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Nielsen MT, Hykkelbjerg Nielsen M, Andersen S, Riahi S, Geisler UW, Lynge Pedersen M, Albertsen N. Quality of care among patients diagnosed with atrial fibrillation in Greenland. Int J Circumpolar Health 2024; 83:2311965. [PMID: 38332615 PMCID: PMC10860410 DOI: 10.1080/22423982.2024.2311965] [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: 11/17/2023] [Accepted: 01/25/2024] [Indexed: 02/10/2024] Open
Abstract
This cross-sectional study sought to assess the prevalence of atrial fibrillation (AF) diagnosis in Greenland among various age groups and examine the corresponding quality of care. We collected data from Greenland's electronic medical records and evaluated the quality of care using six internationally recommended indicators, which are: percentage of AF patients with an assessment of smoking status within the previous year, an assessment of body mass index within the previous year, assessment of blood pressure within the previous year, measurement of thyroid stimulating hormone (TSH), treatment with an anticoagulant and percentage of patients with a measurement of serum-creatinine. We found the prevalence of AF among patients aged 20 years or older in Greenland to be 1.75% (95% CI 1.62-1.88). We found an increasing prevalence of AF with age and a greater proportion of men than women until the age of 74 years. Our study suggests that the associated quality of care could be higher as the requirement of only one of the six quality indicators was met. A lack of registration may partly explain this, and initiatives to improve the quality of care are recommended.
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Affiliation(s)
| | - Maja Hykkelbjerg Nielsen
- Steno Diabetes Centre Greenland, Queen Ingrid’s Hospital, Nuuk, Greenland
- Greenland Centre for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
- Department of Clinical Medicine, Incuba/Skejby, Aarhus University Hospital, Aarhus, Denmark
| | - Stig Andersen
- Greenland Centre for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
- Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, University of Aalborg, Aalborg, Denmark
| | - Sam Riahi
- Department of Clinical Medicine, University of Aalborg, Aalborg, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Michael Lynge Pedersen
- Steno Diabetes Centre Greenland, Queen Ingrid’s Hospital, Nuuk, Greenland
- Greenland Centre for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
| | - Nadja Albertsen
- Greenland Centre for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
- Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, University of Aalborg, Aalborg, Denmark
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2
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Salbach C, Milles BR, Hund H, Biener M, Mueller-Hennessen M, Frey N, Katus H, Giannitsis E, Yildirim M. Effect of impaired kidney function on outcomes and treatment effects of oral anticoagulant regimes in patients with atrial fibrillation in a real-world registry. PLoS One 2024; 19:e0310838. [PMID: 39312541 PMCID: PMC11419350 DOI: 10.1371/journal.pone.0310838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 09/07/2024] [Indexed: 09/25/2024] Open
Abstract
BACKGROUND The impact of impaired kidney function on outcomes and treatment benefits of vitamin-K antagonists (VKA) versus direct oral anticoagulants (DOAC) in patients with atrial fibrillation (AF) has insufficiently been investigated in randomized controlled studies (RCTs). Most studies and registries are either biased due to incomplete enrolment of consecutive patients in large pharma industry sponsored registries, or due to short recruitment periods or incomplete assessment of important variables in national registries. METHODS This study uses data from the Heidelberg Registry of Atrial Fibrillation (HERA-FIB), a retrospective single-center registry of 10,222 consecutive patients with AF presenting to the emergency department of University Hospital of Heidelberg from June 2009 until March 2020. Rates of all-cause mortality, stroke, major bleeding and myocardial infarction (MI) were related to the presence and severity of impaired presenting kidney function, as well as to assigned treatment with VKA vs. DOAC. RESULTS The risks for all-cause mortality (HR: 3.26, p<0.001), stroke (HR: 1.58, p<0.001), major bleeding (HR: 2.28, p<0.001) and MI (HR: 2.48, p<0.001) were significantly higher in patients with an eGFR<60 ml/min at admission and increased with decreasing eGFR. After adjustment for variables of CHA2DS2VASc-score, presence of eGFR <60 ml/min remained as an independent predictor for all-cause mortality, major bleeding and MI. The hazard ratio (HR) for all-cause mortality, major bleedings and MI was significantly lower in patients receiving DOAC compared to VKA. CONCLUSION Findings from our large real-life registry confirm the data from RCTs and extend our knowledge on the effectiveness and safety of DOACs to subjects that were underrepresented in RCTs.
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Affiliation(s)
- Christian Salbach
- Department of Internal Medicine III, Cardiology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Barbara Ruth Milles
- Department of Internal Medicine III, Cardiology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Hauke Hund
- Department of Internal Medicine III, Cardiology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Moritz Biener
- Department of Internal Medicine III, Cardiology, University Hospital of Heidelberg, Heidelberg, Germany
| | | | - Norbert Frey
- Department of Internal Medicine III, Cardiology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Hugo Katus
- Department of Internal Medicine III, Cardiology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Evangelos Giannitsis
- Department of Internal Medicine III, Cardiology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Mustafa Yildirim
- Department of Internal Medicine III, Cardiology, University Hospital of Heidelberg, Heidelberg, Germany
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3
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Li X, Si J, Liu Y, Xu D. Real world experience in effect of torsemide vs. furosemide after discharge in patients with HFpEF. ESC Heart Fail 2024. [PMID: 39238285 DOI: 10.1002/ehf2.15071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 08/20/2024] [Accepted: 08/23/2024] [Indexed: 09/07/2024] Open
Abstract
AIMS Few studies have focused on the effect of torsemide versus furosemide after discharge on prognosis in patients with heart failure with preserved ejection fraction (HFpEF). This single-centre retrospective real-world study was conducted to evaluate the effect of torsemide versus furosemide after discharge on all-cause mortality and rehospitalization for heart failure in patients with HFpEF. METHODS Consecutive patients who were diagnosis with HFpEF after discharge between January 2015 and April 2018 at the First Affiliated Hospital of Dalian Medical University and who had been treated with torsemide or furosemide were included in this study. The primary outcome was all-cause mortality. The second outcome was rehospitalization for heart failure. RESULTS A total of 445 patients (mean age 68.56 ± 8.07, female 55%) were divided into the torsemide group (N = 258) or furosemide group (N = 187) based on the treatment course at discharge from the hospital. During a mean follow-up of 87.67 ± 11.15 months, death occurred in 68 of 258 patients (26.36%) in the torsemide group and 60 of 187 patients (30.09%) in the furosemide group [hazard ratio (HR) 0.81, 95% confidence interval (CI) 0.57-1.15, P = 0.239]. Rehospitalization for heart failure occurred in 111 of 258 patients (43.02%) in the torsemide groups and 110 of 187 patients (58.82%) in the furosemide group (HR 0.64, 95% CI 0.49-0.85, P = 0.002). CONCLUSIONS Compared with furosemide, torsemide did not significantly reduce all-cause mortality, but there was association between torsemide and reduced rehospitalization for heart failure in patients with HFpEF.
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Affiliation(s)
- Xiao Li
- Department of Cardiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jinping Si
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ying Liu
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Danyan Xu
- Department of Cardiology, The Second Xiangya Hospital, Central South University, Changsha, China
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4
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Salbach C, Yildirim M, Hund H, Biener M, Müller‐Hennessen M, Frey N, Katus HA, Giannitsis E, Milles BR. Design, Rationale and Initial Findings From HERA-FIB on 10 222 Patients With Atrial Fibrillation Presenting to an Emergency Department Over An 11-Year Period. J Am Heart Assoc 2024; 13:e033396. [PMID: 38639359 PMCID: PMC11179873 DOI: 10.1161/jaha.123.033396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/21/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND For the majority of patients with atrial fibrillation (AF), disease management has improved in recent years. However, there are still populations underrepresented or excluded in current registries and randomized controlled trials. HERA-FIB (Heidelberg Registry of Atrial Fibrillation) was planned to assess real-world evidence for the prevalence, demographic characteristics and management of patients with the diagnosis of AF presenting consecutively to a chest pain unit. METHODS AND RESULTS HERA-FIB is a retrospective, observational, single-center study on patients with a diagnosis of AF presenting to a chest pain unit from June 2009 until March 2020. This article describes the structure, governance, outcome assessment, quality and data collection processes of the registry. Additionally, characteristics of populations of special interest are described. The study consecutively enrolled 10 222 patients presenting with AF to the chest pain unit of the University Hospital of Heidelberg. Clinical parameters and patient characteristics were assessed retrospectively. Outcome parameters included rates for all-cause death, stroke, myocardial infarction and major bleedings. We were able to investigate patient cohorts of special interest such as advanced chronic kidney disease, octogenarians, and those with acute coronary syndrome who are often underrepresented in current studies and randomized controlled trials. CONCLUSIONS HERA-FIB is one of the largest real-world single-center retrospective registries on patients with AF, which captures the era of transition from vitamin K antagonists to non-vitamin K oral anticoagulation regimens in clinical practice and offers the possibility to investigate patient populations usually underrepresented or excluded in current available randomized controlled trials and registries. REGISTRATION URL: https://www.clinicaltrials.gov; unique identifier: NCT05995561.
