin was not effective by four hours, and longer follow up data on this intervention were not available from RCTs.
AUTHORS' CONCLUSIONS
Nebulised or inhaled salbutamol, or IV insulin-and-glucose are the first-line therapies for the management of emergency hyperkalaemia that are best supported by the evidence. Their combination may be more effective than either alone, and should be considered when hyperkalaemia is severe. When arrhythmias are present, a wealth of anecdotal and animal data suggests that IV calcium is effective in treating arrhythmia. Further studies of the optimal use of combination treatments and of the adverse effects of treatments are needed.
Topics: Adrenergic beta-Agonists; Albuterol; Bicarbonates; Emergency Treatment; Glucose; Humans; Hyperkalemia; Hypoglycemic Agents; Infusions, Intravenous; Insulin; Randomized Controlled Trials as Topic; Renal Dialysis
PubMed: 15846652
DOI: 10.1002/14651858.CD003235.pub2 -
Ultrasound in Obstetrics & Gynecology :... Dec 2022Fetal heart-rate irregularities occur in 1-2% of pregnancies and are usually caused by premature atrial contractions (PAC). Although PAC are considered benign, they may... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Fetal heart-rate irregularities occur in 1-2% of pregnancies and are usually caused by premature atrial contractions (PAC). Although PAC are considered benign, they may be associated with cardiac defects and tachyarrhythmia. We aimed to determine the incidence of congenital heart defects (CHDs) and complications in fetuses with PAC.
METHODS
This was a systematic review and meta-analysis conducted in accordance with the PRISMA statement for reporting items for systematic reviews and meta-analyses. MEDLINE and EMBASE were searched from 1990 to June 2021 to identify studies on fetuses with PAC. The primary outcome was CHD; secondary outcomes were complications using the endpoints supraventricular tachyarrhythmia (SVT), cardiac failure and intrauterine fetal demise. Meta-analysis of proportions was performed, subdivided into high-risk and low-risk populations based on reason for referral. Pooled incidences with 95% CIs were calculated.
RESULTS
Of 2443 unique articles identified, 19 cohort studies including 2260 fetuses were included. The pooled incidence of CHD in fetuses with PAC was 2.8% (95% CI, 1.5-4.1%), when 0.6% is the incidence expected in the general population. The pooled incidence of CHD was 7.2% (95% CI, 3.5-10.9%) in the high-risk population and 0.9% (95% CI, 0.0-2.0%) in the low-risk population. SVT occurred in 1.4% (95% CI, 0.6-3.4%) of fetuses diagnosed with PAC. Cardiac failure was described in 16 fetuses (1.4% (95% CI, 0.5-3.5%)), of which eight were CHD-related. Intrauterine fetal demise occurred in four fetuses (0.9% (95% CI, 0.5-1.7%)) and was related to CHD in two cases.
CONCLUSIONS
Our findings suggest that the risk of CHD in fetuses with PAC is 4-5 times higher than that in the general population. CHD was present more frequently in the high-risk population. Consequently, an advanced ultrasound examination to diagnose PAC correctly and exclude CHD is recommended. Complications of PAC are rare but can result in fetal demise, thus weekly fetal heart-rate monitoring remains advisable to enable early detection of SVT and to prevent cardiac failure. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Topics: Pregnancy; Female; Humans; Fetal Diseases; Premature Birth; Fetal Death; Atrial Premature Complexes; Fetus; Tachycardia; Arrhythmias, Cardiac; Heart Failure
PubMed: 35763619
DOI: 10.1002/uog.26017 -
BMJ Clinical Evidence Dec 2010Pulseless ventricular tachycardia and ventricular fibrillation are the main causes of sudden cardiac death, but other ventricular tachyarrhythmias can occur without... (Review)
Review
INTRODUCTION
Pulseless ventricular tachycardia and ventricular fibrillation are the main causes of sudden cardiac death, but other ventricular tachyarrhythmias can occur without haemodynamic compromise. Ventricular arrhythmias occur mainly as a result of myocardial ischaemia or cardiomyopathies, so risk factors are those of cardiovascular disease.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of electrical therapies for out-of-hospital cardiac arrest associated with ventricular tachycardia or ventricular fibrillation? What are the effects of antiarrhythmic drug treatments for use in out-of-hospital cardiac arrest associated with shock-resistant ventricular tachycardia or ventricular fibrillation? What are the effects of treatments for comatose survivors of out-of-hospital cardiac arrest associated with ventricular tachycardia or ventricular fibrillation? We searched: Medline, Embase, The Cochrane Library, and other important databases up to February 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 15 systematic reviews and RCTs that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: amiodarone, bretylium, defibrillation, lidocaine, procainamide, and therapeutic hypothermia.
Topics: Amiodarone; Death, Sudden, Cardiac; Electric Countershock; Humans; Hypothermia, Induced; Lidocaine; Out-of-Hospital Cardiac Arrest; Ventricular Fibrillation
PubMed: 21418694
DOI: No ID Found -
Value in Health : the Journal of the... Apr 2024Atrial fibrillation (AF) is the most common cardiac arrhythmia, with an increasing incidence and prevalence because of progressively aging populations. Costs related to... (Review)
Review
OBJECTIVES
Atrial fibrillation (AF) is the most common cardiac arrhythmia, with an increasing incidence and prevalence because of progressively aging populations. Costs related to AF are both direct and indirect. This systematic review aims to identify the main cost drivers of the illness, assess the potential economic impact resulting from changes in care strategies, and propose interventions where they are most needed.
METHODS
A systematic literature search of the PubMed and Scopus databases was performed to identify analytical observational studies defining the cost of illness in cases of AF. The search strategy was based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 recommendations.
