Although exercise rehabilitation has been proven to be safe and effective for cardiovascular patients, compliance remains suboptimal. The sustained benefits of exercise are closely related to compliance, yet current research has failed to delineate the relationship between exercise compliance and the recurrence of atrial fibrillation (AF) in patients undergoing radiofrequency ablation.

To investigate the impact of adherence to home-based exercise rehabilitation programs and other relevant factors on the recurrence of atrial fibrillation in patients following radiofrequency ablation.

Convenience sampling was used to select patients with AF who underwent radiofrequency ablation surgery in the Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University from May to November 2020. Patients routinely underwent a 6-minute walk test, balance and flexibility assessments, and cardiopulmonary exercise testing, and individualized exercise prescriptions were formulated based on the assessment results. General patient data were collected, and exercise rehabilitation compliance was assessed using the Cardiac Rehabilitation Inventory (CRI) to evaluate the cardiac rehabilitation needs and willingness of patients with cardiovascular diseases, and the Patient Activation Measure (PAM13) was used to measure the level of knowledge, skills, behaviors, and confidence in participating in their own health management and health care during the disease diagnosis and treatment process. Compliance data on intensity-time and frequency were followed up at the 1st week, 3rd month, 6th month, 9th month, and 12th month. The generalized estimating equations (GEE) model was used to explore the influencing factors of the recurrence of AF in patients after radiofrequency ablation surgery.

A total of 151 patients aged 29 to 84 years, with an average age of (61.7±11.0) years, and 23 patients experienced a recurrence of AF. The changes in intensity-time compliance and frequency compliance of AF patients after radiofrequency ablation surgery at different follow-up stages were statistically significant (P<0.05). After controlling for time, BMI, smoking, type of AF, activation, process anxiety, and outcome anxiety, the GEE analysis showed that intensity-time compliance≥100% was a protective factor for the recurrence of AF after radiofrequency ablation surgery (P<0.05) .

The compliance with home-based exercise rehabilitation in AF patients after radiofrequency ablation surgery changes over time, and it is recommended that clinical medical staff pay attention to the guidance and supervision of exercise intensity, take targeted measures to reduce process and outcome anxiety, in order to more effectively improve patient outcomes through exercise rehabilitation.

Physical activity is the focus of disease management in patients with atrial fibrillation (AF), and different types and intensities of physical activity have different impacts on the health status of patients; however, the current distribution of physical activity types in patients with AF is not clearly characterized.

To explore differences in the distribution of the daily physical activity energy expenditure in patients with AF and the influencing factors.

A total of 300 AF patients newly admitted to the Department of Cardiology Medicine at the First Affiliated Hospital with Nanjing Medical University for elective catheter ablation from July to December 2023 were enrolled. General patient information was collected. The International Physical Activity Questionnaire-Long Form (IPAQ-L) was used to assess the level of physical activity, the Fear of Progression Questionnaire-Short Form (FoP-Q-SF) to evaluate fear of disease progression, the Cancer Acceptance Scale-Revised (CAS-R) to assess perceived control, and the Family Apathy Index (FAI) to gauge family care. A latent profile analysis was conducted on energy expenditure from various types of physical activity among AF patients. Starting from a one-class model, the number of classes was incrementally increased to determine the best-fitting model. Multivariate Logistic regression analysis was employed to investigate the impact of various factors on different latent profiles.

Based on IPAQ-L scores, 80 patients (26.7%) had low, 63 (21.0%) had moderate, and 157 (52.3%) had high levels of physical activity. The latent profile analysis of patients' physical activity energy expenditure categorized them into two profiles: low energy expenditure-primarily sedentary (n=198) and high energy expenditure-primarily occupational physical activity (n=102). Univariate analysis revealed statistically significant differences in age, education level, occupation, family monthly income per capita, and scores on the FoP-Q-SF, CAS-R, and FAI between the two profiles (P<0.05). Multivariate Logistic regression analysis indicated that age 40-59 years (OR=0.280, 95%CI=0.087-0.899, P=0.017), bachelor's degree or higher (OR=0.331, 95%CI=0.124-0.883, P=0.027), mental labor (OR=0.315, 95%CI=0.121-0.817, P=0.032), retirement (OR=0.151, 95%CI=0.050-0.452, P<0.001), FoP-Q-SF score (OR=1.086, 95%CI=1.036-1.139, P<0.001), CAS-R score (OR=0.899, 95%CI=0.820-0.985, P=0.022), and FAI score (OR=0.828, 95%CI=0.707-0.969, P=0.018) were influencing factors of the latent profiles of physical activity (PA) energy expenditure (P<0.05) .

There are different latent profiles of physical activity energy expenditure among AF patients, with heterogeneous distribution characteristics across profiles. Patients aged 40-59, with bachelor's degree or higher, engaged in mental labor, retired, possessing strong perceived control, and receiving high family care are more likely to be classified as low energy expenditure-primarily sedentary. Interventions can be tailored based on the characteristics of different physical activity energy expenditure profiles and influencing factors to promote appropriate and scientific physical activity.

The burden of atrial fibrillation (AF) in China is increasing, and catheter ablation has become a first-line treatment. The perioperative symptom clusters of AF patients undergoing catheter ablation are complex and diverse, closely related to patients´ quality of life, disease prognosis, and healthcare resource utilization, and therefore, warrant significant attention. This paper systematically reviews the research related to the perioperative symptom clusters of AF patients undergoing catheter ablation. It introduces the types and current status of these symptom clusters, summarizes the influencing factors of perioperative symptom clusters, organizes the assessment tools for AF symptom clusters, and finally elucidates the management strategies for perioperative symptom clusters in AF patients. The goal is to provide insights for developing innovative comprehensive management models for perioperative symptom clusters in AF patients.

Insulin resistance (IR) is associated with atrial fibrillation (AF) and atrial remodeling, and the correlation of triacylglycerol glucose (TyG) index, a novel, simple, and valuable indicator of IR, with the development of AF in patients with chronic heart failure (CHF) has been poorly studied.

To investigate the correlation between TyG index and AF in patients with CHF.

A total of 417 CHF patients hospitalized in the Department of Cardiovascular Medicine of the Second Affiliated Hospital of Zhengzhou University from January 2021 to January 2022 were retrospectively selected for the study, and the CHF patients were divided into two groups according to whether they developed AF: the AF group (138 patients) and the non-AF group (279 patients). The TyG index was categorized into four levels based on quartiles: Q1 (TyG index ≤8.20), Q2 (8.20<TyG index≤8.44), Q3 (8.44<TyG index≤8.84), and Q4 (TyG index>8.84). Patients' baseline data, including TyG index and basic information, laboratory test indexes, and echocardiographic data, were collected through the hospital's electronic medical record system. The LASSO regression algorithm was used for variable screening, and multivariate Logistic regression was used to analyze the correlation between TyG index and the risk of AF occurrence in patients with CHF and to construct a regression model. The predictive value of TyG index for the occurrence of AF in CHF patients was also analyzed using the subject work characteristics curve. Restricted cubic spline plots of the correlation between TyG index and the risk of developing AF in CHF patients were plotted.

