Pub Date : 2025-12-17DOI: 10.1016/j.ijcha.2025.101854
Miika Vanhanen , Jussi Jaakkola , Juhani K.E. Airaksinen , Olli Halminen , Jukka Putaala , Pirjo Mustonen , Jari Haukka , Juha Hartikainen , Alex Luojus , Mikko Niemi , Miika Linna , Mika Lehto , Konsta Teppo
Objective
Patients with alcohol use disorder (AUD) often receive inferior treatment for somatic comorbidities. We aimed to examine whether AUD is associated with disparities in the use of antiarrhythmic therapies (AAT) for rhythm control in atrial fibrillation (AF) patients, using a nationwide registry.
Methods
The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) registry includes all 229,565 patients with incident AF diagnosed in Finland between 2007 and 2018, identified from comprehensive national healthcare registries. The primary outcome was initiation of rhythm control therapies, including antiarrhythmic drugs, cardioversion, and catheter ablation, in patients with and without AUD.
Results
The mean age was 72.7 years, 50 % were female and 4.7 % had AUD. Rhythm control was initiated less often in patients with AUD compared to those without (13.6 % vs. 21.8 %, p < 0.001). After adjustment for comorbidities and socioeconomic status, AUD remained associated with lower use of rhythm control therapies (HR 0.65; 95 % CI 0.62–0.69). This disparity was consistent across all modalities of rhythm control (antiarrhythmic drugs, cardioversion and catheter ablation). While no significant interaction was observed with sex or age, income modified the association (p < 0.001), with the lowest income tertile showing the greatest disparity (HR 0.37; 95 % CI 0.32–0.42).
Conclusions
AUD is independently associated with markedly lower use of rhythm control therapies in AF patients. These disparities are most pronounced among socioeconomically disadvantaged individuals, highlighting the need for targeted interventions to ensure equitable treatment access.
{"title":"Alcohol use disorder and use of rhythm control therapies in patients with atrial fibrillation: A nationwide cohort study","authors":"Miika Vanhanen , Jussi Jaakkola , Juhani K.E. Airaksinen , Olli Halminen , Jukka Putaala , Pirjo Mustonen , Jari Haukka , Juha Hartikainen , Alex Luojus , Mikko Niemi , Miika Linna , Mika Lehto , Konsta Teppo","doi":"10.1016/j.ijcha.2025.101854","DOIUrl":"10.1016/j.ijcha.2025.101854","url":null,"abstract":"<div><h3>Objective</h3><div>Patients with alcohol use disorder (AUD) often receive inferior treatment for somatic comorbidities. We aimed to examine whether AUD is associated with disparities in the use of antiarrhythmic therapies (AAT) for rhythm control in atrial fibrillation (AF) patients, using a nationwide registry.</div></div><div><h3>Methods</h3><div>The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) registry includes all 229,565 patients with incident AF diagnosed in Finland between 2007 and 2018, identified from comprehensive national healthcare registries. The primary outcome was initiation of rhythm control therapies, including antiarrhythmic drugs, cardioversion, and catheter ablation, in patients with and without AUD.</div></div><div><h3>Results</h3><div>The mean age was 72.7 years, 50 % were female and 4.7 % had AUD. Rhythm control was initiated less often in patients with AUD compared to those without (13.6 % vs. 21.8 %, p < 0.001). After adjustment for comorbidities and socioeconomic status, AUD remained associated with lower use of rhythm control therapies (HR 0.65; 95 % CI 0.62–0.69). This disparity was consistent across all modalities of rhythm control (antiarrhythmic drugs, cardioversion and catheter ablation). While no significant interaction was observed with sex or age, income modified the association (p < 0.001), with the lowest income tertile showing the greatest disparity (HR 0.37; 95 % CI 0.32–0.42).</div></div><div><h3>Conclusions</h3><div>AUD is independently associated with markedly lower use of rhythm control therapies in AF patients. These disparities are most pronounced among socioeconomically disadvantaged individuals, highlighting the need for targeted interventions to ensure equitable treatment access.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"62 ","pages":"Article 101854"},"PeriodicalIF":2.5,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-11DOI: 10.1016/j.ijcha.2025.101851
Rebeca Lorca , Alberto Alen , Carlos Moliner-Abós , Fernando de Frutos , Néstor Báez-Ferrer , María Luisa Peña-Peña , Eduardo Villacorta , Tomas Ripoll-Vera , Esther Zorio , Aaron Martínez-Gimeno , José Bermúdez-Jiménez , Javier Limeres , Coloma Tiron , José M. Larrañaga-Moreira , Eva Cabrera-Romero , Pablo García-Pavía , María Angeles Espinosa , Jesús Piqueras , Soledad García-Hernández , Julián Palomino-Doza , Carmen Muñoz
Background
DM1 is an autosomal dominant disorder caused by unstable CTG repeats that expand over lifetime and in successive generations, contributing to genetic anticipation. Cardiac conduction abnormalities (CCAs) are a major source of morbidity and premature death in DM1, yet the influence of age at diagnosis, generation, and CTG repeat length on the timing and progression of cardiac involvement remains poorly defined.
