Alcohol consumption associated with immediate and significantly increased risk for an atrial fibrillation event

1. Alcohol consumption associated with immediate and significantly increased risk for an atrial fibrillation event

Abstract: https://www.acpjournals.org/doi/10.7326/M21-0228    

Editorial: https://www.acpjournals.org/doi/10.7326/M21-3193     

Free patient summary: https://www.acpjournals.org/doi/10.7326/P21-0008     

New data suggests that even one glass of alcohol can immediately and substantially increase a person’s risk for discrete atrial fibrillation. The strength of the study lies in the fact that alcohol consumption was measured using real-time and objective methods, eliminating recall bias or errors in self-report and allowing for the first assessment of temporal relationships. The findings are published in Annals of Internal Medicine.

Atrial fibrillation is the most common cardiac arrhythmia. Long-term alcohol use has been associated with the development of atrial fibrillation and avoiding alcohol has been associated with reduced atrial fibrillation. However, the specific and near-term relationship between drinking alcohol and atrial fibrillation is difficult to determine because of how commonly alcohol is consumed.

Researchers from the University of California, San Francisco, studied 100 adults with intermittent atrial fibrillation who drank an average of 1 drink per month to determine if drinking alcohol increased the risk for a near-term and discrete atrial fibrillation event. Participants wore an electrocardiogram monitor to record the time and length of each episode of atrial fibrillation and an ankle monitor to passively record their alcohol consumption. At 4 weeks, the researchers compared the number of episodes of atrial fibrillation and whether or not the episodes were preceded by alcohol use. They found that of the 56 participants who had an episode of atrial fibrillation, it was about twice as likely that they had had alcohol in the 4 hours before the episode. The association was slightly more with more drinks and with a 6-hour time frame, but it decreased with longer time frames.

According to the researchers, these findings are broadly relevant given that alcohol is the most commonly consumed drug in the world. These data suggest that the likelihood a given atrial fibrillation event will happen is not due to chance alone but is influenced by modifiable factors that the patient can control.

Media contacts For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Gregory M. Marcus, MD, MAS, please contact Elizabeth Fernandez at Elizabeth.Fernandez@UCSF.edu.

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2. Low-tech intervention increased participation in advanced care planning in outpatient setting

Abstract: https://www.acpjournals.org/doi/10.7326/M20-1007     

Editorial: https://www.acpjournals.org/doi/10.7326/M21-3294

URL goes live when the embargo lifts

A randomized trial found that an easy-to-implement, tailored intervention increased participation in advance care planning in an outpatient setting. This is important because advance care planning, a process where a person, their family, and their clinicians prepare for future treatment decisions at a time of intact decision-making capacity, remains underutilized in clinical practice. The findings are published in Annals of Internal Medicine.

Interventions with the potential for broad reach in ambulatory settings are necessary to achieve increased participation in advance care planning. The STAMP (Sharing and Talking About My Preferences) program addresses gaps in existing programs and promotes engagement through a brief assessment followed by feedback reports tailored to the individual with supplementary brochures.

Researchers from the VA Connecticut Healthcare System randomly assigned 10 pairs of primary and selected specialty care practices to either usual care or the STAMP intervention to compare the effect on engagement in advanced care planning. The researchers compared completion of four advance care planning activities at 6 months (identifying and communicating with a trusted person about views on quality versus quantity of life, assignment of a health care agent, completion of a living will, and ensuring that the documents are in the medical record—assessed by a blinded interviewer) between the two groups. They found that patients in the intervention group were more likely to participate in advanced care planning activities. And because the intervention can be delivered using the web and by telephone and mail, it is a feasible population-based approach to increasing engagement in advance care planning.

Media contacts For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author, Terri R. Fried, MD, CERC, please contact Julie Parry at julie.parry@yale.edu.

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New COVID-related content also published in this issue:

The Race to Understand Post–COVID-19 Conditions

Paul G. Auwaerter, MD

Ideas and Opinions

Free full text: https://www.acpjournals.org/doi/10.7326/M21-3072     

A new commentary from the Johns Hopkins University School of Medicine suggests that deaths and hospitalizations from the current COVID-19 pandemic are only one way to measure the impact of SARS-CoV-2 on the population. Postinfectious health and economic consequences may last long after the worst of the pandemic has passed, as up to 61% of patients have experienced symptoms that persist for months after COVID-19. According to the author, these consequences will affect even those who have never had COVID-19, with spillover effects not only on postponed health care and prevention but socioeconomic disruption that may prompt anxiety, depression, and posttraumatic stress disorder.

Even if only 10% of patients experience persistent symptoms after COVID-19, the number of those affected will easily be in the tens of millions. According to the author, this makes it obvious that research designed to address these post-pandemic issues should become a priority. A program similar to the successful Operation Warp Speed effort focused on research is sorely needed and long overdue for helping those with postinfectious complications.

Media contacts For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author, Paul G. Auwaerter, MD, please contact Kim Polyniak at kpolyni1@jhmi.edu.

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