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Ikemura N, Kohsaka S, Kimura T, Jones PG, Katsumata Y, Tanimoto K, Ueda I, Takatsuki S, Ieda M, Chan PS, Spertus JA. Physician Estimates and Patient-Reported Health Status in Atrial Fibrillation. JAMA Netw Open 2024; 7:e2356693. [PMID: 38393730 PMCID: PMC10891467 DOI: 10.1001/jamanetworkopen.2023.56693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/21/2023] [Indexed: 02/25/2024] Open
Abstract
Importance A primary objective in managing atrial fibrillation (AF) is to optimize patients' health status, which can be done only if physicians accurately quantify the outcomes associated with AF in patients' lives. Objective To explore physicians' estimation of the health status of patients with AF and its association with subsequent care and outcomes. Design, Setting, and Participants A multicenter, prospective cohort study was conducted in 2 outpatient practices in Tokyo, Japan. Participants included patients with newly diagnosed AF or those referred for initial treatment of AF at outpatient practices and treating physicians from November 8, 2018, to April 1, 2020. Data analysis was performed from December 22, 2022, to July 7, 2023. Exposures Participating patients completed the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire, a 20-item tool covering 4 domains with a 7-point Likert scale; 3 domains (symptoms, daily activities, and treatment concerns) were used in this study. Blinded to patients' responses, treating physicians answered a 3-item questionnaire quantifying each patient's AFEQT domain with a single item. Patients' mean Likert scale responses within each AFEQT domain were subtracted from the physicians' assessments so that higher scores (≥0.5 points) indicate physician underestimation, while lower scores (≤0.5 points) indicate physician overestimation of the health status of patients with AF. Main Outcomes and Measures The independent association of physician-patient concordance with treatment escalation (alteration or initiation of antiarrhythmic drugs, cardioversion, or catheter ablation) and 1-year adjusted changes in AFEQT scores. Results Among 330 patients (238 [72.1%] men; mean [SD] age, 67.9 [11.9] years; 163 [49.4%] with paroxysmal AF), physicians correctly estimated health status in 112 patients (33.9%), underestimated it in 42 patients (12.7%), and overestimated it in 176 patients (53.3%). Treatment escalation occurred in 63.6% of patients whose health status was correctly estimated, 47.6% of those whose health status was underestimated, and 66.3% of patients whose health status was overestimated. After multivariable adjustment, underestimation of health status was independently associated with less treatment escalation (adjusted odds ratio, 0.43; 95% CI, 0.20-0.90) and less frequent AFEQT overall summary score improvement at 1 year (underestimated, 2.5 [95% CI, -1.6 to 6.7] vs correctly and overestimated health status, 8.4 [95% CI, 7.0-9.9] points; P = .01). Conclusions and Relevance In this cohort study, physician underestimation of the health status of patients with AF was common and associated with less aggressive treatment and less health status improvement at 1 year.
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Affiliation(s)
- Nobuhiro Ikemura
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
- University of Missouri–Kansas City’s Healthcare Institute for Innovations in Quality and Saint Luke’s Mid America Heart Institute, Kansas City
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Takehiro Kimura
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Philip G. Jones
- University of Missouri–Kansas City’s Healthcare Institute for Innovations in Quality and Saint Luke’s Mid America Heart Institute, Kansas City
| | | | - Kojiro Tanimoto
- Department of Cardiology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Ikuko Ueda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Seiji Takatsuki
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Masaki Ieda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Paul S. Chan
- University of Missouri–Kansas City’s Healthcare Institute for Innovations in Quality and Saint Luke’s Mid America Heart Institute, Kansas City
| | - John A. Spertus
- University of Missouri–Kansas City’s Healthcare Institute for Innovations in Quality and Saint Luke’s Mid America Heart Institute, Kansas City
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Farraj H, Alriyalat S. Urinary Incontinence Following Robotic-Assisted Radical Prostatectomy: A Literature Review. Cureus 2024; 16:e53058. [PMID: 38410341 PMCID: PMC10896250 DOI: 10.7759/cureus.53058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2024] [Indexed: 02/28/2024] Open
Abstract
Prostate cancer ranks as one of the most prevalent cancers among men in the United States, contributing significantly to cancer-related mortality. Robot-assisted radical prostatectomy (RARP) has become a cornerstone in the management of localized prostate cancer. This literature review delves into the outcomes of RARP, specifically its impact on urinary incontinence (UI) compared to other surgical methods. We also present the importance of patient perception versus medical reports. Recent studies and trials have unveiled that postoperative UI and erectile dysfunction (ED) remain common concerns following prostatectomy. However, studies have shown that RARP has lower occurrences of UI and ED compared to radical retropubic prostatectomy (RRP). While the choice of surgical method may not drastically affect these outcomes, the review emphasizes that urinary incontinence extends beyond physical symptoms. It profoundly impacts patients' psychological well-being, social interactions, and overall quality of life. Differences in symptom recording and interpretation between patients and healthcare professionals can significantly influence the diagnosis and treatment of prostate cancer. Enhanced patient-physician communication and patient-centered care are essential to providing a holistic approach to prostate cancer management. The choice of surgical methods may not significantly impact postoperative urinary incontinence and erectile dysfunction. Continued research and advancements in treatment and patient care are crucial for improving outcomes and the overall well-being of prostate cancer patients.