Patients in the AF group had higher BMI, New York Heart Association cardiac function class Ⅲ-Ⅳ, proportion of hypertension, serum uric acid (SUA), triacylglycerol, blood urea nitrogen (BUN), fasting blood glucose, N-terminal B-type natriuretic peptide precursor, TyG index, left atrial diameter (LAD), the proportions of β-blockers, calcium antagonists, and diuretics were higher than those in the non-AF group; total cholesterol (TC), endogenous creatinine clearance (Ccr), left ventricular ejection fraction, and the proportion of angiotensin-converting enzyme inhibitors/angiotensin Ⅱ receptor blockers (ACEI/ARB) class of drug use was lower than that of the non-AF group (P<0.05). The results of multivariate Logistic regression analysis showed that the combination of hypertension (OR=1.749, 95%CI=1.048-2.918, P=0.032), elevated BUN (OR=1.269, 95%CI=1.104-1.457, P=0.001), elevated SUA (OR=1.002, 95%CI=1.000-1.005, P=0.047), elevated TyG index (OR=2.360, 95%CI=1.397-3.987, P=0.001), elevated LAD (OR=1.065, 95%CI=1.034-1.097, P<0.001), and use of diuretics (OR=4.019, 95%CI=2.140-7.548, P<0.001) were risk factors for the development of AF in patients with CHF; Ccr (OR=0.985, 95%CI=0.975-0.996, P=0.006), TC (OR=0.587, 95%CI=0.445-0.775, P<0.001), and the proportion of ACEI/ARB class of drug (OR=0.427, 95%CI=0.253-0.718, P= 0.001) were protective factors for the development of AF in patients with CHF. After fully adjusting for confounders, the risk of AF occurrence in CHF patients at the Q2, Q3, and Q4 levels of TyG index was 1.902, 2.060, and 2.841 times higher than that at the Q1 level (P<0.05). Restricted cubic spline analysis showed a linear positive correlation between TyG index and the risk of developing AF (P_nonlinear=0.494). The area under the curve of TyG index and LASSO-Logistic regression model for predicting the development of AF in patients with CHF were 0.661 (95%CI=0.608-0.724, P<0.001), 0.843 (95%CI=0.803-0.882, P<0.001). In addition, the correlation between TyG index and AF was consistent across subgroups.

The TyG index is independently associated with the AF in patients with CHF, with significant clinical value in predicting AF.

Atrial fibrillation (AF) is a common clinical arrhythmia characterized by high prevalence, high disability rate, and high treatment costs, severely affecting patients' quality of life. Currently, there is no large-scale epidemiological survey on the prevalence of AF in the Xinjiang Corps region.

To further understand the prevalence, associated risk factors, and standardized treatment status of AF in the Shihezi area of the Xinjiang Corps, this study aims to provide reliable data support for the prevention, management, and treatment of AF in this region.

A cross-sectional age-stratified random sampling survey was conducted from May 2021 to June 2023 among 63 079 permanent residents aged 18 years and above in 18 pastoral and agricultural groups and urban areas of the Shihezi area of the Xinjiang Corps. A questionnaire was used to collect baseline data, epidemiological information, awareness, and treatment status of AF. Patients were divided into an AF group (n=737) and a non-AF group (n=62 342). Multifactorial Logistic regression analysis was used to explore the influencing factors of AF occurrence.

A total of 63 079 residents from the Shihezi area of the Eighth Division of the Xinjiang Corps were included, with an average age of (54.9±15.3) years. A total of 737 AF patients were identified, with a prevalence rate of 1.17%, and an age-adjusted prevalence rate of 1.12%. The awareness rate of AF in the screened population was only 1.62% (1 021/63 079), of which the awareness rate among diagnosed AF patients was 52.78% (389/737). The prevalence rates of AF in the 18-39, 40-49, 50-59, 60-69, 70-79, and ≥80 years age groups were 0.05% (5/9 964), 0.32% (29/9 076), 0.62% (135/21 686), 1.28% (151/11 810), 3.05% (207/6 776), and 5.57% (210/3 767), respectively. The prevalence rates of AF in males and females were 1.60% (441/27 591) and 0.83% (296/35 488), respectively. The prevalence rates of AF among Han, Hui, Uyghur, Kazakh, and other ethnic groups were 1.20% (720/60 014), 0.70% (7/1 007), 0.62% (7/1 130), 1.67% (2/120), and 1.41% (1/171), respectively. The prevalence rates of AF in urban and pastoral and agricultural areas were 0.79% (350/44 504) and 2.08% (387/18 575), respectively. There were statistically significant differences in age, gender, age group distribution, residential area, and education level between the AF and non-AF groups (P<0.05). The prevalence of smoking, alcohol consumption, hypertension, coronary heart disease, type 2 diabetes, hyperlipidemia, chronic heart failure, cerebrovascular diseases, valvular heart disease, chronic pulmonary disease, sleep apnea syndrome, thyroid dysfunction, peripheral vascular disease, and tumors was higher in the AF group than in the non-AF group (P<0.05). Multifactorial Logistic regression analysis showed that age, gender, alcohol consumption, hypertension, valvular heart disease, chronic heart failure, thyroid dysfunction, sleep apnea syndrome, and tumors were influencing factors for the occurrence of AF (P<0.05). There were 85 newly diagnosed cases of AF (11.53%), 257 paroxysmal AF cases (34.87%), 178 persistent AF cases (21.16%), and 217 permanent AF cases (29.44%) ; 360 cases received oral anticoagulant therapy, and 23 cases underwent radiofrequency ablation or one-stop treatment for AF, with a treatment rate of 51.96% in this region. Among AF patients, the rates of standardized treatment, non-standardized treatment, and no treatment were 360 cases (48.85%), 21 cases (2.85%), and 356 cases (48.30%), respectively. The standardized treatment rates for newly diagnosed AF, paroxysmal AF, persistent AF, and permanent AF were 11.11%, 28.89%, 24.72%, and 35.28%, respectively. There was a statistically significant difference in the standardized treatment rates among different types of AF (χ²=18.918, P=0.004) .

