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Gabet A, Guenancia C, Duloquin G, Olié V, Béjot Y. Ischemic Stroke With Atrial Fibrillation: Characteristics and Time Trends 2006 to 2017 in the Dijon Stroke Registry. Stroke 2021; 52:2077-2085. [PMID: 33874745 DOI: 10.1161/strokeaha.120.030812] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Amélie Gabet
- Cardiovascular and Neurovascular Division, Department of Non-Communicable Diseases, Santé Publique France, Saint-Maurice, France (A.G., V.O.)
| | - Charles Guenancia
- Department of Cardiology (C.G.), University Hospital of Dijon, France
| | - Gauthier Duloquin
- Department of Neurology (G.D., Y.B.), University Hospital of Dijon, France
| | - Valérie Olié
- Cardiovascular and Neurovascular Division, Department of Non-Communicable Diseases, Santé Publique France, Saint-Maurice, France (A.G., V.O.)
| | - Yannick Béjot
- Department of Neurology (G.D., Y.B.), University Hospital of Dijon, France.,Dijon Stroke Registry, EA4184, University Hospital and Medical School of Dijon, University of Burgundy, France (Y.B.)
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Abbas SS, Majeed T, Weaver N, Nair BR, Forder PM, Byles JE. Utility estimations of health states of older Australian women with atrial fibrillation using SF-6D. Qual Life Res 2021; 30:1457-1466. [PMID: 33550542 DOI: 10.1007/s11136-020-02748-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To estimate SF-6D utility scores for older women with atrial fibrillation (AF); calculate and compare mean utility scores for women with AF with various demographic, health behaviours, and clinical characteristics; and develop a multivariable regression model to determine factors associated with SF-6D utility scores. METHODS This study evaluated N = 1432 women diagnosed with AF from 2000 to 2015 of the old cohort (born 1921-26) of the Australian Longitudinal Study on Women's Health (ALSWH) who remained alive for at least 12 months post first recorded AF diagnosis. Self-reported data on demographics, health behaviours, health conditions, and SF-36 were obtained from the ALSWH surveys, corresponding to within three years of the date of the first record of AF diagnosis. Linked Pharmaceutical Benefits Scheme (PBS) data determined the use of oral anticoagulants and comorbid conditions, included in CHA2DS2-VA (Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes, Stroke or TIA, Vascular disease and Age 65-74 years) score calculation, were assessed using state-based hospital admissions data. Utility scores were calculated for every woman from their SF-36 responses using the SF-6D algorithm with Australian population norms. Mean utility scores were then calculated for women with various demographic, health behaviours, and clinical characteristics. Ordinary Least Square (OLS) regression modelling was performed to determine factors associated with these utility scores. Two different scenarios were used for the analysis: (1) complete-case, for women with complete data on all the SF-36 items required to estimate SF-6D (N = 584 women), and (2) Multiple Imputation (MI) for missing data, applied to missing values on SF-36 items (N = 1432 women). MI scenario was included to gauge the potential bias when using complete data only. RESULTS The mean health utility was estimated to be 0.638 ± 0.119 for the complete dataset and 0.642 ± 0.120 for the dataset where missing values were handled using MI. Using the MI technique, living in regional and remote areas ([Formula: see text]) and the use of oral anticoagulants ([Formula: see text] were positively associated with health utility compared to living in major cities and no use of anticoagulants, respectively. Difficulty to manage on available income [Formula: see text], no/low physical activity [Formula: see text], disability [Formula: see text], history of stroke ([Formula: see text] and history of arthritis [Formula: see text] were negatively associated with health utility. CONCLUSION This study presents health utility estimates for older women with AF. These estimates can be used in future clinical and economic research. The study also highlights better health utilities for women living in regional and remote areas, which requires further exploration.