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Affiliation(s)
- Hamzeh Farraj
- Department of Special Surgery, Division of Urology, Al-Balqa Applied University, Salt, JOR
| | - Sulieman Alriyalat
- Department of Special Surgery, Division of Urology, Al-Balqa Applied University, Salt, JOR
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Ikemura N, Spertus JA, Nguyen DD, Kimura T, Katsumata Y, Fu Z, Jones PG, Niimi N, Shoji S, Ueda I, Tanimoto K, Suzuki M, Fukuda K, Takatsuki S, Kohsaka S. Baseline Health Status and its Association With Subsequent Cardiovascular Events in Patients With Atrial Fibrillation. JACC Clin Electrophysiol 2023; 9:1934-1944. [PMID: 37498250 DOI: 10.1016/j.jacep.2023.05.037] [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] [Received: 01/09/2023] [Revised: 05/11/2023] [Accepted: 05/23/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Clinical practice guidelines recommend optimizing the health status of patients with atrial fibrillation (AF) as a primary treatment goal. Whether disease-specific health status is associated with subsequent clinical events is unknown. OBJECTIVES The aim of this study was to investigate the association between health status and subsequent clinical events among patients with AF. METHODS Using a prospective cohort study of patients with new-onset AF referred to 11 hospitals (n = 3,313, 68.4% men, mean age 67.8 ± 11.6 years), data were extracted from 3,296 patients (99.4%) who completed the disease-specific Atrial Fibrillation Effects on Quality-of-Life (AFEQT) questionnaire between 2012 and 2018. Factors associated with baseline AFEQT overall summary (OS) score and associations between major adverse cardiovascular or neurologic events (MACNE; a composite of all-cause death, stroke, or new-onset heart failure hospitalization) over 2 years were investigated. RESULTS Overall, 517 participants (15.6%) had poor to fair health status (AFEQT OS <60), and 1,035 (31.2%) had fair to good health status (AFEQT OS 60 to <80) at baseline. Female sex, younger age, family history of AF, higher baseline heart rate, paroxysmal AF, initial visit to the emergency department, and history of heart failure were associated with lower AFEQT OS scores. Of those, 226 participants (6.8%) experienced MACNE; restricted cubic spline analysis with adjustment for factors associated with baseline AFEQT score showed a nonlinear increase in the risk for MACNE with AFEQT OS score <80. The strongest associations were observed for baseline AFEQT daily activity scores (for AFEQT daily activity score of <80 vs ≥80, HR: 1.65; 95% CI: 1.21-2.25). CONCLUSIONS Diminished health status in patients with AF is common and is independently associated with subsequent adverse cardiovascular events.