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Affiliation(s)
- Christian Salbach
- Department of Internal Medicine III, CardiologyUniversity Hospital of HeidelbergHeidelbergGermany
| | - Mustafa Yildirim
- Department of Internal Medicine III, CardiologyUniversity Hospital of HeidelbergHeidelbergGermany
| | - Hauke Hund
- Department of Internal Medicine III, CardiologyUniversity Hospital of HeidelbergHeidelbergGermany
| | - Moritz Biener
- Department of Internal Medicine III, CardiologyUniversity Hospital of HeidelbergHeidelbergGermany
| | | | - Norbert Frey
- Department of Internal Medicine III, CardiologyUniversity Hospital of HeidelbergHeidelbergGermany
| | - Hugo A. Katus
- Department of Internal Medicine III, CardiologyUniversity Hospital of HeidelbergHeidelbergGermany
| | - Evangelos Giannitsis
- Department of Internal Medicine III, CardiologyUniversity Hospital of HeidelbergHeidelbergGermany
| | - Barbara Ruth Milles
- Department of Internal Medicine III, CardiologyUniversity Hospital of HeidelbergHeidelbergGermany
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5
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Franco-Moreno A, Muñoz-Rivas N, Torres-Macho J, Bustamante-Fermosel A, Ancos-Aracil CL, Madroñal-Cerezo E. Systematic review of clinical trials on antithrombotic therapy with factor XI inhibitors. Rev Clin Esp 2024; 224:167-177. [PMID: 38309621 DOI: 10.1016/j.rceng.2024.01.006] [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] [Indexed: 02/05/2024]
Abstract
INTRODUCTION AND OBJECTIVE Data from phase 2 clinical trials suggest that factor XI inhibitors may exhibit a more favorable efficacy/safety profile compared to current antithrombotic therapies. The aim of this systematic review is to analyze the available evidence derived from these studies. METHODS A literature search in the PubMed, Cochrane Library, Scopus, EMBASE databases, and clinical trial registration platforms Clinical Trials and Cochrane Central Register of Controlled was conducted. In accordance with the PRISMA statement, results were reported. RESULTS A total of 18 completed or ongoing clinical trials addressing multiple scenarios, including atrial fibrillation, stroke, myocardial infarction, and venous thromboembolism, were identified. Evidence from 8 studies with available results was analyzed. Phase 2 studies with factor XI inhibitors, overall, demonstrated an acceptable efficacy and safety profile. The benefit-risk balance, in terms of reducing venous thromboembolism in patients undergoing total knee arthroplasty, was more favorable. For this scenario, factor XI inhibitors showed a 50% reduction in the overall rate of thrombotic complications and a 60% reduction in the rate of bleeding compared to enoxaparin. Modest results in studies involving patients with atrial fibrillation, stroke, and myocardial infarction were observed. CONCLUSIONS Factor XI inhibitors offer new prospects in antithrombotic treatment and prophylaxis. Ongoing phase 3 studies will help define the most suitable drugs and indications.
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Affiliation(s)
- A Franco-Moreno
- Servicio de Medicina Interna, Unidad de Tromboembolismo Venoso, Hospital Universitario Infanta Leonor-Virgen de la Torre, Madrid, Spain.
| | - N Muñoz-Rivas
- Servicio de Medicina Interna, Unidad de Tromboembolismo Venoso, Hospital Universitario Infanta Leonor-Virgen de la Torre, Madrid, Spain
| | - J Torres-Macho
- Servicio de Medicina Interna, Hospital Universitario Infanta Leonor-Virgen de la Torre, Madrid, Spain
| | - A Bustamante-Fermosel
- Servicio de Medicina Interna, Hospital Universitario Infanta Leonor-Virgen de la Torre, Madrid, Spain
| | - C L Ancos-Aracil
- Servicio de Medicina Interna, Unidad de Tromboembolismo Venoso, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - E Madroñal-Cerezo
- Servicio de Medicina Interna, Unidad de Tromboembolismo Venoso, Hospital Universitario de Fuenlabrada, Madrid, Spain
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Iliodromitis K, Tzeis S, Xintarakou A, Pyrgakis V, Zarifis I, Patsilinakos S, Draganigos A, Triposkiadis F, Hahalis G, Karanasios A, Goudevenos I, Michalis L, Karvounis C, Parthenakis F, Kanakakis I, Tousoulis D, Iliodromitis E, Vardas P. The burden of atrial fibrillation and heart failure in hospitalized patients: A real-world survey in a nationwide snapshot. Hellenic J Cardiol 2023; 74:18-23. [PMID: 37141945 DOI: 10.1016/j.hjc.2023.04.008] [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: 10/12/2022] [Revised: 02/09/2023] [Accepted: 04/25/2023] [Indexed: 05/06/2023] Open
Abstract
PURPOSE Atrial fibrillation (AF) and heart failure (HF) are common and commonly coexisting cardiovascular diseases in hospitalized patients. We report the absolute number and interrelation between AF and HF, assess the daily burden of both diseases on the healthcare system, and describe the medical treatment in a real-world, nationwide conducted snapshot survey. METHODS A questionnaire was equally distributed to various healthcare institutions. Data on the baseline characteristics, prior hospitalizations, and medical treatments of all hospitalized patients with AF and HF at a predefined date were collected and analyzed. RESULTS Seventy-five cardiological departments participated in this multicenter Greek nationwide study. A total of 603 patients (mean age, 74.5 ± 11.4 years) with AF, HF, or the combination of both were nationwide admitted. AF, HF, and the combination of both were registered in 122 (20.2%), 196 (32.5%), and 285 (47.3%) patients, respectively. First-time hospital admission was recorded in 273 (45.7%) of 597 patients, whereas 324 (54.3%) of 597 patients had readmissions in the past 12 months. Of the entire population, 453 (75.1%) were on beta-blockers (BBs), and 430 (71.3%) were on loop diuretics. Furthermore, 315 patients with AF (77.4%) were on oral anticoagulation, of whom 191 (46.9%) were on a direct oral anticoagulant and 124 (30.5%) were on a vitamin K antagonist. CONCLUSION Hospitalized patients with AF and/or HF have more than one admission within a year. Coexistence of AF and HF is more common. BBs and loop diuretics are the most commonly used drugs. More than three-quarters of the patients with AF were on oral anticoagulation.
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Affiliation(s)
- Konstantinos Iliodromitis
- Clinic for Cardiology and Electrophysiology, Evangelical Hospital Hagen-Haspe, Germany & Hellenic Cardioresearch Foundation, Greece; School of Medicine, Witten/Herdecke University, Witten, Germany.
| | - Stylianos Tzeis
- Cardiology Department, Mitera General Hospital, Athens, Greece
| | | | - Vlasios Pyrgakis
- Cardiology Department, G. Gennimatas General Hospital, Athens, Greece
| | - Ioannis Zarifis
- Cardiology Department, Papanicolaou General Hospital, Thessaloniki, Greece
| | | | | | - Filippos Triposkiadis
- Department of Cardiology, Larissa University General Hospital, 413 34, Larissa, Greece
| | - George Hahalis
- Department of Cardiology Medical School, University Hospital of Patra, Patra, Greece
| | | | - Ioannis Goudevenos
- Department of Cardiology Medical School, University Hospital of Ioannina, Ioannina, Greece
| | - Lampros Michalis
- Department of Cardiology Medical School, University Hospital of Ioannina, Ioannina, Greece
| | - Charalampos Karvounis
- First Department of Cardiology, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Fraggiskos Parthenakis
- Department of Cardiology, Medical School, University Hospital of Heraklion, Crete, Greece
| | | | - Dimitrios Tousoulis
- First Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Panos Vardas
- Professor Emeritus of Cardiology, University of Crete, Former President of the European Society of Cardiology, Mitera General Hospital, HYGEIA Group, Greece & Hellenic Cardioresearch Foundation, Athens, Greece
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One-Year Clinical Outcome in Middle Eastern Patients with Atrial Fibrillation: The Jordan Atrial Fibrillation (JoFib) Study. Int J Vasc Med 2022; 2022:4240999. [PMID: 35462945 PMCID: PMC9020983 DOI: 10.1155/2022/4240999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 12/12/2022] Open
Abstract
Background. Prevention of stroke and systemic embolism (SE) prevention in patients with atrial fibrillation (AF) has radically changed in recent years. Data on contemporary utilization of oral anticoagulants (OACs) and cardiovascular outcome in Middle Eastern patients with AF are needed. Methods. The Jordan atrial fibrillation (JoFib) study enrolled consecutive patients with AF in Jordan from May 2019 through October 2020 and were followed up for one year after enrollment. Results. Overall, 2020 patients were enrolled. The mean age was
years. Nonvalvular (NVAF) was diagnosed in 1849 (91.5%) patients. OACs were used in 85.7% of high-risk patients with NVAF (CHA2DS2-VASc score>3 in women, and>2 in men), including direct OACs (DOACs) in 64.1% and vitamin K antagonists (VKA) in 35.9%. Adherence rate to the use of the same OAC agent was 90.6% of patients. One-year cardiovascular (CV) mortality was 7.8%, stroke/SE was 4.5%, and major bleeding events were 2.6%. Independent predictors for all-cause mortality in patients with NVAF were age>75 years, heart failure, major bleeding event, type 2 diabetes mellitus, study enrollment as an in-patient, and coronary heart disease. The use of OACs was associated with lower all-cause mortality. The strongest independent predictors for stroke/SE were high-risk CHA2DS2-VASc score and prior history of stroke. Conclusions. This study of Middle Eastern AF patients has reported high adherence to OACs. The use of OACs was associated with a lower risk for all-cause mortality. One-year rates of stroke and major bleeding events were comparable to those reported from other regions in the world.
