論文

Objectives: This study sought to investigate whether symptom under-recognition is associated with the application of catheter ablation. Background: Atrial fibrillation (AF) symptom burden is frequently under-recognized and may affect the choice of treatment strategies. Methods: A total of 3,276 patients with AF consecutively registered in a Japanese multicenter database from 2012 to 2017 were analyzed. All patients underwent AF symptom burden assessment via the symptom and daily activities domain within the Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) questionnaire. For the present analysis, 1,173 symptomatic patients (AFEQT score ≤80) with a clinical indication for catheter ablation were included. Under-recognition of symptom burden was defined as no subjective complaints checked by physicians despite self-reported AFEQT scores ≤80. Logistic regression analysis identified the predictors associated with receiving catheter ablation. Results: Of the 1,173 patients (age: 68 ± 12 years, men: 61%) analyzed, 459 underwent catheter ablation (ablation group); they had lower overall AFEQT scores (p < 0.01 for all domains) compared with the nonablation group. At the 1-year follow-up, greater improvement in the AFEQT scores was noted in the ablation group, even after adjusting for clinically relevant factors (+20.0 ± 1.2, +14.2 ± 0.9, respectively; p < 0.001). Notably, 306 (28%) patients met the criteria for symptom under-recognition, which was associated with the nonuse of catheter ablation during follow-up (odds ratio: 0.41; 95% confidence interval: 0.28 to 0.60; p < 0.001). Conclusions: Under-recognition of AF symptom burden was frequently noted and was associated with less use of catheter ablation. Standardized recognition of symptoms using the application of validated questionnaires may facilitate outcome improvement.

Background: A goal of post-resuscitation care among patients successfully resuscitated from in-hospital cardiac arrest (IHCA) is fever avoidance. However, the incidence of post-resuscitation fever after the initial therapeutic hypothermia trials in 2002 and after the Targeted Temperature Management (TTM) trial in 2013 is unknown. Methods: Within the U.S. Get With The Guidelines-Resuscitation registry for IHCA, we identified adults with return of spontaneous circulation (ROSC). Patients with sepsis or COVID-19 were excluded. Temporal trends in post-resuscitation fever (≥100 °F) within 24 h of ROSC following the initial hypothermia trials (2005–2013) and after the TTM trial (2014–2022) were described. Hospital-level variation in post-resuscitation fever rates was assessed for the latter period. Results: Among 41,155 patients, mean age was 64.8 ± 15.0 years, 40.0 % were women, and 68.6 % were White. Overall, 11,745 (28.5 %) had post-resuscitation fever. Annual rates of post-resuscitation fever decreased from 39.1 % in 2005 to 29.0 % in 2013 (P for trend <0.001), and modestly from as high as 29.0 % in 2015 to 26.0 % in 2022 (P for trend of 0.003). Among 127 hospitals since the publication of the TTM trial, the rate of post-resuscitation fever varied widely from 3.4 % to 46.0 %, with a median OR of 1.81 (95 % CI: 1.72–1.91), indicating that, on average, the odds of post-resuscitation fever for patients with identical characteristics from two randomly selected hospitals varied by 81 %. Conclusions: Post-resuscitation fever rates have decreased among patients with IHCA after the initial therapeutic hypothermia trials, but substantial hospital-level variation remains. Our findings highlight potential opportunities for improvement in post-resuscitation care.

Background: Cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) is associated with higher survival. The association between time to bystander CPR at different time thresholds, compared with those with no bystander CPR, is less clear. Methods: Within the Cardiac Arrest Registry to Enhance Survival, we identified 194,807 witnessed OHCAs during 2013–2023. Multivariable hierarchical logistic regression was used to evaluate the association between each time interval for initiation of bystander CPR (0–1, 2–3, 4–5, 6–7, 8–9, 10 + minutes), compared with no bystander CPR, for survival to discharge and favorable neurological survival (i.e. without severe neurological deficits). Results: The mean age was 64.4 ± 15.9 years, and 33.8% were female. Bystander CPR was provided in 48.4% of cases, with a median initiation time of 2 min (IQR: 1–5). Overall, 15.3% survived to discharge, and 12.9% had favorable neurological survival. Compared with no bystander CPR, survival to discharge was higher for patients with bystander CPR initiated at 0–1 min (OR 1.78 [95% CI: 1.73–1.84]), 2–3 min (OR 1.57 [1.51–1.64]), 4–5 min (OR 1.23 [1.17–1.30]), 6–7 min (OR 1.25 [1.15–1.35]), and 8–9 min (OR 1.13 [1.03–1.25]), but no survival association was seen at ≥ 10 min (OR 0.80 [0.74–0.86]). A similar pattern was observed for neurological survival. Conclusions: Compared with no bystander CPR, bystander CPR was associated with improved survival even when started at 8 to 9 min. Given that there is a graded, inverse relationship between time to bystander CPR and survival, these findings underscore the urgency of immediate bystander CPR initiation to optimize OHCA survival.

