Aims : The aim of this study was to examine contemporary data on the 1-year prognosis of patients surviving acute coronary syndrome (ACS) and concomitant first-time detected atrial fibrillation (AF). Methods and results: Using Danish nationwide registries, we identified all patients surviving a first-time admission with ACS from 2000 to 2018 and grouped them into (i) those without AF prior to or during ACS; (ii) those with a history of AF; and (iii) those with first-time detected AF during admission with ACS. With 1 year of follow-up, rates of ischaemic stroke, death, and bleeding were compared between study groups using multivariable adjusted Cox proportional hazards analysis. We included 161 266 ACS survivors: 135 878 (84.2%) without AF, 18 961 (11.8%) with history of AF, and 6427 (4.0%) with first-time detected AF at admission with ACS. Compared to those without AF, the adjusted 1-year rates of outcomes were as follows: ischaemic stroke [hazard ratio (HR) 1.38 (95% CI 1.22–1.56) for patients with history of AF and HR 1.67 (95% CI 1.38–2.01) for patients with first-time detected AF]; mortality [HR 1.25 (95% CI 1.21–1.31) for patients with history of AF and HR 1.52 (95% CI 1.43–1.62) for patients with first-time detected AF]; and bleeding [HR 1.22 (95% CI 1.14–1.30) for patients with history of AF and HR 1.28 (95% CI 1.15–1.43) for patients with first-time detected AF]. Conclusion : In patients with ACS, first-time detected AF appeared to be at least as strongly associated with the 1-year rates of ischaemic stroke, mortality, and bleeding as compared with patients with a history of AF.

Background: Valve surgery guidelines for infective endocarditis (IE) are unchanged over decades and nationwide data about the use of valve surgery do not exist. Methods: We included patients with first-time IE (1999–2018) using Danish nationwide registries. Proportions of valve surgery were reported for calendar periods (1999–2003, 2004–2008, 2009–2013, 2014–2018). Comparing calendar periods in multivariable analyses, we computed likelihoods of valve surgery with logistic regression and rates of 30 day postoperative mortality with Cox regression. Results: We included 8804 patients with first-time IE; 1981 (22.5%) underwent surgery during admission, decreasing by calendar periods (N = 360 [24.4%], N = 483 [24.0%], N = 553 [23.5%], N = 585 [19.7%], P = < 0.001 for trend). For patients undergoing valve surgery, median age increased from 59.7 to 66.9 years (P ≤ 0.001) and the proportion of males increased from 67.8% to 72.6% (P = 0.008) from 1999–2003 to 2014–2018. Compared with 1999–2003, associated likelihoods of valve surgery were: Odds ratio (OR) = 1.14 (95% CI: 0.96–1.35), OR = 1.20 (95% CI: 1.02–1.42), and OR = 1.10 (95% CI: 0.93–1.29) in 2004–2008, 2009–2013, and 2014–2018, respectively. 30 day postoperative mortalities were: 12.7%, 12.8%, 6.9%, and 9.7% by calendar periods. Compared with 1999–2003, associated mortality rates were: Hazard ratio (HR) = 0.96 (95% CI: 0.65–1.41), HR = 0.43 (95% CI: 0.28–0.67), and HR = 0.55 (95% CI 0.37–0.83) in 2004–2008, 2009–2013, and 2014–2018, respectively. Conclusions: On a nationwide scale, 22.5% of patients with IE underwent valve surgery. Patient characteristics changed considerably and use of valve surgery decreased over time. The adjusted likelihood of valve surgery was similar between calendar periods with a trend towards an increase while rates of 30 day postoperative mortality decreased.