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Barriers to prescribing oral anticoagulants to inpatients aged 80 years and older with nonvalvular atrial fibrillation: a cross-sectional study. BMC Geriatr 2022; 22:263. [PMID: 35354397 PMCID: PMC8969391 DOI: 10.1186/s12877-022-02965-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/22/2022] [Indexed: 02/08/2023] Open
Abstract
Background To investigate the temporal trend of the prevalence of underprescription of anticoagulation treatment and explore the factors associated with underprescription of oral anticoagulants (OACs) among inpatients aged ≥ 80 years with nonvalvular atrial fibrillation (NVAF). Methods We retrospectively reviewed the medical records of inpatients with a discharge diagnosis of NVAF from a medical database. We used the Pearson chi-square or Fisher’s exact test to compare categorical variables between patients with and without OAC prescriptions during hospitalization. Logistic regression analysis was used to assess the association between risk factors and underprescription of OACs. Results A total of 4375 patients aged ≥ 80 years with AF were assessed in the largest academic hospital in China from August 1, 2016, to July 31, 2020, and 3165 NVAF patients were included. The prevalence of underprescription of OACs was 79.1% in 2017, 71.3% in 2018, 64.4% in 2019, and 56.1% in 2020. Of all participants, 2138 (67.6%) were not prescribed OACs; 66.3% and 68.2% of patients with and without prior stroke did not receive OACs, respectively. Age (85–89 vs 80–84, OR = 1.48, 95% CI (1.25–1.74); 90 + vs 80–84, OR = 2.66, 95% CI: 2.09–3.42), clinical department where patients were discharged (Reference = Cardiology, Geriatrics: OR = 2.97, 95% CI: 2.45- 3.61; neurology: OR = 1.25, 95% CI: 0.96, 1.63; others: OR = 4.23, 95% CI: 3.43- 5.24), use of antiplatelets (OR = 1.69, 95% CI: 1.45- 1.97), and history of stroke (OR = 0.83, 95% CI: 0.71- 0.98 adjusted age), and dementia (OR = 2.16, 95% CI: 1.60- 2.96) were significantly associated with not prescribing OACs. Conclusions The prevalence of underprescription of OACs has decreased over the past several years. The rate of underprescription of OACs was higher among NVAF patients who were older, prescribed antiplatelets, discharged from nondepartmental cardiology, and suffered from comorbidities. This study found iatrogenic factors affecting the underprescription of OACs in inpatients aged ≥ 80 years, providing clues and a basis for the standardized use of OACs in inpatients.
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Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 2629] [Impact Index Per Article: 1314.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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10
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Hornestam B, Adiels M, Wai Giang K, Hansson PO, Björck L, Rosengren A. Atrial fibrillation and risk of venous thromboembolism: a Swedish Nationwide Registry Study. Europace 2021; 23:1913-1921. [PMID: 34279622 DOI: 10.1093/europace/euab180] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 06/30/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS Atrial fibrillation (AF) is associated with arterial thromboembolism, mainly ischaemic stroke, while venous thromboembolism (VTE) in AF is less well studied. The aim of this study, therefore, was to examine the relationship between AF and VTE, including pulmonary embolism (PE) and deep venous thrombosis (DVT). METHODS AND RESULTS AF cases without previous VTE, ischaemic stroke or pulmonary arterial hypertension were identified from the Swedish Inpatient Registry between 1987 and 2013 and compared to two population controls per case without AF matched for age, sex, and county with respect to the incidence of VTE, PE, and DVT. In total, 463 244 AF cases were compared to 887 336 population controls. In both men and women, VTE rates were higher among AF patients the first 30 days after an AF diagnosis [40.2 vs. 5.7 in men and 55.7 vs. 6.6 in women per 1000 person-years at risk, respectively; hazard ratios 6.64 (95% confidence interval, 5.74-7.69) and 7.56 (6.47-8.83)]; and then decreasing, simultaneously with an increasing number of AF patients being treated with oral anticoagulation. VTE risk was similar to controls after 9 months in men but remained slightly elevated in women. CONCLUSION AF is strongly associated with an increased risk of VTE during the first months after diagnosis. Introduction of anticoagulant therapy soon after AF diagnosis might reduce the risk of VTE as well as of ischaemic stroke.
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Affiliation(s)
- Björn Hornestam
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg, Sweden.,Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Medicine, Geriatrics and Emergency Medicine, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Martin Adiels
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg, Sweden.,Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Medicine, Geriatrics and Emergency Medicine, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.,Department of Public Health and Community Medicine, Health Metrics Unit, Gothenburg, Sweden
| | - Kok Wai Giang
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg, Sweden.,Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Medicine, Geriatrics and Emergency Medicine, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Per-Olof Hansson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg, Sweden.,Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Medicine, Geriatrics and Emergency Medicine, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Lena Björck
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg, Sweden.,Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Medicine, Geriatrics and Emergency Medicine, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg, Sweden.,Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Medicine, Geriatrics and Emergency Medicine, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
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11
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Mazurek M, Halperin JL, Huisman MV, Diener HC, Dubner SJ, Ma CS, Rothman KJ, Healey JS, Teutsch C, Paquette M, França LR, Lu S, Bartels DB, Lip GYH. Antithrombotic treatment for newly diagnosed atrial fibrillation in relation to patient age: the GLORIA-AF registry programme. Europace 2021; 22:47-57. [PMID: 31651951 DOI: 10.1093/europace/euz278] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 10/21/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS To assess antithrombotic therapy choices in relation to patient age in a large, global registry on atrial fibrillation (AF). METHODS AND RESULTS Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF) is an international programme involving patients with newly diagnosed AF and ≥1 risk factors for stroke. We used Phase II data (from November 2011 through December 2014), which commenced immediately following first non-vitamin K antagonist oral anticoagulants (NOACs) approval in participating countries. Of 15 092 patients (mean age 70.5 ± 11.0 years), enrolled at 982 centres, 26.9% were aged <65 years, 33.9% 65-74, 30.5% 75-84, and 8.6% ≥85 years old. Oral anticoagulant (OAC) use was 73.5%, 81.4%, 83.3%, and 82.3% (overall NOACs use was 44.4%, 49.7%, 48.7%, and 45.6%) for those aged <65, 65-74, 75-84 and ≥85 years, respectively. Corresponding proportions for antiplatelet monotherapy and no treatment were: 16.2% and 10.2%; 11.2% and 7.3%; 10.0% and 6.5%; 10.5% and 7.0%, respectively. Of those aged 65-74, 75-84, and ≥85 years, respectively, 83.7, 86.8 and 85.4% received OAC unless bleeding risk was high (HAS-BLED ≥3), whereby 64.1%, 63.5%, and 64.5% were anticoagulated, and 31.1%, 30.3%, and 31.3% received antiplatelets only. Of patients ≥85 years, OAC use was 88.1% in Europe (NOAC 45.1%), 79.5% in North America (NOAC 44.8%), and 54.1% in Asia (NOAC 40.2%). CONCLUSION Despite geographic differences in OAC use, neither OAC nor NOAC uptake was lower for patients ≥85 years old compared with younger patients. Although the majority of patients was prescribed OAC at all ages, nearly one-third received antiplatelet monotherapy when bleeding risk was increased. CLINICAL TRIAL REGISTRATION http://www.clinicaltrials.gov. Unique identifier: NCT01468701.