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Affiliation(s)
- Shazia S Abbas
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.
| | - Tazeen Majeed
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Natasha Weaver
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Balakrishnan R Nair
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Peta M Forder
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Julie E Byles
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
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Medina-Morales DA, Machado-Duque ME, Gaviria-Mendoza A, Carvajal-Varón AF, Machado-Alba JE. Clinical characteristics and stratification of the cerebrovascular accident risk among patients with atrial fibrillation in Colombia, 2011-2016. Expert Rev Cardiovasc Ther 2021; 19:181-187. [PMID: 33430660 DOI: 10.1080/14779072.2021.1873766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Atrial fibrillation (AF) is the most common type of cardiac arrhythmia worldwide. This study aimed to determine the sociodemographic and clinical features of AF in a Colombian population.Methods: An observational, retrospective study was conducted using a sample of patients diagnosed with AF. Electronic medical records were reviewed to determine specific sociodemographic, clinical, risk stratification, outcome, and pharmacological variables.Results: A total of 357 patients with a mean age of 69.4 ± 13.3 years were included; 52.4% (n = 187) were women. Most patients (84.0%; n = 300) had an elevated risk of thromboembolism and an indication for anticoagulation, but 72 (24.0%) of these patients did not receive such treatment. Among the patients, 23.2% had HAS-BLED scores ≥3. During the study period, 76 patients (21.3%) had 121 adverse events, of which 75.2% (n = 91) were any bleeding events (major, minor, etc.) and 24.8% (n = 30) were thrombosis events (i.e., stroke). At the end of the follow-up period, the number of prescriptions for direct anticoagulants had increased, and warfarin decreased.Conclusions: AF primarily affects Colombian adults >65 years old. A high burden of comorbidities and a risk of thromboembolism were found in most patients; however, lack of treatment was evident in a large percentage of cases.
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Affiliation(s)
- Diego Alejandro Medina-Morales
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira, Colombia.,Grupo de Investigación en Medicina Interna. Facultad Ciencias de la Salud, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Manuel Enrique Machado-Duque
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira, Colombia.,Grupo Biomedicina, Fundación Universitaria Autonoma de las Américas, Pereira, Colombia
| | - Andrés Gaviria-Mendoza
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira, Colombia.,Grupo Biomedicina, Fundación Universitaria Autonoma de las Américas, Pereira, Colombia
| | - Andrés Felipe Carvajal-Varón
- Grupo de Investigación en Medicina Interna. Facultad Ciencias de la Salud, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Jorge Enrique Machado-Alba
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira, Colombia.,Grupo Biomedicina, Fundación Universitaria Autonoma de las Américas, Pereira, Colombia
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Abbas SS, Majeed T, Nair BR, Forder PM, Biostatistics M, Weaver N, Byles JE. Patterns of Medications for Atrial Fibrillation Among Older Women: Results From the Australian Longitudinal Study on Women's Health. J Cardiovasc Pharmacol Ther 2020; 26:59-66. [PMID: 32757782 DOI: 10.1177/1074248420947278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE Examine patterns of medication use, changes in medication patterns over time, and investigate factors associated with medication patterns among older Australian women with Atrial Fibrillation (AF). METHODS It is a retrospective analysis of the 1921-26 birth cohort of the Australian Longitudinal Study on Women's Health (ALSWH), diagnosed with AF between 2000-2015 (N = 1206). Survey data of these women was linked with national registries for medications and death. Latent Transition Analysis (LTA) identified distinct patterns of medication use and transitions among these patterns for 3 consecutive years following AF diagnosis. LTA with co-variates determined the factors associated with latent status membership. RESULTS One-tenth (9.6%, 11.7%, 11.4%) of the study population did not receive any medication for AF in all 3 years following AF diagnosis and about 60% did not receive any medication for the prevention of thromboembolism. Among those who received medications, almost three-quarters (76.6%, 68.4%, 68.5%) received some kind of combination of medications. LTA indicated at least 6 different patterns of AF medications. These patterns had transition probabilities >85% for most of the latent statuses. All factors but diabetes mellitus among the CHA2DS2-VA scoring scheme were independently associated with latent status membership at the time of AF diagnosis. CONCLUSIONS Evaluation of pharmacological treatment indicates that prevention of thromboembolism is inadequate among women with AF. There exists wide variations in medication patterns. However, once in a particular pattern, women are likely to continue the same medications long-term. This underscores the importance of initial assessment of patient profile and stroke risk score in determining the treatment for AF. Failure to assess risk makes women susceptible to devastating AF complications.