The advances in the integrated management of patients with coronary artery disease undergoing percutaneous coronary intervention (PCI) have reduced subsequent cardiovascular events. Nonetheless, sudden cardiac death (SCD) remains a major concern. Therefore, we aimed to investigate the time trend in SCD incidence after PCI and to identify the clinical factors contributing to SCD. From a prospective, multicenter cohort registry in Japan, 8,723 consecutive patients with coronary artery disease undergoing PCI between 2009 and 2017 were included. We evaluated the SCD incidence 2 years after PCI; all death events were adjudicated, and SCD was defined as unexpected death without a noncardiovascular cause in a previously stable patient within 24 hours from the onset. The Fine and Gray method was used to identify the factors associated with SCD. Overall, the mean age of the patients was 68.3 ± 11.3 years, and 1,173 patients (13.4%) had heart failure (HF). During the study period, the use of second-generation drug-eluting stents increased. The 2-year cumulative incidence of all-cause mortality and SCD was 4.29% and 0.45%, respectively. All-cause mortality remained stable during the study period (p for trend = 0.98), whereas the crude incidence of SCD tended to decrease over the study period (p for trend = 0.052). HF was the strongest predictor associated with the risk of SCD (crude incidence [vs non-HF] 2.13% vs 0.19%; p <0.001). In conclusion, the incidence of SCD after PCI decreased over the last decade, albeit the high incidence of SCD among patients with HF remains concerning.

Background: Clinical trials typically report average health status outcomes by treatment at single points in time, as opposed to participants’ trajectories (or journeys) over time. Although ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) demonstrated better mean health status at discrete times with an invasive treatment among those with baseline angina, the patterns of individual participants’ angina over time are unknown. Objectives: The purpose of this study was to identify patterns of individual participants’ angina over time after invasive or conservative management strategies for chronic coronary disease. Methods: In this secondary analysis of the ISCHEMIA trial, which enrolled participants with chronic coronary disease and moderate to severe ischemia from July 2012 to January 2018, we used ordinal latent trajectory analysis to assess angina frequency over a 2-year period, separately for participants assigned to the initial invasive and initial conservative arms. Angina frequency was defined using the SAQ-AF (Seattle Angina Questionnaire Angina Frequency) score, recategorized as daily/weekly (0-60 points), monthly (61-99 points), and no angina (100 points). Participants without baseline angina were excluded. Results: Among 2,977 participants with baseline angina, 1,505 (50.6%) were randomized to initial invasive and 1,472 (49.4%) to initial conservative management; baseline characteristics were well balanced between groups. Six distinct patterns of angina trajectories were identified in each arm and were qualitatively similar: 1) rapid resolution; 2) gradual resolution; 3) early improvement with persistent infrequent angina; 4) severe angina with improvement; 5) modest angina with minimal change; and 6) severe angina without improvement. In the invasive group, the most common patterns included rapid resolution (27.1%) and early improvement with persistent infrequent angina (32.1%), whereas the conservative group more often showed modest angina with minimal change (42.1%) and fewer cases of rapid resolution (12.8%) or early improvement with persistent infrequent angina (10.2%). Conclusions: Patients with chronic coronary disease and angina experienced diverse symptom trajectories, ranging from rapid resolution to severe or persistent angina. A greater proportion of conservatively managed patients experienced unfavorable angina patterns over 2 years compared with those treated invasively. When health status is monitored over time, such patterns may help identify patients with persistent symptoms who could benefit from additional therapy. (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches [ISCHEMIA]; NCT01471522)