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Affiliation(s)
- Michał Mazurek
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Medical University, Silesian Centre for Heart Diseases, Zabrze, Poland
| | | | - Menno V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Sergio J Dubner
- Clínica y Maternidad Suizo Argentina, Buenos Aires, Argentina
| | - Chang Sheng Ma
- Department of Cardiology, Atrial Fibrillation Center, Beijing AnZhen Hospital, Capital Medical University, Beijing, China
| | - Kenneth J Rothman
- RTI Health Solutions, Research Triangle Institute, Research Triangle Park, NC, USA
| | - Jeff S Healey
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Christine Teutsch
- Department of Clinical Development and Medical Affairs, Boehringer Ingelheim Pharma GmbH und Co KG, Ingelheim, Germany
| | - Miney Paquette
- Department of Medicine, Boehringer Ingelheim, Burlington, Canada
| | - Lionel Riou França
- Global Epidemiology, Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Shihai Lu
- Department of Biostatistics and Data Sciences, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | - Dorothee B Bartels
- Global Epidemiology, Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany.,Hannover Medical School, Hannover, Germany
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
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12
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Ouali S, Ben Halima A, Chabrak S, Chettaoui R, Ben Halima M, Haggui A, Krichane S, Noureddine L, Marrakchi S, Charfeddine S, Hassine M, Sayahi K, Abbes Mohamed F, Nasraoui W, Ajmi H, Ben Miled M, Jebbari Z, Meghaieth MA, Allouche E, Mechmeche R, Zakhama L, Sdiri W, Ben Khalfallah A, Gharbi A, Milouchi S, Neji A, Antit S, Battikh K, Drissa M, Kaabachi S, Najar T, Tlili R, Chahbani I, Charfeddine H, Ben MM, Braham S, Maatouk F, Abdesselem S, Ayari M, Garbaa R, Hamrouni N, Mbarek D, Rekik H, Zaghdoudi H, Ayadi W, Baraket F, Ben Brahim K, Ben Romdhane M, Bousadia H, Brahim W, Mezri M, Guesmi A, Ounissi T, Kammoun S, Smati W, Tlili S, Zoughi K, Zemni J, Cheikh Bouhlel M, Islem S, Jemli R, Joulak A, Mzoughi K, Naanea H, Hached L, Hadrich M, Hmem M, Kacem S, Kammoun I, Othmani R, Ouerghi A, Abid S, Ennouri R, Haidar S, Heraiech S, Jammali M, Jarrar M, Riahi L, Trimech B, Azaiez MA, Azzouzi F, Ben Jemaa K, Ben Rejab O, Chrigui R, Wechtati W, Boughzela E, Jridi G, Bezdah L, Kraiem S, Drissa H, Ben Youssef S, Fehri W, Kachboura S, Gamra H, Kammoun S, Mourali MS, Addad F, Abid L. Epidemiological characteristics, management, and outcomes of atrial fibrillation in TUNISIA: Results from the National Tunisian Registry of Atrial Fibrillation (NATURE-AF). Clin Cardiol 2021; 44:501-510. [PMID: 33704830 PMCID: PMC8027580 DOI: 10.1002/clc.23558] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/18/2021] [Accepted: 01/27/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Contemporary registries on atrial fibrillation (AF) are scare in North African countries. HYPOTHESIS In the context of the epidemiological transition, prevalence of valvular AF in Tunisia has decreased and the quality of management is still suboptimal. METHODS NATURE-AF is a prospective Tunisian registry, involving consecutive patients with AF from March 1, 2017 to May 31, 2017, with a one-year follow-up period. All the patients with an Electrocardiogram-documented AF, confirmed in the year prior to enrolment were eligible. The epidemiological characteristics and outcomes were described. RESULTS A total of 915 patients were included in this study, with a mean age of 64.3 ± 22 years and a male/female sex ratio of 0.93. Valvular AF was identified in 22.4% of the patients. The mean CHA2 DS2 VASC score in nonvalvular AF was 2.4 ± 1.6. Monotherapy with antiplatelet agents was prescribed for 13.8% of the patients. However, 21.7% of the subjects did not receive any antithrombotic agent. Oral anticoagulants were prescribed for half of the patients with a low embolic risk score. In 341 patients, the mean time in therapeutic range was 48.87 ± 28.69%. Amiodarone was the most common antiarrhythmic agent used (52.6%). During a 12-month follow-up period, 15 patients (1.64%) had thromboembolism, 53 patients (5.8%) had major hemorrhage, and 52 patients (5.7%) died. CONCLUSIONS NATURE-AF has provided systematic collection of contemporary data regarding the epidemiological and clinical characteristics as well as the management of AF by cardiologists in Tunisia. Valvular AF is still prevalent and the quality of anticoagulation was suboptimal.
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Affiliation(s)
| | - Afef Ben Halima
- Abderrahman Mami Pneumology and Phthisiology Hospital, Ariana, Tunisia
| | | | | | | | | | | | | | - Sonia Marrakchi
- Abderrahman Mami Pneumology and Phthisiology Hospital, Ariana, Tunisia
| | | | - Majed Hassine
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | | | | | | | | | | | | | | | | | | | - Lilia Zakhama
- La Marsa Internal Security Forces Hospital, La Marsa, Tunisia
| | | | | | | | | | - Ali Neji
- Ben Guerdane Hospital, Medenine, Tunisia
| | - Saoussen Antit
- La Marsa Internal Security Forces Hospital, La Marsa, Tunisia
| | | | | | | | | | - Rami Tlili
- University Hospital Center Mongi Slim, La Marsa, Tunisia
| | | | | | | | | | - Faouzi Maatouk
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | | | | | | | | | - Dorra Mbarek
- University Hospital Center Mongi Slim, La Marsa, Tunisia
| | | | | | | | | | | | | | | | | | | | - Ali Guesmi
- Mohamed Ben Sassi Hospital, Gabes, Tunisia
| | - Taha Ounissi
- Mohamed Taher Al Maamouri Hospital, Nabeul, Tunisia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ikram Kammoun
- Abderrahman Mami Pneumology and Phthisiology Hospital, Ariana, Tunisia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Wafa Fehri
- Hôpital Militaire Principal d'instruction de Tunis, Tunis, Tunisia
| | - Salem Kachboura
- Abderrahman Mami Pneumology and Phthisiology Hospital, Ariana, Tunisia
| | - Habib Gamra
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | | | | | - Faouzi Addad
- Abderrahman Mami Pneumology and Phthisiology Hospital, Ariana, Tunisia
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13
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Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 3176] [Impact Index Per Article: 1058.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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14
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Kotalczyk A, Gue YX, Potpara TS, Lip GYH. Current trends in the use of anticoagulant pharmacotherapy in the United Kingdom are changes on the horizon? Expert Opin Pharmacother 2021; 22:1061-1070. [PMID: 33491506 DOI: 10.1080/14656566.2021.1879050] [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: 12/16/2022]
Abstract
INTRODUCTION Effective stroke prevention with oral anticoagulation (OAC) reduces the risk of stroke and death among patients with atrial fibrillation (AF). For most patients with AF, treatment options include vitamin K antagonists (VKA) or non-vitamin K antagonist oral anticoagulants (NOACs). NOACs have been introduced as an alternative to VKAs, and their use has been steadily increasing in the United Kingdom and Europe over a decade. In randomized clinical trials, NOACs had a favorable risk-benefit profile as compared to warfarin. However, there is a concern about their long-term safety in clinical practice, especially in high-risk patients. There have been a number of registries and surveys based on the real-world patients with AF which has been conducted and published, providing data on contemporary AF management. AREAS COVERED In this narrative review, the authors discuss current trends in the use of OAC in the United Kingdom and Europe, considering the potential directions for future anticoagulant therapy in patients with AF. EXPERT OPINION The increasing prevalence of AF and AF-related comorbidities proves the need for comprehensive prevention and management strategies. The challenge is the optimization of therapy for each patient. However, there are still gaps in optimal stroke prevention, and the mortality rates remain high in patients with AF.
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Affiliation(s)
- Agnieszka Kotalczyk
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Ying X Gue
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Tatjana S Potpara
- School of Medicine, Belgrade University; Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland.,School of Medicine, Belgrade University; Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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15
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Boriani G, Huisman MV, Teutsch C, Marler S, França LR, Lu S, Lip GYH. Influence of BMI and geographical region on prescription of oral anticoagulants in newly diagnosed atrial fibrillation: The GLORIA-AF Registry Program. Eur J Intern Med 2020; 80:35-44. [PMID: 32414640 DOI: 10.1016/j.ejim.2020.04.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/08/2020] [Accepted: 04/13/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To investigate the association between body mass index (BMI) and oral anticoagulant (OAC) prescription in atrial fibrillation (AF). METHODS Patients with newly diagnosed non-valvular AF (<3 months) with ≥1 stroke risk factors enrolled in the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF) in Asia, Europe and North America were evaluated. RESULTS The cohort (n = 13,793) comprised patients from all BMI categories (kg/m2): 1.4% were underweight (<18.5), 27.3% had a normal BMI (18.5 to <25), 37.9% were overweight (25 to <30), 19.3% were moderately obese (30 to <35), and 12.7% were morbidly obese (≥35). The highest proportion of Asians had a BMI of 18.5 to <25 kg/m2, while the highest proportion of patients from Europe and North America were overweight and a substantial proportion of North Americans morbidly obese. In the multivariable analysis, the probability ratio of non-prescription of OAC, as compared to normal BMI, decreased for overweight (RR = 0.907), moderately obese (RR = 0.802) and severe very severe obese patients (RR = 0.659). Moreover, the probability ratio of non-prescription of OACs was increased in the Asia or North America regions, as compared with Europe, in patients aged <65 years or female patients, as well as in patients with prior bleeding or vascular disease. CONCLUSIONS The distribution of BMI differed among the continents. An increased BMI was associated with a lower probability of non-prescription of OACs, as compared with a normal BMI. The probability of non-prescription of OACs was increased in the Asia or North America regions, as compared with Europe.
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Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Italy.
| | - Menno V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Christine Teutsch
- Department of Clinical Development and Medical Affairs, Therapeutic Area Cardiometabolism, Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - Sabrina Marler
- Biostatistics and Data Sciences Department, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | | | - Shihai Lu
- Biostatistics and Data Sciences Department, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
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16
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Vitolo M, Proietti M, Harrison S, Lane DA, Potpara TS, Boriani G, Lip GYH. The Euro Heart Survey and EURObservational Research Programme (EORP) in atrial fibrillation registries: contribution to epidemiology, clinical management and therapy of atrial fibrillation patients over the last 20 years. Intern Emerg Med 2020; 15:1183-1192. [PMID: 32557091 DOI: 10.1007/s11739-020-02405-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/08/2020] [Indexed: 12/17/2022]
Abstract
Management of atrial fibrillation (AF) may be challenging in clinical practice. Given the complexity of AF patients and the continuous advances in AF clinical management, there is a need for standardized programmes aimed at collecting so-called 'real-world clinical practice data' regarding the epidemiology, diagnostic/therapeutic/management practices and assessing adherence to guidelines. Over the past 20 years, the number of registries and surveys based on real-world AF patients has been dramatically increased. In Europe, based on the Euro Heart Survey (EHS) and the EURObservational Research Programme (EORP), a large series of studies based on these prospective, observational, large-scale multicentre registries on AF have been published. This narrative review gives an overview of these two projects on AF led by the European Society of Cardiology, focusing mainly on the contribution that these studies have provided to AF management and patient outcomes. Both the EHS and the EORP registries have collected a large amount of data regarding contemporary clinical practice, and despite some limitations, mainly related to their observational nature, these registries have contributed to our knowledge and clinical management of AF patients.
