Long-Term Impact of Newly Diagnosed Atrial Fibrillation During Critical Care: A South Korean Nationwide Cohort Study

Kyu Kim; Pil Sung Yang; Eunsun Jang; Hee Tae Yu; Tae Hoon Kim; Jae Sun Uhm; Jong Youn Kim; Jung Hoon Sung; Hui Nam Pak; Moon Hyoung Lee; Gregory Y.H. Lip; Boyoung Joung

doi:10.1016/j.chest.2019.04.011

Long-Term Impact of Newly Diagnosed Atrial Fibrillation During Critical Care: A South Korean Nationwide Cohort Study

Kyu Kim, Pil Sung Yang, Eunsun Jang, Hee Tae Yu, Tae Hoon Kim, Jae Sun Uhm, Jong Youn Kim, Jung Hoon Sung, Hui Nam Pak, Moon Hyoung Lee, Gregory Y.H. Lip, Boyoung Joung

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

10 Citations (Scopus)

Abstract

Background: The long-term risks of thromboembolism and mortality are unknown in patients who survived following atrial fibrillation (AF) newly diagnosed during critical care. Methods: Using the Korean National Health Insurance Service database, we identified 30,869 adults who survived for > 6 months following AF newly diagnosed during critical care (ICU-AF), 269,751 control subjects with non-ICU AF (AF-control), and 439,868 control subjects without AF (No-AF) from 2005 to 2013. We performed propensity score matching and compared the risks of stroke/systemic embolism and all-cause mortality. Results: The adjusted hazard ratios (HRs) for long-term stroke/systemic embolism in the patients with ICU-AF were 0.93 (95% CI, 0.88-0.98) compared with the AF-control group and 1.50 (95% CI, 1.42-1.60) compared with the No-AF group. The adjusted HRs of the ICU-AF group for long-term mortality were 1.73 (95% CI, 1.70-1.83) and 3.20 (95% CI, 3.08-3.33) compared with the AF-control and No-AF groups, respectively. The risks of stroke/systemic embolism and mortality were significantly higher in the ICU-AF group than in the No-AF group after excluding patients with AF recurrence (adjusted HR, 1.08; 95% CI, 1.01-1.17), regardless of the causes of critical care and cardiovascular or noncardiovascular surgery. Conclusions: The patients who survived following AF newly diagnosed during critical care remained at a higher risk of long-term stroke/systemic embolism and mortality than the patients without AF regardless of AF recurrence and the causes of critical care. Close follow-up and continuous anticoagulation might be needed for these patients.

Original language	English
Pages (from-to)	518-528
Number of pages	11
Journal	Chest
Volume	156
Issue number	3
DOIs	https://doi.org/10.1016/j.chest.2019.04.011
Publication status	Published - 2019 Sep

Bibliographical note

Funding Information:
FUNDING/SUPPORT: This study was supported by a research grant from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science, and Technology [NRF-2017R1A2B3003303] and grants from the Korean Healthcare Technology R&D project funded by the Ministry of Health & Welfare [HI16C0058 and HI15C1200].Author contributions: K. K. and P.-S. Y contributed to data collection, data interpretation, figure creation, and writing of the manuscript. E. J. contributed to data collection. T.-H. K. J.-S. U. J.-Y. K. J.-H. S. contributed to data collection and literature search. H.-N. P. and M.-H. L. contributed with advice and provided critical revisions to the manuscript. G. Y. H. L. and B. J. contributed to study design and writing of the manuscript. Financial/nonfinancial disclosures: The authors have reported to CHEST the following: G. Y. H. L. has served as a consultant for Bayer/Janssen, BMS/Pfizer, Biotronik, Medtronic, Boehringer Ingelheim, Novartis, Verseon, and Daiichi-Sankyo, and as a speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi-Sankyo; no fees were directly received personally. B. J. has served as a speaker for Bayer, BMS/Pfizer, Medtronic, and Daiichi-Sankyo, and has received research funding from Medtronic and Abbott; no fees were directly received personally. None declared (K. K. P.-S. Y. E. J. H. T. Y. T.-H. K. J.-S. U. J.-Y. K. J.-H. S. H.-N. P. M.-H. L.). Role of sponsors: The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript. Additional information: The e-Figure, e-Appendix 1, and e-Tables can be found in the Supplemental Materials section of the online article. FUNDING/SUPPORT: This study was supported by a research grant from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science, and Technology [NRF-2017R1A2B3003303] and grants from the Korean Healthcare Technology R&D project funded by the Ministry of Health & Welfare [HI16C0058 and HI15C1200].