Importance Unprotected left main percutaneous coronary intervention (LM PCI) is recognized as a reasonable strategy for patients who have coronary artery disease with low anatomic complexity. However, recent trends in its procedural volume, patient characteristics, and procedural techniques and their association with clinical outcomes have not been well described, making it important to confirm the safety of LM PCI in contemporary clinical practice. Objectives To examine temporal trends in the use and in-hospital outcomes of unprotected LM PCI in Japan. Design, Setting, and Participants This retrospective cohort study used prospectively collected data from the nationwide, multicenter Japanese Percutaneous Coronary Intervention registry including approximately 1100 PCI-capable institutions across Japan. Data were restricted to the period after the registry’s 2019 update to ensure consistency in definitions. Temporal trends in PCI procedures were analyzed from January 2019 through December 2023. Patients with prior coronary artery bypass grafting, recent cardiogenic shock, cardiac arrest within 24 hours of treatment, restenosis, or balloon angioplasty alone were excluded. Exposures Calendar year of PCI (2019-2023). Main Outcomes and Measures The primary outcome was in-hospital mortality. Multivariable logistic regression was used to assess temporal trends and whether differences were explained by baseline or procedural characteristics. Results Among 851 468 included procedures (mean [SD] patient age, 74.1 [10.2] years; 78.1% men), unprotected LM PCI accounted for 9490 of 182 739 PCI procedures in 2019 (5.2%) and 8583 of 164 332 in 2023 (5.2%). From 2019 to 2023, mean (SD) patient age increased from 73.4 (10.1) to 74.6 (10.1) years, and patients were more likely to have heart failure (increasing from 1676 of 9058 cases in 2019 [18.5%] to 1704 of 8200 [20.8%] in 2023). Unadjusted in-hospital mortality increased from 148 cases in 2019 (1.6%) to 157 in 2023 (1.9%), but this was not significant after adjusting for patient characteristics (adjusted odds ratio for 2023 vs 2019: 1.08; 95% CI, 0.85-1.37). From 2019 to 2023, further adjustment for procedural factors, including increased use of radial access (from 5789 cases [63.9%] to 5985 cases [73.0%]) and mechanical circulatory support (from 828 cases [9.1%] to 941 cases [11.5%]), did not alter the association between year and mortality. Conclusions and Relevance In a nationwide Japanese PCI registry, unprotected LM PCI consistently accounted for 5% of PCI procedures. Although unadjusted in-hospital mortality rose modestly over time, the findings indicate this was largely explained by increasing patient complexity, with risk-adjusted outcomes remaining stable, supporting the continued role of LM PCI as a safe revascularization option in contemporary practice.

Background: Clinical congestion is the most frequent reason for hospital admission in patients with acute heart failure (AHF). However, few studies have investigated the patterns and prognostic implication of the physical congestion using unbiased and robust statistical methods. Methods: A hierarchical agglomerative clustering analysis was performed in the multicenter Japanese AHF registry (N = 3151) with the distance calculated by Jaccard's distance for jugular vein distention (JVD), leg edema, S3, crackles, and orthopnea. The primary outcome was a composite of cardiac death and heart failure readmission within 1-year. Results: At the time of admission, the median number of prevalent congestive signs was 2. We identified three phenogroups: ‘no physical congestions’ (N = 251); ‘congestion without JVD’ (N = 1415); and ‘congestion with JVD’ (N = 1495). Patients in ‘no physical congestion’ were the youngest (median 75 [62, 83] years) with the lowest systolic blood pressure (122 [106, 142] mmHg). Patients in ‘congestion without JVD’, and ‘congestion with JVD’ were similar in terms of age (77 [67, 84] vs. 78 [69, 84] years) and systolic blood pressure (138 [118, 160] vs. 137 [118, 158] mmHg). While 30-day mortality was similar (4.0%, 3.7%, and 4.3% in ‘no physical congestion,’ ‘congestion without JVD,’ and ‘congestion with JVD’, respectively), the patients in ‘congestion with JVD’ were at the highest risk for the primary outcome (adjusted hazard ratio 1.79, 95% CI 1.26–2.55 when ‘no physical congestion’ was a reference). Conclusions: Our clustering analysis demonstrated that congestion signs, particularly JVD, allowed identification of AHF phenogroups with distinct clinical characteristics and long-term outcomes.

