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Worldwide, there are differences in hypertension control by sex. The use of home blood pressure monitoring (HBPM) is associated with lower average blood pressures and higher medication adherence. However, little is known about adherence trajectories and sex differences in HBPM. This study characterizes adherence to HBPM among those with and without hypertension. Electronic Framingham Heart Study participants were instructed to perform HBPM weekly for 1 year. Adherence was defined as having ≥1 measurement per week averaged over 4-week segments. Primary exposures of hypertension status and sex were self-reported. Group-based trajectory modeling was used to identify adherence trajectories. Logistic regression was applied to investigate factors associated with membership in each trajectory group in the sex-stratified and whole cohorts. Among 990 participants (58% women, age 53 ± 9 years, 26% hypertension), three groups with distinct HBPM adherence patterns were identified: \"early discontinuation\", \"gradual decrease\", and \"high adherence\". Participants with hypertension were more likely to maintain \"high adherence\" compared to those without (OR 1.55; 95% CI 1.08-2.23), with similar findings seen among women with hypertension (OR 2.24; 95% CI 1.35-3.72) but not men. In women, these findings remained significant when adjusting for anxiety, depression, and blood pressure, but were attenuated by adjusting for age and income. This study highlights HBPM adherence trajectories and shows that women with hypertension were more likely to be in the high adherence group, though these associations were attenuated after adjusting for demographic factors and co-morbidities. Future studies should explore strategies to enhance adherence in populations at risk of early discontinuation.

Chronic starvation and its associated metabolic derangements are known to have dangerous cardiovascular implications in the long term, but less is known about the cardiovascular consequences of acute starvation, such as in the context of a hunger strike. This case describes a patient who presented with signs and symptoms of acute coronary syndrome which began two weeks into a hunger strike and was ultimately found to have stress cardiomyopathy with complete resolution on subsequent imaging.

Background Holistic care models emphasize management of comorbid conditions to improve patient-reported outcomes in treatment of atrial fibrillation (AF). We investigated relations between multimorbidity, physical frailty, and self-rated health (SRH) among older adults with AF. Methods Patients ( n  = 1235) with AF aged 65 years and older were recruited from five medical centers in Massachusetts and Georgia between 2015 and 2018. Ten previously diagnosed cardiometabolic and 8 non-cardiometabolic conditions were assessed from medical records. Physical Frailty was assessed with the Cardiovascular Health Study frailty scale. SRH was categorized as either “excellent/very good”, “good”, and “fair/poor”. Separate multivariable ordinal logistic models were used to examine the associations between multimorbidity and SRH, physical frailty and SRH, and multimorbidity and physical frailty. Results Overall, 16% of participants rated their health as fair/poor and 14% were frail. Hypertension (90%), dyslipidemia (80%), and heart failure (37%) were the most prevalent cardiometabolic conditions. Arthritis (51%), anemia (31%), and cancer (30%), the most common non-cardiometabolic diseases. After multivariable adjustment, patients with higher multimorbidity were more likely to report poorer health status (Odds Ratio (OR): 2.15 [95% CI: 1.53–3.03], ≥ 8 vs 1–4; OR: 1.37 [95% CI: 1.02–1.83], 5–7 vs 1–4), as did those with more prevalent cardiometabolic and non-cardiometabolic conditions. Patients who were pre-frail (OR: 1.73 [95% CI: 1.30–2.30]) or frail (OR: 6.81 [95% CI: 4.34–10.68]) reported poorer health status. Higher multimorbidity was associated with worse frailty status. Conclusions Multimorbidity and physical frailty were common and related to SRH. Our findings suggest that holistic management approaches may influence SRH among older patients with AF.

Current guidelines encourage regular physical activity (PA) to gain cardiovascular health benefit. However, little is known about whether older adults with atrial fibrillation (AF) who engage in the guideline-recommended level of PA are less likely to experience clinically relevant outcomes. We did a retrospective study based on the data from Systemic Assessment of Geriatric Elements in AF (SAGE-AF) prospective cohort study. The study population consisted of older participants with AF (≥65 years) and a congestive heart failure, hypertension, age, diabetes, stroke vascular disease, age 65 to 75 and sex(CHA2DS2-VASc) score ≥2. PA was quantified by self-reported Minnesota Leisure Time PA questionnaire. Competing risk models were used to examine the association between PA level and clinical outcomes over 2 years while controlling for several potentially confounding variables. A total of 1,244 participants (average age 76 years; 51% men; 85% non-Hispanic White) were studied. A total of 50.5% of participants engaged in regular PA. Meeting the recommended level of PA was associated with lower mortality over 2 years (adjusted hazard ratio 0.60, 95% confidence interval 0.38 to 0.95) but was not associated with rates of stroke or major bleeding. In conclusion, older adults with AF who engaged in guideline-recommended PA are more likely to survive in the long term. Healthcare providers should promote and encourage engagement in PA and tailor interventions to address barriers of engagement.

