57 research outputs found

    Impact of renal impairment on atrial fibrillation: ESC-EHRA EORP-AF Long-Term General Registry

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    Background: Atrial fibrillation (AF) and renal impairment share a bidirectional relationship with important pathophysiological interactions. We evaluated the impact of renal impairment in a contemporary cohort of patients with AF. Methods: We utilised the ESC-EHRA EORP-AF Long-Term General Registry. Outcomes were analysed according to renal function by CKD-EPI equation. The primary endpoint was a composite of thromboembolism, major bleeding, acute coronary syndrome and all-cause death. Secondary endpoints were each of these separately including ischaemic stroke, haemorrhagic event, intracranial haemorrhage, cardiovascular death and hospital admission. Results: A total of 9306 patients were included. The distribution of patients with no, mild, moderate and severe renal impairment at baseline were 16.9%, 49.3%, 30% and 3.8%, respectively. AF patients with impaired renal function were older, more likely to be females, had worse cardiac imaging parameters and multiple comorbidities. Among patients with an indication for anticoagulation, prescription of these agents was reduced in those with severe renal impairment, p <.001. Over 24 months, impaired renal function was associated with significantly greater incidence of the primary composite outcome and all secondary outcomes. Multivariable Cox regression analysis demonstrated an inverse relationship between eGFR and the primary outcome (HR 1.07 [95% CI, 1.01–1.14] per 10 ml/min/1.73 m2 decrease), that was most notable in patients with eGFR <30 ml/min/1.73 m2 (HR 2.21 [95% CI, 1.23–3.99] compared to eGFR ≄90 ml/min/1.73 m2). Conclusion: A significant proportion of patients with AF suffer from concomitant renal impairment which impacts their overall management. Furthermore, renal impairment is an independent predictor of major adverse events including thromboembolism, major bleeding, acute coronary syndrome and all-cause death in patients with AF

    Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry

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    Background: Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. Methods: From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. Results: Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58–0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52–0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58–0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56–0.98) and composite outcome (aHR: 0.76, 95%CI 0.60–0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome. Conclusions: An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients

    Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

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    Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P <.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes

    Search for Higgs boson pair production in the two bottom quarks plus two photons final state in pp collisions at s =13 TeV with the ATLAS detector

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    Searches are performed for nonresonant and resonant di-Higgs boson production in the bb¯γγ final state. The dataset used corresponds to an integrated luminosity of 139 fb-1 of proton-proton collisions at a center-of-mass energy of 13 TeV recorded by the ATLAS detector at the CERN Large Hadron Collider. No excess above the expected background is found and upper limits on the di-Higgs boson production cross sections are set. A 95% confidence-level upper limit of 4.2 times the cross section predicted by the Standard Model is set on pp→HH nonresonant production, where the expected limit is 5.7 times the Standard Model predicted value. The expected constraints are obtained for a background hypothesis excluding pp→HH production. The observed (expected) constraints on the Higgs boson trilinear coupling modifier Îșλ are determined to be [-1.5,6.7] ([-2.4,7.7]) at 95% confidence level, where the expected constraints on Îșλ are obtained excluding pp→HH production from the background hypothesis. For resonant production of a new hypothetical scalar particle X (X→HH→bb¯γγ), limits on the cross section for pp→X→HH are presented in the narrow-width approximation as a function of mX in the range 251 GeV≀mX≀1000 GeV. The observed (expected) limits on the cross section for pp→X→HH range from 640 fb to 44 fb (391 fb to 46 fb) over the considered mass range

    Search for Higgs boson pair production in the two bottom quarks plus two photons final state in pp collisions at root s=13 TeV with the ATLAS detector

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    Measurement of the tt¯tt¯ production cross section in pp collisions at √s=13 TeV with the ATLAS detector

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    A measurement of four-top-quark production using proton-proton collision data at a centre-of-mass energy of 13 TeV collected by the ATLAS detector at the Large Hadron Collider corresponding to an integrated luminosity of 139 fb−1 is presented. Events are selected if they contain a single lepton (electron or muon) or an opposite-sign lepton pair, in association with multiple jets. The events are categorised according to the number of jets and how likely these are to contain b-hadrons. A multivariate technique is then used to discriminate between signal and background events. The measured four-top-quark production cross section is found to be 26+17−15 fb, with a corresponding observed (expected) significance of 1.9 (1.0) standard deviations over the background-only hypothesis. The result is combined with the previous measurement performed by the ATLAS Collaboration in the multilepton final state. The combined four-top-quark production cross section is measured to be 24+7−6 fb, with a corresponding observed (expected) signal significance of 4.7 (2.6) standard deviations over the background-only predictions. It is consistent within 2.0 standard deviations with the Standard Model expectation of 12.0 ± 2.4 fb

    Search for R-parity-violating supersymmetry in a final state containing leptons and many jets with the ATLAS experiment using s√=13 TeV proton–proton collision data