RESULTS
Of the 944 articles retrieved, 24 met the inclusion criteria. These studies were conducted in several countries. All studies calculated the direct medical costs, whereas 8 of 24 studies assessed indirect costs. The median annual direct medical cost per patient, considering all studies, was €9409 (13 333 US dollars in purchasing power parities), with a very large variability due to the heterogeneity of different analyses. Hospitalization costs are generally the main cost drivers. Comorbidities and complications, such as stroke, considerably increase the average annual direct medical cost of AF.
CONCLUSIONS
In most of the analyzed studies, inpatient care cost represents the main component of the mean direct medical cost per patient. Stroke and heart failure are responsible for a large share of the total costs; therefore, implementing guidelines to manage comorbidities in AF is a necessary step to improve health and mitigate healthcare costs.
Topics: Humans; Atrial Fibrillation; Health Care Costs; Hospitalization; Stroke; Cost of Illness
PubMed: 38296049
DOI: 10.1016/j.jval.2023.12.015 -
Indian Journal of Dermatology,... 2016Patients with psoriasis might have a higher risk of developing atrial fibrillation as a result of chronic inflammation. This study aimed to investigate this association... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND OBJECTIVES
Patients with psoriasis might have a higher risk of developing atrial fibrillation as a result of chronic inflammation. This study aimed to investigate this association by comprehensively reviewing all available evidence.
METHODS
We conducted a systematic review and meta-analysis of cohort studies that reported relative risk, hazard ratio, incidence ratio or standardized incidence ratio with 95% confidence intervals comparing the risk of incident atrial fibrillation in patients with psoriasis versus participants without psoriasis. Both retrospective and prospective cohort studies were eligible. Pooled risk ratio and 95% confidence intervals were calculated using random-effect, generic inverse variance methods of DerSimonian and Laird.
RESULTS
Three retrospective studies with 110,568 cases of psoriasis and 5,352,817 participants without psoriasis were included in this meta-analysis. The pooled risk ratio of subsequent development of atrial fibrillation in patients with psoriasis versus participants without psoriasis was 1.21 (95% confidence interval, 1.14-1.29). The statistical heterogeneity was low with an I2 of 29%.
LIMITATIONS
Coding-based design of the primary studies that had limited accuracy.
CONCLUSIONS
Our meta-analysis demonstrated a statistically significant increase in the risk of incident atrial fibrillation among patients with psoriasis.
Topics: Atrial Fibrillation; Cohort Studies; Humans; Incidence; Prospective Studies; Psoriasis; Retrospective Studies; Risk Factors
PubMed: 27451924
DOI: 10.4103/0378-6323.186480 -
Physiological Reviews Apr 2007Triggered activity in cardiac muscle and intracellular Ca2+ have been linked in the past. However, today not only are there a number of cellular proteins that show clear... (Review)
Review
Triggered activity in cardiac muscle and intracellular Ca2+ have been linked in the past. However, today not only are there a number of cellular proteins that show clear Ca2+ dependence but also there are a number of arrhythmias whose mechanism appears to be linked to Ca2+-dependent processes. Thus we present a systematic review of the mechanisms of Ca2+ transport (forward excitation-contraction coupling) in the ventricular cell as well as what is known for other cardiac cell types. Second, we review the molecular nature of the proteins that are involved in this process as well as the functional consequences of both normal and abnormal Ca2+ cycling (e.g., Ca2+ waves). Finally, we review what we understand to be the role of Ca2+ cycling in various forms of arrhythmias, that is, those associated with inherited mutations and those that are acquired and resulting from reentrant excitation and/or abnormal impulse generation (e.g., triggered activity). Further solving the nature of these intricate and dynamic interactions promises to be an important area of research for a better recognition and understanding of the nature of Ca2+ and arrhythmias. Our solutions will provide a more complete understanding of the molecular basis for the targeted control of cellular calcium in the treatment and prevention of such.
Topics: Animals; Arrhythmias, Cardiac; Biological Transport, Active; Calcium; Calcium Signaling; Humans; Myocardial Contraction; Myocardium
PubMed: 17429038
DOI: 10.1152/physrev.00011.2006 -
Journal of Cardiovascular Medicine... Dec 2015Atrial fibrillation is the most common supraventricular arrhythmia. Its prevalence increases with age and preferentially affects male patients. Over 75 years of age,... (Review)
Review
Atrial fibrillation is the most common supraventricular arrhythmia. Its prevalence increases with age and preferentially affects male patients. Over 75 years of age, however, female patients being more prevalent, the absolute number of patients affected is similar between sexes. Despite this, few data are available in the literature concerning sex-related differences in atrial fibrillation patients. The present systematic review therefore considers comorbidities, referring symptoms, quality of life, pharmacological approaches and trans-catheter ablation in female rather than in male atrial fibrillation patients in search of parameters that may have an impact on the treatment outcome. In brief, female atrial fibrillation patients more commonly present comorbidities, leading to a higher prevalence of persistent atrial fibrillation; moreover, they refer to hospital care later and with a longer disease history. Atrial fibrillation symptoms relate to low quality of life in female patients; in fact, atrial fibrillation paroxysm usually presents higher heart rate, leading to preferentially adopt a rate rather than a rhythm-control strategy. Female atrial fibrillation patients present an increased risk of stroke, worsened by the lower oral anticoagulant prescription rate related to the concomitant higher haemorrhagic risk profile. Trans-catheter ablation is under-used in female patients and, on the contrary, they are more commonly affected by anti-arrhythmic drug side effects.
Topics: Anticoagulants; Atrial Fibrillation; Catheter Ablation; Comorbidity; Female; Hemorrhage; Humans; Quality of Life; Sex Distribution; Sex Factors; Thromboembolism
PubMed: 25806470
DOI: 10.2459/JCM.0000000000000239