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Affiliation(s)
- Shazia Shehzad Abbas
- School of Medicine and Public Health, Faculty of Health and Medicine, 64834University of Newcastle, Newcastle, Australia
| | - Tazeen Majeed
- School of Medicine and Public Health, Faculty of Health and Medicine, 64834University of Newcastle, Newcastle, Australia
| | - Balakrishnan R Nair
- School of Medicine and Public Health, Faculty of Health and Medicine, 64834University of Newcastle, Newcastle, Australia
| | | | - M Biostatistics
- School of Medicine and Public Health, Faculty of Health and Medicine, 64834University of Newcastle, Newcastle, Australia
| | - Natasha Weaver
- School of Medicine and Public Health, Faculty of Health and Medicine, 64834University of Newcastle, Newcastle, Australia
| | - Julie E Byles
- School of Medicine and Public Health, Faculty of Health and Medicine, 64834University of Newcastle, Newcastle, Australia
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Abbas SS, Majeed T, Nair BR, Forder P, Weaver N, Byles J. Burden of atrial fibrillation and stroke risk among octagenarian and nonagenarian women in Australia. Ann Epidemiol 2020; 44:31-37.e2. [PMID: 32249009 DOI: 10.1016/j.annepidem.2020.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/24/2020] [Accepted: 02/17/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE To determine the prevalence and incidence of atrial fibrillation (AF) among older Australian women from 2000 to 2015, determine factors associated with AF, and to calculate risk of stroke at the time of AF diagnosis. METHODS This is a retrospective analysis of 6671 women of the 1921-1926 birth cohort of the Australian Longitudinal Study on Women's Health, linked to data from hospital admissions to identify AF and National Death Index to determine date of death. Yearly prevalence and incidence proportions of AF, and stroke risk using CHA2DS2-VA scheme, were calculated. Factors associated with AF were assessed using logistic regression. RESULTS From 2000 to 2015, a total of 1827 women with AF were identified. AF prevalence increased every year as women aged from 2.71% (95% CI 1.62%-3.80%) in 2000 among women aged 74-79 years to 24.83% (95% CI = 23.23%-26.44%) in 2015 among women aged 89-94 years. The incidence proportion remained constant (between 3% and 5%) throughout the study period. Sedentary lifestyle (OR = 1.24, 95% CI = 1.04-1.49), hypertension (OR = 1.24, 95% CI = 1.09-1.42), arthritis (OR = 1.24, 95% CI = 1.09-1.41), heart attack (OR = 1.62, 95% CI = 1.18-2.24), and angina (OR = 1.39, 95% CI = 1.14-1.70) were independently associated with AF. Mean CHA2DS2-VA score for women with AF was 3.43 (SD ± 1.23). CONCLUSIONS The prevalence of AF reported in Australian women is among the highest compared to previous estimations from other countries and regions. According to the findings, about one in four women over the age of 90 years had AF. These women were also at high risk of stroke. This has significant public health implications especially with changing demographics of increase in the aging population. Further research is required on understanding how women with AF are treated in Australia and their health outcomes.
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Affiliation(s)
- Shazia Shehzad Abbas
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, New South Wales, Australia.
| | - Tazeen Majeed
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
| | - Balakrishnan R Nair
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
| | - Peta Forder
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
| | - Natasha Weaver
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
| | - Julie Byles
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
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Gabet A, Chatignoux E, Billionnet C, Maura G, Giroud M, Béjot Y, Olié V. Annual rate of newly treated atrial fibrillation by age and gender in France, 2010-2016. Eur J Epidemiol 2019; 35:1139-1147. [PMID: 31873812 DOI: 10.1007/s10654-019-00594-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 12/05/2019] [Indexed: 11/25/2022]
Abstract
Few studies are available on atrial fibrillation (AF) burden at a whole country scale. The objective was to estimate the rate of AF patients newly treated with oral anticoagulants (OAC) in France each year between 2010 and 2016 and to describe age and gender differences. We used the French national health data system. For each year between 2010 and 2016, we identified patients aged over 20 initiating OAC. OAC indicated for the treatment of AF was determined by hospitalization diagnoses, specific procedures and registered long-term disease status, or a multiple imputation process for patients with no recorded information as to why they initiated OAC. Among the 421,453 individuals initiating OAC treatment in 2016, the estimated number of newly treated AF patients was 210,131, women accounting for 46%, patients under 65 years old 17%, and 21.4% of patients living in most deprived area. Age-standardized rates reached 400/100,000 inhabitants. Approximately 19% of patients were recently hospitalized for heart failure and 7% for stroke. Age-standardized rates increased by 35% over the study period in both genders, with a marked increase in patients under 55 (+ 41%) and those over 85 years old (+ 60%). Annual rates of AF patients newly treated with OAC increased by 35% between 2010 and 2016. Important differences in rates were observed according to age, gender and the deprivation level of the living area.
