Background Comprehensive data on patients at high risk of sudden cardiac death (SCD) in emerging countries are lacking. The aim was to deepen our understanding of the SCD phenotype and identify risk factors for death among patients at high risk of SCD in emerging countries. Methods Patients who met the class I indication for implantable cardioverter-defibrillator (ICD) implantation according to guideline recommendations in 17 countries and regions underrepresented in previous trials were enrolled. Countries were stratified by the WHO regional classification. Patients were or were not implanted with an ICD at their discretion. The outcomes were all-cause mortality and SCD. Results We enrolled 4222 patients, and 3889 patients were included in the analysis. The mean follow-up period was 21.6 ± 10.2 months. There were 433 (11.1%) instances of all-cause mortality and 117 (3.0%) cases of SCD. All-cause mortality was highest in primary prevention (PP) patients from Southeast Asia and secondary prevention (SP) patients from the Middle East and Africa. The SCD rates among PP and SP patients were both highest in South Asia. Multivariate Cox regression modelling demonstrated that in addition to the independent predictors identified in previous studies, both geographic region and ICD use were associated with all-cause mortality in patients with high SCD risk. Primary prophylactic ICD implantation was associated with a 36% (HR = 0.64, 95% CI 0.531–0.802, p < 0.0001) lower all-cause mortality risk and an 80% (HR = 0.20, 95% CI = 0.116–0.343, p < 0.0001) lower SCD risk. Conclusions There was significant heterogeneity among patients with high SCD risk in emerging countries. The influences of geographic regions on patient characteristics and outcomes were significant. Improvement in increasing ICD utilization and uptake of guideline-directed medical therapy in emerging countries is urgent. Trial registration ClinicalTrials.gov, NCT02099721.

BACKGROUND:Underutilization of implantable cardioverter defibrillators (ICD) to prevent sudden cardiac death (SCD) in post-myocardial infarction (MI) patients remains an issue across several geographies. A better understanding of risk factors for SCD in post-MI patients from regions with low ICD adoption rates will help identify those who will benefit from an ICD. This analysis assessed risk factors for all-cause and cardiovascular-related mortality in post-MI patients from the Improve Sudden Cardiac Arrest (SCA) Bridge Trial.RESULTS:For the entire cohort, the overall 1-year mortality rate was 5.9% (88/1491) and 3.4% (51/1491) for all-cause and cardiovascular mortality, respectively, with 76.5% of all cardiac deaths being from SCD. A multivariate model determined increased age, reduced left ventricular ejection fraction (LVEF), increased time from myocardial infarction to hospital admission, being female, being from Southeast Asia (SEA), and having coronary artery disease to be significant risk factors for all-cause mortality. The risk factors for cardiovascular-related mortality revealed increased age, reduced LVEF, and being from SEA as significant risk factors.CONCLUSIONS:We show several characteristics as being predictors of cardiovascular-related mortality in post-MI patients from the Improve SCA Bridge study. Patients who experience an MI and present with these characteristics would benefit from a referral to an electrophysiologist for further SCD risk stratification and management and possible subsequent ICD implantation to reduce unnecessary death.

Background & Objective: Despite the burden of sudden cardiac arrest (SCA) worldwide, implantable cardioverter-defibrillators (ICDs) are underutilized, particularly in Asia, Latin America, Eastern Europe, the Middle East, and Africa. The Improve SCA trial demonstrated that primary prevention (PP) patients in these regions benefit from an ICD or a cardiac resynchronization therapy defibrillator (CRT-D). We aimed to compare the rate of device therapy and mortality among ischemic and non-ischemic cardiomyopathy (ICM and NICM) PP patients who met guideline indications for ICD therapy and had an ICD/CRT-D implanted. Methods: Improve SCA was a prospective, non-randomized, non-blinded multicenter trial that enrolled patients from the above-mentioned regions. All-cause mortality and device therapy were examined by cardiomyopathy (ICM vs NICM) and implantation status. Cox proportional hazards methods were used, adjusting for factors affecting mortality risk. Results: Of 1848 PP NICM patients, 1007 (54.5%) received ICD/CRT-D, while 303 of 581 (52.1%) PP ICM patients received an ICD/CRT-D. The all-cause mortality rate at 3 years for NICM patients with and without an ICD/CRT-D was 13.1% and 18.3%, respectively (HR 0.51, 95% CI 0.38-0.68, p < 0.001). Similarly, all-cause mortality at 3 years in ICM patients was 13.8% in those with a device and 19.9% in those without an ICD/CRT-D (HR 0.54, 95% CI 0.33-.0.88, p = 0.011). The time to first device therapy, time to first shock, and time to first antitachycardia pacing (ATP) therapy were not significantly different between groups (p >= 0.263). Conclusions: In this large data set of patients with a guideline-based PP ICD indication, defibrillator device implantation conferred a significant mortality benefit in both NICM and ICM patients. The rate of appropriate device therapy was also similar in both groups.