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Affiliation(s)
- Nobuhiro Ikemura
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan; University of Missouri's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - John A Spertus
- University of Missouri's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Dan D Nguyen
- University of Missouri's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Takehiro Kimura
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | | | - Zhuxuan Fu
- University of Missouri's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Philip G Jones
- University of Missouri's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Nozomi Niimi
- Department of General Internal Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Satoshi Shoji
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Ikuko Ueda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Kojiro Tanimoto
- Department of Cardiology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Masahiro Suzuki
- Department of Cardiology, National Hospital Organization Saitama Hospital, Wako, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Seiji Takatsuki
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
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Kim JY, Park HS, Park HW, Choi EK, Park JK, Kim JB, Kang KW, Shim J, Joung B, Park KM. Clinical Outcomes of Rhythm Control Strategies for Asymptomatic Atrial Fibrillation According to the Quality-of-Life Score: The CODE-AF (Comparison Study of Drugs for Symptom Control and Complication Prevention of Atrial Fibrillation) Registry. J Am Heart Assoc 2022; 11:e025956. [PMID: 36073646 PMCID: PMC9683675 DOI: 10.1161/jaha.122.025956] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Atrial fibrillation (AF) is associated with an increased risk of poor cardiovascular outcomes; appropriate rhythm control can reduce the incidence of these adverse events. Therefore, catheter ablation is recommended in symptomatic patients with AF. The aims of this study were to compare AF-related outcomes according to a baseline symptom scale score and to determine the best treatment strategy for asymptomatic patients with AF. Methods and Results This study enrolled all patients who completed a baseline Atrial Fibrillation Effect on Quality-of-Life (AFEQT) survey in a prospective observational registry. The patients were divided into 2 groups according to AFEQT score at baseline; scores ≤80 were defined as symptomatic, whereas scores >80 represented asymptomatic patients. The primary outcome was defined as a composite of hospitalization for heart failure, ischemic stroke, or cardiac death. This study included 1515 patients (mean age: 65.7±10.5 years; 998 [65.9%] men). The survival curve showed a poorer outcome in the symptomatic group compared with the asymptomatic group (log-rank P=0.04). Rhythm control led to a significantly lower risk of a composite outcome in asymptomatic patients (hazard ratio [HR], 0.47 [95% CI, 0.27-0.84], P=0.01). Rhythm control was associated with more favorable composite outcomes in the asymptomatic group with paroxysmal AF, left atrium diameter ≤50 mm, and CHA2DS2-VASc score ≥3. Conclusions Symptomatic patients with AF experienced more adverse outcomes compared with asymptomatic patients. In asymptomatic patients with AF, a strategy of rhythm control improved the outcomes, especially with paroxysmal AF, smaller left atrium size, or higher stroke risk. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02786095.
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Affiliation(s)
- Ju Youn Kim
- Division of Cardiology, Department of Internal Medicine Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Hyoung-Seob Park
- Department of Cardiology Keimyung University Dongsan Hospital Daegu Republic of Korea
| | - Hyung Wook Park
- Department of Cardiovascular Medicine Chonnam National University Medical School Gwangju Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine Seoul National University Hospital Seoul Republic of Korea
| | - Jin-Kyu Park
- Division of Cardiology Hanyang University Medical College Seoul Republic of Korea
| | - Jin-Bae Kim
- Division of Cardiology Kyung Hee University Medical College Seoul Republic of Korea
| | - Ki-Woon Kang
- Division of Cardiology Chung-Ang University Hospital Seoul Republic of Korea
| | - Jaemin Shim
- Division of Cardiology Korea University Anam Hospital Seoul Republic of Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine Severance Cardiovascular Hospital, Yonsei University College of Medicine Seoul Republic of Korea
| | - Kyoung-Min Park
- Division of Cardiology, Department of Internal Medicine Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul Republic of Korea
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Miyama H, Ikemura N, Kimura T, Katsumata Y, Fujisawa T, Ueda I, Mitamura H, Negishi K, Nagami K, Fukuda K, Kohsaka S, Takatsuki S. Implications of QRS Prolongation in Patients With Atrial Fibrillation (from a Multicenter Outpatient Registry). Am J Cardiol 2022; 178:43-51. [PMID: 35811145 DOI: 10.1016/j.amjcard.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/17/2022] [Accepted: 05/23/2022] [Indexed: 11/01/2022]
Abstract
Patients with atrial fibrillation (AF) at the highest risk of progression to heart failure (HF) need to be identified. We investigated whether QRS duration can stratify patients with AF at risk for poor clinical outcomes, including health-related quality of life (HR-QoL). We analyzed data from a multicenter registry-based cohort study of patients with AF. Patients were grouped according to the QRS duration (narrow: <120 ms; wide: ≥120 ms) at registration (baseline). The primary outcome was a composite of all-cause death and HF hospitalizations during a 2-year follow-up. In addition, the AF effect on the quality-of-life overall summary score was compared between the groups. In 3,269 patients, 302 (9.2%) had a wide QRS; these patients were more likely to be older, male, and have higher CHA2DS2-VASc scores than those with a narrow QRS. The incidence of the composite outcome was higher in patients with a wide QRS than those with a narrow QRS (13.1% vs 4.9%, p <0.001). After adjustment, a wide QRS was an independent predictor of the primary outcome (adjusted hazard ratio 1.58, 95% confidence interval 1.09 to 2.29, p = 0.016), and the results persisted after the exclusion of patients with bundle branch block or cardiac implantable electronic devices. Regarding HR-QoL outcomes, patients with a wide QRS were less likely to improve AF effect on quality-of-life overall summary scores at 1 year than those with a narrow QRS (adjusted difference -2.31, 95% confidence interval -4.06 to -0.57, p = 0.009). QRS prolongation, even for a nonspecific conduction disturbance, was an independent predictor of adverse outcomes and worse HR-QoL in patients with AF.