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Affiliation(s)
- Amélie Gabet
- Department of Non-Communicable Diseases, Santé Publique France, Saint Maurice, France.
| | - Edouard Chatignoux
- Department of Non-Communicable Diseases, Santé Publique France, Saint Maurice, France
| | - Cécile Billionnet
- Department of Studies in Public Health, French National Health Insurance, Paris, France
| | - Géric Maura
- Department of Studies in Public Health, French National Health Insurance, Paris, France
- Team Pharmacoepidemiology, Inserm, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
| | - Maurice Giroud
- Dijon Stroke Registry, EA 7460, University Hospital of Burgundy, Dijon, France
| | - Yannick Béjot
- Dijon Stroke Registry, EA 7460, University Hospital of Burgundy, Dijon, France
| | - Valérie Olié
- Department of Non-Communicable Diseases, Santé Publique France, Saint Maurice, France
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Turner GM, Calvert M, Feltham MG, Ryan R, Finnikin S, Marshall T. Clinical and Demographic Characteristics Associated With Suboptimal Primary Stroke and Transient Ischemic Attack Prevention: Retrospective Analysis. Stroke 2018; 49:682-687. [PMID: 29440471 DOI: 10.1161/strokeaha.117.020080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 12/18/2017] [Accepted: 01/03/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE Primary prevention of stroke and transient ischemic attack (TIA) is important to reduce the burden of these conditions; however, prescribing of prevention drugs is suboptimal. We aimed to identify individual clinical and demographic characteristics associated with potential missed opportunities for prevention therapy with lipid-lowering, anticoagulant, or antihypertensive drugs before stroke/TIA. METHODS We analyzed anonymized electronic primary care records from a UK primary care database that covers 561 family practices. Patients with first-ever stroke/TIA, ≥18 years, with diagnosis between January 1, 2009, and December 31, 2013, were included. Missed opportunities for prevention were defined as people with clinical indications for lipid-lowering, anticoagulant, or antihypertensive drugs but not prescribed these drugs before their stroke/TIA. Mixed-effect logistic regression models evaluated the relationship between missed opportunities and individual clinical/demographic characteristics. RESULTS The inclusion criteria were met by 29 043 people with stroke/TIA. Patients with coronary heart disease, chronic kidney disease, peripheral arterial disease, or diabetes mellitus were at less risk of a missed opportunity for prescription of lipid-lowering and antihypertensive drugs. However, patients with a 10-year cardiovascular disease risk ≥20% but without these diagnoses had increased risk of having a missed opportunity for prescription of lipid-lowering drugs or antihypertensive drugs. Women were less likely to be prescribed anticoagulants but more likely to be prescribed antihypertensive drugs. The elderly (≥85 years of age) were less likely to be prescribed all 3 prevention drugs, compared with people aged 75 to 79 years. CONCLUSIONS Knowing the patient characteristics predictive of missed opportunities for stroke prevention may help primary care identify and appropriately manage these patients. Improving the management of these groups may reduce their risk and potentially prevent large number of future strokes and TIAs in the population.