Method
This multicentric retrospective study included 549 adult DM1 patients from 16 hospitals in Spain. The primary composite endpoint comprised significant CCAs, device implantation, malignant ventricular arrhythmias and cardiac syncope. Patients were stratified by age‑at‑diagnosis (<40, 40–59, and ≥60 years); birth generation (1920–1965, 1966–1990, 1991–2015), and CTG repeat length (<100, 100–599, and ≥600).
Results
During follow‑up, 33.1 % of patients experienced the primary endpoint. This risk was 4.7‑fold higher in the youngest group versus the oldest group (HR 4.70; p < 0.001); 35‑fold higher in the 3rd generation versus the 1st and increased progressively with longer CTG expansions. Device implantation rates were likewise higher in younger patients, later generations, and those with larger repeat lengths.
Conclusion
The results demonstrate a striking anticipation pattern in the cardiac phenotype of DM1, with progressively earlier and more severe electrical disease paralleling CTG expansion across generations. Incorporating age at diagnosis, generational cohort, and genetic repeat burden into clinical assessment may enhance risk stratification and enable earlier, targeted rhythm surveillance and device therapy to prevent sudden cardiac death in DM1.
ddm1是一种常染色体显性遗传病，由不稳定的CTG重复序列在一生中和连续几代中扩展引起，有助于遗传预期。心传导异常（CCAs）是DM1发病和过早死亡的主要原因，但诊断年龄、世代和CTG重复长度对心脏受累时间和进展的影响仍不明确。方法本多中心回顾性研究纳入西班牙16家医院549例成年DM1患者。主要复合终点包括显著cca、器械植入、恶性室性心律失常和心源性晕厥。患者按诊断年龄分层（40岁、40 - 59岁和≥60岁）；出生世代（1920-1965、1966-1990、1991-2015）和CTG重复长度（<；100、100 - 599和≥600）。结果在随访期间，33.1%的患者达到了主要终点。这一风险在最年轻组比最年长组高4.7倍（HR 4.70; p < 0.001）；第三代比第一代高35倍，并随着CTG扩展时间的延长而逐渐增加。同样，在年轻患者、后代患者和重复长度较大的患者中，器械植入率也较高。结果表明，DM1的心脏表型具有显著的预测模式，随着CTG的代际扩展，电性疾病的发生时间越来越早，越来越严重。将诊断年龄、世代队列和遗传重复负担纳入临床评估可能会加强风险分层，并使早期、有针对性的节律监测和器械治疗成为可能，以预防DM1的心源性猝死。
{"title":"Genetic anticipation and cardiac conduction abnormalities in myotonic dystrophy type 1: implications for early stratification from a multicenter registry","authors":"Rebeca Lorca , Alberto Alen , Carlos Moliner-Abós , Fernando de Frutos , Néstor Báez-Ferrer , María Luisa Peña-Peña , Eduardo Villacorta , Tomas Ripoll-Vera , Esther Zorio , Aaron Martínez-Gimeno , José Bermúdez-Jiménez , Javier Limeres , Coloma Tiron , José M. Larrañaga-Moreira , Eva Cabrera-Romero , Pablo García-Pavía , María Angeles Espinosa , Jesús Piqueras , Soledad García-Hernández , Julián Palomino-Doza , Carmen Muñoz","doi":"10.1016/j.ijcha.2025.101851","DOIUrl":"10.1016/j.ijcha.2025.101851","url":null,"abstract":"<div><h3>Background</h3><div>DM1 is an autosomal dominant disorder caused by unstable CTG repeats that expand over lifetime and in successive generations, contributing to genetic anticipation. Cardiac conduction abnormalities (CCAs) are a major source of morbidity and premature death in DM1, yet the influence of age at diagnosis, generation, and CTG repeat length on the timing and progression of cardiac involvement remains poorly defined.</div></div><div><h3>Method</h3><div>This multicentric retrospective study included 549 adult DM1 patients from 16 hospitals in Spain. The primary composite endpoint comprised significant CCAs, device implantation, malignant ventricular arrhythmias and cardiac syncope. Patients were stratified by age‑at‑diagnosis (<40, 40–59, and ≥60 years); birth generation (1920–1965, 1966–1990, 1991–2015), and CTG repeat length (<100, 100–599, and ≥600).</div></div><div><h3>Results</h3><div>During follow‑up, 33.1 % of patients experienced the primary endpoint. This risk was 4.7‑fold higher in the youngest group versus the oldest group (HR 4.70; p < 0.001); 35‑fold higher in the 3rd generation versus the 1st and increased progressively with longer CTG expansions. Device implantation rates were likewise higher in younger patients, later generations, and those with larger repeat lengths.</div></div><div><h3>Conclusion</h3><div>The results demonstrate a striking anticipation pattern in the cardiac phenotype of DM1, with progressively earlier and more severe electrical disease paralleling CTG expansion across generations. Incorporating age at diagnosis, generational cohort, and genetic repeat burden into clinical assessment may enhance risk stratification and enable earlier, targeted rhythm surveillance and device therapy to prevent sudden cardiac death in DM1.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"62 ","pages":"Article 101851"},"PeriodicalIF":2.5,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145737407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-10DOI: 10.1016/j.ijcha.2025.101849
Shabiga Sivanesan , Aleksandra Gąsecka , Niels M.R. van der Sangen , Wout W.A. van den Broek , Jaouad Azzahhafi , Dean R.P.P. Chan Pin Yin , Qiu Ying F. van de Pol , Ronald J. Walhout , Melvyn Tjon Joe Gin , Ron Pisters , Deborah M. Nicastia , Gerben J. de Roest , Georgios J. Vlachojannis , Rutger J. van Bommel , Wouter J. Kikkert , José P.S. Henriques , Jurriën M. ten Berg , Yolande Appelman
Aims
This study reports sex differences in the clinical presentation, treatment management and outcomes of patients with acute coronary syndrome (ACS) in The Netherlands, using data from the FORCE-ACS registry.