Funding Information:
FUNDING/SUPPORT: This study was supported by a research grant from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education , Science, and Technology [NRF-2017R1A2B3003303] and grants from the Korean Healthcare Technology R&D project funded by the Ministry of Health & Welfare [HI16C0058 and HI15C1200].

Funding Information:
Financial/nonfinancial disclosures: The authors have reported to CHEST the following: G. Y. H. L. has served as a consultant for Bayer /Janssen, BMS / Pfizer , Biotronik , Medtronic , Boehringer Ingelheim , Novartis , Verseon, and Daiichi-Sankyo , and as a speaker for Bayer , BMS / Pfizer , Medtronic , Boehringer Ingelheim , and Daiichi-Sankyo; no fees were directly received personally. B. J. has served as a speaker for Bayer , BMS / Pfizer , Medtronic , and Daiichi-Sankyo , and has received research funding from Medtronic and Abbott; no fees were directly received personally. None declared (K. K., P.-S. Y., E. J., H. T. Y., T.-H. K., J.-S. U., J.-Y. K., J.-H. S., H.-N. P., M.-H. L.).

Funding Information:
FUNDING/SUPPORT: This study was supported by a research grant from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science, and Technology [NRF-2017R1A2B3003303] and grants from the Korean Healthcare Technology R&D project funded by the Ministry of Health & Welfare [HI16C0058 and HI15C1200].Author contributions: K. K. and P.-S. Y contributed to data collection, data interpretation, figure creation, and writing of the manuscript. E. J. contributed to data collection. T.-H. K. J.-S. U. J.-Y. K. J.-H. S. contributed to data collection and literature search. H.-N. P. and M.-H. L. contributed with advice and provided critical revisions to the manuscript. G. Y. H. L. and B. J. contributed to study design and writing of the manuscript. Financial/nonfinancial disclosures: The authors have reported to CHEST the following: G. Y. H. L. has served as a consultant for Bayer/Janssen, BMS/Pfizer, Biotronik, Medtronic, Boehringer Ingelheim, Novartis, Verseon, and Daiichi-Sankyo, and as a speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi-Sankyo; no fees were directly received personally. B. J. has served as a speaker for Bayer, BMS/Pfizer, Medtronic, and Daiichi-Sankyo, and has received research funding from Medtronic and Abbott; no fees were directly received personally. None declared (K. K. P.-S. Y. E. J. H. T. Y. T.-H. K. J.-S. U. J.-Y. K. J.-H. S. H.-N. P. M.-H. L.). Role of sponsors: The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript. Additional information: The e-Figure, e-Appendix 1, and e-Tables can be found in the Supplemental Materials section of the online article.