Background:Implantable cardioverter-defibrillator (ICD) implantation to prevent sudden cardiac death (SCD) in post-myocardial infarction (MI) patients varies by geography but remains low in many regions despite guideline recommendations.Objectives:This study aimed to characterize the care pathway of post-MI patients and understand barriers to referral for further SCD risk stratification and management in patients meeting referral criteria.Methods:This prospective, nonrandomized, multi-nation study included patients ≥18 years of age, with an acute MI ≤30 days and left ventricular ejection fraction <50% ≤14 days post-MI. The primary endpoint was defined as the physician's decision to refer a patient for SCD stratification and management.Results:In total, 1,491 post-MI patients were enrolled (60.2 ± 12.0 years of age, 82.4% male). During the study, 26.7% (n = 398) of patients met criteria for further SCD risk stratification; however, only 59.3% of those meeting criteria (n = 236; 95% CI: 54.4%-64.0%) were referred for a visit. Of patients referred for SCD risk stratification and management, 94.9% (n = 224) attended the visit of which 56.7% (n =127; 95% CI: 50.1%-63.0%) met ICD indication criteria. Of patients who met ICD indication criteria, 14.2% (n = 18) were implanted.Conclusions:We found that ∼40% of patients meeting criteria were not referred for further SCD risk stratification and management and ∼85% of patients who met ICD indications did not receive a guideline-directed ICD. Physician and patient reasons for refusing referral to SCD risk stratification and management or ICD implant varied by geography suggesting that improvement will require both physician- and patient-focused approaches. (Improve Sudden Cardiac Arrest [SCA] Bridge Study; NCT03715790).

Background: Data on patients in emerging countries at high risk of sudden cardiac death (SCD) are lacking. The Improve SCA registry is the first prospective, global registry to evaluate this population.Methods: Patients who met guideline recommendations for implantable cardioverter-defibrillator (ICD) implantation were enrolled in 17 countries and regions in regions underrepresented in previous trials. Countries were stratified by WHO regional classification and income level based on the World Bank classification system. Primary outcomes were all-cause mortality and SCD.Findings: We enrolled 4,222 patients and 3,889 patients were included in the analysis. The mean follow-up period was 21·6±10·2 months. There were 433 (11·1%) instances of all-cause mortality and 117 (3·0%) SCD. All-cause mortality was highest in primary prevention (PP) patients from Southeast Asia (Southeast Asia/Europe, HR=3·18, 95%CI: 1·14-8·91, P=0·0275), while it was highest in secondary prevention (SP) patients from the Middle East and Africa (MEA) (MEA/Europe, HR=5·1, 95%CI 1·13-23·0, P=0·0341). The SCD rate of PP and SP patients was highest in South Asia. All-cause mortality in PP patients from upper middle income (UMI) countries was higher than high income (HI) (HR=1·38, 95% CI: 1·04-1·84, p=0·0276) and lower middle income countries (LMI) (HR=1·563, 95% CI: 1·18-2·08, p=0·0021). SCD rates of PP and SP patients of LMI countries were higher than UMI and HI (p<0·0001).Interpretation: There was significant heterogeneity among high SCD risk patients in emerging countries. Influences of both geography and income level on patient outcomes were significant. These findings emphasize the need to increase ICD/CRT-D utilization in emerging countries.Trial Registration: ClinicalTrials.gov identifier: NCT02099721Funding: This study was funded by Medtronic Inc.Declaration of Interest: S. Zhao declare no conflicts of interest. S. Zhang: speakers bureau/consulting fees: Boston Scientific, Medtronic, St. Jude Medical, Biotronik, steering committee fees: Medtronic; CK Ching: speaker fees/steering committee fees: Medtronic; D. Huang: speaker/consultant fees: Boston Scientific, St. Jude Medical; YB Liu: speaker fees/steering committee fees, Medtronic; DA. Rodriguez: proctor/lecture fees: Boston Scientific, proctorship: Biosense Webster, St. Jude Medical/Abbott, steering committee fees: Medtronic; Azlan Hussin: speaker fees/steering committee fees, Medtronic; YH. Kim: steering committee fees: Medtronic; AR. Chasnoits: steering committee fees: Medtronic; J. Cerkvenik: Employment: Medtronic; D. Lexcen: Employment: Medtronic; K. Muckala: Employment: Medtronic; M. Brown: Employment: Medtronic; A. Cheng: Employment: Medtronic; XH Zhou: Employment: Medtronic; B. Singh: steering committee fees: MedtronicEthical Approval: The protocol was approved by the ethics committee at each participating institution and associated national and local regulatory agencies. All patients provided writteninformed consent before undergoing study procedures.