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Affiliation(s)
- Grace M Turner
- From the Institute of Applied Health Research (G.M.T., M.C., M.G.F., R.R., S.F., T.M.), Centre for Patient Reported Outcomes Research (G.M.T., M.C., S.F., T.M.), and Birmingham Clinical Trials Unit (M.G.F.), University of Birmingham, Edgbaston, United Kingdom.
| | - Melanie Calvert
- From the Institute of Applied Health Research (G.M.T., M.C., M.G.F., R.R., S.F., T.M.), Centre for Patient Reported Outcomes Research (G.M.T., M.C., S.F., T.M.), and Birmingham Clinical Trials Unit (M.G.F.), University of Birmingham, Edgbaston, United Kingdom
| | - Max G Feltham
- From the Institute of Applied Health Research (G.M.T., M.C., M.G.F., R.R., S.F., T.M.), Centre for Patient Reported Outcomes Research (G.M.T., M.C., S.F., T.M.), and Birmingham Clinical Trials Unit (M.G.F.), University of Birmingham, Edgbaston, United Kingdom
| | - Ronan Ryan
- From the Institute of Applied Health Research (G.M.T., M.C., M.G.F., R.R., S.F., T.M.), Centre for Patient Reported Outcomes Research (G.M.T., M.C., S.F., T.M.), and Birmingham Clinical Trials Unit (M.G.F.), University of Birmingham, Edgbaston, United Kingdom
| | - Samuel Finnikin
- From the Institute of Applied Health Research (G.M.T., M.C., M.G.F., R.R., S.F., T.M.), Centre for Patient Reported Outcomes Research (G.M.T., M.C., S.F., T.M.), and Birmingham Clinical Trials Unit (M.G.F.), University of Birmingham, Edgbaston, United Kingdom
| | - Tom Marshall
- From the Institute of Applied Health Research (G.M.T., M.C., M.G.F., R.R., S.F., T.M.), Centre for Patient Reported Outcomes Research (G.M.T., M.C., S.F., T.M.), and Birmingham Clinical Trials Unit (M.G.F.), University of Birmingham, Edgbaston, United Kingdom
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Gómez EA. Trombosis y anticoagulación en la mujer. REVISTA COLOMBIANA DE CARDIOLOGÍA 2018. [DOI: 10.1016/j.rccar.2017.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Prognosis in patients with atrial fibrillation and a presumed “temporary cause” in a community-based cohort study. Clin Res Cardiol 2016; 106:202-210. [DOI: 10.1007/s00392-016-1040-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 09/26/2016] [Indexed: 11/25/2022]
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10
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Gender Differences of Thromboembolic Events in Atrial Fibrillation. Am J Cardiol 2016; 117:1021-7. [PMID: 26923085 DOI: 10.1016/j.amjcard.2015.12.040] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/21/2015] [Accepted: 12/21/2015] [Indexed: 11/20/2022]
Abstract
Atrial fibrillation (AF) is the most common clinically relevant arrhythmia and increases the risk of thromboembolism and stroke; however, these risks are not the same for women and men. This review examines the evidence and clinical significance of increased thromboembolic risk in women with AF. The balance of results from over 30 recent studies suggests that female gender is an independent stroke risk factor in AF, and the inclusion of female gender in stroke risk stratification models, such as CHA2DS2-VASc, has improved risk assessment. Reasons for the increased thrombogenicity in women remain incompletely elucidated, but biological factors including increased hypertension, renal dysfunction, and hyperthyroidism in female patients with AF; cardiovascular remodeling; increased hypercoagulability, and estrogen hormone replacement therapy in women have been proposed. More importantly, gender differences exist in medical management of patients with AF, and compared with men, women have been found to have greater thromboembolic risk when not on anticoagulants, but may benefit from greater risk reduction when systemically anticoagulated. In conclusion, increased clinician awareness of these gender differences may help to improve the management of patients with AF.