Publisher Copyright:
© 2019 American College of Chest Physicians

All Science Journal Classification (ASJC) codes

Pulmonary and Respiratory Medicine
Critical Care and Intensive Care Medicine
Cardiology and Cardiovascular Medicine

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10.1016/j.chest.2019.04.011

Cite this

@article{43e916bb2fa44d54bcaabeb0fe98cb33,

title = "Long-Term Impact of Newly Diagnosed Atrial Fibrillation During Critical Care: A South Korean Nationwide Cohort Study",

abstract = "Background: The long-term risks of thromboembolism and mortality are unknown in patients who survived following atrial fibrillation (AF) newly diagnosed during critical care. Methods: Using the Korean National Health Insurance Service database, we identified 30,869 adults who survived for > 6 months following AF newly diagnosed during critical care (ICU-AF), 269,751 control subjects with non-ICU AF (AF-control), and 439,868 control subjects without AF (No-AF) from 2005 to 2013. We performed propensity score matching and compared the risks of stroke/systemic embolism and all-cause mortality. Results: The adjusted hazard ratios (HRs) for long-term stroke/systemic embolism in the patients with ICU-AF were 0.93 (95% CI, 0.88-0.98) compared with the AF-control group and 1.50 (95% CI, 1.42-1.60) compared with the No-AF group. The adjusted HRs of the ICU-AF group for long-term mortality were 1.73 (95% CI, 1.70-1.83) and 3.20 (95% CI, 3.08-3.33) compared with the AF-control and No-AF groups, respectively. The risks of stroke/systemic embolism and mortality were significantly higher in the ICU-AF group than in the No-AF group after excluding patients with AF recurrence (adjusted HR, 1.08; 95% CI, 1.01-1.17), regardless of the causes of critical care and cardiovascular or noncardiovascular surgery. Conclusions: The patients who survived following AF newly diagnosed during critical care remained at a higher risk of long-term stroke/systemic embolism and mortality than the patients without AF regardless of AF recurrence and the causes of critical care. Close follow-up and continuous anticoagulation might be needed for these patients.",

author = "Kyu Kim and Yang, {Pil Sung} and Eunsun Jang and Yu, {Hee Tae} and Kim, {Tae Hoon} and Uhm, {Jae Sun} and Kim, {Jong Youn} and Sung, {Jung Hoon} and Pak, {Hui Nam} and Lee, {Moon Hyoung} and Lip, {Gregory Y.H.} and Boyoung Joung",