The prevalence rate of atrial fibrillation in Shihezi area of Xinjiang Corps is basically the same as that of the whole country, and the risk factors are similar to domestic and foreign studies. However, the awareness rate of atrial fibrillation and the standardized treatment rate of atrial fibrillation in the population are obviously low, and the situation is not optimistic.

Atrial fibrillation (AF) is among the most prevalent types of arrhythmia, leading to severe complications such as heart failure and stroke, thus increasing rates of mortality and disability. Silent AF, which lacks clinical symptoms and has irregular onset, tends to have a low diagnosis rate and often experiences delays in receiving standardized treatments, resulting in negative clinical outcomes. Recent clinical studies highlight the significant benefits of wearable devices in the screening and management of silent AF. In this article, we review the clinical outcomes, cost-effectiveness, challenges and future application prospects of wearable devices in the detection and management of silent AF based on relevant domestic and international literature of recent years to provide more evidence-based support for its further applications.

Atrial fibrillation (AF) is the most common arrhythmia in cardiovascular disease, and it often coexists and interacts with sick sinus syndrome. In the past, pacemaker implantation combined with antiarrhythmic drugs was preferred for symptomatic atrial fibrillation with long interval treatment. However, in recent years, more and more studies have shown that compared with pacemaker implantation, radiofrequency ablation can reduce the hospitalization rate related to tachycardia, effectively control atrial fibrillation, and improve patient prognosis and hospitalization rate of heart failure. However, some patients present intrinsic sinus node dysfunction (SND), and SND may progress and worsen in some patients with atrial fibrillation. Therefore, the first-line treatment strategy for patients with atrial fibrillation with long interval remains controversial. This article reviews the selection of long-term intermittent treatment strategies for atrial fibrillation.

Telerehabilitation based on digital medical care can efficiently improve the health status of patients after radiofrequency ablation of atrial fibrillation. However, the current participation rate in telerehabilitation is low.

To analyse the reasons for refusal of exercise rehabilitation in patients after radiofrequency ablation of atrial fibrillation in the context digital medical care based on the theory of leisure constraints.

Patients after radiofrequency ablation of atrial fibrillation in the inpatient department or outpatient clinic of Department of Cardiology, at the First Affiliated Hospital of Nanjing Medical University from July to September 2022 were selected as the study subjects by using the purposive sampling method. The phenomenological approach was adopted to collect data from patients who refused exercise telerehabilitation after radiofrequency ablation through semi-structured interviews, and Colaizzi analysis was used to summarize the reasons.

A total of 14 patients were finally included in this study. Three themes including self-limiting factors, interpersonal limiting factors, and structural limiting factors, and twelve sub-themes were extracted, namely, low level of digital literacy, negative illness perception, psychological distress caused by disease, digital medical trust crisis, deep-rooted personal exercise habits, alienation sense from rehabilitation team, insufficient social network establishment, economic burden related to equipment acquisition, harsh climate, low rehabilitation service capacity in primary care, constraints of available time by role pressure, and poor applicability of wearable devices.

The reasons for refusal to exercise telerehabilitation include lack of literacy and trust in digital medical care, high level of illness perception and psychological distress, poor exercise habits, rehabilitation team and peer alienation, economic burden, harsh climate, lack of capacity and personal time for rehabilitation service capacity in primary care, and inadequate applicability of existing wearable devices.

Older adults are at high risk for atrial fibrillation (AF). Improving the efficiency of AF screening among the community-based elderly population can help to reduce the risk of AF-related stroke.

To compare the screening efficiency of different AF screening methods in the elderly population.

A total of 1 300 cases of older adults were selected from three neighborhood committees of Xiangshan, Huangshan, and Luoshan in Jinyang Community, Pudong New Area, Shanghai from July 2022 to January 2023. AF screening was detected using palpation of radial artery pulse, electronic sphygmomanometer with AF detection function, and single-lead ECG recorder. A positive result of any one of the three methods was considered positive for AF, and finally an electrocardiogram (ECG) was performed and interpreted by a physician in the ECG room. The receiver operating characteristic (ROC) curves of the subjects with different screening methods were plotted, the area under the ROC curve (AUC) was calculated to evaluate the screening value; the association between AF stroke score (CHA₂DS₂-VASc score) and AF was analyzed using the chi-square test for trend.

AF was detected in 93 of the 1 300 people, including 57 asymptomatic people; 375 people had a positive palpated pulse, 331 people had a positive electronic blood pressure monitor with AF detection function, and 128 people had a positive result of single-lead ECG recorder. The AUCs for the diagnostic value of palpation pulse, electronic sphygmomanometer with AF detection function and single-lead ECG recorder in the elderly was 0.750 (95%CI=0.697-0.803, P<0.01), 0.832 (95%CI=0.790-0.874, P<0.01), 0.939 (95%CI=0.906-0.973, P<0.01) ; the incidence of AF in the elderly gradually increased as the CHA₂DS₂-VASc score increased (χ²_trend=197.46, P<0.01) .

Screening for AF using single-lead ECG recorder is convenient, efficient and accurate, and can be promoted in AF screening among community-based elderly population.

The prevalence of atrial fibrillation (AF) has continued to rise globally in recent years, and AF increases the risk of stroke, heart failure, myocardial infarction, chronic kidney disease, and other diseases. Studies have identified hypertension, diabetes, smoking, obstructive sleep apnea, obesity and sedentary lifestyle as risk factors for AF. And most of these factors are within the scope of the "Life's Essential 8" (LE8) proposed by the American Heart Association.

To investigate the relationship between cardiovascular health (CVH) score based on the LE8 and AF.

A study was conducted in which 91 131 employees of Kailuan Group in Tangshan, Hebei Province were selected for physical examination from June 2006 to October 2007, and the LE8 score was evaluated according to the algorithm developed by the American Heart Association, and combined with the actual situation of the Kailuan study to form the Kailuan study version of LE8, including 4 health behaviors (diet, physical activity, tobacco exposure, and sleep) and 4 health factors (BMI, blood lipids, blood glucose, and blood pressure). The study subjects were divided into the three groups of the low CVH group (n=8 407) with a LE8 score less than 50, the medium CVH group (n=73 493) with a LE8 score of 50 or more but less than 80, and the high CVH group (n=9 231) with a LE8 score of 80 or more. The follow-up visit was performed per year with the time of the study subject's first Kailuan physical examination as the starting point, the occurrence of AF as the endpoint event, the end of AF and follow-up (2020-12-31) as the endpoint time. Kaplan Meier survival curve was used to analyze the cumulative incidence of new-onset AF in different groups, and log rank test was used to compare the differences between groups; Cox proportional hazards regression analysis was used to investigate the impact of different LE8 score groups and single factor scores on the risk of new-onset AF.