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Affiliation(s)
- Marco Vitolo
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
| | - Marco Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Geriatric Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Stephanie Harrison
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Tatjana S Potpara
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK.
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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17
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Potpara TS, Lip GYH, Dagres N, Crijns HJMG, Boriani G, Kirchhof P, Arbelo E, Savelieva I, Lenarczyk R, Fauchier L, Maggioni AP, Gale CP. Cohort profile: the ESC EURObservational Research Programme Atrial Fibrillation III (AF III) Registry. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2020; 7:229-237. [DOI: 10.1093/ehjqcco/qcaa050] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/02/2020] [Indexed: 01/14/2023]
Abstract
Abstract
Aims
The European Society of Cardiology (ESC) EURObservational Research Programme (EORP)-Atrial Fibrillation (AF) III Registry aims to identify contemporary patterns in AF management in clinical practice, assess their compliance with the 2016 ESC AF Guidelines, identify major gaps in guideline implementation, characterize the clinical practice settings associated with good vs. poor guideline implementation and assess and compare the 1-year outcome of guideline-adherent vs. guideline non-adherent management strategies.
Methods and results
Consecutive adult AF patients (n = 8306) were enrolled between 1 July 2018 and 15 July 2019, and individual patient data were prospectively collected across 192 centres and 31 participating countries during the 3-month enrolment period per centre. The Registry collected baseline and 1-year follow-up data in the eight main domains: patient demographic/enrolment setting, AF diagnosis/characterization, diagnostic assessment, stroke prevention treatments, arrhythmia-directed therapies, integrated AF management, major outcomes (death, non-fatal stroke or systemic embolic event, and non-fatal bleeding event), and the quality of life questionnaire.
Conclusion
The EORP-AF III Registry is an international, prospective registry of care and outcomes of patients treated for AF, which will provide insights into the contemporary patterns in AF management, ESC AF Guidelines implementation in routine practice and barriers to optimal management of this highly prevalent arrhythmia.
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Affiliation(s)
- Tatjana S Potpara
- School of Medicine, Belgrade University, Dr Subotica 8, 11000 Belgrade, Serbia
- Cardiology Clinic, Clinical Centre of Serbia, Visegradska 26, 11000 Belgrade, Serbia
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Harry J M G Crijns
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | | | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, Medical School, University of Birmingham, Edgbaston, Birmingham, UK
- University Heart and Vascular Center, UKE Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Barcelona, Spain
| | - Elena Arbelo
- Department of Cardiology, Cardiovascular Institute, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Instit d’Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Irina Savelieva
- Division of Cardiac and Vascular Sciences, Molecular and Clinical Sciences Research Institute, St George’s University of London, London, UK
| | - Radoslaw Lenarczyk
- Department of Cardiology, Congenital Heart Disease and Electrotherapy, Silesian Medical University, Silesian Centre for Heart Diseases, Silesian Medical University, 9 Curie-Sklodowskiej St., Zabrze, Poland
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseauet Faculté de Médecine EA7505, Université de Tours, Tours, France
| | - Aldo P Maggioni
- EURObservational Research Programme, European Society of Cardiology, 2035 Route des Colles,Biot, 06903 Sophia-Antipolis, France
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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Vesa ŞC, Vlaicu SI, Sabin O, Văcăraș V, Crișan S, Istratoaie S, Samantar F, Popa DE, Macarie AE, Buzoianu AD. Evaluating Physician Adherence to Antithrombotic Recommendations in Patients with Atrial Fibrillation: A Pathway to Better Medical Education. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4008. [PMID: 32512937 PMCID: PMC7312043 DOI: 10.3390/ijerph17114008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/25/2020] [Accepted: 06/02/2020] [Indexed: 05/04/2023]
Abstract
BACKGROUND Atrial fibrillation is a major health problem due to the stroke risk associated with it. To reduce stroke risk, oral anticoagulants (OAC) are prescribed using the CHA2DS2-VASc (Congestive heart failure; Hypertension; Age ≥75 years; Diabetes Mellitus; Stroke; Vascular disease; Age 65-74 years; Sex category) risk score, a clinical probability assessment that includes a combination of risk factors predicting the probability of a stroke. Not all patients with high risk are receiving this treatment. The aim of this study was to assess physician adherence to clinical guidelines concerning the OAC treatment and to identify the factors that were associated with the decision to prescribe it. METHODS Registry data from 784 patients with non-valvular atrial fibrillation were evaluated in this retrospective cross-sectional study. Demographic data, subtype of AF, comorbidities associated with higher stroke and bleeding risk, and antithrombotic treatment received were recorded. We compared stroke and bleeding risk in patients with and without OAC treatment to determine if the clinicians followed guidelines: prescribed when necessary and abstained when not needed. RESULTS OAC treatment was administered in 617 (78.7%) patients. Of the 167 patients who did not receive OAC, 161 (96.4%) were undertreated according to their risk score, as opposed to those who received OAC in which the percentage of overtreated was 3.2%. Most undertreated patients (60.5%, p < 0.001) were with paroxysmal atrial fibrillation subtype. CONCLUSIONS The decision to use anticoagulants for stroke prevention was based on the type of atrial fibrillation, rather than on the risk of stroke as quantified by CHA2DS2-VASc as per the recommended guidelines.
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Affiliation(s)
- Ştefan Cristian Vesa
- Department of Pharmacology, Toxicology and Clinical Pharmacology, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania; (Ş.C.V.); (S.I.); (A.D.B.)
| | - Sonia Irina Vlaicu
- Department of Internal Medicine, 1st Medical Clinic, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania;
| | - Octavia Sabin
- Department of Pharmacology, Toxicology and Clinical Pharmacology, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania; (Ş.C.V.); (S.I.); (A.D.B.)
| | - Vitalie Văcăraș
- Department of Neurology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Sorin Crișan
- Department of Internal Medicine, 5th Medical Clinic, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400139 Cluj-Napoca, Romania;
| | - Sabina Istratoaie
- Department of Pharmacology, Toxicology and Clinical Pharmacology, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania; (Ş.C.V.); (S.I.); (A.D.B.)
| | - Fatuma Samantar
- Graduate of “Iuliu Haţieganu” Faculty of Medicine, University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania;
| | - Daciana Elena Popa
- Department of Cardiology, “Niculae Stăncioiu” Heart Institute, 400001 Cluj-Napoca, Romania;
| | - Antonia Eugenia Macarie
- Department of Geriatrics-Gerontology, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400139 Cluj-Napoca, Romania;
| | - Anca Dana Buzoianu
- Department of Pharmacology, Toxicology and Clinical Pharmacology, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania; (Ş.C.V.); (S.I.); (A.D.B.)
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19
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Cemin R, Colivicchi F, Maggioni AP, Boriani G, De Luca L, Di Lenarda A, Di Pasquale G, Fabbri G, Lucci D, Gulizia MM. One-year clinical events and management of patients with atrial fibrillation hospitalized in cardiology centers: Data from the BLITZ-AF study. Eur J Intern Med 2020; 74:55-60. [PMID: 31952984 DOI: 10.1016/j.ejim.2019.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 12/11/2019] [Accepted: 12/15/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND The management of atrial fibrillation (AF) has changed with the introduction of direct anticoagulants (DOACs) and new techniques such as catheter ablation. An update collection of data from "real world" AF patients followed by cardiologists is useful to obtain information on both management, outcomes and guideline adherence in clinical practice. METHODS Follow-up information on survival, embolic and bleeding events and hospital readmission, persistence of oral anticoagulant (OAC) therapy was collected in 84 centers participating to the BLITZ-AF study. RESULTS Patients were followed for a median of 366 days (IQR: 356-378) and vital status was available for 2159 patients. Mortality was 9.2%. Heart failure was the most common cardiovascular cause of death (70%) followed by arrhythmias (6.7%), acute coronary syndrome (5.0%) and ischemic stroke (2.5%). During follow-up 18.1% of the patients were readmitted, mainly (81.3%) for cardiovascular causes. Patients on OAC were 83.4%, 9.1% were on antiplatelets and 7.5% did not receive antithrombotic therapy. The use of DOACs increased from 42.1% to 46.4% during the follow-up, OAC discontinuation occurred in 9.1%. AF recurrences occurred in 23.4% of the patients discharged in sinus rhythm. Rate control strategy was adopted in 55.9% and beta-blockers were the most used drugs (81.9%). Amiodarone (22%) and flecainide (9.7%) were the most frequent used antiahrrythmic drugs. CONCLUSIONS The follow-up of the BLITZ-AF study provide an up to date picture of the clinical course of patients with AF, who appear frequently affected by heart failure and severe comorbidities which might have led to the high mortality rate.
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Affiliation(s)
- Roberto Cemin
- Cardiology Division, San Maurizio Regional Hospital of Bolzano, Bolzano, Italy
| | | | - Aldo P Maggioni
- ANMCO Research Center of the Heart Care Foundation, Florence, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Leonardo De Luca
- Division of Cardiology, San Giovanni Evangelista Hospital, Tivoli, Italy
| | - Andrea Di Lenarda
- Cardiovascular Center, University Hospital and Health Services of Trieste, Italy
| | | | - Gianna Fabbri
- ANMCO Research Center of the Heart Care Foundation, Florence, Italy
| | - Donata Lucci
- ANMCO Research Center of the Heart Care Foundation, Florence, Italy
| | - Michele Massimo Gulizia
- ANMCO Research Center of the Heart Care Foundation, Florence, Italy; Cardiology Division, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi" Catania, Italy.