note = "Funding Information: FUNDING/SUPPORT: This study was supported by a research grant from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science, and Technology [NRF-2017R1A2B3003303] and grants from the Korean Healthcare Technology R&D project funded by the Ministry of Health & Welfare [HI16C0058 and HI15C1200].Author contributions: K. K. and P.-S. Y contributed to data collection, data interpretation, figure creation, and writing of the manuscript. E. J. contributed to data collection. T.-H. K. J.-S. U. J.-Y. K. J.-H. S. contributed to data collection and literature search. H.-N. P. and M.-H. L. contributed with advice and provided critical revisions to the manuscript. G. Y. H. L. and B. J. contributed to study design and writing of the manuscript. Financial/nonfinancial disclosures: The authors have reported to CHEST the following: G. Y. H. L. has served as a consultant for Bayer/Janssen, BMS/Pfizer, Biotronik, Medtronic, Boehringer Ingelheim, Novartis, Verseon, and Daiichi-Sankyo, and as a speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi-Sankyo; no fees were directly received personally. B. J. has served as a speaker for Bayer, BMS/Pfizer, Medtronic, and Daiichi-Sankyo, and has received research funding from Medtronic and Abbott; no fees were directly received personally. None declared (K. K. P.-S. Y. E. J. H. T. Y. T.-H. K. J.-S. U. J.-Y. K. J.-H. S. H.-N. P. M.-H. L.). Role of sponsors: The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript. Additional information: The e-Figure, e-Appendix 1, and e-Tables can be found in the Supplemental Materials section of the online article. FUNDING/SUPPORT: This study was supported by a research grant from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science, and Technology [NRF-2017R1A2B3003303] and grants from the Korean Healthcare Technology R&D project funded by the Ministry of Health & Welfare [HI16C0058 and HI15C1200]. Funding Information: FUNDING/SUPPORT: This study was supported by a research grant from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education , Science, and Technology [NRF-2017R1A2B3003303] and grants from the Korean Healthcare Technology R&D project funded by the Ministry of Health & Welfare [HI16C0058 and HI15C1200]. Funding Information: Financial/nonfinancial disclosures: The authors have reported to CHEST the following: G. Y. H. L. has served as a consultant for Bayer /Janssen, BMS / Pfizer , Biotronik , Medtronic , Boehringer Ingelheim , Novartis , Verseon, and Daiichi-Sankyo , and as a speaker for Bayer , BMS / Pfizer , Medtronic , Boehringer Ingelheim , and Daiichi-Sankyo; no fees were directly received personally. B. J. has served as a speaker for Bayer , BMS / Pfizer , Medtronic , and Daiichi-Sankyo , and has received research funding from Medtronic and Abbott; no fees were directly received personally. None declared (K. K., P.-S. Y., E. J., H. T. Y., T.-H. K., J.-S. U., J.-Y. K., J.-H. S., H.-N. P., M.-H. L.). Funding Information: FUNDING/SUPPORT: This study was supported by a research grant from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science, and Technology [NRF-2017R1A2B3003303] and grants from the Korean Healthcare Technology R&D project funded by the Ministry of Health & Welfare [HI16C0058 and HI15C1200].Author contributions: K. K. and P.-S. Y contributed to data collection, data interpretation, figure creation, and writing of the manuscript. E. J. contributed to data collection. T.-H. K. J.-S. U. J.-Y. K. J.-H. S. contributed to data collection and literature search. H.-N. P. and M.-H. L. contributed with advice and provided critical revisions to the manuscript. G. Y. H. L. and B. J. contributed to study design and writing of the manuscript. Financial/nonfinancial disclosures: The authors have reported to CHEST the following: G. Y. H. L. has served as a consultant for Bayer/Janssen, BMS/Pfizer, Biotronik, Medtronic, Boehringer Ingelheim, Novartis, Verseon, and Daiichi-Sankyo, and as a speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi-Sankyo; no fees were directly received personally. B. J. has served as a speaker for Bayer, BMS/Pfizer, Medtronic, and Daiichi-Sankyo, and has received research funding from Medtronic and Abbott; no fees were directly received personally. None declared (K. K. P.-S. Y. E. J. H. T. Y. T.-H. K. J.-S. U. J.-Y. K. J.-H. S. H.-N. P. M.-H. L.). Role of sponsors: The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript. Additional information: The e-Figure, e-Appendix 1, and e-Tables can be found in the Supplemental Materials section of the online article. Publisher Copyright: {\textcopyright} 2019 American College of Chest Physicians",

year = "2019",

month = sep,

doi = "10.1016/j.chest.2019.04.011",

language = "English",

volume = "156",

pages = "518--528",

journal = "Diseases of the chest",

issn = "0012-3692",

publisher = "American College of Chest Physicians",

number = "3",

}

TY - JOUR

T1 - Long-Term Impact of Newly Diagnosed Atrial Fibrillation During Critical Care

T2 - A South Korean Nationwide Cohort Study

AU - Kim, Kyu

AU - Yang, Pil Sung

AU - Jang, Eunsun

AU - Yu, Hee Tae

AU - Kim, Tae Hoon

AU - Uhm, Jae Sun

AU - Kim, Jong Youn

AU - Sung, Jung Hoon

AU - Pak, Hui Nam

AU - Lee, Moon Hyoung

AU - Lip, Gregory Y.H.