BACKGROUND: Oral anticoagulation is suggested in patients with atrial fibrillation and a CHA ₂ DS ₂ -VASc score ≥1 (congestive heart failure, hypertension, age ≥75 years, diabetes, stroke, vascular disease, age 65–74 years, and sex score). To assess granular differences within CHA ₂ DS ₂ -VASc 1, the incidence of arterial thromboembolism according to CHA ₂ DS ₂ -VASc 1 subgroups was examined. METHODS: The Danish National Patient Registry and the Danish Prescription Registry were linked on a nationwide level to identify patients with atrial fibrillation from 2000 to 2021 without oral anticoagulation and categorized according to CHA ₂ DS ₂ -VASc score: CHA ₂ DS ₂ -VASc 0 (male and female subjects); CHA ₂ DS ₂ -VASc 1 (hypertension, heart failure, diabetes, vascular disease, and age 65–74 years); or CHA ₂ DS ₂ -VASc 2 (age ≥75 years without other risk factors). Female sex was not considered a risk factor in any risk group. The outcome was arterial thromboembolism (ischemic stroke, embolism of extremity, or transient cerebral ischemia). Study groups were compared using Cox regression analysis. RESULTS: We included 26 701 patients with a CHA ₂ DS ₂ -VASc 0 score; 22 915 with CHA ₂ DS ₂ -VASc 1 (1483 patients with heart failure, 9066 with hypertension, 843 with diabetes, 770 with vascular disease, and 10 753 who were 65 to 74 years of age); and 14 525 patients with CHA ₂ DS ₂ -VASc 2 (≥75 years of age without other risk factors). With a median of 1 year of observation time, the cumulative incidence of arterial thromboembolism was 0.6% (n=154 [95% CI, 0.6%–0.8%]), 1.4% (n=16 [95% CI, 0.8%–2.2%]), 1.9% (n=141 [95% CI, 1.6%–2.2%]), 1.7% (n=12 [95% CI, 0.9%–2.9%]), 2.0% (n=13 [95% CI, 1.1%–3.4%]), 2.3% (n=187 [95% CI, 2.0%–2.7%]), and 4.4% (n=533 [95% CI, 4.1%–4.8%]) for CHA ₂ DS ₂ -VASc 0, heart failure, hypertension, diabetes, vascular disease, age 65 to 74 years (CHA ₂ DS ₂ -VASc 1), and age ≥75 years (CHA ₂ DS ₂ -VASc 2), respectively. No statistically significant difference was identified among subgroups of CHA ₂ DS ₂ -VASc 1 ( P =0.15 for difference). CONCLUSIONS: For patients with atrial fibrillation, all subgroups of CHA ₂ DS ₂ -VASc 1 were associated with lower incidence of arterial thromboembolism compared with age ≥75 years without other risk factors (ie, CHA ₂ DS ₂ -VASc 2) and a higher incidence compared with CHA ₂ DS ₂ -VASc 0. No statistically significant difference was identified between the subgroups of CHA ₂ DS ₂ -VASc 1. These findings support current recommendations that patients within this intermediate risk group could be identified with a similar risk of arterial thromboembolism.

BACKGROUND: Surgery is an essential treatment for selected patients with infective endocarditis (IE). Despite indications for surgery, not all patients undergo surgery. Most previous IE cohorts have examined a selected group of patients from primary tertiary centers. Thus, the aims of this study were to describe the use of surgery by indication and to assess mortality in a nationwide cohort of patients with left-sided IE. METHODS: This study was an observational cohort study including patients with left-sided IE from the National Danish Endocarditis Studies (2016-2021). Patients were categorized according to the presence of surgical indications defined as a Class I indication for surgery according to the 2015 European guidelines or a vegetation ≥10 mm on the diagnostic echocardiography and whether surgery was performed. One-year mortality was assessed with the 1-Kaplan-Meier estimator and multivariable Cox regression models. RESULTS: Among 3017 patients, 662 (21.9%; median age, 66.9 years) underwent surgery, 655 (21.6%; median age, 75.9 years) had surgical indications but received conservative treatment, and 1700 (56.5%; median age, 76.0 years) had no surgical indications. Patients who underwent surgery had fewer comorbidities and more streptococci, whereas conservatively treated patients had more comorbidities and Staphylococcus aureus . Patients with surgical indications who did not undergo surgery had the highest in-hospital (31.8% versus 12.5% versus 15.7%; P <0.001) and 1-year (50.5% versus 17.0% versus 33.5%, P <0.001) mortality compared with patients who underwent surgery and those without indications for surgery. Multivariable Cox models confirmed these findings. High surgical risk (22.8%) was the most reported reason for withholding surgery. CONCLUSIONS: In a nationwide consecutive cohort of patients with left-sided IE, 40% had indications for surgery according to guidelines, but only half of these underwent surgery. Surgically treated patients had the highest survival but were a decade younger, had fewer comorbidities, and had less frequent IE caused by S aureus. Thus, confounding by indication remains a limitation, and more studies are warranted to explore the management of patients at high surgical risk.