Cardiac resynchronization therapy (CRT) is one of the effective treatments for chronic heart failure. With the popularization and application of CRT in China, the increasing abundance of evidence-based data, and the progress of resynchronization technology, the indications of CRT are also constantly developing. To further standardize and guide the application of CRT, the expert group discussed some controversial issues and proposed a new expert consensus on the indications, treatment recommendations, novel techniques, follow-up, and programming, on the basis of the “Recommendations for CRT for Chronic Heart Failure (Revision 2013).”

Background Natural disasters are believed to be associated with cardiovascular disease. This study aimed to explore the changes in mortality due to ischemic heart disease (IHD) and their associations with natural disasters at the global level. Methods Country-specific data on the impact of natural disasters, rates of mortality due to IHD and years of life lost (YLL) and socioeconomic variables were obtained for 193 countries for the period from 1990 to 2017. An ecological trend study was conducted to estimate the changes in the IHD mortality and YLL rates and their associations with natural disasters (occurrence, casualties and total damage). Correlation analyses and multivariate linear regression were used. Results Significant changes were found in the IHD mortality and YLL rates and the occurrence of disasters between the two equal periods (1990 to 2003 and 2004 to 2017) (p<0.001). The bivariate Pearson correlation test revealed that the trend in the occurrence of natural disasters was positively correlated with trends in the IHD mortality and YLL rates among females and all individuals (p<0.05) and was marginally correlated among males. Multiple linear regression revealed an independent association between the occurrence of natural disasters and the IHD mortality rate among males, females and all individuals (standardized coefficients = 0.163, 0.357 and 0.241, p<0.05), and similar associations were found for the YLL rate (standardized coefficients = 0.194, 0.233 and 0.189, p<0.05). Conclusions Our study demonstrated significant changes in the IHD mortality and YLL rates at the global level and their independent associations with natural disasters. Both males and females were vulnerable to natural disasters. These results provide evidence that can be used to support policy making and resource allocation when responding to disasters and developing strategies to reduce the burden of IHD.

本文评述了无导线起搏器在治疗心动过缓的研发历史及思路、适应证探讨、国内外的应用现状、存在的问题、解决的方案，并探讨了未来的发展方向。

Atrial fibrillation (AF) is the most common tachycardia arrhythmia in clinical practice. Catheter ablation has been one of the most effective established therapies for AF. In recent years, cryoballoon ablation (CBA) is a novel technique of AF treatment. Much experience in the operations, therapeutic parameters, and the prevention against complications has been gained during the process of clinical application and promotion. Chinese Society of Pacing and Electrophysiology and Chinese Society of Arrhythmias organized experts, jointly initiated, and compiled “The interpretation of CBA of AF: Consensus of Chinese experts,” aiming to standardize and promote the clinical application of CBA. Based on the real-world situation in China, this article interprets and reviews the important contents of this consensus, combined with the domestic and overseas guidelines, consensus, and recent literature on AF management.