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20
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Seligman WH, Das-Gupta Z, Jobi-Odeneye AO, Arbelo E, Banerjee A, Bollmann A, Caffrey-Armstrong B, Cehic DA, Corbalan R, Collins M, Dandamudi G, Dorairaj P, Fay M, Van Gelder IC, Goto S, Granger CB, Gyorgy B, Healey JS, Hendriks JM, Hills MT, Hobbs FDR, Huisman MV, Koplan KE, Lane DA, Lewis WR, Lobban T, Steinberg BA, McLeod CJ, Moseley S, Timmis A, Yutao G, Camm AJ. Development of an international standard set of outcome measures for patients with atrial fibrillation: a report of the International Consortium for Health Outcomes Measurement (ICHOM) atrial fibrillation working group. Eur Heart J 2020; 41:1132-1140. [PMID: 31995195 PMCID: PMC7060456 DOI: 10.1093/eurheartj/ehz871] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 10/14/2019] [Accepted: 12/02/2019] [Indexed: 12/28/2022] Open
Abstract
AIMS As health systems around the world increasingly look to measure and improve the value of care that they provide to patients, being able to measure the outcomes that matter most to patients is vital. To support the shift towards value-based health care in atrial fibrillation (AF), the International Consortium for Health Outcomes Measurement (ICHOM) assembled an international Working Group (WG) of 30 volunteers, including health professionals and patient representatives to develop a standardized minimum set of outcomes for benchmarking care delivery in clinical settings. METHODS AND RESULTS Using an online-modified Delphi process, outcomes important to patients and health professionals were selected and categorized into (i) long-term consequences of disease outcomes, (ii) complications of treatment outcomes, and (iii) patient-reported outcomes. The WG identified demographic and clinical variables for use as case-mix risk adjusters. These included baseline demographics, comorbidities, cognitive function, date of diagnosis, disease duration, medications prescribed and AF procedures, as well as smoking, body mass index (BMI), alcohol intake, and physical activity. Where appropriate, and for ease of implementation, standardization of outcomes and case-mix variables was achieved using ICD codes. The standard set underwent an open review process in which over 80% of patients surveyed agreed with the outcomes captured by the standard set. CONCLUSION Implementation of these consensus recommendations could help institutions to monitor, compare and improve the quality and delivery of chronic AF care. Their consistent definition and collection, using ICD codes where applicable, could also broaden the implementation of more patient-centric clinical outcomes research in AF.
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Affiliation(s)
- William H Seligman
- International Consortium for Health Outcomes Measurement, Hamilton House, London WC1H 9BB, UK
| | - Zofia Das-Gupta
- International Consortium for Health Outcomes Measurement, Hamilton House, London WC1H 9BB, UK
| | - Adedayo O Jobi-Odeneye
- International Consortium for Health Outcomes Measurement, Hamilton House, London WC1H 9BB, UK
| | - Elena Arbelo
- Hospital Clínic, Universitat de Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain
- IDIBAPS, Institut d'Investigacio, August Pi I Sunyer, Rossello, 149-153, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Av. Monforte de Lemos, 3-5. Pabellon 11. Planta 0 28029 Madrid, Spain
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, 222 Euston Road, London NW1 2DA, UK
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Strumpellstrabe 39, 04289 Leipzig, Germany
- Leipzig Heart Institute, Russenstrabe 69A, 04289 Leipzig, Germany
- Leipzig Heart Digital, Russenstrabe 69A, 04289 Leipzig, Germany
| | | | - Daniel A Cehic
- GenesisCare, Buildings 1&11, The Mill, 41-43 Bourke Road, Alexandria, NSW 2015, Australia
| | - Ramon Corbalan
- Cardiovascular Division, Pontificia Universidad Catolica de Chile, Av Libertador Bernardo O'Higgins 340, Santiago, Region Metropolitana, Chile
| | | | - Gopi Dandamudi
- CHI Franciscan, 2709 Hemlock Street, Bremerton, WA 98310, USA
| | - Prabhakaran Dorairaj
- Public Health Foundation of India, Unit No 316, 3rd Floor, Rectangle -1 Building, Plot No D-4, District Centre Saket, New Delhi-110017, India
| | - Matthew Fay
- University of Warwick Medical School, The University of Warwick, Coventry CV4 7AL, UK
- Affinity Care, Westcliffe Road, Shipley, BD18 3EE, UK
| | - Isabelle C Van Gelder
- University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, Netherlands
| | - Shinya Goto
- Tokai University, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan
| | | | | | - Jeff S Healey
- Population Health Research Institute, McMaster University, 237 Barton Street East, Hamilton, Ontario, ON L8L 2X2, Canada
| | - Jeroen M Hendriks
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, North Terrace, Adelaide SA 5000, Australia
| | - Mellanie True Hills
- StopAfib.org, American Foundation for Women's Health, PO Box 541, Greenwood, TX 76246, USA
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Oxford OX2 6GG, UK
| | - Menno V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Akbinusdreef 2, 2333 ZA Leiden, Netherlands
| | - Kate E Koplan
- The Southeast Permanente Medical Group, Kaiser Permanente Georgia, 9, 3495 Piedmont Rd NE, Atlanta, GA 30305, USA
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Faculty of Health and Life Sciences, University of Liverpool, Brownlow Hill, Liverpool L69 3BX, UK
| | - William R Lewis
- MetroHealth System, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
| | - Trudie Lobban
- Arrhythmia Alliance & AF Association, Unit 6B, Essex House, Cromwell Business Park, Chipping Norton, OX7 5SR, UK
| | - Benjamin A Steinberg
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, 50 N Medical Dr, Salt Lake City, UT 84132, USA
| | - Christopher J McLeod
- Department of Cardiovascular Medicine, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA
| | | | - Adam Timmis
- Barts and The London School of Medicine and Dentistry, Garrod Building, Turner Street, Whitechapel, London E1 2AD, UK
- Department of Interventional Cardiology, Barts Heart Centre, W Smithfield, London EC1A 7BE, UK
| | - Guo Yutao
- Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, China
| | - A John Camm
- Department of Clinical Cardiology, St George's University of London, Blackshaw Road, Tooting, London SW17 0QT, UK
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21
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Hiasa KI, Kaku H, Inoue H, Yamashita T, Akao M, Atarashi H, Koretsune Y, Okumura K, Shimizu W, Ikeda T, Toyoda K, Hirayama A, Yasaka M, Yamaguchi T, Teramukai S, Kimura T, Kaburagi J, Takita A, Tsutsui H. Age-Related Differences in the Clinical Characteristics and Treatment of Elderly Patients With Atrial Fibrillation in Japan - Insight From the ANAFIE (All Nippon AF In Elderly) Registry. Circ J 2020; 84:388-396. [PMID: 31969518 DOI: 10.1253/circj.cj-19-0898] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is increasing as the global population ages. Elderly AF patients (≥75 years) have a worse prognosis than younger patients, and effective management is often difficult due to multiple comorbidities. This analysis examined the age-related differences in clinical characteristics and treatment in real-world elderly Japanese AF patients.Methods and Results:The ANAFIE Registry is a multicenter, prospective, observational registry of 32,726 non-valvular AF patients aged ≥75 years. The present study assessed the age-related differences in baseline clinical status and anticoagulant therapy between age groups 75-<80, 80-<85, 85-<90, and ≥90 years. The prevalence of persistent or permanent AF increased, and that of paroxysmal AF decreased, with increasing age (trend P<0.0001). The risk of stroke, based on CHADS2and CHA2DS2-VASc scores, and bleeding, based on HAS-BLED score, increased with age. Both warfarin and apixaban were used more often as age increased (trend P<0.0001, for each), while other anticoagulants were used less. Anticoagulant doses were significantly lower in older patients. CONCLUSIONS Permanent/persistent AF, comorbidities, and cardiovascular and bleeding risk all increased significantly with age. Furthermore, use of warfarin and apixaban increased with age, accompanied by a decrease in other oral anticoagulant usage.