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Cotté FE, Chaize G, Gaudin AF, Samson A, Vainchtock A, Fauchier L. Burden of stroke and other cardiovascular complications in patients with atrial fibrillation hospitalized in France. Europace 2015; 18:501-7. [PMID: 26718532 PMCID: PMC4865060 DOI: 10.1093/europace/euv248] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 06/23/2015] [Indexed: 11/13/2022] Open
Abstract
AIMS Atrial fibrillation (AF) is associated with numerous cardiovascular complications. We sought to estimate the annual burden of cardiovascular complications in AF patients in French hospitals. METHODS AND RESULTS All AF patients hospitalized in France in 2012 were identified from the national public/private hospital database. Comorbid conditions and medical histories were documented using medical records dating back 5 years. Reasons for hospitalization, type of admission (emergency or otherwise), length of stay, rehabilitation transfers, and death at discharge were identified and costs of acute and rehabilitation care determined (2012 Euros). In total, 533 044 AF patients (mean age ± SD 78.0 ± 11.4 years, 47.1% women) were hospitalized in 2012 for any reason. Hospitalizations were cardiovascular-related in 267 681 patients [22.5% cardiac dysrhythmia, 18.3% heart failure, 7.1% vascular/ischaemic diseases, 6.9% stroke/transient ischaemic attack (TIA)/systemic embolism (SE), and 1.3% haemorrhages]. Patients with stroke/TIA/SE had higher rates of emergency admission (68.1%), transfer to rehabilitation unit (28.1%), and death at discharge (13.7%) than those with other cardiovascular complications, with the exception of haemorrhages, where emergency admission rates were similar. They also had longer mean lengths of stay (12.6 ± 13.2 days for acute care and 46.8 ± 42.5 days for rehabilitation). The annual total cost (acute care and rehabilitation) for all hospitalized cardiovascular events was €1.94 billion, of which heart failure represented €805 million, vascular/ischaemic diseases €386 million, stroke €362 million, cardiac dysrhythmia €341 million, and haemorrhage €48 million. CONCLUSION Half a million patients with AF were hospitalized in France in 2012. Cardiovascular-related hospitalizations involved half of these admissions, for a global burden of almost €2 billion, equivalent to 2.6% of total expenditure in French hospitals. Among these hospitalizations stroke/TIA/SE represented costly, but potentially preventable, complications.
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Affiliation(s)
- Francois-Emery Cotté
- Bristol-Myers Squibb, Health Economics & Outcomes Research, Rueil-Malmaison, France
| | | | | | - Adeline Samson
- Bristol-Myers Squibb, Health Economics & Outcomes Research, Rueil-Malmaison, France Paris-Dauphine University, Paris, France
| | | | - Laurent Fauchier
- Service de Cardiologie B et Laboratoire d'Electrophysiologie Cardiaque, Pôle Cœur Thorax, Vasculaire, Centre Hospitalier Universitaire Trousseau, Tours 37044, France Faculté de Médecine, Université François Rabelais, Tours 37032, France
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Fox H, Bitter T, Horstkotte D, Oldenburg O. Cardioversion of atrial fibrillation or atrial flutter into sinus rhythm reduces nocturnal central respiratory events and unmasks obstructive sleep apnoea. Clin Res Cardiol 2015; 105:451-9. [DOI: 10.1007/s00392-015-0940-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 10/29/2015] [Indexed: 12/26/2022]
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13
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Discrepancy between guidelines for stroke prevention in atrial fibrillation and practice patterns in primary care. The nationwide French AFIGP survey. Arch Cardiovasc Dis 2015; 108:544-53. [DOI: 10.1016/j.acvd.2015.05.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 04/17/2015] [Accepted: 05/12/2015] [Indexed: 11/21/2022]
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Pregnancy outcome after exposure to the novel oral anticoagulant rivaroxaban in women at suspected risk for thromboembolic events: a case series from the German Embryotox Pharmacovigilance Centre. Clin Res Cardiol 2015. [PMID: 26195125 DOI: 10.1007/s00392-015-0893-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND New oral anticoagulants are increasingly used in women of childbearing age, but apart from one case report there is no published experience with rivaroxaban exposure during pregnancy. METHODS From October 2008 to December 2014, the German Embryotox Pharmacovigilance Centre identified 63 exposed pregnancies among 94 requests concerning rivaroxaban use during childbearing age. Follow-up included paediatric checks until 6 weeks after birth. RESULTS All pregnancies with completed follow-up were exposed at least during the first trimester. Treatment indications included venous thromboembolism, knee surgery, and atrial fibrillation. 37 pregnancies were prospectively ascertained and resulted in six spontaneous abortions, eight elective terminations of pregnancy, and 23 live births. All women had discontinued rivaroxaban after recognition of pregnancy, mostly in the first trimester, but in one woman treatment continued until gestational week 26. There was one major malformation (conotruncal cardiac defect) among the 37 prospectively ascertained pregnancies in a woman with complex medication and a previous foetus with cardiac malformation without exposure to rivaroxaban. Only one case of bleeding concerning a retrospective report of surgery for missed abortion was observed in our case series. CONCLUSION Our results might give reassurance to those women, who were inadvertently exposed to rivaroxaban in early pregnancy. However, our limited cohort size does not allow ruling out an increased malformation risk and does not support the use of rivaroxaban during pregnancy. In all cases of (inadvertent) rivaroxaban exposure during 1st trimester, anticoagulation regimen should be reconsidered and a detailed ultrasound assessment recommended to confirm normal foetal development.