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Affiliation(s)
- Hiroshi Miyama
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Nobuhiro Ikemura
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan; Division of Molecular Epidemiology, Jikei University School of Medicine, Tokyo, Japan
| | - Takehiro Kimura
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | | | - Taishi Fujisawa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Ikuko Ueda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hideo Mitamura
- Department of Cardiology, Tachikawa Hospital, Tachikawa, Tokyo, Japan
| | - Koji Negishi
- Department of Cardiology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Keiichi Nagami
- Department of Cardiology, Keiyu Hospital, Yokohama, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Seiji Takatsuki
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
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Tavazzi L, Maggioni AP, Rapezzi C, Ferrari R. Heart failure and catheter ablation of atrial fibrillation: Navigating the difficult waters of heart failure phenotypes. Eur J Intern Med 2022; 99:13-18. [PMID: 35241349 DOI: 10.1016/j.ejim.2022.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/07/2022] [Accepted: 02/16/2022] [Indexed: 11/03/2022]
Abstract
The use of catheter ablation of atrial fibrillation (AFA) is increasing and it has now been extended to include higher risk patients with heart failure (HF), based on evidence from observational studies and meta-analyses of randomized controlled trials (RCTs) indicating it as safe and beneficial in terms of quality of life, AF recurrence and hospital readmissions in the short-to-middle term. However, the RCTs so far have been relatively small with short follow-up, and few larger trials with long follow-up inconclusive about hard outcomes for large patient crossover undermining the robustness of the results. Importantly, most RCTs involved HF patients with reduced left ventricular ejection fraction (HFrEF). In contrast, most observational studies show that the majority of ablated HF patients in clinical practice have a preserved ejection fraction (HFpEF), a condition representing roughly half of all HF patients. This article provides an overview of the available scientific evidence in this clinical field and examines the current guideline recommendations. In the absence of robust evidence-based research, the recommendations on AFA in HF may be inconsistent or abstain from taking firm positions, particularly regarding AFA in HFpEF. There is need for clinical research in such a surprisingly orphan setting, in parallel with the current attempts to sort out the knotty question of the HF phenotypes, in particular, again, of the HFpEF phenotypes.
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Affiliation(s)
- Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care&Research, Cotignola (RA), Italy.
| | - Aldo P Maggioni
- Maria Cecilia Hospital, GVM Care&Research, Cotignola (RA), Italy; Centro Studi ANMCO, Firenze, Italy
| | - Claudio Rapezzi
- Maria Cecilia Hospital, GVM Care&Research, Cotignola (RA), Italy; Azienda Ospedaliero-Universitaria di Ferrara "Arcispedale S. Anna", Cona, Ferrara, Italy
| | - Roberto Ferrari
- Scientific Department, Medical Trial Analysis, Lugano, Switzerland
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Ikemura N, Spertus JA, Kimura T, Katsumata Y, Fujisawa T, Ueda I, Fukuda K, Takatsuki S, Kohsaka S. Baseline and Postprocedural Health Status Outcomes in Contemporary Patients With Atrial Fibrillation Who Underwent Catheter Ablation: A Report from the Japanese Outpatient Registry. J Am Heart Assoc 2021; 10:e019983. [PMID: 34514817 PMCID: PMC8649523 DOI: 10.1161/jaha.120.019983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Randomized clinical trials have demonstrated that catheter ablation (CA) for atrial fibrillation improves health‐related quality of life (HRQoL). In daily practice, however, CA is performed on a wide range of patients, and outcomes may vary. We aimed to examine baseline and 1‐year HRQoL outcomes of patients with atrial fibrillation after CA in daily practice. Methods and Results Using a registry‐based cohort study designed to recruit patients with atrial fibrillation newly referred to 11 hospitals, we extracted data from 1097 consecutive patients with atrial fibrillation who underwent CA between 2012 and 2019. The Atrial Fibrillation Effects on Quality of Life Overall Summary (AFEQT‐OS) was assessed at registration and 1 year after, and a 5‐point increase in AFEQT‐OS score was considered a meaningful improvement. Overall, the median age was 64 (interquartile range, 56–70) years, 836 (76.2%) were men, and 93.0% (n=1021) of the patients answered the AFEQT questionnaire. The mean AFEQT‐OS score was 74.9 (SD, 18.0) at registration and 88.8 (SD, 12.6) at 1 year after. Notably, the incidence of meaningful improvement in HRQoL after CA was 88.6% for the patients with impaired HRQoL (AFEQT‐OS score <80), which was only 40.1% in those with preserved HRQoL (AFEQT‐OS score ≥80). Female sex, left atrium diameter, and high baseline HRQoL were independently associated with nonimprovement after CA. Conclusions The improvement in HRQoL after CA was similar to that seen in clinical trials; however, one‐third of patients did not show improvement. These results underscore the importance of quantitative evaluation of patients’ HRQoL to maximize the effect of CA before its performance.