Clinical practice guidelines for atrial fibrillation (AF) recommend thromboembolic risk stratification using empirical risk scores. We aimed to investigate how appropriately physicians recognize patients' actual thromboembolic risk and how this correlates with the use of oral anticoagulants (OACs). This prospective cohort study enrolled consecutive patients with initial AF treatment. Physicians were asked to numerically estimate each patient's thromboembolic risk, which was consecutively categorized as low (<1.0%/year), intermediate (1.0%≤ to <2.0%/year), or high risk (2.0%≤/year). The empirical thromboembolic risk was defined by the CHA2DS2-VASc score and categorized into 3 groups: low (0 or 1 point), intermediate (2 points), and high risk (3≤ points). Overestimation and underestimation were defined as physicians assigning a higher or lower risk category than the empirical risk. A multivariable logistic regression model was constructed to investigate the association between physicians' underestimation and OAC use. Among the 285 patients (68±12 years, female 27%), the mean CHA2DS2-VASc score was 2.3 ± 1.6. The thromboembolic risk was accurately estimated by treating physicians in 51.6% of cases, while 39.6% were overestimated and 8.8% were underestimated. OACs were used in 89.8%, 84.1%, and 72.0% of the correctly, over, and underestimated group, respectively. After multivariable adjustment, physicians' underestimation of thromboembolic risk was independently associated with less use of OACs (adjusted OR 0.17, 95% CI 0.05-0.54, P = 0.003). In conclusion, physicians frequently misrecognized thromboembolic risk in AF patients. Risk underestimation was independently associated with lower OAC use, suggesting the importance of integrating validated risk stratification tools into clinical practice to enhance shared decision-making.

BACKGROUND: Atrial fibrillation (AF) is managed with various strategies, including rate and rhythm control, to improve patients’ health status. Although its incidence increases with age, how age affects health status improvements following AF treatment remains unknown. METHODS: Using data from a multicenter registry for outpatients with newly recognized AF, baseline and 1-year health status was assessed with the Atrial Fibrillation Effect on Quality-of- life quesTionnaire (AFEQT). The associations between age and 1-year changes in AFEQT-overall summary and subdomain scores with rate or rhythm control strategies were estimated using generalized additive models. To address nonlinear relationships, we developed multivariable linear regression models with age range categories (<65, 65–75, and ≥75 years). RESULTS: Among 2786 patients (31.7% women); 946 were <65, 1019 were ≥65 to 75, and 821 were ≥75 years, with rate control pursued in 23.4%, 42.0%, and 66.4%, respectively, and their mean 1-year improvements in the AFEQT overall summary were 11.1 (SD: 16.6), 8.0 (17.0), and 4.7 (18.2), respectively. After multivariable adjustment, older age was independently associated with less AFEQT overall summary improvement, regardless of treatment strategy. Patients aged ≥75 years had a smaller AFEQT overall summary improvements than those aged <65 years (difference between groups −3.86 points [−5.29 to −2.42]), primarily driven by smaller improvements in AFEQT daily activities scores with similar improvements in the AFEQT symptoms or treatment concern domains. CONCLUSIONS: Although older adults with AF exhibited smaller gains in functional limitation following disease-specific treatment, they experienced measurable improvements in overall health status regardless of treatment strategies.