Background: Despite a proven mortality benefit in primary prevention (PP) patients, the utilization of implantable cardioverter-defibrillators (ICD) and cardiac resynchronization therapy-defibrillators (CRT-D) remains low in many geographies. Purpose: The objective of this analysis was to examine the mortality benefit in PP patients by guideline-indicated device type: implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy-defibrillator (CRT-D). Methods: Improve SCA was a prospective, non-randomized, non-blinded multicenter trial that enrolled patients from regions where ICD utilization is low. PP patient’s CRT-D or ICD eligibility was based upon the 2008 ACC/AHA/HRS and 2006 ESC guidelines. Mortality was assessed according to guideline-indicated device type comparing implanted and non-implanted patients. Cox proportional hazards methods were used, adjusting for known factors affecting mortality risk. Results: Among 2,618 PP patients followed for a mean of 20.8 ± 10.8 months, 1,073 were indicated for a CRT-D, and 1,545 were indicated for an ICD. PP CRT-D-indicated patients who received CRT-D therapy had a 58% risk reduction in mortality compared to those without implant (adjusted HR 0.42, 95% CI: 0.28-0.61, P<0.0001). PP patients with an ICD indication had a 43% risk reduction in mortality with an ICD implant compared with no implant (adjusted HR 0.57, 95% CI: 0.41-0.81, P=0.002). Conclusions: This analysis confirms the mortality benefit of adherence to guideline-indicated implantable defibrillation therapy for PP patients in geographies where ICD therapy was underutilized. These results affirm that medical practice should follow clinical guidelines when choosing therapy for PP patients who meet the respective defibrillator device implant indication.

新型冠状病毒肺炎(COVID-19)可合并或导致各种类型心律失常, 其临床管理具有一定特殊性, 目前尚缺乏统一的规范管理方案。本文根据国家卫生健康委员会COVID-19诊疗方案的指导原则, 参考国内外相关文献资料, 并结合临床一线专家的有限经验, 形成COVID-19合并心律失常的管理方案, 以供临床医护人员参考。

Abstract Aims This study aims to investigate the current status of biventricular pacemaker and defibrillator implantation in chronic heart failure (CHF) patients with indications for primary prevention of sudden cardiac death (SCD) in China and the effects of cardiac resynchronization therapy (CRT)‐pacemaker (P) and CRT‐defibrillator (D) implantation on the clinical prognosis of CHF among patients undergoing CRT. Methods and results Overall, 798 consecutive patients who had devices implanted (implantable cardioverter defibrillator: 199, CRT‐D: 362, and CRT‐P: 237) from May 2012 to July 2013 in POSCD‐China, a multicentric prospective cohort study, were enrolled. The primary endpoint was all‐cause death, and the secondary endpoint was SCD. In total, 71.3% of patients had non‐ischaemic CHF. The mean follow‐up time was 27.7 ± 12.0 months, and death occurred in 158 cases, with 35 cases of SCD. CHF was the main cause of death (68.4%), followed by sudden death (22.2%). In the CRT‐P group, the SCD rate was 8.0%, which was much higher than that in the CRT‐D (3.3%) and implantable cardioverter defibrillator (2.0%) groups. No significant differences were identified in the all‐cause death rate between the CRT‐D and CRT‐P groups (CRT‐D vs. CRT‐P, 20.4% vs. 19.4%, P = 0.840). Conclusions In China, among CHF patients with indications for primary prevention of SCD who received device implantation, non‐ischaemic CHF was the main aetiology, and the most important cause of death was heart failure. No differences in all‐cause death were observed between the CRT‐D and CRT‐P groups, but the CRT‐D group had a lower SCD rate than the CRT‐P group.

Background: The improve sudden cardiac arrest (SCA) study was a nonrandomized prospective global study that identified a subset of primary prevention (PP) patients at an elevated risk for SCA labeled 1.5PP. These 1.5PP patients had one or more of the following additional risk factors: Syncope, nonsustained ventricular tachycardia, premature ventricular contractions >10/h, and left ventricular ejection fraction <25%. The purpose of this sub-analysis was to examine the China population cohort according to the improve SCA study's primary and secondary objectives. We aim to analyze the improve SCA study objective outcomes explicitly in the Chinese cohort to better understand the utility of PP implantable cardioverter-defibrillator (ICD) therapy in China. Subjects and Methods: The improve SCA study enrolled patients (n = 4222) during March 2014 and July 2017, including 87 sites in 17 countries from the geographies of Asia, Latin America, Eastern Europe, the Middle East, and Africa. In this analysis, the China cohort of improve SCA patients (n = 1654) was analyzed according to the objectives of the main study; the primary objective compared time to first appropriate ventricular tachycardia (VT) or ventricular fibrillation (VF) therapy between 1.5PP (n = 904) and secondary prevention (SP) patients (n = 470). All-cause mortality rates of 1.5PP with ICDs versus no implant, and an analysis of ischemic versus nonischemic results (n = 280) were also analyzed. PP patients without an additional risk factor were labeled 1.0PP (n = 280). Cox-proportional hazards model was used for hazard ratio (HR) calculations. This study was approved by the Ethics Committee of each participating institution and the associated national and local regulatory agencies, and registered with ClinicalTrials.gov (identifier: NCT02099721). Results: The time to first VT/VF therapy for 1.5PP was not within 30% of SP (HR = 0.42, 95% confidence interval [CI]: 0.31–0.56, P < 0.0001). However, there was a 49% reduction (HR = 0.51, 95% CI: 0.35–0.74, P = 0.0004) in all-cause mortality in the 1.5PP implanted versus nonimplanted patients, and a 70% reduction (HR = 0.30, 95% CI: 0.09–0.99, P = 0.05) in 1.0PP implanted patients. Nonischemic cardiomyopathy (NICM) 1.5PP patients showed a 51% reduction (HR = 0.49, 95% CI: 0.34–0.77, P = 0.0012) in all-cause mortality compared to those who did not receive an ICD implant. Conclusion: The China populations of 1.0PP and 1.5PP patients obtain a significant benefit with implantable defibrillation therapy.