AU - Joung, Boyoung

N1 - Funding Information: FUNDING/SUPPORT: This study was supported by a research grant from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science, and Technology [NRF-2017R1A2B3003303] and grants from the Korean Healthcare Technology R&D project funded by the Ministry of Health & Welfare [HI16C0058 and HI15C1200].Author contributions: K. K. and P.-S. Y contributed to data collection, data interpretation, figure creation, and writing of the manuscript. E. J. contributed to data collection. T.-H. K. J.-S. U. J.-Y. K. J.-H. S. contributed to data collection and literature search. H.-N. P. and M.-H. L. contributed with advice and provided critical revisions to the manuscript. G. Y. H. L. and B. J. contributed to study design and writing of the manuscript. Financial/nonfinancial disclosures: The authors have reported to CHEST the following: G. Y. H. L. has served as a consultant for Bayer/Janssen, BMS/Pfizer, Biotronik, Medtronic, Boehringer Ingelheim, Novartis, Verseon, and Daiichi-Sankyo, and as a speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi-Sankyo; no fees were directly received personally. B. J. has served as a speaker for Bayer, BMS/Pfizer, Medtronic, and Daiichi-Sankyo, and has received research funding from Medtronic and Abbott; no fees were directly received personally. None declared (K. K. P.-S. Y. E. J. H. T. Y. T.-H. K. J.-S. U. J.-Y. K. J.-H. S. H.-N. P. M.-H. L.). Role of sponsors: The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript. Additional information: The e-Figure, e-Appendix 1, and e-Tables can be found in the Supplemental Materials section of the online article. FUNDING/SUPPORT: This study was supported by a research grant from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science, and Technology [NRF-2017R1A2B3003303] and grants from the Korean Healthcare Technology R&D project funded by the Ministry of Health & Welfare [HI16C0058 and HI15C1200]. Funding Information: FUNDING/SUPPORT: This study was supported by a research grant from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education , Science, and Technology [NRF-2017R1A2B3003303] and grants from the Korean Healthcare Technology R&D project funded by the Ministry of Health & Welfare [HI16C0058 and HI15C1200]. Funding Information: Financial/nonfinancial disclosures: The authors have reported to CHEST the following: G. Y. H. L. has served as a consultant for Bayer /Janssen, BMS / Pfizer , Biotronik , Medtronic , Boehringer Ingelheim , Novartis , Verseon, and Daiichi-Sankyo , and as a speaker for Bayer , BMS / Pfizer , Medtronic , Boehringer Ingelheim , and Daiichi-Sankyo; no fees were directly received personally. B. J. has served as a speaker for Bayer , BMS / Pfizer , Medtronic , and Daiichi-Sankyo , and has received research funding from Medtronic and Abbott; no fees were directly received personally. None declared (K. K., P.-S. Y., E. J., H. T. Y., T.-H. K., J.-S. U., J.-Y. K., J.-H. S., H.-N. P., M.-H. L.). Funding Information: FUNDING/SUPPORT: This study was supported by a research grant from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science, and Technology [NRF-2017R1A2B3003303] and grants from the Korean Healthcare Technology R&D project funded by the Ministry of Health & Welfare [HI16C0058 and HI15C1200].Author contributions: K. K. and P.-S. Y contributed to data collection, data interpretation, figure creation, and writing of the manuscript. E. J. contributed to data collection. T.-H. K. J.-S. U. J.-Y. K. J.-H. S. contributed to data collection and literature search. H.-N. P. and M.-H. L. contributed with advice and provided critical revisions to the manuscript. G. Y. H. L. and B. J. contributed to study design and writing of the manuscript. Financial/nonfinancial disclosures: The authors have reported to CHEST the following: G. Y. H. L. has served as a consultant for Bayer/Janssen, BMS/Pfizer, Biotronik, Medtronic, Boehringer Ingelheim, Novartis, Verseon, and Daiichi-Sankyo, and as a speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi-Sankyo; no fees were directly received personally. B. J. has served as a speaker for Bayer, BMS/Pfizer, Medtronic, and Daiichi-Sankyo, and has received research funding from Medtronic and Abbott; no fees were directly received personally. None declared (K. K. P.-S. Y. E. J. H. T. Y. T.-H. K. J.-S. U. J.-Y. K. J.-H. S. H.-N. P. M.-H. L.). Role of sponsors: The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript. Additional information: The e-Figure, e-Appendix 1, and e-Tables can be found in the Supplemental Materials section of the online article. Publisher Copyright: © 2019 American College of Chest Physicians