Background: Body mass index (BMI), a key clinical marker, may influence outcomes after in-hospital cardiac arrest (IHCA), but its association with neurologically favorable survival remains unclear. Methods: Within Get With The Guidelines®-Resuscitation, we analyzed 56,411 IHCA patients with BMI data during 2006–2012. BMI was classified as underweight (<18.5 kg/m2), normal (18.5–24.9), overweight (25.0–29.9), obese (30.0–34.9), and very obese (≥35.0). Multivariable hierarchical models with hospital as a random effect assessed the association between BMI and favorable neurological survival (discharge cerebral performance category score of 1) and survival to discharge. Results: Among 10,219 patients with a shockable rhythm, 3014 (29.4%) had favorable neurological survival, and 3,964 (38.7%) survived to discharge. After adjustment, compared with normal BMI patients, underweight patients had lower favorable neurological survival (OR 0.64 [95%CI: 0.49–0.84]), while overweight (OR 1.17 [1.04–1.33]) and obese (OR 1.16 [1.00–1.34]) patients had higher rates of favorable neurological survival; no difference was seen for very obese patients (OR 1.06 [0.91–1.24]). A similar pattern was observed for survival to discharge. Among 46,192 patients with a non-shockable arrest rhythm, 4844 (10.4%) had favorable neurological survival, and 7,331 (15.8%) survived to discharge. After adjustment, all BMI groups had similar rates of favorable neurological survival and survival to discharge, except for underweight patients (OR 0.76 [0.66–0.89] and 0.85 [0.75–0.95], respectively). Conclusions: For patients with IHCA, underweight patients had lower rates of survival and favorable neurological survival, regardless of initial cardiac arrest rhythm. In contrast, overweight and obese patients had better outcomes only when the initial rhythm was shockable.

BACKGROUND: Same-day discharge (SDD) after percutaneous coronary intervention (PCI) may be altered when complications occur. We sought to determine whether risk of the most common complication, acute kidney injury (AKI), is associated with SDD in practice. METHODS: Using the NCDR (National Cardiovascular Data Registry) CathPCI registry, we calculated the AKI risk for elective PCIs from 2018 to 2022 using the NCDR prediction model. Hierarchical logistic regression models were constructed to predict SDD with AKI risk and procedural variables as fixed effects, and site as a random effect. Trends in SDD rate across AKI risk categories were described and variability across sites was quantified using median odds ratios (ORs). RESULTS: Among 1 033 096 eligible patients, 414 297 (40.1%) had SDD after PCI and rates increased throughout the study period (27.9% in 2018 to 53.4% in 2022; 1.9% per quarter). Higher AKI risks were associated with lower SDD rates (OR, 0.97 per 1% increase in AKI risk [95% CI 0.968–0.971]) although even in 2022, 41.2% of high-risk patients underwent SDD. Marked variation in SDD practices was observed across sites (overall median OR, 3.75 [95% CI 2.63–5.34]) even among the highest risk group (median OR, 3.60 [95% CI 2.34–5.56]). CONCLUSIONS: Although patients at higher risk of AKI are less likely to undergo SDD overall, currently, 2 in 5 patients with >10% AKI risk are discharged the day of their procedure with marked variation across sites. Further work is needed to better understand the postdischarge risk of SDD in patients at higher AKI risk to improve delivery and safety of PCI.

BACKGROUND: Randomized clinical trials have demonstrated that catheter ablation (CA) for atrial fibrillation improves health-related quality of life (HRQoL). In daily practice, however, CA is performed on a wide range of patients, and outcomes may vary. We aimed to examine baseline and 1-year HRQoL outcomes of patients with atrial fibrillation after CA in daily practice. METHODS AND RESULTS: Using a registry-based cohort study designed to recruit patients with atrial fibrillation newly referred to 11 hospitals, we extracted data from 1097 consecutive patients with atrial fibrillation who underwent CA between 2012 and 2019. The Atrial Fibrillation Effects on Quality of Life Overall Summary (AFEQT-OS) was assessed at registration and 1 year after, and a 5-point increase in AFEQT-OS score was considered a meaningful improvement. Overall, the median age was 64 (interquartile range, 56–70) years, 836 (76.2%) were men, and 93.0% (n=1021) of the patients answered the AFEQT questionnaire. The mean AFEQT-OS score was 74.9 (SD, 18.0) at registration and 88.8 (SD, 12.6) at 1 year after. Notably, the incidence of meaningful improvement in HRQoL after CA was 88.6% for the patients with impaired HRQoL (AFEQT-OS score <80), which was only 40.1% in those with preserved HRQoL (AFEQT-OS score ≥80). Female sex, left atrium diameter, and high baseline HRQoL were independently associated with nonimprovement after CA. CONCLUSIONS: The improvement in HRQoL after CA was similar to that seen in clinical trials; however, one-third of patients did not show improvement. These results underscore the importance of quantitative evaluation of patients’ HRQoL to maximize the effect of CA before its performance.