Background: Natural disaster is considered to be associated with cardiovascular disease. This study aimed to explore the association between natural disaster and ischemic heart disease (IHD) mortality at the global level. Methods: Country-specific data on natural disaster impact (occurrence, casualties and total damage), IHD death and years of life lost (YLL) rates and socioeconomic variables were obtained for 193 countries from open sources for the period 1990 to 2017. An ecological trend study was conducted, and correlation analysis and multivariate linear regression were used to investigate the association among the variables and identify the determinants of IHD death and YLL rates. Findings: The trend in the occurrence of natural disasters between two periods (1990 to 2013 and 2014 to 2017) was positively correlated with trends in the IHD death and YLL rates. Significant correlations were found between the occurrence of natural disasters and the IHD death rate and the YLL rate for both sexes (p<0.05). Multiple linear regression revealed independent association between disaster occurrence and the IHD death rate for males, females and both sexes together (standardized coefficients=0.163, 0.357 and 0.241, p<0.05), similar associations were found for the YLL rate (standardized coefficients=0.194, 0.233 and 0.189, p<0.05). Interpretation: Our study demonstrated the independent association between natural disaster and ischemic heart disease (IHD) mortality at the global level. Both males and females were vulnerable to natural disasters in terms of IHD. These results provide evidence for policy making and resource allocation for disaster response and IHD burden. Funding Statement: This study was funded by the Health Commission of Sichuan Province (19PJ207), the Science and Technology Department of Sichuan Province (2018JY0389, 2018ZR0007, 2019YFS0443) and the Deyang Science and Technology Bureau (FY202008). Declaration of Interests: None. Ethics Approval Statement: Not required.

