Sinus Node Dysfunction Is Associated With Higher Symptom Burden and Increased Comorbid Illness: Results From the ORBIT-AF Registry.
Abstract
BACKGROUND: Patients with sinus node dysfunction (SND) have increased risk of atrial
tachyarrhythmias, including atrial fibrillation (AF). To date, treatment patterns
and outcomes of patients with SND and AF have not been well described. HYPOTHESIS:
Patients with SND and AF have higher risk of adverse cardiovascular outcomes. METHODS:
Sinus node dysfunction was defined clinically, based on treating physician. Treatment
patterns were described and logistic regression analysis performed to assess outcomes.
RESULTS: Overall, 1710 (17.7%) out of 9631 patients had SND at enrollment. Patients
with SND and AF had increased comorbid medical illnesses, more severe symptoms (European
Heart Rhythm Association class IV: 17.5% vs 13.9%; P = 0.0007), and poorer quality
of life (median 12-month Atrial Fibrillation Effect on Quality of Life score: 79.6
vs 85.2; P = 0.0008). There were no differences in AF management strategy between
patients with SND and those without (rate control, 69.7% vs 67.7%; rhythm control,
30.0% vs 32.0%; P = 0.11). After adjustment, patients with SND were more likely than
those without SND to progress from paroxysmal AF at baseline to persistent or permanent
AF at any follow-up, or persistent AF at baseline to permanent AF at any follow-up
(odds ratio: 1.23, 95% confidence interval: 1.01-1.49, P = 0.035). However, there
was no association between SND and major risk-adjusted outcomes. CONCLUSIONS: Sinus
node dysfunction is present in 1 of 6 patients with AF and is associated with increased
comorbidities and higher symptom burden. However, SND is not associated with an increase
in major risk-adjusted outcomes.
Type
Journal articleSubject
AgedAged, 80 and over
Atrial Fibrillation
Chi-Square Distribution
Comorbidity
Disease Progression
Female
Humans
Logistic Models
Male
Odds Ratio
Proportional Hazards Models
Prospective Studies
Quality of Life
Registries
Risk Assessment
Risk Factors
Severity of Illness Index
Sick Sinus Syndrome
Time Factors
Treatment Outcome
United States
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https://hdl.handle.net/10161/14993Published Version (Please cite this version)
10.1002/clc.22504Publication Info
Jackson, Larry R; Kim, Sung Hee; Piccini, Jonathan P; Gersh, Bernard J; Naccarelli,
Gerald V; Reiffel, James A; ... Kowey, Peter R (2016). Sinus Node Dysfunction Is Associated With Higher Symptom Burden and Increased Comorbid
Illness: Results From the ORBIT-AF Registry. Clin Cardiol, 39(2). pp. 119-125. 10.1002/clc.22504. Retrieved from https://hdl.handle.net/10161/14993.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Larry Ronald Jackson II
Associate Professor of Medicine
Dr. Jackson is a physician-scientist with clinical expertise in adult clinical cardiac
electrophysiology. His research focuses on identifying determinants of racial/ethnic
differences in arrhythmia care and the development and implementation of patient-centered
interventions aimed at facilitating shared decision-making in populations that have
been systemically disadvantaged with abnormal heart rhythm conditions. Dr. Jackson
has an advanced degree (MHSc) in clinical and qualitative res
Eric David Peterson
Fred Cobb, M.D. Distinguished Professor of Medicine
Dr Peterson is the Fred Cobb Distinguished Professor of Medicine in the Division of
Cardiology, a DukeMed Scholar, and the Past Executive Director of the Duke Clinical
Research Institute (DCRI), Durham, NC, USA.
Dr Peterson is the Principal Investigator of the National Institute of Health, Lung
and Blood Institute (NHLBI) Spironolactone Initiation Registry Randomized Interventional
Trial in Heart Failure With Preserved Ejection Fraction (SPIRRIT) Trial He is also
the Principal I
This author no longer has a Scholars@Duke profile, so the information shown here reflects
their Duke status at the time this item was deposited.
Jonathan Paul Piccini Sr.
Professor of Medicine
Jonathan P. Piccini, MD, MHS, FACC, FAHA, FHRS is a clinical cardiac electrophysiologist
and Associate Professor of Medicine with Tenure at Duke University Medical Center
and the Duke Clinical Research Institute. He is the Director of the Cardiac Electrophysiology
section at the Duke Heart Center. His focus is on the care of patients with atrial
fibrillation and complex arrhythmias, with particular emphasis on catheter ablation,
left atrial appendage occlusion, and lead extraction. His resear
Laine Elliott Thomas
Professor of Biostatistics & Bioinformatics
As Deputy Director, Laine Thomas, PhD provides complementary leadership in strategy
and development of the group and DCRI. She has an outstanding record of scientific
and strategic collaboration, independent research, leadership and mentoring well known
to her colleagues at the DCRI.
Thomas joined the DCRI in 2009. She serves as Associate Director for Biostatistics
at DCRI and Associate Chair for Equity, Diversity and Inclusion within the Department
of
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