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Detournay B, Halimi S, Robert J, Deschaseaux C, Dejager S. Hypoglycemia hospitalization frequency in patients with type 2 diabetes mellitus: a comparison of dipeptidyl peptidase 4 inhibitors and insulin secretagogues using the French health insurance database. Vasc Health Risk Manag 2015; 11:417-25. [PMID: 26229480 PMCID: PMC4514348 DOI: 10.2147/vhrm.s84507] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Aim We aimed to compare the frequency of severe hypoglycemia leading to hospitalization (HH) and emergency visits (EV) for any cause in patients with type 2 diabetes mellitus exposed to dipeptidyl peptidase 4 (DPP4) inhibitors (DPP4-i) versus those exposed to insulin secretagogues (IS; sulfonylureas or glinides). Methods Data were extracted from the EGB (Echantillon Généraliste des Bénéficiaires) database, comprising a representative sample of ~1% of patients registered in the French National Health Insurance System (~600,000 patients). Type 2 diabetes mellitus patients exposed to regimens containing either a DPP4-i (excluding treatment with IS, insulin, or glucagon-like peptide 1 analog) or IS (excluding treatment with insulin and any incretin therapy) between 2009 and 2012 were selected. HH and EV during the exposure periods were identified in both cohorts. A similar analysis was conducted considering vildagliptin alone versus IS. Comparative analyses adjusting for covariates within the model (subjects matched for key characteristics) and using multinomial regression models were performed. Results Overall, 7,152 patients exposed to any DPP4-i and 1,440 patients exposed to vildagliptin were compared to 10,019 patients exposed to IS. Eight patients (0.11%) from the DPP4-i cohort and none from the vildagliptin cohort (0.0%) were hospitalized for hypoglycemia versus 130 patients (1.30%) from the IS cohort (138 hospitalizations) (P=0.02 and P<0.0001, respectively). Crude rates of HH/1,000 patient-years were 1.4 (95% CI: 0.7; 2.4) in the DPP4-i cohort, 0.0 in the vildagliptin cohort (95% CI: 0.0; 4.0), versus 5.6 (95% CI, 4.7; 6.6) in the IS cohort (P<0.0001). After adjustments, rates per 1,000 patient-years of HH were 1.4 (95% CI: 0.7; 2.4) with DPP4-i versus 7.5 (95% CI: 6.0; 9.2) with IS (P<0.0001), and 0.0 (95% CI: 0.0; 4.0) with vildagliptin versus 13.6 (95% CI: 10.4; 17.5) with IS (P<0.0001). Adjusted EV rates were also significantly lower with all DPP4-i or with vildagliptin, as compared to IS (P<0.0001). Consistent results were found when considering only treatment initiations for all compared cohorts. Conclusion HH and EV were significantly less frequent in patients exposed to any DPP4-i or to vildagliptin versus IS. These real-life data should be considered in the benefit/risk evaluation of the drugs.