Methods
A prospective analysis was conducted using data from 5023 patients admitted with ACS between 2015 and 2019, with complete three-year follow-up. Demographic data, clinical characteristics, in-hospital treatment and outcomes were compared by sex. Multivariable regression analyses explored associations between sex and clinical outcomes.
Results
Of the 5023 patients, 29 % were women. Women were generally older, with a significantly higher prevalence of hypertension (61.7 % vs 54.2 %), chronic kidney disease (25.7 % vs. 18.5 %) and myocardial infarction with non-obstructive coronary arteries (MINOCA) (13.5 % vs. 6.5 %). Women less frequently underwent revascularisation, even after excluding those with non-obstructive coronary artery disease, and received less medical treatment compared to their male counterparts. At 36 months, women had higher unadjusted mortality rate (13.7 % vs. 11.0 %, OR 1.28, 95 % CI: 1.07–1.54) and bleeding events (26.2 % vs. 22.3 %, OR 1.24, 95 % CI: 1.08–1.43). However, after adjustment for age and baseline characteristics, these differences were no longer statistically significant. Recurrent ACS and stroke remained similar in both groups, also after correction.
Conclusion
Differences between women and men were observed in clinical presentation, interventional treatment, pharmacotherapy and outcomes among ACS patients in The Netherlands. Despite receiving less guideline-recommended care, women had similar adjusted 36-month outcomes as men. These findings show that there is room for improvement in the management of ACS, with a focus on optimized treatment strategies for women.
{"title":"Sex differences in the presentation and management of acute coronary syndrome patients: Insights from the FORCE-ACS registry","authors":"Shabiga Sivanesan , Aleksandra Gąsecka , Niels M.R. van der Sangen , Wout W.A. van den Broek , Jaouad Azzahhafi , Dean R.P.P. Chan Pin Yin , Qiu Ying F. van de Pol , Ronald J. Walhout , Melvyn Tjon Joe Gin , Ron Pisters , Deborah M. Nicastia , Gerben J. de Roest , Georgios J. Vlachojannis , Rutger J. van Bommel , Wouter J. Kikkert , José P.S. Henriques , Jurriën M. ten Berg , Yolande Appelman","doi":"10.1016/j.ijcha.2025.101849","DOIUrl":"10.1016/j.ijcha.2025.101849","url":null,"abstract":"<div><h3>Aims</h3><div>This study reports sex differences in the clinical presentation, treatment management and outcomes of patients with acute coronary syndrome (ACS) in The Netherlands, using data from the FORCE-ACS registry.</div></div><div><h3>Methods</h3><div>A prospective analysis was conducted using data from 5023 patients admitted with ACS between 2015 and 2019, with complete three-year follow-up. Demographic data, clinical characteristics, in-hospital treatment and outcomes were compared by sex. Multivariable regression analyses explored associations between sex and clinical outcomes.</div></div><div><h3>Results</h3><div>Of the 5023 patients, 29 % were women. Women were generally older, with a significantly higher prevalence of hypertension (61.7 % vs 54.2 %), chronic kidney disease (25.7 % vs. 18.5 %) and myocardial infarction with non-obstructive coronary arteries (MINOCA) (13.5 % vs. 6.5 %). Women less frequently underwent revascularisation, even after excluding those with non-obstructive coronary artery disease, and received less medical treatment compared to their male counterparts. At 36 months, women had higher unadjusted mortality rate (13.7 % vs. 11.0 %, OR 1.28, 95 % CI: 1.07–1.54) and bleeding events (26.2 % vs. 22.3 %, OR 1.24, 95 % CI: 1.08–1.43). However, after adjustment for age and baseline characteristics, these differences were no longer statistically significant. Recurrent ACS and stroke remained similar in both groups, also after correction.</div></div><div><h3>Conclusion</h3><div>Differences between women and men were observed in clinical presentation, interventional treatment, pharmacotherapy and outcomes among ACS patients in The Netherlands. Despite receiving less guideline-recommended care, women had similar adjusted 36-month outcomes as men. These findings show that there is room for improvement in the management of ACS, with a focus on optimized treatment strategies for women.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"62 ","pages":"Article 101849"},"PeriodicalIF":2.5,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145737345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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