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Affiliation(s)
- Ken-Ichi Hiasa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Hidetaka Kaku
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | | | | | | | | | | | | | | | | | - Kazunori Toyoda
- National Cerebral and Cardiovascular Research Center Hospital
| | | | | | | | | | | | | | - Atsushi Takita
- Biostatistics and Data Management Department, Daiichi Sankyo Co., Ltd
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
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22
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Gumprecht J, Lip GYH, Potpara TS. Regional registries on the management of atrial fibrillation: Essential pieces in the global puzzle. IJC HEART & VASCULATURE 2020; 26:100473. [PMID: 32142061 PMCID: PMC7046532 DOI: 10.1016/j.ijcha.2020.100473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 01/15/2020] [Accepted: 01/17/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Jakub Gumprecht
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Medical University, Silesian Centre for Heart Diseases, Zabrze, Poland
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Medical University, Silesian Centre for Heart Diseases, Zabrze, Poland
- School of Medicine, Belgrade University, Belgrade, Serbia
- School of Medicine, Belgrade University, Belgrade, Serbia
- Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Medical University, Silesian Centre for Heart Diseases, Zabrze, Poland
- School of Medicine, Belgrade University, Belgrade, Serbia
- School of Medicine, Belgrade University, Belgrade, Serbia
- Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Tatjana S Potpara
- School of Medicine, Belgrade University, Belgrade, Serbia
- Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
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23
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Essien UR, Magnani JW, Chen N, Gellad WF, Fine MJ, Hernandez I. Race/Ethnicity and Sex-Related Differences in Direct Oral Anticoagulant Initiation in Newly Diagnosed Atrial Fibrillation: A Retrospective Study of Medicare Data. J Natl Med Assoc 2020; 112:103-108. [PMID: 32035755 PMCID: PMC7183759 DOI: 10.1016/j.jnma.2019.10.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/08/2019] [Accepted: 10/29/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common heart rhythm disorder and is associated with a 5-fold increased risk of ischemic stroke. Racial/ethnic minorities and women with AF have higher rates of stroke compared to white individuals and men respectively. Oral anticoagulation reduces the risk of stroke, yet prior research has described racial/ethnic and sex-based variation in its use. We sought to examine the initiation of any oral anticoagulant (warfarin or direct-acting oral anticoagulants, DOACs) by race/ethnicity and sex in patients with incident, non-valvular AF. Further in those who initiated any anticoagulant, we examined DOAC vs. warfarin initiation by race/ethnicity and sex. METHODS We used claims data from a 5% sample of Medicare beneficiaries to identify patients with incident AF from 2012 to 2014, excluding those without continuous Medicare enrollment. We used logistic regression to assess the association between race/ethnicity (white, black, Hispanic), sex, and oral anticoagulant initiation (any, warfarin vs. DOAC), adjusting for sociodemographics, medical comorbidities, stroke and bleeding risk. RESULTS The cohort of 42,952 patients with AF included 17,935 women, 3282 blacks, and 1958 Hispanics. Overall OAC initiation was low (49.2% whites, 48.1% blacks, 47.5% Hispanics, 48.1% men, and 51.5% women). After adjusting, blacks (odds ratio (OR) 0.84; 95% CI, 0.78-0.91) were less likely than whites to initiate any oral anticoagulant with no difference observed between Hispanics and whites (OR 0.92; 95% CI, 0.83-1.01). Women were less likely than men to initiate any oral anticoagulant, OR 0.59 (95% CI 0.55-0.64). Among initiators of oral anticoagulation, DOAC use was low (35.8% whites, 29.3% blacks, 40.0% Hispanics, 41.6% men, and 42.4% women). After adjusting, blacks were less likely to initiate DOACs than whites, OR 0.75 (95% CI 0.66-0.85); the odds of DOAC initiation did not differ between Hispanic and white patients or between men and women. CONCLUSION In a national cohort of Medicare beneficiaries with newly-diagnosed AF, overall oral anticoagulant initiation was lower in blacks and women, with no difference observed by Hispanic ethnicity. Among oral anticoagulant initiators, blacks were less likely to initiate novel DOACs, with no differences identified by Hispanic ethnicity or sex. Identifying modifiable causes of treatment disparities is needed to improve quality of care for all patients with AF.
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Affiliation(s)
- Utibe R Essien
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
| | - Jared W Magnani
- Department of Medicine, Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nemin Chen
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Walid F Gellad
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Michael J Fine
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Inmaculada Hernandez
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
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24
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Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4939] [Impact Index Per Article: 1234.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Anticoagulantes orales directos frente a antagonistas de la vitamina K en pacientes del «mundo real» con fibrilación auricular no valvular. Estudio FANTASIIA. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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26
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Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019; 139:e56-e528. [PMID: 30700139 DOI: 10.1161/cir.0000000000000659] [Citation(s) in RCA: 5401] [Impact Index Per Article: 1080.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Prognostic impact of atrial fibrillation and flutter temporal pattern on anticoagulation and return visits to the emergency department: A historic cohort of 1112 patients. J Electrocardiol 2019; 56:109-114. [PMID: 31376745 DOI: 10.1016/j.jelectrocard.2019.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/14/2019] [Accepted: 07/24/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Emergency department (ED) visits due to atrial fibrillation and flutter (AFF) are common, and provide an opportunity to define stroke risk. The prognostic impact of AFF duration on return ED visits is unknown. We aimed to investigate both the prognostic impact of AFF classification on ED visits and the adherence to guideline recommendations on anticoagulation. METHODS This single-center historic cohort of every patient treated for AFF in our ED during 2012. Follow-up data was obtained on May 2015 (median follow-up of 863 days). RESULTS Among 1112 patients (495 Paroxysmal AF - parAF, 475 Persistent AF - persAF, and 142 flutter), those with parAF were less frequently under oral anticoagulation than persAF and flutter patients (15.8%, 39.4%, 40.1%, p < 0.01). Mean CHA2DS2-VASc scores of parAF were lower than persAF (2.2 vs. 3.12, p < 0.01), and did not differ from those with flutter. Return visits to the ED were highest among flutter patients and lowest among parAF (49.3% vs. 37.2%, p < 0.01). Heart failure, hypertension, female gender and atrial flutter were independent risk factors for repeated visits on multivariate regression. CONCLUSIONS AFF duration provide prognostic information in the ED. ED return visits were common and particularly incident among flutter patients. Furthermore, stroke risk was high and anticoagulation rates were low across all groups. Patients with paroxysmal AF were less commonly anticoagulated even though their mean CHA2DS2-VASc scores were 2.2. These results reveal that guideline adherence is still lacking and should raise awareness to a stricter patient follow-up after ED visits.
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28
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Gorczyca I, Michalska A, Chrapek M, Jelonek O, Wałek P, Wożakowska-Kapłon B. Non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation in secondary stroke and systemic embolism prevention. Cardiol J 2019; 28:896-904. [PMID: 31313276 PMCID: PMC8747826 DOI: 10.5603/cj.a2019.0069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 05/12/2019] [Accepted: 05/23/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Oral anticoagulants (OAC) are recommended in all patients with atrial fibrillation (AF) after thromboembolic events without contraindications. It is hypothesized herein, that the majority of patients with AF after thromboembolic events receive OAC and the presence of specific factors, predisposes the use of non-vitamin K antagonist oral anticoagulants (NOACs). METHODS This is a retrospective study, encompassing patients with AF hospitalized in a reference cardiology center over the years 2014-2017. Thromboembolic events were defined as: ischemic stroke, transient ischemic attack and systemic embolism. Inclusion criteria were the following: diagnosis of non-valvular AF at discharge from hospital, hospitalization not resulting in death. RESULTS Among 2834 hospitalized patients with AF, a history of thromboembolic events was identified in 347 (12.2%) patients. In the group studied, of 347 patients with AF after a thromboembolic event, 322 (92.8%) received OAC, including 133 patients on vitamin K antagonist (41.3% of patients on OAC) and 189 patients on NOACs (58.7% of patients on OAC). Among patients treated with NOACs the majority were on dabigatran (116 patients, 61.4%), followed by rivaroxaban (54 patients, 28.6%), and apixaban (19 patients, 10%). Multivariate logistic regression analysis demonstrated that the presence of arterial hypertension reduced the chance for NOACs use (odds ratio [OR] 0.4, 95% confidence interval [CI] 0.2-0.9, p = 0.04) and left atrial size ≤ 40 mm was a factor increasing the chance for the use of NOACs (OR 2.5, 95% CI 1.1-5.8, p = 0.03). CONCLUSIONS Nearly all hospitalized patients with AF received OAC in the secondary prevention of thromboembolic complications. NOACs were used for secondary prevention of stroke among patients with AF in patients with fewer comorbidities.
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Affiliation(s)
- Iwona Gorczyca
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Center, Kielce, Poland.
- Collegium Medicum, The Jan Kochanowski University, Kielce, Poland.
| | - Anna Michalska
- Collegium Medicum, The Jan Kochanowski University, Kielce, Poland
| | - Magdalena Chrapek
- Faculty of Mathematics and Natural Sciences, The Jan Kochanowski University, Kielce, Poland
| | - Olga Jelonek
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Center, Kielce, Poland
| | - Paweł Wałek
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Center, Kielce, Poland
| | - Beata Wożakowska-Kapłon
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Center, Kielce, Poland
- Collegium Medicum, The Jan Kochanowski University, Kielce, Poland
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Reiffel JA, Verma A, Kowey PR, Halperin JL, Gersh BJ, Wachter R, Pouliot E, Ziegler PD. Incidence of Previously Undiagnosed Atrial Fibrillation Using Insertable Cardiac Monitors in a High-Risk Population: The REVEAL AF Study. JAMA Cardiol 2019; 2:1120-1127. [PMID: 28842973 DOI: 10.1001/jamacardio.2017.3180] [Citation(s) in RCA: 187] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Importance In approximately 20% of atrial fibrillation (AF)-related ischemic strokes, stroke is the first clinical manifestation of AF. Strategies are needed to identify and therapeutically address previously undetected AF. Objective To quantify the incidence of AF in patients at high risk for but without previously known AF using an insertable cardiac monitor. Design, Setting, and Participants This prospective, single-arm, multicenter study was conducted from November 2012 to January 2017. Visits took place at 57 centers in the United States and Europe. Patients with a CHADS2 score of 3 or greater (or 2 with at least 1 additional risk factor) were enrolled. Approximately 90% had nonspecific symptoms potentially compatible with AF, such as fatigue, dyspnea, and/or palpitations. Exposures Patients underwent monitoring with an insertable cardiac monitor for 18 to 30 months. Main Outcomes and Measures The primary end point was adjudicated AF lasting 6 or more minutes and was assessed at 18 months. Other analyses included detection rates at points from 30 days to 30 months and among CHADS2 score subgroups. Median time from insertion to detection and the percentage of patients subsequently prescribed oral anticoagulation therapy was also determined. Results A total of 446 patients were enrolled; 233 (52.2%) were male, and the mean (SD) age was 71.5 (9.9) years. A total of 385 patients (86.3%) received an insertable cardiac monitor, met the primary analysis cohort definition, and were observed for a mean (SD) period of 22.5 (7.7) months. The detection rate of AF lasting 6 or more minutes at 18 months was 29.3%. Detection rates at 30 days and 6, 12, 24, and 30 months were 6.2%, 20.4%, 27.1%, 33.6%, and 40.0%, respectively. At 18 months, AF incidence was similar among patients with CHADS2 scores of 2 (24.7%; 95% CI, 17.3-31.4), 3 (32.7%; 95% CI, 23.8-40.7), and 4 or greater (31.7%; 95% CI, 22.0-40.3) (P = .23). Median (interquartile) time from device insertion to first AF episode detection was 123 (41-330) days. Of patients meeting the primary end point, 13 (10.2%) had 1 or more episodes lasting 24 hours or longer, and oral anticoagulation therapy was prescribed for 72 patients (56.3%). Conclusions and Relevance The incidence of previously undiagnosed AF may be substantial in patients with risk factors for AF and stroke. Atrial fibrillation would have gone undetected in most patients had monitoring been limited to 30 days. Further trials regarding the value of detecting subclinical AF and of prophylactic therapies are warranted. Trial Registration clinicaltrials.gov Identifier: NCT01727297.