Background: Clinical practice guidelines recommend optimizing the health status of patients with atrial fibrillation (AF) as a primary treatment goal. Whether disease-specific health status is associated with subsequent clinical events is unknown. Objectives: The aim of this study was to investigate the association between health status and subsequent clinical events among patients with AF. Methods: Using a prospective cohort study of patients with new-onset AF referred to 11 hospitals (n = 3,313, 68.4% men, mean age 67.8 ± 11.6 years), data were extracted from 3,296 patients (99.4%) who completed the disease-specific Atrial Fibrillation Effects on Quality-of-Life (AFEQT) questionnaire between 2012 and 2018. Factors associated with baseline AFEQT overall summary (OS) score and associations between major adverse cardiovascular or neurologic events (MACNE; a composite of all-cause death, stroke, or new-onset heart failure hospitalization) over 2 years were investigated. Results: Overall, 517 participants (15.6%) had poor to fair health status (AFEQT OS <60), and 1,035 (31.2%) had fair to good health status (AFEQT OS 60 to <80) at baseline. Female sex, younger age, family history of AF, higher baseline heart rate, paroxysmal AF, initial visit to the emergency department, and history of heart failure were associated with lower AFEQT OS scores. Of those, 226 participants (6.8%) experienced MACNE; restricted cubic spline analysis with adjustment for factors associated with baseline AFEQT score showed a nonlinear increase in the risk for MACNE with AFEQT OS score <80. The strongest associations were observed for baseline AFEQT daily activity scores (for AFEQT daily activity score of <80 vs ≥80, HR: 1.65; 95% CI: 1.21-2.25). Conclusions: Diminished health status in patients with AF is common and is independently associated with subsequent adverse cardiovascular events.

The prognostic impact of anemia, especially mild anemia, in atrial fibrillation (AF) remains unclear. We examined clinical burdens of mild anemia on the quality of life (QoL) and clinical outcomes of 1,677 AF patients. Patients were divided into a non-anemia (hemoglobin [Hb] ≥13 g/dl for men and Hb ≥12 g/dl for women) and a mild anemia group (10≤ Hb <13 g/dl for men and 10≤ Hb <12 g/dl for women). At baseline, 22.5% of patients (n = 378) had anemia; patients in the mild anemia group had higher CHA2DS2-VASc scores (3.7 vs 2.7; p <0.01) and brain natriuretic peptide levels (253.5 vs 159.6 pg/ml; p <0.01) and were more likely to develop chronic kidney disease (64.2 vs 42.9%; p <0.01) than those in the non-anemia group. During follow-up (mean 1.7 ± 0.4 years), patients with mild anemia had a higher risk of heart failure hospitalization and major bleeding events than those without (12.2 vs 3.8%; p <0.01 and 5.6 vs 2.5%; p <0.01, respectively). Mild anemia was an independent risk factor for heart failure hospitalization (adjusted hazard ratio: 1.67, 95% confidence interval 1.06 to 2.62, p = 0.03) but not for major bleeding (adjusted hazard ratio: 1.44, 95% confidence interval 0.80 to 2.62, p = 0.23). QoL improvement was less likely in the mild anemia group during follow-up, despite the lack of significant differences at baseline. In conclusion, the presence of even mild anemia was associated with increased risks of heart failure hospitalization and poor QoL improvement.