Atrial fibrillation (AF) is a growing public health problem in the context of the epidemiologic transition from communicable to non-communicable diseases, and a high prevalence of AF was found in Chinese patients who died in hospital.[1] Indeed, most understanding of AF is based on findings from clinical trials and observational studies performed in North America and Western Europe,[2] and some studies have described the characteristics of patients with AF in other regions. These data have highlighted the important differences in the clinical characteristics and treatment of patients with AF in these regions.[3,4] However, few studies have investigated the characteristics of patients with AF in China. Hence, the aim of this study was to investigate the clinical demographics, management, and outcomes of patients hospitalized for AF using data from a recently registered AF-specific nationwide cohort study in China, the real-world study of Chinese atrial fibrillation (RWS-CAF) registry. The RWS-CAF registry (registration number: ChiCTR1900021250) comprises a multicenter, observational, prospective cohort that includes consecutive patients requiring hospitalization with a diagnosis of AF made according to the Chinese AF guidelines, spanning from November 1, 2017, to October 31, 2018. All of the enrolled hospitals are grade A class three hospitals. Individual patients hospitalized with AF who were aged 18 years or older were recruited. Data were collected with the use of case report forms and were entered into an internet-based system. The collected data included age, sex, type of AF, body mass index, valvular or non-valvular AF, hypertension, coronary heart disease (CHD), heart failure, diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), CHA2DS2-VASc score, and HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly) score. Treatment-related data were collected during hospitalization, including data related to medicines, and ablation procedures. The authors had access to information that could identify individual participants during or after data collection. The present status of anticoagulant treatment for patients with CHA2DS2-VASc scores <2 or ≥2 was reported. The annual rates of in-hospital AF ablation in the study period were also evaluated. Continuous variables were presented as mean ± standard deviation (normal distribution) or median (interquartile range) (non-normal distribution), and categorical variables were expressed as numbers and percentages. The baseline characteristics were compared by Chi-squared test. All statistical testing was two-sided at a significance level of 0.05. Statistical analyses were conducted with SPSS version 19.0 (SPSS Inc., Chicago, IL, USA). The study sample included a total of 170,646 hospitalized patients with AF as the primary discharge diagnosis in 362 hospitals. The mean patient age at enrollment was 68.7 ± 23.0 years, and 55.9% (95,442/170,646) of the patients were male. The type of AF was available for 151,457 patients (88.8%), of whom 54.3% (92,580/170,646) had paroxysmal AF, 25.3% (43,243/170,646) had persistent AF, and 9.2% (15,634/170,646) of patients had long-standing persistent and permanent AF. The most comorbidity of AF was hypertension (42.7%), followed by CHD (25.9%), heart failure (21.4%), DM (14.3%), cardiomyopathy (4.7%), and COPD (2.9%). The CHA2DS2-VASc score was available for 137,181 patients (80.4%), of whom 64.8% (88,893/137,181) received anticoagulant treatment, 4.9% (6722/137,181) received antiplatelet treatment, and 30.3% (41,566/170,646) of patients received no anticoagulant therapy. More than 66% (91,246/137,181) of patients had a CHA2DS2-VASc score of 2 or more, of whom 79.1% (72,176/91,246) received anticoagulant treatment. However, approximately 21.9% (19,070/91,246) of patients with CHA2DS2-VASc scores of 2 or more did not receive anticoagulant therapy. In contrast, 51.8% (23,789/45,935) of patients with a CHA2DS2-VASc score of 0 or 1 received anticoagulant treatment. New oral anticoagulants were more commonly used than warfarin (53.6% vs. 46.4%, χ2 = 748.1, P = 0.006) in patients who had a CHA2DS2-VASc score of 2 or more, while warfarin was more commonly used than new oral anticoagulants (56.7% vs. 43.6%, χ2 = 523.6, P = 0.004) in patients who had a CHA2DS2-VASc score of 0 or 1. In patients who underwent radiofrequency ablation, more pulmonary vein isolation procedures were performed alone than in combination with additional ablation procedures (77.6% vs. 22.4%, χ2 = 13583.5, P < 0.001). Pulmonary vein isolation procedures were also more frequently used alone than in combination with other ablation procedures in patients with long-standing persistent AF (67.7% vs. 32.3%, χ2 = 362.7, P < 0.001). However, approximately 15.4% of patients with paroxysmal AF underwent pulmonary vein isolation combined with additional ablation procedures. For patients who did not undergo ablation, only 30.7% (44,439/144,966) received anti-arrhythmic drug therapy. With regard to the anti-arrhythmic drugs, β-receptor blockers, amiodarone, propafenone, sotalol, and moricizine were used in 31.0% (13,776/44,439), 21.5% (9554/44,439), 14.7% (6533/44,439), 15.1% (6710/44,439), and 1.0% (442/44,439) of the patients receiving treatment, respectively. The RWS-CAF registry provides data regarding the clinical characteristics, in-hospital treatment, and outcomes of AF patients hospitalized in China. The major findings of this study are as follows: (1) hypertension and CHD are the most common comorbidities of AF in Chinese patients, with a lower prevalence of comorbid DM and COPD. The proportion of AF patients with hypertension in the present study is similar to the proportion found in US patients with AF.[5] The high comorbidities of AF with hypertension and CHD may be related to atrial hypertension and atrial ischemia respectively. (2) Approximately 21.9% of patients with a CHA2DS2-VASc score of 2 or more did not receive anticoagulant therapy, while about 50% of patients with a CHA2DS2-VASc score of 0 or 1 received anticoagulant treatment. (3) 30.7% of patients who did not undergo ablation received anti-arrhythmic drug therapy. In this study, the data show that new oral anticoagulants were used more often than warfarin in patients with a CHA2DS2-VASc score of 2 or more. However, approximately 21.9% of patients with a CHA2DS2-VASc score of 2 or more did not receive anticoagulant treatment. This implies that indications for anticoagulant therapy in patients with AF need further evaluation by clinicians in China. Although warfarin has various disadvantages, such as ongoing monitoring that necessitates strict patient adherence, low price may be the main reason for patients to receive warfarin treatment. In summary, this study indicated that the management of hypertension or CHD may have benefit for the patients hospitalized with AF, and anticoagulant and anti-arrhythmic drug therapy for patients with AF needs further optimization in China. Conflicts of interest None.