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Affiliation(s)
| | - Serge Halimi
- Department of Diabetology, Endocrinology and Nutrition, Grenoble University Hospital Center, Grenoble, France ; University Joseph Fourier, Grenoble, France
| | | | | | - Sylvie Dejager
- Novartis Pharma SAS, Medical and Scientific Affairs, Rueil Malmaison, France ; Department of Diabetology, Metabolism and Endocrinology, Pitié-Salpétrière Hospital, Paris, France
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[Update on therapy of chronic heart failure. Innovations and studies from last year]. Herz 2015; 40:1084-9. [PMID: 26135467 DOI: 10.1007/s00059-015-4334-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 05/28/2015] [Accepted: 05/31/2015] [Indexed: 12/11/2022]
Abstract
Chronic heart failure is one of the most common chronic diseases worldwide with increasing prevalence and incidence. Due to the high morbidity and mortality a standardized and evidence-based therapy is crucial. The present review article gives an overview about the innovations in 2014 based on the current guidelines of the European Society of Cardiology. First, improvements in established medication regimens regarding beta blockers and mineralocorticoid receptor antagonists as well as treatment options for heart rate reduction will be explained. Second, new pharmacological developments, such as angiotensin receptor neprilysin inhibition will be discussed. Finally, new insights into common comorbidities of patients with chronic heart failure, such as atrial fibrillation and hyperkalemia will be presented.
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Gloekler S, Shakir S, Doblies J, Khattab AA, Praz F, Guerios Ê, Koermendy D, Stortecky S, Pilgrim T, Buellesfeld L, Wenaweser P, Windecker S, Moschovitis A, Jaguszewski M, Landmesser U, Nietlispach F, Meier B. Early results of first versus second generation Amplatzer occluders for left atrial appendage closure in patients with atrial fibrillation. Clin Res Cardiol 2015; 104:656-65. [PMID: 25736061 DOI: 10.1007/s00392-015-0828-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 02/17/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Transcatheter left atrial appendage (LAA) occlusion has been proven to be an effective treatment for stroke prophylaxis in patients with atrial fibrillation. For this purpose, the Amplatzer cardiac plug (ACP) was introduced. Its second generation, the Amulet, was developed for easier delivery, better coverage, and reduction of complications. AIM To investigate the safety and efficacy of first generation versus second generation Amplatzer occluders for LAA occlusion. METHODS Retrospective analysis of prospectively collected data from the LAA occlusion registries of the Bern and Zurich university hospitals. Comparison of the last consecutive 50 ACP cases versus the first consecutive 50 Amulet cases in patients with non-valvular atrial fibrillation. For safety, a periprocedural combined endpoint, which is composed of death, stroke, cardiac tamponade, and bailout by surgery was predefined. For efficacy, the endpoint was procedural success. RESULTS There were no differences between the two groups in baseline characteristics. The percentage of associated interventions during LAA occlusion was high in (78% with ACP vs. 70% with Amulet p = ns). Procedural success was similar in both groups (98 vs. 94%, p = 0.61). The combined safety endpoint for severe adverse events was reached by a similar rate of patients in both groups (6 vs. 8%, p = 0.7). Overall complication rate was insignificantly higher in the ACP group, which was mainly driven by clinically irrelevant pericardial effusions (24 vs. 14%, p = 0.31). Death, stroke, or tamponade were similar between the groups (0 vs. 2%, 0 vs. 0%, or 6 vs. 6%, p = ns). CONCLUSION Transcatheter LAA occlusion for stroke prophylaxis in patients with atrial fibrillation can be performed with similarly high success rates with first and second generations of Amplatzer occluders. According to this early experience, the Amulet has failed to improve results of LAA occlusion. The risk for major procedural adverse events is acceptable but has to be taken into account when selecting patients for LAA occlusion, a preventive procedure.
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Affiliation(s)
- Steffen Gloekler
- Cardiology, Cardiovascular Department, Bern University Hospital, Bern, Switzerland
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Wernhart S, Halle M. Atrial fibrillation and long-term sports practice: epidemiology and mechanisms. Clin Res Cardiol 2014; 104:369-79. [DOI: 10.1007/s00392-014-0805-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 12/16/2014] [Indexed: 12/19/2022]
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Cotté FE, Benhaddi H, Duprat-Lomon I, Doble A, Marchant N, Letierce A, Huguet M. Vitamin K Antagonist Treatment in Patients With Atrial Fibrillation and Time in Therapeutic Range in Four European Countries. Clin Ther 2014; 36:1160-8. [DOI: 10.1016/j.clinthera.2014.07.016] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 07/11/2014] [Accepted: 07/23/2014] [Indexed: 11/27/2022]
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