Aims: The usefulness of catheter ablation (CA) for atrial fibrillation (AF) across a broad spectrum of heart failure (HF) patients remains to be established. We assessed the association of CA with both health-related quality of life (QoL) and cardiovascular events among HF patients with reduced and preserved left ventricular ejection fraction (LVEF) in an 'all-comer' outpatient-based AF registry. Methods and results: Of 3303 patients with AF consecutively enrolled in a retrospective multicentre registry that mandated the Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) questionnaire at registration and 1-year follow-up, we extracted data from 530 patients complicating clinical HF. The association between CA and both 1-year change in AFEQT Overall Summary (AFEQT-OS) scores and 2-year composite clinical outcomes (including all-cause death, stroke, and HF hospitalization) was assessed by multivariable analyses. The median duration of AF was 108 days (52-218 days), and 83.4% had LVEF >35%. Overall, 75 patients (14.2%) underwent CA for AF within 1-year after registration. At 1-year follow-up, 67.2% in the ablation group showed clinically meaningful improvements of ≥ 5 points in AFEQT-OS score than 47.8% in the non-ablation group {adjusted odds ratio, 2.03 [95% confidence interval (CI): 1.13-3.64], P = 0.017}. Furthermore, the composite endpoint of all-cause death, stroke, and HF hospitalization occurred less frequently in the ablation group than the non-ablation group [adjusted hazard ratio, 0.27 (95% CI: 0.09-0.86), P = 0.027]. Conclusion: Among AF-HF patients, CA was associated with improved QoL and lower risk of cardiovascular events against drug therapy alone, even for patients with mildly reduced and preserved LVEF.

Background: Catheter ablation is widely used as first-line therapy for patients with impaired quality of life; however, whether catheter ablation improves survival and other outcomes in atrial fibrillation (AF) cases remains unclear. Objective: The purpose of this study was to evaluate whether catheter ablation reduces adverse clinical outcomes and improves patients’ quality of life using data from a contemporary Japanese multicenter registry of patients with early-stage AF. Methods: The Keio Interhospital Cardiovascular Studies-Atrial Fibrillation registered 3318 patients with AF newly diagnosed at or referred to participating hospitals between 2014 and 2018. Propensity score matching based on 47 demographic variables was performed. We extracted 823 pairs who underwent catheter ablation or medical therapy alone. The primary outcome was the composite of all-cause death, stroke, bleeding events, and heart failure hospitalization during a 2-year follow-up period. Additionally, the Atrial Fibrillation Effect on QualiΤy-of-Life scores at baseline and 1-year follow-up were evaluated. Results: Within the matched cohort, the median time since AF diagnosis was 0.3 years (interquartile range [IQR] 0.1‒2.3 years), age was 67.0 years (IQR 59.0‒73.0 years), and the CHA2DS2-VASc score was 2.0 (IQR 1.0‒2.0). During a median follow-up period of 730 days (IQR 366‒731 days), patients who underwent catheter ablation had a lower risk of primary outcomes (hazard ratio 0.49; 95% confidence interval 0.30‒0.79; P = .004), with a significantly lower risk of heart failure hospitalization (hazard ratio 0.33; 95% confidence interval 0.14–0.77; P = .010) and improved Atrial Fibrillation Effect on QualiΤy-of-Life scores, than did those who received medical therapy. Conclusion: In patients with propensity score–matched, early-stage, real-world AF, catheter ablation was associated with a lower risk of adverse clinical events and improved quality of life as compared with medical therapy.

Background: Early detection of atrial fibrillation (AF) is important. Japan has a universal screening system, and regular health screening (HS) is available to support AF detection without a hospital visit. However, health-related outcomes and other characteristics of HS-detected and conventionally diagnosed AF remain unknown. Hypothesis: That the characteristics and health-related outcomes of patients with HS-detected AF may differ from those of patients whose AF was detected by other procedures. Methods: In total, 3318 consecutive newly referred AF cases were enrolled; demographic characteristics and health-related and clinical outcomes were compared between two groups created based on the mode of AF detection (the HS and non-HS groups). Health-related outcomes were assessed using the AF Effect on QualiTy-of-life (AFEQT) questionnaire at baseline and after 1 year of follow-up. Results: AF was detected by HS in 25.0% of patients; these patients had lower CHADS2 scores (1.01 vs. 1.50, p <.001), higher prevalence of persistent AF (odds ratio, 95% confidence interval; 2.21, 1.88–2.60) and asymptomatic presentation (3.19, 2.71–3.76), and better baseline QoL scores (83.6 vs. 75.0; p <.001). Catheter ablation was more frequently performed in the HS group at follow-up (44.4% vs. 34.1%; p <.001). At 1-year follow-up, the AFEQT scores of the HS group were significantly better in most subdomains. Conclusions: In the Japanese registry, AF was detected via HS in 25% of patients referred to specialty centers for management. Notably, the overall health status of patients with HS-detected AF improved after medical interventions, including catheter ablations.