There were significant differences in age, gender, education level, monthly per capita household income, history of alcohol consumption, and LE8 scores among the three groups of subjects (P<0.001). During follow-up, 1 088 cases of new-onset AF were identified, including 133 cases (1.58%) in the low CVH group, 883 cases (1.20%) in the medium CVH group, and 72 cases (0.78%) in the high CVH group. The median follow-up time was 15.0 (14.7, 15.2) years; there was statistically significant difference in the comparison of cumulative incidence rate of new-onset AF in the three groups (P<0.000 1). Cox proportional hazards regression analysis after adjusting for age, gender, education level, monthly per capita household income, and history of alcohol consumption showed that, compared with the low CVH group, both the medium CVH group (HR=0.697, 95%CI=0.579-0.841, P<0.001) and the high CVH group (HR=0.609, 95%CI=0.454-0.816, P=0.001) reduced the risk of new-onset AF. An increase in LE8 score could reduce the risk of new-onset AF (HR=0.859, 95%CI=0.804-0.918, P<0.001). The individual factors of LE8, including BMI score (HR=0.762, 95%CI=0.717-0.809, P<0.001) and blood pressure score (HR=0.824, 95%CI=0.776-0.876, P<0.001), were negatively correlated with the risk of new-onset AF.

The LE8 score of CVH is negatively correlated with the risk of new-onset AF, and the individual factors of LE8, including BMI score and blood pressure score, are negatively correlated with the risk of new-onset AF.

Atrial fibrillation (AF) is an important risk factor for stroke, cardiovascular disease and all-cause mortality with high prevalence, and appropriate anticoagulant therapy is the core of preventing AF-related stroke. Warfarin is still the main anticoagulant at present, but the therapeutic window of warfarin is narrow, fixed dose of warfarin can easily lead to excessive coagulation or insufficient anticoagulation at the initial stage of treatment. There are few previous clinical studies on overanticoagulation of warfarin.

To analyze the epidemiological and clinical characteristics of overanticoagulation in patients with AF at the initial stage of warfarin anticoagulation therapy, and explore the influencing factors of overanticoagulation.

The study was a single-center retrospective cohort study. A total of 552 patients with AF treated with warfarin 2.5 mg/d admitted to Linyi City's Hospital from January 2017 to December 2022 were included as the study subjects. The clinical data of patients were collected, including age, gender, body mass, type of AF (non-valvular/valvular), comorbidities (hypertension, diabetes, hypoproteinemia, transaminase abnormalities, heart failure), combined medication (number of combined drugs, combined antibiotics, combined amiodarone), the laboratory test results before treatment were also collected, including serum albumin (Alb), serum creatinine (Scr), serum alanine aminotransferase (ALT) and serum aspartate aminotransferase (AST) levels, as well as international normalized ratio (INR) before treatment and INR after 7 days of treatment. Patients were divided into the overanticoagulation group (INR>3.0, n=122) and non-overanticoagulation group (INR≤3.0, n=430) according to whether INR>3.0 after 7 days of warfarin therapy. The data of patients between the two groups were compared, univariate and multivariate Logistic regression analysis was used to explore the influencing factors of overanticoagulation in the initial stage of warfarin anticoagulation therapy.

The age, proportion of female, valvular atrial fibrillation, hypoproteinemia, transaminase abnormalities, number of combined drugs, proportion of combined amiodarone and AST of patients in the overanticoagulation group were higher than those in the non-overanticoagulation group, and the body mass, hypertension, diabetes, Alb and ALT were lower than those in the non-overanticoagulation group (P<0.05). Multivariate Logistic regression analysis showed age≥65 years (OR=1.954, 95%CI=1.243-3.073, P=0.004), body mass≤63 kg (OR=2.967, 95%CI=1.841-4.783, P<0.001), number of combined drugs>5 (OR=1.976, 95%CI=1.175-3.323, P=0.010), and Scr≥91 μmol/L (OR=2.087, 95%CI=1.222-3.561, P=0.007) were independent risk factors for overanticoagulation at the initial stage of warfarin anticoagulation in patients with AF, while diabetes (OR=0.424, 95%CI=0.191-0.939, P=0.034) was a protective factor for overanticoagulation at the initial stage of warfarin anticoagulation therapy in patients with AF.

Age≥65 years, body mass≤63 kg, number of combined drugs>5, Scr≥91 μmol/L may be risk factors for overanticoagulation at the initial stage of warfarin anticoagulation therapy in patients with AF, while diabetes may be a protective factor at the initial stage of warfarin anticoagulation therapy in patients with AF. INR should be closely monitored in patients on warfarin anticoagulation with advanced age, low body mass, multiple drug combinations and elevated Scr level.

The prevalence of atrial fibrillation (AF) in China is increasing year by year, and the prognosis and quality of life of patients urgently need attention. Current studies have confirmed that exercise rehabilitation is a beneficial way to improve the prognosis and poor quality of life in patients with AF after radiofrequency catheter ablation (RFCA). Adherence is a key measure of whether the benefits of exercise rehabilitation persist, but its trajectory remains unknown.

To examine the development trajectory and predictors of strength-duration adherence to home-based exercise rehabilitation among patients with AF after RFCA using five-period follow-up data based on prospective longitudinal observation.

Convenience sampling method was used to select 246 patients with AF who attended the Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University for RFCA from May to November 2020 for follow-up. The baseline survey was conducted 1 week after enrollment, and the follow-up survey was conducted at 3, 6, 9 and 12 months after enrollment. The general and clinical data of patients were collected. The strength-duration adherence was monitored and recorded using smart devices or fitness log to assess exercise adherence in terms of strength-duration adherence; Self-efficacy for Exercise Scale (SEE), Fear of Activity in Patients with Chronic Heart Failure (Fact-CHF), Perceived Social Support Scale (PSSS), Patient Activation Measure 13 (PAM13) were used for assessing self-efficacy of exercise, fear of activity, social support and motivation level. Mplus tool was used to construct latent class growth model (LCGM), and the optimal fitting model was selected to determine the development trajectory of strength-duration adherence to home-based exercise rehabilitation among patients with AF after RFCA. Logistic regression analysis was used to identify the predictors of trajectory categories.