PY - 2019/9

Y1 - 2019/9

N2 - Background: The long-term risks of thromboembolism and mortality are unknown in patients who survived following atrial fibrillation (AF) newly diagnosed during critical care. Methods: Using the Korean National Health Insurance Service database, we identified 30,869 adults who survived for > 6 months following AF newly diagnosed during critical care (ICU-AF), 269,751 control subjects with non-ICU AF (AF-control), and 439,868 control subjects without AF (No-AF) from 2005 to 2013. We performed propensity score matching and compared the risks of stroke/systemic embolism and all-cause mortality. Results: The adjusted hazard ratios (HRs) for long-term stroke/systemic embolism in the patients with ICU-AF were 0.93 (95% CI, 0.88-0.98) compared with the AF-control group and 1.50 (95% CI, 1.42-1.60) compared with the No-AF group. The adjusted HRs of the ICU-AF group for long-term mortality were 1.73 (95% CI, 1.70-1.83) and 3.20 (95% CI, 3.08-3.33) compared with the AF-control and No-AF groups, respectively. The risks of stroke/systemic embolism and mortality were significantly higher in the ICU-AF group than in the No-AF group after excluding patients with AF recurrence (adjusted HR, 1.08; 95% CI, 1.01-1.17), regardless of the causes of critical care and cardiovascular or noncardiovascular surgery. Conclusions: The patients who survived following AF newly diagnosed during critical care remained at a higher risk of long-term stroke/systemic embolism and mortality than the patients without AF regardless of AF recurrence and the causes of critical care. Close follow-up and continuous anticoagulation might be needed for these patients.

AB - Background: The long-term risks of thromboembolism and mortality are unknown in patients who survived following atrial fibrillation (AF) newly diagnosed during critical care. Methods: Using the Korean National Health Insurance Service database, we identified 30,869 adults who survived for > 6 months following AF newly diagnosed during critical care (ICU-AF), 269,751 control subjects with non-ICU AF (AF-control), and 439,868 control subjects without AF (No-AF) from 2005 to 2013. We performed propensity score matching and compared the risks of stroke/systemic embolism and all-cause mortality. Results: The adjusted hazard ratios (HRs) for long-term stroke/systemic embolism in the patients with ICU-AF were 0.93 (95% CI, 0.88-0.98) compared with the AF-control group and 1.50 (95% CI, 1.42-1.60) compared with the No-AF group. The adjusted HRs of the ICU-AF group for long-term mortality were 1.73 (95% CI, 1.70-1.83) and 3.20 (95% CI, 3.08-3.33) compared with the AF-control and No-AF groups, respectively. The risks of stroke/systemic embolism and mortality were significantly higher in the ICU-AF group than in the No-AF group after excluding patients with AF recurrence (adjusted HR, 1.08; 95% CI, 1.01-1.17), regardless of the causes of critical care and cardiovascular or noncardiovascular surgery. Conclusions: The patients who survived following AF newly diagnosed during critical care remained at a higher risk of long-term stroke/systemic embolism and mortality than the patients without AF regardless of AF recurrence and the causes of critical care. Close follow-up and continuous anticoagulation might be needed for these patients.

UR - http://www.scopus.com/inward/record.url?scp=85067349481&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85067349481&partnerID=8YFLogxK

U2 - 10.1016/j.chest.2019.04.011

DO - 10.1016/j.chest.2019.04.011

M3 - Article

C2 - 31051171

AN - SCOPUS:85067349481

VL - 156

SP - 518

EP - 528

JO - Diseases of the chest

JF - Diseases of the chest

SN - 0012-3692

IS - 3

ER -

Long-Term Impact of Newly Diagnosed Atrial Fibrillation During Critical Care: A South Korean Nationwide Cohort Study

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