BACKGROUND Implantable cardioverter-defibrillators (ICDs) are underutilized in Asia, Latin America, Eastern Europe, the Middle East, and Africa. The Improve SCA Study is the largest prospective study to evaluate the benefit of ICD therapy in underrepresented geographies. This analysis reports the primary objective of the study. OBJECTIVES The objectives of this study was to determine whether patients with primary prevention (PP) indications with specific risk factors (1.5PP: syncope, nonsustained ventricular tachycardia, premature ventricular contractions >10/h, and low ventricular ejection fraction < 25%) are at a similar risk of life-threatening arrhythmias as patients with secondary prevention (SP) indications and to evaluate all-cause mortality rates in 1.5PP patients with and without devices. METHODS A total of 3889 patients were included in the analysis to evaluate ventricular tachycardia or fibrillation therapy and mortality rates. Patients were stratified as SP (n - 1193) and patients with PP indications. The PP cohort was divided into 1.5PP patients (n - 1913) and those without any 1.5PP criteria (n 5 783). The decision to undergo ICD implantation was left to the patient and/or physician. The Cox proportional hazards model was used to compute hazard ratios. RESULTS Patients had predominantly nonischemic cardiomyopathy. The rate of ventricular tachycardia or fibrillation in 1.5PP patients was not equivalent (within 30%) to that in patients with SP indications (hazard ratio 0.47; 95% confidence interval 0.38-0.57) but was higher than that in PP patients without any 1.5PP criteria (hazard ratio 0.67; 95% confidence interval 0.46-0.97) (P = .03). There was a 49% relative risk reduction in all-cause mortality in ICD implanted 1.5PP patients. In addition, the number needed to treat to save 1 life over 3 years was 10.0 in the 1.5PP cohort vs 40.0 in PP patients without any 1.5PP criteria. CONCLUSION These data corroborate the mortality benefit of ICD therapy and support extension to a selected PP population from underrepresented geographies.

Ageing is a risk factor for both coronary artery disease (CAD) and reduced renal function (RRF), and it is also associated with poor prognosis in patients with CAD or RRF. However, little is known about whether the impact of RRF on clinical outcomes are different in CAD patients at different age groups. This study aimed to investigate whether ageing influences the effect of RRF on long-term risk of death in patients with CAD. A retrospective analysis was conducted using data from a single-center cohort study. Three thousand and two consecutive patients with CAD confirmed by coronary angiography were enrolled. RRF was defined as an estimated glomerular filtration rate (eGFR) of less than 60 ml/min. The primary endpoint in this study was all-cause mortality. The mean follow-up time was 29.1 ± 12.5 months and death events occurred in 275 cases (all-cause mortality: 9.2%). The correlation analysis revealed a negative correlation between eGFR and age (r = − 0.386, P < 0.001). Comparing the younger group (age ≤ 59) with the elderly one (age ≥ 70), the prevalence of RRF increased from 5.9 to 27.5%. Multivariable Cox regression revealed that RRF was independently associated with all-cause mortality in all age groups, and the relative risks in older patients were lower than those in younger ones (age ≤ 59 vs. age 60–69 vs. age ≥ 70: hazard ratio [HR] 2.57, 95% confidence interval [CI] 1.04–6.37 vs. HR 2.00, 95% CI 1.17–3.42 vs. HR 1.46, 95% CI 1.06–2.02). There was a significant trend for HRs for all-cause mortality according to the interaction terms for RRF and age group (RRF*age [≤59] vs. RRF*age [60–69] vs. RRF*age [≥70]: HR 1.00[reference] vs. HR 0.60, 95% CI 0.23–1.54 vs. HR 0.32, 95% CI 0.14–0.75; P for trend = 0.010). RRF may have different impacts on clinical outcomes in CAD patients at different age groups. The association of RRF with the risk of all-cause mortality was attenuated with ageing.

The role of triglyceride (TG) in secondary prevention of patients with coronary artery disease (CAD) was debated. In the present study, we assessed the association between admission TG levels and long-term mortality risk in CAD patients.