A total of 202 patients were included in the final analysis with 44 patients lost to follow-up. The number of patients at baseline, 3 months, 6 months, 9 months, and 12 months after exercise were 202, 201, 185, 174 and 159, respectively, and the strength-duration adherence were (0.83±0.55), (1.07±0.54), (0.99±0.57), (0.91±0.55) and (0.89±0.60). The LCGM results showed group heterogeneity in the process of change in strength-duration adherence to exercise rehabilitation in patients, which was divided into 3 latent classes based on their development trajectories, including 69 in slow decline-low level group (34.2%), 14 in rapid increase-high level group (6.9%), and 119 in sustained adherence group (58.9%). Multinomial unordered Logistic regression showed higher levels of intensity-time adherence in the rapid increase-high level group and sustained adherence group using the slow decline-low level group as the reference group (P<0.001). The patients in the rapid increase-high level group and sustained adherence group were older, with higher level of exercise self-efficacy (P<0.05). The level of fear of activity was lower in the rapid increase-high level group, and the level of activation was higher in the sustained adherence group (P<0.05) .

The strength-duration adherence to home-based exercise rehabilitation among patients with AF after RFCA showed a multi-class curve growth trajectory. In the future, intensive interventions can be conducted periodically according to the time-varying characteristics and predictors, to improve and stabilize the adherence to home-based exercise rehabilitation.

Direct oral anticoagulants (DOACs) have gradually replaced the vitamin K antagonist warfarin and become the first line drugs for anticoagulant therapy in patients with non-valvular atrial fibrillation (NVAF), however, the safety and efficacy of DOACs in clinical use require sustained attention.

To promote rational use of DOACs by investigating and analyzing the potentially inappropriate medication (PIM) of DOACs in elderly patients with atrial fibrillation (AF) hospitalized in Cardiology Department.

Beers criteria, DOACs drug inserts and anticoagulant treatment guidelines were integrated to develop the PIM evaluation criteria for DOACs therapy, including criterias for the indication of DOACs for AF, PIM evaluation of DOACs dose matched to renal function, DOACs application in patients with different liver function and PIM evaluation of DOACs drug interaction, evaluation references for age related PIM, body weight related PIM and bleeding risk related PIM. A retrospective analysis was performed to collect elderly NVAF patients from Hospital Information System (HIS) who were admitted to the department of cardiology and received DOACs (rivaroxaban tablets, edoxaban tablets and dabigatran etexilate capsules) therapy from January 2022 to December 2022 in the Second Affiliated Hospital of Zhejiang Chinese Medical University. The target population was screened according to the inclusion and exclusion criteria and evaluated individually according to the PIM evaluation criteria.

A total of 89 elderly NVAF patients were enrolled with an average age of (77.9±8.1) years, and the incidence of PIM was 56.18% (50/89). A total of 58 cases of PIM in the three DOACs, including 47 cases (81.03%) in the rivaroxaban, 6 cases (10.35%) in the edoxaban and 5 cases (8.62%) in the dabigatran etexilate. Sorted by PIM categories, the incidence of renal function-related PIM was 75.86% (44 cases), drug interaction related PIM was 15.52% (9 cases), liver function related PIM was 6.90% (4 cases) and weight related PIM was 1.72% (1 case) .

Anticoagulation treatment with DOACs in elderly patients with NVAF is associated with non-negligible PIM, rivaroxaban-treated patients have the highest incidence of PIM, followed by edoxaban-treated patients, which mainly manifests as renal function related PIM, drug interaction related PIM and liver function related PIM. Therefore, the clinicians need to develop individualized anticoagulation regimens integrating patient-specific conditions in the anticoagulation in elderly patients with NVAF, thereby reducing the PIM of DOACs therapy.

Diabetes mellitus has been a major concern as a common risk factor for cardiovascular disease. Glycated hemoglobin (HbA_1c) variability is an indicator of long-term blood glucose fluctuation. Therefore, it is of great clinical significance to explore the correlation between HbA_1c variability and new-onset atrial fibrillation (AF) in diabetic patients combined with heart failure with preserved ejection fraction (HFpEF) .

To investigate the correlation between HbA_1c variability and new onset AF in type 2 diabetes mellitus (T2DM) patients combined with HFpEF.

The clinical data of 317 T2DM patients combined with HFpEF diagnosed in the Department of Cardiology, the Second Affiliated Hospital of Zhengzhou University from January 2018 to January 2019 were retrospectively analyzed. The follow-up was performed until February 2022, with a mean follow-up time of 3.4 years. The included patients were divided into the AF group (34 cases) and non-AF group (283 cases) based on the presence of new-onset AF during the follow-up period. The HbA_1c variability was expressed as standard deviation of HbA_1c measurement (HbA_1c-SD) and HbA_1c coefficient of variation (HbA_1c-CV). Multivariate Cox regression analysis was used to explore the correlation between HbA_1c variability and new-onset AF in T2DM patients combined with HFpEF. The survival curves were plotted by the Kaplan-Meier (K-M) method. The receiver operating characteristic (ROC) curve of HbA_1c variability predicting new-onset AF in T2DM patients combined with HFpEF was plotted.

The HbA_1c-SD and HbA_1c-CV of patients in the AF group were higher than those in the non-AF group (P<0.05). The included patients were divided into the low HbA_1c variability (HbA_1c-SD≤0.34%, HbA_1c-CV≤4.74%) and high HbA_1c variability (HbA_1c-SD>0.34%, HbA_1c-CV>4.74%) groups according to the median of HbA_1c variability. Log-rank test results showed higher incidence of new-onset AF in patients with high HbA_1c variability (P_HbA1c-SD<0.001, P_HbA1c-CV=0.004). Multivariate Cox regression analysis showed that HbA_1c-SD〔HR=2.22, 95%CI (1.37, 3.61), P=0.001〕 and HbA_1c-CV〔HR=1.65, 95%CI (1.01, 2.67), P=0.001〕 were independent influencing factors for new-onset AF in T2DM patients combined with HFpEF. The AUC of HbA_1c-SD for predicting AF in T2DM patients combined with HFpEF was 0.784 〔95%CI (0.713, 0.855), P=0.001〕, with the optimum cutoff value of 0.36%, sensitivity and specificity of 79.4% and 73.1%, respectively. The AUC of HbA_1c-CV for predicting AF in patients with T2DM and HFpEF was 0.694 〔95%CI (0.591, 0.797), P<0.001〕, with the optimal cutoff value of 4.97%, sensitivity and specificity of 73.5% and 72.1%, respectively.

High HbA_1c variability (HbA_1c-SD>0.34%, HbA_1c-CV>4.74%) is independently associated with an increased risk of new-onset AF in T2DM patients combined with HFpEF, with significant clinical value in predicting AF.

The global population disease burden report shows that atrial fibrillation (AF) and chronic kidney disease (CKD) have emerged as the fast-growing causes of death in the last 20 years. The concept of cardiorenal syndrome suggests that AF may increase the risk of new-onset CKD, however, there are few studies related to the increased risk of new-onset CKD with AF at home and abroad, and the interaction with age remains unclear atpresent.