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Affiliation(s)
- Nobuhiro Ikemura
- Department of Cardiology Keio University School of Medicine Tokyo Japan.,Division of Molecular Epidemiology Jikei University School of Medicine Tokyo Japan
| | - John A Spertus
- Cardiovascular Research Department of Biomedical and Health Informatics Saint Luke's Mid America Heart Institute/UMKC Kansas City MO
| | - Takehiro Kimura
- Department of Cardiology Keio University School of Medicine Tokyo Japan
| | | | - Taishi Fujisawa
- Department of Cardiology Keio University School of Medicine Tokyo Japan
| | - Ikuko Ueda
- Department of Cardiology Keio University School of Medicine Tokyo Japan
| | - Keiichi Fukuda
- Department of Cardiology Keio University School of Medicine Tokyo Japan
| | - Seiji Takatsuki
- Department of Cardiology Keio University School of Medicine Tokyo Japan
| | - Shun Kohsaka
- Department of Cardiology Keio University School of Medicine Tokyo Japan
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Bhat A, Khanna S, Chen HHL, Gupta A, Gan GCH, Denniss AR, MacIntyre CR, Tan TC. Integrated Care in Atrial Fibrillation: A Road Map to the Future. Circ Cardiovasc Qual Outcomes 2021; 14:e007411. [PMID: 33663224 PMCID: PMC7982130 DOI: 10.1161/circoutcomes.120.007411] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Atrial fibrillation (AF) is the most commonly encountered arrhythmia in clinical practice with an epidemiological coupling appreciated with advancing age, cardiometabolic risk factors, and structural heart disease. This has resulted in a significant public health burden over the years, evident through increasing rates of hospitalization and AF-related clinical encounters. The resultant gap in health care outcomes is largely twinned with suboptimal rates of anticoagulation prescription and adherence, deficits in symptom identification and management, and insufficient comorbid cardiovascular risk factor investigation and modification. In view of these shortfalls in care, the establishment of integrated chronic care models serves as a road map to best clinical practice. The expansion of integrated chronic care programs, which include multidisciplinary team care, nurse-led AF clinics, and use of telemedicine, are expected to improve AF-related outcomes in the coming years. This review will delve into current gaps in AF care and the role of integrated chronic care models in bridging fragmentations in its management.
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Affiliation(s)
- Aditya Bhat
- Department of Cardiology, Blacktown Hospital, Australia (A.B., S.K., H.H.L.C., A.G., G.C.H.G., A.R.D., T.C.T.).,School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia (A.B., G.C.H.G., C.R.M.)
| | - Shaun Khanna
- Department of Cardiology, Blacktown Hospital, Australia (A.B., S.K., H.H.L.C., A.G., G.C.H.G., A.R.D., T.C.T.)
| | - Henry H L Chen
- Department of Cardiology, Blacktown Hospital, Australia (A.B., S.K., H.H.L.C., A.G., G.C.H.G., A.R.D., T.C.T.)
| | - Arnav Gupta
- Department of Cardiology, Blacktown Hospital, Australia (A.B., S.K., H.H.L.C., A.G., G.C.H.G., A.R.D., T.C.T.)