Background Older persons with atrial fibrillation (AF) experience significant impairment in quality of life (QoL), which may be partly attributable to their comorbid diseases. A greater understanding of the impact of comorbidities on QoL could optimize patient-centered care among older persons with AF. Objective To assess impairment in disease-specific QoL due to comorbid conditions in older adults with AF. Methods Patients aged ≥ 65 years diagnosed with AF were recruited from five medical centers in Massachusetts and Georgia between 2015 and 2018. At 1 year of follow-up, the Quality of Life Disease Impact Scale—for Multiple Chronic Conditions was used to provide standardized assessment of patient self-reported impairment in QoL attributable to 34 comorbid conditions grouped in 10 clusters. Results The mean age of study participants ( n  = 1097) was 75 years and 48% were women. Overall, cardiometabolic, musculoskeletal, and pulmonary conditions were the most prevalent comorbidity clusters. A high proportion of participants (82%) reported that musculoskeletal conditions exerted the greatest impact on their QoL. Men were more likely than women to report that osteoarthritis and stroke severely impacted their QoL. Patients aged < 75 years were more likely to report that obesity, hip/knee joint problems, and fibromyalgia extremely impacted their QoL than older participants. Conclusions Among older persons with AF, while cardiometabolic diseases were highly prevalent, musculoskeletal conditions exerted the greatest impact on patients’ disease-specific QoL. Understanding the extent of impairment in QoL due to underlying comorbidities provides an opportunity to develop interventions targeted at diseases that may cause significant impairment in QoL.

Increasing ownership of smartphones among Americans provides an opportunity to use these technologies to manage medical conditions. We examine the influence of baseline smartwatch ownership on changes in self-reported anxiety, patient engagement, and health-related quality of life when prescribed smartwatch for AF detection. We performed a secondary analysis of the Pulsewatch study (NCT03761394), a clinical trial in which 120 participants were randomized to receive a smartwatch-smartphone app dyad and ECG patch monitor compared to an ECG patch monitor alone to establish the accuracy of the smartwatch-smartphone app dyad for detection of AF. At baseline, 14 days, and 44 days, participants completed the Generalized Anxiety Disorder-7 survey, the Health Survey SF-12, and the Consumer Health Activation Index. Mixed-effects linear regression models using repeated measures with anxiety, patient activation, physical and mental health status as outcomes were used to examine their association with smartwatch ownership at baseline. Ninety-six participants, primarily White with high income and tertiary education, were randomized to receive a study smartwatch-smartphone dyad. Twenty-four (25%) participants previously owned a smartwatch. Compared to those who did not previously own a smartwatch, smartwatch owners reported significant greater increase in their self-reported physical health (  = 5.07,  < 0.05), no differences in anxiety (  = 0.92,  = 0.33), mental health (  = -2.42,  = 0.16), or patient activation (  = 1.86,  = 0.54). Participants who own a smartwatch at baseline reported a greater positive change in self-reported physical health, but not in anxiety, patient activation, or self-reported mental health over the study period.

In older adults with atrial fibrillation (AF), the presence of comorbid chronic kidney disease (CKD) may be more challenging for optimal disease management, influence stroke prophylaxis with oral anticoagulation, and impact bleeding risk. We examined the prevalence and burden of CKD in older patients with AF, patterns of anticoagulation prescribing according to CKD stage, and major bleeding events. Patients aged 65 years and older with AF were enrolled in a cohort study from clinics in Massachusetts and Georgia between 2016 and 2018. Kidney function was assessed with estimated glomerular filtration rate (GFR) values at study enrollment. Anticoagulation therapy with direct acting oral anticoagulation therapy (DOAC) or warfarin; and major bleeding events were ascertained from medical records. Cox proportional hazards model was used to estimate the multivariable adjusted risk of two-year major bleeding events. Participants' (n = 1,244) mean age was 75 years; 48% were women, and 86% were White. Overall, 25% had a normal GFR, 44%, 28%, and 3% had mild, moderate, and severe CKD/kidney failure, respectively. Patients with severe CKD/kidney failure were more likely to be the oldest participants, dependent in their instrumental activities of daily living, and had the highest burden of frailty, multimorbidity, and polypharmacy. Approximately 44% of patients with normal GFR and 39% of those with mild CKD were prescribed a DOAC, while a majority of those with severe CKD/kidney failure (69%) were prescribed warfarin. Overall, 8% (n = 105) experienced a major bleeding event over the 2-year follow-up. After adjusting for sociodemographic, psychosocial, geriatric, and clinical variables, patients with severe CKD/kidney failure (HR: 2.81 [95% CI:1.10-7.17]) had a higher bleeding risk than those with a normal GFR. In managing older patients with AF and comorbid CKD, healthcare providers should be increasingly aware of the increased burden of frailty, dependence for care, multimorbidity, polypharmacy, and the high risk of major bleeding especially among those with severely impaired kidney function. This finding emphasizes the need for a more holistic and multidisciplinary approach to stroke prophylaxis in older adults with AF and comorbid CKD.