To investigate whether AF increases the risk of new-onset CKD in northern Chinese population.

The population who attended a comprehensive health check-up for the employees of Kailuan Group in Hebei Province from 2006 to 2010 were selected as study subjects. The general information and laboratory test results of the study subjects were collected, and the study subjects were followed up with the final follow-up date of 2020-12-31 and the end point of new-onset CKD. The included patients were divided into AF group (n=368) and non-AF group (n=110 487) according to the presence or absence of AF. The cumulative incidence of new-onset CKD in patients was calculated using the lifetable method. The Kaplan-Meier method was used to plot the survival curves of the cumulative incidence of new-onset CKD in the AF group and the non-AF group. The Log-rank test was used to compare the differences in the cumulative incidence of CKD between the two groups. The multivariate Cox proportional hazard regression model was used to explore the effect of AF on the risk of new-onset CKD.

AF group was higher than non-AF group in age, male proportion, systolic blood pressure level, diastolic blood pressure level, body mass index, the proportions of education level, participation in physical exercise, hypertension, diabetes, taking hypotensive drugs and hypoglycemic drugs, and high-sensitivity C-reactive protein level (P<0.05) . AF group was lower than non-AF group in the proportion of alcohol consumption, total cholesterol, triacylglycerol and low density lipoprotein cholesterinlevels (P<0.05) . There were statistically significant differences in the incidence and cumulative incidence of new-onset CKD between atrial fibrillation group and non-atrial fibrillation group (P<0.05) . Stratifying the study population by age, there were statistically significant differences in the incidence and cumulative incidence of new-onset CKD in the study subjects aged≤65 years (P<0.05) and statistically significant difference in the incidence of new-onset CKD in the study subjects aged>65 years (P<0.05) . The results of the adjusted multivariate Cox proportional hazard regression analysis showed that AF was a risk factor for new-onset CKD in people aged≤65 years〔HR=1.350, 95%CI (1.038, 1.755) , P=0.025〕.

AF is an independent risk factor for new-onset CKD in northern Chinese population, especially for young and middle-aged populationaged≤65 years.

With the aging of the population, the prevalence of atrial fibrillation is increasing year by year. As the "gatekeepers" of community residents' health, grassroots medical staff with a high level of knowledge about atrial fibrillation is particularly important for standardized management of atrial fibrillation.

To analyze the mastery of atrial fibrillation-related knowledge among grassroots medical staff in Fengxian District, Shanghai and its influencing factors, thus, providing a theoretical basis for subsequent training work.

This study is a cross-sectional survey study. From June to July 2021, a systematic sampling method was used to select 1 393 grassroots medical staff as the research objects including general practitioners, nurses, pharmacists, public health physicians and other medical staff (imaging technology/physician, laboratory technician, traditional Chinese medicine doctor and so on) from 21 community health service centers in Fengxian District, Shanghai. This study used a self-developed electronic questionnaire to investigate them. The contents of the questionnaire included general information and knowledge related to atrial fibrillation (basic knowledge about atrial fibrillation, knowledge about anticoagulant therapy and knowledge about rhythm/heart rate control) . This study compared the mastery of atrial fibrillation-related knowledge among grassroots medical staff in different positions, and used univariate Logistic regression, ordinal multiple classification or binary Logistic regression to analyze the influencing factors of grassroots medical staff's mastery of atrial fibrillation-related knowledge.

A total of 1 383 valid questionnaires were recovered, and the valid questionnaire recovery rate was 99.28%. Among 1 383 grassroots medical staff, 506 cases (36.59%) were general practitioners. 54.88% (759/1 383) , 97.69% (1 351/1 383) and 69.63% (963/1 383) failed in the basic knowledge about atrial fibrillation, knowledge about anticoagulation and knowledge about heart rhythm/heart rate control, respectively. There were statistically significant differences in the scores of atrial fibrillation knowledge, anticoagulation knowledge and heart rhythm/heart rate control knowledge among grassroots medical staff in different positions (P<0.05) . Ordinal multiple classification or binary Logistic regression analysis showed that the position as a general practitioner and professional title were the influencing factors of score in the basic knowledge related to atrial fibrillation among grassroots medical staff (P<0.05) . Age and position as a general practitioner were the influencing factors of whether the score in knowledge related to anticoagulation therapy reaches the pass level or above among grassroots medical staff (P<0.05) . The position as a general practitioner, received standardized training and reading the atrial fibrillation guideline within one year were the influencing factors of the score in knowledge related to heart rhythm/heart rate control among grassroots medical staff (P<0.05) .

The mastery of knowledge about atrial fibrillation among grassroots medical staff is generally not ideal, especially the lack of knowledge about anticoagulation therapy. Atrial fibrillation related knowledge training should be especially strengthened for grassroots medical staff who are not general practitioners, have low professional titles, and have not received standardized training.

Global population epidemiology research shows that by 2019, there were 1.28 billion hypertensive patients, and about 59.7 million patients with atrial fibrillation (AF) worldwide. Hypertension greatly increases the risk of AF. And in older hypertensive patients, the incidence of AF will be higher than 60%. Moreover, AF increases the risk of ischemic stroke, heart failure, myocardial infarction, chronic kidney disease and dementia. However, there are few studies on whether AF increases the risk of new-onset myocardial infarction, and whether the risk interacts with age is still unclear in large hypertensive populations.

To examine whether AF increases the risk of new-onset myocardial infarction in hypertensive patients.

Individuals with hypertension were selected as subjects from the employees of Kailuan Group who underwent the medical check-up in Tangshan Gongren Hospital and Kailuan General Hospital from June 2006 to October 2007. General data and laboratory test results of subjects were collected. And all of them were regularly followed up until 2020-12-31. The endpoint event was new-onset myocardial infarction. The finally enrolled cases (n=42 833) included 270 with AF diagnosed by baseline ECG (AF group) and 42 563 without (non-AF group) . The cumulative incidence of myocardial infarction was calculated by the life table method. The survival curve for the cumulative incidence of new-onset myocardial infarction was plotted by Kaplan-Meier method. The difference of the cumulative incidence of myocardial infarction between AF and non-AF groups was compared by Log-rank test. Multivariate Cox proportional hazards regression model was used to investigate the effect of AF on new-onset myocardial infarction in hypertension.