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    A search for R-parity-violating supersymmetry in final states characterized by high jet multiplicity, at least one isolated light lepton and either zero or at least three b-tagged jets is presented. The search uses 139fb−1 of s√=13 TeV proton–proton collision data collected by the ATLAS experiment during Run 2 of the Large Hadron Collider. The results are interpreted in the context of R-parity-violating supersymmetry models that feature gluino production, top-squark production, or electroweakino production. The dominant sources of background are estimated using a data-driven model, based on observables at medium jet multiplicity, to predict the b-tagged jet multiplicity distribution at the higher jet multiplicities used in the search. Machine-learning techniques are used to reach sensitivity to electroweakino production, extending the data-driven background estimation to the shape of the machine-learning discriminant. No significant excess over the Standard Model expectation is observed and exclusion limits at the 95% confidence level are extracted, reaching as high as 2.4 TeV in gluino mass, 1.35 TeV in top-squark mass, and 320 (365) GeV in higgsino (wino) mass

    Search for Higgs boson pair production in the two bottom quarks plus two photons final state in pp collisions at √s = 13 TeV with the ATLAS detector

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    Searches are performed for nonresonant and resonant di-Higgs boson production in the b ÂŻ b Îł Îł final state. The dataset used corresponds to an integrated luminosity of 139     fb − 1 of proton–proton collisions at a center-of-mass energy of 13 TeV recorded by the ATLAS detector at the CERN Large Hadron Collider. No excess above the expected background is found and upper limits on the di-Higgs boson production cross sections are set. A 95% confidence-level upper limit of 4.2 times the cross section predicted by the Standard Model is set on p p → H H nonresonant production, where the expected limit is 5.7 times the Standard Model predicted value. The expected constraints are obtained for a background hypothesis excluding p p → H H production. The observed (expected) constraints on the Higgs boson trilinear coupling modifier Îș λ are determined to be [ − 1.5 , 6.7 ] ( [ − 2.4 , 7.7 ] ) at 95% confidence level, where the expected constraints on Îș λ are obtained excluding p p → H H production from the background hypothesis. For resonant production of a new hypothetical scalar particle X ( X → H H → b ÂŻ b Îł Îł ), limits on the cross section for p p → X → H H are presented in the narrow-width approximation as a function of m X in the range 251     GeV ≀ m X ≀ 1000     GeV . The observed (expected) limits on the cross section for p p → X → H H range from 640 fb to 44 fb (391 fb to 46 fb) over the considered mass range

    Search for Higgs boson pair production in the two bottom quarks plus two photons final state in pp collisions at √s=13 TeV with the ATLAS detector

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    Searches are performed for nonresonant and resonant di-Higgs boson production in the bÂŻbγγ final state. Thedataset used corresponds to an integrated luminosity of 139 fb−1 of proton–proton collisions at a centerof-mass energy of 13 TeV recorded by the ATLAS detector at the CERN Large Hadron Collider. No excess above the expected background is found and upper limits on the di-Higgs boson production cross sections are set. A 95% confidence-level upper limit of 4.2 times the cross section predicted by the Standard Model is set on pp → HH nonresonant production, where the expected limit is 5.7 times the Standard Model predicted value. The expected constraints are obtained for a background hypothesis excluding pp → HH production. The observed (expected) constraints on the Higgs boson trilinear coupling modifier Îșλ are determined to be œ−1.5;6.7 Ă°Âœâˆ’2.4;7.7 Þ at 95% confidence level, where the expected constraints on Îșλ are obtained excluding pp → HH production from the background hypothesis. For resonant production of a new hypothetical scalar particle X (X → HH → bÂŻbγγ), limits on the cross section for pp → X → HH are presented in the narrow-width approximation as a function of mX in the range 251 GeV ≀ mX ≀ 1000 GeV. The observed (expected) limits on the cross section for pp → X → HH range from 640 fb to 44 fb (391 fb to 46 fb) over the considered mass range

    Search for long-lived charginos based on a disappearing-track signature using 136 fb-1 of pp collisions at √s = 13 TeV with the ATLAS detector

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    A search for long-lived charginos produced either directly or in the cascade decay of heavy prompt gluino states is presented. The search is based on proton–proton collision data collected at a centre-of-mass energy of √s = 13 TeV between 2015 and 2018 with the ATLAS detector at the LHC, corresponding to an integrated luminosity of 136 fb−1. Long-lived charginos are characterised by a distinct signature of a short and then disappearing track, and are reconstructed using at least four measurements in the ATLAS pixel detector, with no subsequent measurements in the silicon-microstrip tracking volume nor any associated energy deposits in the calorimeter. The final state is complemented by a large missing transverse-momentum requirement for triggering purposes and at least one high-transverse-momentum jet. No excess above the expected backgrounds is observed. Exclusion limits are set at 95% confidence level on the masses of the chargino and gluino for different chargino lifetimes. Chargino masses up to 660 (210) GeV are excluded in scenarios where the chargino is a pure wino (higgsino). For charginos produced during the cascade decay of a heavy gluino, gluinos with masses below 2.1 TeV are excluded for a chargino mass of 300 GeV and a lifetime of 0.2 ns
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