6418 Treatment of Subclinical Hyperthyroidism and Incident Atrial Fibrillation
Notice bibliographique
Résumé
Abstract Disclosure: M. Jay: None. P. Huan: None. N. Cliffe: None. J. Rakoff: None. E. Morris: None. P. Kavsak: Advisory Board Member; Self; Roche Diagnostics, QuidelOrtho, Siemens. Consulting Fee; Self; QuidelOrtho, Roche Diagnostics. Grant Recipient; Self; QuidelOrtho. Speaker; Self; Abbott Laboratories. Other; Self; Siemens(Other Research Support (includes receipt of drugs, supplies, equipment or other in-kind support), Speaker/Honoraria)). M. Luthra: Advisory Board Member; Self; Bayer, Inc., Novonordisk. Consulting Fee; Self; Bayer, Inc., Novonordisk. Speaker; Self; Lilly/BI alliance, Novonordisk, Sanofi. Z. Punthakee: None. Background: Treating overt hyperthyroidism prevents atrial fibrillation (AF). Though subclinical hyperthyroidism (SH) has been associated with AF risk, it is unknown whether treating SH prevents AF. Objective: We aimed to identify the association between treating SH and incident AF in outpatients. Methods: In a retrospective chart review, 2169 patients ≥ 18 years, diagnosed with SH between 2000-2021 were identified using the regional biochemistry database. After excluding those with prior AF, hypothyroidism, thyroid cancer, pituitary disease, and pregnancy, 360 patients categorized as treated (n=131) or untreated (n=229) were analyzed. The primary outcome was incident AF. Incidence rates were compared between the two groups over the time since SH treatment start for the treated group, and time since diagnosis of SH for the untreated group. Pharmacoepidemiologic Cox analysis adjusted for age and hypertension, with treatment as a time dependent covariate was used to account for untreated time in the treated group. Secondary outcomes were AF prevalence, P wave duration on ECG, as well as ventricular and ascending aorta diameters on echocardiogram. We included sensitivity and subgroup analyses. Results: Mean age of patients with SH was 55.19 years, 78% were female, 43% had toxic nodules and 14% had Grave’s disease. Amongst the 19 patients who developed AF, 58% had toxic nodules and no patient had Grave’s disease. In the treated and untreated groups, AF occurred in 3.1% and 6.6% (p=0.15) and AF incidence was 0.8 and 1.4 %/year (p=0.31), respectively. The hazard ratio (HR) was 0.60 (95% CI 0.19-1.92; p=0.39). In the subgroup of patients with free T4 (FT4) ≥ 15 pmol/L, AF incidence was 0.5 and 3.0 %/yr in the treated and untreated groups, respectively (p=0.01), while adjusted HR was 0.185 (95% CI 0.022-1.59, p=0.12). In those with TSH ≤ 0.1 mU/L, treatment was not associated with AF incidence. As some cases of AF were documented nearly simultaneously with treatment of SH, a sensitivity analysis was performed reassigning 2 patients diagnosed with AF <30 days after starting SH treatment to the untreated group. Here, in the treated and untreated groups, AF occurred in 1.6% and 7.4% (p=0.02), and AF incidence was 0.4 and 1.8 %/year (p=0.02), respectively. The HR was 0.25 (0.06-1.13; p=0.07). In the treated versus untreated groups, the mean p wave duration, ventricular diameter, and ascending aorta diameter were 73.47 vs 73.42 ms (p=0.99), 4.29 vs 4.34 cm (p=0.86), and 3.33 vs 3.23 cm (p=0.58), respectively. Conclusions: We report the first study assessing the effect of treating SH in preventing incident AF. There was an overall trend towards lower AF following treatment of SH. Lack of statistical significance may be related to small sample size, supporting the need for larger scale studies. These data suggest the etiology of SH (toxic nodules) and FT4 levels could be factored into treatment decisions. Presentation: 6/2/2024
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».