AF group had greater mean age, and lower mean levels of diastolic blood pressure, total cholesterol, triglyceride, low-density lipoprotein cholesterol than non-AF group (P<0.05) . There were also statistically differences in the incidence of myocardial infarction and cumulative incidence of new-onset myocardial infarction between the two groups (P<0.05) . After age-stratification, it was found that the differences in the incidence of new-onset myocardial infarction and cumulative incidence of myocardial infarction were statistically significant between those aged ≤60 years with AF and without AF (P<0.05) , but were insignificant between those aged > 60 years with and without AF (P>0.05) . Adjusted multivariate Cox proportional hazards regression analysis showed that AF was a risk factor for new-onset myocardial infarction in hypertensive population〔HR=2.89, 95%CI (1.74, 4.82) , P<0.01〕, and also in hypertensive population aged ≤60 years old〔HR=4.72, 95%CI (2.11, 10.56) , P<0.01〕.

AF is a risk factor for new-onset myocardial infarction in hypertensive population, especially in those ≤60 years old. Active control of blood pressure and treatment of AF are important prevention and treatment measures for new-onset myocardial infarction.

Atrial fibrillation (AF) is a common clinical tachyarrhythmia with high prevalence, and a predisposing factor of stroke. In addition, it has a causal relationship with heart failure (HF) . Treatment options for AF have changed recently owing to the emergence of new drugs. Many investigations are focused on anticoagulant therapies for AF, but relevant multicenter investigations on AF and HF are rare.

To investigate the clinical characteristics and treatment of patients with AF combined with HF in Chongqing, China.

A total of 4 011 patients with AF and HF who were discharged from 21 hospitals in Chongqing in 2018 were included. Data were collected through the electronic medical record system of the hospitals, including sex, age, basic comorbid conditions, type of AF, NYHA class, thromboembolism history, bleeding history, Color Doppler echocardiography results, HF type and use of drugs (including antithrombotic drugs, rhythm/ventricular rate-control drugs, ACEIs/ARBs, cardiotonic drugs) . The risk of thromboembolism and bleeding were assessed using admission CHA₂DS₂-VASc score and HAS-BLED score. Sex, basic comorbid conditions, AF type, NYHA class, admission CHA₂DS₂-VASc score and HAS-BLED score, left atrial diameter, left ventricular end-diastolic diameter, left ventricular ejection fraction, endpoint events (thromboembolism and bleeding) , HF type, and treatment options were compared across three age groups (<65, 65-75, >75) and across patients by the level of hospitalized hospital (secondary and tertiary) .

In terms of clinical characteristics, the patients had an average age of (74.0±10.6) years, 2 279 (56.8%) were female. The top three prevalent basic comorbid conditions were coronary heart disease (65.1%) , hypertension (51.0%) , and diabetes (17.5%) . 3 346 (83.4%) patients with nonvalvular atrial fibrillation (NVAF) . NYHA class was Ⅲ and Ⅳ in 3 059 patients (76.3%) , thromboembolism events occurred in 531 patients (13.2%) , and bleeding events occurred in 176 patients (4.4%) . In Color Doppler echocardiography results, The average left atrial diameter was (44.12±9.21) mm. The average left ventricular end-diastolic diameter was (48.45±10.06) mm. The average left ventricular ejection fraction was (54.23±11.94) mm. The main type of HF was HF with preserved ejection fraction, accounting for 66.2%. The average CHA₂DS₂-VASc score was (3.9±1.5) points, and the admission CHA₂DS₂-VASc score was positively correlated with age (r=0.589, P<0.001) . The average HAS-BLED score was (1.7±1.0) points. 3 641 (90.8%) patients were at high risk of thromboembolism and 723 (18.0%) patients were at high risk of bleeding. In terms of antithrombotic treatment, the overall prevalence of anticoagulation treatment was 47.1%, warfarin was the main anticoagulant (37.8%) , the prevalence of use of the new oral anticoagulant was only 9.3%. The overall prevalence of antiplatelet treatment was 44.6%, most of them were monoclonal antiplatelet agents (13.2%) . The prevalence of anticoagulation treatment decreased with age (χ²_trend=136.502, P<0.001) , but that of antiplatelet treatment increased with age (χ²_trend=135.730, P<0.001) . The prevalence of anticoagulation treatment, and use of warfarin and new oral anticoagulants in secondary hospitals was significantly lower than that in tertiary hospitals (P<0.001) . A total of 3 162 (78.8%) patients with atrial fibrillation received ventricular rate control. The prevalence of use of beta-blockers, digoxin and ACEIs/ARBs was 61.6%, 17.6%, and 59.7%, respectively.

The majority of patients with AF complicated with HF in Chongqing are elderly, and the proportion of women is relatively high. HFpEF is the main type of atrial fibrillation, and the NYHA classification is mainly classⅢandⅣ. Most were at high risk for thromboembolism, but less than 1/4 were at high risk of bleeding. The prevalence of antithrombotic treatmentin all ages and levels of hospitals was unsatisfactory, and there was a large gap between current treatment and guideline recommendations in improving HF. In view of this, hospitalphysicians should increase their awareness and capability of standardized diagnosis and treatmentregarding AF with HF.

Atrial fibrillation (AF) patients are prone to stroke and peripheral arterial embolism. Studying the pathogenesis of thrombosis formation in AF and providing effective interventions to reduce the risk is an important direction of clinical and basic research on AF.

To investigate the correlation of markers of inflammation and endothelial injury with thrombosis in the left atrium (LA) in AF patients.

Twenty-nine patients with valvular heart disease and 10 patients with coronary heart disease who underwent thoracotomy at the First Affiliated Hospital of Guangxi Medical University from July 2017 to December 2019 were selected, and divided into sinus rhythm group (15 cases) and AF group 〔24 cases, including 12 with left atrial appendage thrombus (LAAT), and 12 without LAAT〕 according to heart rhythm. General demographics were collected. Besides that, other data were also collected, including left atrial diameter (LAD) and left ventricular ejection fraction (LVEF), levels of protein kinase B (AKT), nuclear factor-κ B (NF-κ B), high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), IL-8, tumor necrosis factor (TNF-α), endothelin-1 (ET-1), nitric oxide (NO), von Willebrand factor (VWF), intercellular adhesion molecule (ICAM-1) and vascular cell adhesion factor (VCAM-1) in the left atrial blood sample, and calculated thrombus area in patients with AF and LAAT. The relationships of LAD, LVEF, markers of inflammation and endothelial injury with calculated area of thrombus in AF with LAAT patients were analyzed by Pearson correlation.