| | - Gary C H Gan
- Department of Cardiology, Blacktown Hospital, Australia (A.B., S.K., H.H.L.C., A.G., G.C.H.G., A.R.D., T.C.T.).,School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia (A.B., G.C.H.G., C.R.M.)
| | - A Robert Denniss
- Department of Cardiology, Blacktown Hospital, Australia (A.B., S.K., H.H.L.C., A.G., G.C.H.G., A.R.D., T.C.T.).,Department of Cardiology, Westmead Hospital, Australia (A.R.D., T.C.T.)
| | - C Raina MacIntyre
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia (A.B., G.C.H.G., C.R.M.)
| | - Timothy C Tan
- Department of Cardiology, Blacktown Hospital, Australia (A.B., S.K., H.H.L.C., A.G., G.C.H.G., A.R.D., T.C.T.).,Department of Cardiology, Westmead Hospital, Australia (A.R.D., T.C.T.)
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Katsumata Y, Kohsaka S, Ikemura N, Ueda I, Hashimoto K, Yamashita T, Miyama H, Fujisawa T, Kimura T, Tanimoto K, Momiyama Y, Suzuki M, Fukuda K, Takatsuki S. Symptom Under-Recognition of Atrial Fibrillation Patients in Consideration for Catheter Ablation: A Report From the KiCS-AF Registry. JACC Clin Electrophysiol 2020; 7:565-574. [PMID: 33358669 DOI: 10.1016/j.jacep.2020.10.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/14/2020] [Accepted: 10/18/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES This study sought to investigate whether symptom under-recognition is associated with the application of catheter ablation. BACKGROUND Atrial fibrillation (AF) symptom burden is frequently under-recognized and may affect the choice of treatment strategies. METHODS A total of 3,276 patients with AF consecutively registered in a Japanese multicenter database from 2012 to 2017 were analyzed. All patients underwent AF symptom burden assessment via the symptom and daily activities domain within the Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) questionnaire. For the present analysis, 1,173 symptomatic patients (AFEQT score ≤80) with a clinical indication for catheter ablation were included. Under-recognition of symptom burden was defined as no subjective complaints checked by physicians despite self-reported AFEQT scores ≤80. Logistic regression analysis identified the predictors associated with receiving catheter ablation. RESULTS Of the 1,173 patients (age: 68 ± 12 years, men: 61%) analyzed, 459 underwent catheter ablation (ablation group); they had lower overall AFEQT scores (p < 0.01 for all domains) compared with the nonablation group. At the 1-year follow-up, greater improvement in the AFEQT scores was noted in the ablation group, even after adjusting for clinically relevant factors (+20.0 ± 1.2, +14.2 ± 0.9, respectively; p < 0.001). Notably, 306 (28%) patients met the criteria for symptom under-recognition, which was associated with the nonuse of catheter ablation during follow-up (odds ratio: 0.41; 95% confidence interval: 0.28 to 0.60; p < 0.001). CONCLUSIONS Under-recognition of AF symptom burden was frequently noted and was associated with less use of catheter ablation. Standardized recognition of symptoms using the application of validated questionnaires may facilitate outcome improvement.
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Affiliation(s)
- Yoshinori Katsumata
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan; Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Nobuhiro Ikemura
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Ikuko Ueda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Kenji Hashimoto
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Terumasa Yamashita
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroshi Miyama
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Taishi Fujisawa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Takehiro Kimura
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Kojiro Tanimoto
- Department of Cardiology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yukihiko Momiyama
- Department of Cardiology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Masahiro Suzuki
- Department of Cardiology, National Hospital Organization Saitama National Hospital, Saitama, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Seiji Takatsuki
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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10
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Sears SF, Anthony S, Naniwadekar A. Modern atrial fibrillation care: Becoming a pro at using PROs. J Cardiovasc Electrophysiol 2020; 31:3196-3198. [PMID: 33118655 DOI: 10.1111/jce.14793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Samuel F Sears
- Department of Psychology, East Carolina University, Greenville, North Carolina, USA.,Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | - Scarlett Anthony
- Department of Psychology, East Carolina University, Greenville, North Carolina, USA
| | - Aditi Naniwadekar
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
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11
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Mirwais M, Reynolds M. Extending physicians' reach in grasping AF symptoms. Am Heart J 2020; 226:250-251. [PMID: 32460960 DOI: 10.1016/j.ahj.2020.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Maiwand Mirwais
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA
| | - Matthew Reynolds
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA.
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