Staphylococcus aureus bacteremia (SAB) can be community-acquired or healthcare-associated, and prior small studies have suggested that this mode of acquisition impacts the subsequent prevalence of infective endocarditis (IE) and patient outcomes. First-time SAB was identified from 2010 to 2018 using Danish nationwide registries and categorized into community-acquired (no healthcare contact within 30 days) or healthcare-associated (SAB >48 hours of hospital admission, hospitalization within 30 days, or outpatient hemodialysis). Prevalence of IE (defined from hospital codes) was compared between groups using multivariable adjusted logistic regression analysis. One-year mortality of S aureus IE (SAIE) was compared between groups using multivariable adjusted Cox proportional hazard analysis. We identified 5549 patients with community-acquired SAB and 7491 with healthcare-associated SAB. The prevalence of IE was 12.1% for community-acquired and 6.6% for healthcare-associated SAB. Community-acquired SAB was associated with a higher odds of IE as compared with healthcare-associated SAB (odds ratio, 2.12 [95% confidence interval {CI}, 1.86–2.41]). No difference in mortality was observed with 0–40 days of follow-up for community-acquired SAIE as compared with healthcare-associated SAIE (HR, 1.07 [95% CI, .83–1.37]), while with 41–365 days of follow-up, community-acquired SAIE was associated with a lower mortality (HR, 0.71 [95% CI, .53–.95]). Community-acquired SAB was associated with twice the odds for IE, as compared with healthcare-associated SAB. We identified no significant difference in short-term mortality between community-acquired and healthcare-associated SAIE. Beyond 40 days of survival, community-acquired SAIE was associated with a lower mortality.

Background: In patients undergoing transcatheter aortic valve replacement (TAVR), the impact of acute kidney injury (AKI) on the prognosis and especially on future kidney function has been sparsely examined, and data from large cohorts are warranted. Methods and Results: With Danish nationwide registries, we identified all patients undergoing TAVR from 2014 to 2021 with no previous dialysis treatment. According to 2 plasma creatinine samples, we identified those suffering a postprocedural AKI within 21 days after TAVR. With 1 year of follow‐up, we compared the associated rates of dialysis treatment and death between patients with and without an AKI using multivariable Cox analysis. Finally, according to the lowest recorded creatinine sample, we assessed the kidney function among AKI survivors between 90 and 180 days after the index date. We identified 4091 TAVRs: 193 (4.7%) with AKI (55.4% men; median age, 82 years) and 3898 (95.3%) without AKI (57.0% men; median age, 81 years). Compared with those without AKI, patients with AKI showed increased associated 1‐year rates of dialysis treatment (hazard ratio [HR], 7.20 [95% CI, 4.10–12.66]) and death (HR, 2.39 [95% CI, 1.59–3.58]). After 6 months, 74% of AKI survivors had complete kidney recovery, 14.7% had incomplete kidney recovery, 6.3% failed to recover, and 5.1% were on dialysis treatment. Conclusions: We identified that AKI after TAVR was associated with an increased rate of future dialysis treatment and all‐cause death. Among survivors, 74% had complete kidney recovery within 6 months.