There were significant differences in LAD and LVEF between sinus rhythm patients and AF patients with or without LAAT (P<0.05). AF patients with and without LAAT had no significant differences in LAD and LVEF (P>0.05). AF patients without LAAT had higher levels of AKT, NF-κB, IL-8, ET-1, ICAM-1 and VCAM-1 and lower NO level in left atrium than patients with sinus rhythm (P<0.05). AF patients with LAAT had higher levels of AKT and hs-CRP, and lower NO level in left atrium than those without (P<0.05). AF patients with and without LAAT had no significant differences in levels of NF-κB, IL-6, IL-8, TNF-α, ET-1, vWF, ICAM-1 and VCAM-1 (P>0.05). The maximum area, minimum area, and average area of the left atrial appendage thrombus in AF patients with LAAT were 4.8 cm², 1.67 cm², and (3.48±0.83) cm², respectively. Pearson correlation analysis showed LAD, LVEF, AKT, NF-κB, hs-CRP, IL-6, IL-8, TNF-α, ET-1, NO, vWF, ICAM-1, and VCAM-1 had no linear correlation with the area of thrombus in AF patients with LAAT (P>0.05) .

Increased levels of markers of inflammation and endothelial injury in left atrium were found in AF patients, which were even more higher when the patients also had LAAT. Detecting the markers of inflammation and endothelial injury in left atrium is helpful to evaluate the thrombus prevalence in AF patients.

Stroke is highly prevalent in patients with atrial fibrillation (AF) , a most common cardiac arrhythmia with high morbidity, and anticoagulation therapy is a key strategy to prevent AF-related stroke. However, there is short of research on the use of anticoagulation therapy in patients with AF in the community.

To explore the prevalence of use of anticoagulation therapy and influencing factors in elderly patients with nonvalvular atrial fibrillation (NVAF) in Shanghai's communities.

A cross-sectional survey design was used. Stratified sampling was used to select elderly patients with AF who received the 2018 annual physical examination at four community health centers in Shanghai during July to December 2019, and they were surveyed using a questionnaire (consisting of three parts: demographics, CHA2DS2-VASc score and ORBIT score) compiled by our research team for collecting information on their AF prevalence and associated medication use, awareness of AF, comorbidities, and complication, as well as risk for stroke and bleeding. Based on the results of the survey, we excluded those without previous AF-related medical experience and valvular AF, then analyzed the prevalence of anticoagulation therapy in those with NVAF. Anticoagulation therapy was recommended for patients at high risk for stroke in accordance with the CHA2DS2-VASc score. Univariate and multivariate Logistic regression analyses were used to identify influencing factors of anticoagulation therapy in NVAF patients at high risk of stroke.

Three hundred and two patients with NVAF were finally included, of whom the prevalence of current use of anticoagulant and antiplatelet drugs was 29.5% (89/302) , and 39.7% (120/302) , respectively, and that of non-use of anticoagulant or antiplatelet drugs was 30.8% (93/302) . By the CHA2DS2-VASc score, 279 of the 302 NVAF patients (92.4%) were assessed with high risk of stroke, among whom the prevalence of current use of anticoagulant and antiplatelet drugs was 30.5% (85/279) , 40.1% (112/279) , respectively, and the rest 29.4% (82/279) did not take anticoagulant or antiplatelet drugs. Univariate Logistic regression analysis demonstrated that age, marital status, type of AF, onset of AF symptoms, duration of AF, prescription of anticoagulants at the first visit for AF, knowledge of the harmfulness of AF, prevalence of hyperlipidemia, and risk of bleeding were associated with the use of anticoagulation therapy in NVAF patients at high risk of stroke (P<0.05) . Multivariate Logistic regression analysis showed that age, type of AF, prescription of anticoagulants at the first visit for AF, and knowledge of the harmfulness of AF were associated with the use of anticoagulation therapy in NVAF patients at high risk of stroke (P<0.05) .

The prevalence of the use of anticoagulation therapy in community-living NVAF patients at higher risk of stroke is unsatisfactory, so the use of anticoagulation therapy for this population needs to be further standardized, especially in patients with advanced age and low awareness of the harmfulness of AF.

Atrial fibrillation is the most obvious arrhythmia in medical practice. Atrial fibrillation has been listed as one of the eight fastest-growing causes of death since 1990. Epidemiological investigation shows that the highest incidence of atrial fibrillation is 9% in people over 65 years old and 17% in people over 80 years old; more than 60% of patients with hypertension will develop atrial fibrillation after the age of 60. Atrial fibrillation increases the risk of ischemic stroke, heart failure, chronic kidney disease, cognitive impairment and dementia, but it is unclear whether it increases the risk of new onset myocardial infarction.

To investigate whether atrial fibrillation increases the risk of new onset myocardial infarction.

From June 2006 to October 2007, 96 750 employees of Kailuan Group in Tangshan, Hebei Province (Kailuan population) were selected for the study, including 458 patients with atrial fibrillation (atrial fibrillation group) and 96 292 patients without atrial fibrillation (non atrial fibrillation group) . The general information of patients was recorded, including age, gender, personal history (smoking history, drinking history) , past medical history (hypertension, coronary heart disease, diabetes, dyslipidemia) , anthropometric parameters (weight, height, blood pressure, etc.) . Total cholesterol (TC) , triglyceride (TG) , high density lipoprotein cholesterol (HDL-C) , low density lipoprotein cholesterol (LDL-C) and fasting blood glucose (FPG) were collected. The patients were followed up every 2 years, respectively, that was from 2008 to 2009, 2010 to 2011, 2012 to 2013, 2014 to 2015, and 2016 to 2017. The median follow-up was 10 years, and the end point was new onset myocardial infarction. Multivariate Cox regression model was used to analyze the effect of atrial fibrillation on new onset myocardial infarction.

(1) There were significant differences in age, body mass index (BMI) , systolic blood pressure (SBP) , LDL-C, FPG, diabetes, smoking, drinking and new onset myocardial infarction between atrial fibrillation group and non atrial fibrillation group (P<0.05) . (2) Multivariate Cox regression analysis showed that atrial fibrillation increased the risk of new onset myocardial infarction compared with non atrial fibrillation〔RR=1.841, 95%CI (1.118, 2.869) , P<0.05〕. After adjusting for age and gender (male) , atrial fibrillation increased the risk of new onset myocardial infarction compared with non atrial fibrillation〔RR=1.635, 95%CI (1.049, 2.547) , P<0.05〕, after further adjustment for BMI, SBP, LDL-C, FPG, smoking and drinking, atrial fibrillation increased the risk of new onset myocardial infarction compared with non atrial fibrillation〔RR=1.381, 95%CI (1.087, 1.573) , P<0.05〕; drinking was the protective factor of new onset myocardial infarction 〔RR=0.664, 95%CI (0.572, 0.770) , P<0.05〕.

Atrial fibrillation is an independent risk factor of new onset myocardial infarction.