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Affiliation(s)
- James A Reiffel
- Columbia University College of Physicians and Surgeons, New York, New York
| | - Atul Verma
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Peter R Kowey
- Lankenau Institute for Medical Research, Wynnewood, Pennsylvania
| | | | | | - Rolf Wachter
- Clinic for Cardiology and Pneumology, University Medicine Göttingen, Göttingen, Germany
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Anguita Sánchez M, Bertomeu Martínez V, Ruiz Ortiz M, Cequier Fillat Á, Roldán Rabadán I, Muñiz García J, Badimón Maestro L, Esteve Pastor MA, Marín Ortuño F. Direct oral anticoagulants versus vitamin K antagonists in real-world patients with nonvalvular atrial fibrillation. The FANTASIIA study. ACTA ACUST UNITED AC 2019; 73:14-20. [PMID: 31160265 DOI: 10.1016/j.rec.2019.02.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 02/14/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES To compare the long-term results of direct oral anticoagulants (DOAC) vs vitamin K antagonists (VKA) in real-world-patients with nonvalvular atrial fibrillation (NVAF) in a nationwide, prospective study. METHODS The FANTASIIA registry prospectively included outpatients with AF anticoagulated with DOAC or VKA (per protocol, proportion of VKA and DOAC 4:1), consecutively recruited from June 2013 to October 2014 in Spain. The incidence of major events was analyzed and compared according to the anticoagulant treatment received. RESULTS A total of 2178 patients were included in the study (mean age 73.8±9.4 years), and 43.8% were women. Of these, 533 (24.5%) received DOAC and 1645 (75.5%) VKA. After a median follow up of 32.4 months, patients receiving DOAC vs those receiving VKA had lower rates of stroke-0.40 (95%CI, 0.17-0.97) vs 1.07 (95%CI,0.79-1.46) patients/y, P=.032-, severe bleedings-2.13 (95%CI, 1.45-3.13) vs 3.28 (95%CI, 2.75-3.93) patients/y; P = .044-, cardiovascular death-1.20 (95%CI, 0.72-1.99) vs 2.45 (95%CI, 2.00-3.00) patients/y; P = .009-, and all-cause death-3.77 (95%CI, 2.83-5.01) vs 5.54 (95%CI, 4.83-6.34) patients/y; P = .016-. In a modified Cox regression model by the Andersen-Gill method for multiple events, hazard ratios for patients receiving DOAC were: 0.42 (0.16-1.07) for stroke; 0.47 (0.20-1.16) for total embolisms; 0.76 (0.50-1.15) for severe bleedings; 0.67 (0.39-1.18) for cardiovascular death; 0.86 (0.62-1.19) for all-cause death, and 0.82 (0.64-1.05) for the combined event consisting of stroke, embolism, severe bleeding, and all-cause death. CONCLUSIONS Compared with VKA, DOAC is associated with a trend to a lower incidence of all major events, including death, in patients with NVAF in Spain.
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Affiliation(s)
| | | | - Martín Ruiz Ortiz
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Ángel Cequier Fillat
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | - Lina Badimón Maestro
- Instituto de Investigación Cardiovascular (CSIC-ICCC)-Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - María Asunción Esteve Pastor
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, CIBERCV, EL Palmar, Murcia, Spain
| | - Francisco Marín Ortuño
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, CIBERCV, EL Palmar, Murcia, Spain
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Fawzy AM, Yang WY, Lip GY. Safety of direct oral anticoagulants in real-world clinical practice: translating the trials to everyday clinical management. Expert Opin Drug Saf 2019; 18:187-209. [PMID: 30712419 DOI: 10.1080/14740338.2019.1578344] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Direct oral anticoagulants (DOACs) may be regarded as some of the most successful innovations in recent times. These drugs which were specifically developed to overcome the challenges posed by warfarin did just that and in the process, have changed the outlook towards stroke prevention with anticoagulation. The decade of experience with these drugs that has resulted in the availability of large scale data on their safety profile has aided this. Areas covered: This review examines existing real-world studies (RWS) and their interpretation to better appreciate how they either complement or contradict findings from the hallmark trials. Specific focus has been made on the safety of DOACs, on their risks of major bleeding, intra-cranial haemorrhage (ICH), gastro-intestinal (GI) bleeding and all-cause mortality compared to warfarin and each other. DOAC use in the elderly and other sub-groups are briefly discussed. Expert opinion: Results for safety outcomes according to 'real world evidence' (RWE) are in-keeping with randomised controlled trials (RCTs) and currently, all 4 DOACs have been deemed at least as effective as warfarin, while demonstrating superiority in some aspects. While real world studies act as a complementary source of knowledge, traditional RCTs remain the gold standard for determining cause-effect relationships.
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Affiliation(s)
- Ameenathul M Fawzy
- a Institute of Cardiovascular Sciences , University of Birmingham , Birmingham , UK
| | - Wang-Yang Yang
- a Institute of Cardiovascular Sciences , University of Birmingham , Birmingham , UK.,b Department of Cardiology, Beijing AnZhen Hospital, National Clinical Research Centre for Cardiovascular Diseases , Capital Medical University , Beijing , China
| | - Gregory Yh Lip
- c Liverpool Centre for Cardiovascular Science , University of Liverpool and Liverpool Heart & Chest Hospital , Liverpool , UK
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Miyazawa K, Li YG, Rashed WA, Al Mahmeed W, Shehab A, Zubaid M, Lip GY. Secondary stroke prevention and guideline adherent antithrombotic treatment in patients with atrial fibrillation: Insights from the Gulf Survey of atrial fibrillation events (Gulf SAFE). Int J Cardiol 2019; 274:126-131. [DOI: 10.1016/j.ijcard.2018.07.120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/16/2018] [Accepted: 07/23/2018] [Indexed: 12/01/2022]
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Boriani G, Proietti M, Laroche C, Diemberger I, Popescu MI, Riahi S, Shantsila A, Dan GA, Tavazzi L, Maggioni AP, Lip GY. Changes to oral anticoagulant therapy and risk of death over a 3-year follow-up of a contemporary cohort of European patients with atrial fibrillation final report of the EURObservational Research Programme on Atrial Fibrillation (EORP-AF) pilot general registry. Int J Cardiol 2018; 271:68-74. [DOI: 10.1016/j.ijcard.2018.05.034] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 04/22/2018] [Accepted: 05/10/2018] [Indexed: 12/20/2022]
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Proietti M, Laroche C, Nieuwlaat R, Crijns HJGM, Maggioni AP, Lane DA, Boriani G, Lip GYH. Increased burden of comorbidities and risk of cardiovascular death in atrial fibrillation patients in Europe over ten years: A comparison between EORP-AF pilot and EHS-AF registries. Eur J Intern Med 2018; 55:28-34. [PMID: 29778588 DOI: 10.1016/j.ejim.2018.05.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/13/2018] [Accepted: 05/09/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND In 2002, the European Society of Cardiology conducted the Euro Heart Survey (EHS), while in 2014concluded 1-year follow-up of the EURObservational Research Programme AF (EORP-AF) Pilot Registry. METHODS We analysed differences in clinical profiles, therapeutic approaches and outcomes between these two cohorts after propensity score matching (PSM). RESULTS After PSM, 5206 patients were analysed. In EORP-AF there were more elderly patients than EHS (p < .001). EORP-AF patients were more burdened with cardiovascular (CV) and non-CV comorbidities, with a higher proportion of patients with high thromboembolic risk. EORP-AF patients used more oral-anticoagulant (OAC) (p < .001). At 1-year follow-up EORP-AF patients had lower risk for thromboembolic and CV events, readmission for AF and other CV reasons (all p < .001), showing conversely a higher risk for CV death (p = .015). Kaplan-Meier curves showed that EORP-AF patients had higher risk for CV death (p < .0001) and all-cause death (p = .0019). Cox regression confirmed that EORP-AF patients were at higher risk for CV death (p = .021). CONCLUSIONS We found significant changes in AF epidemiology over a decade in Europe, with older patients, more burdened with comorbidities. A greater use of OAC was found. Despite a reduction in risk for thromboembolic events, a high risk of CV-related death was still evident.
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Affiliation(s)
- Marco Proietti
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Cécile Laroche
- EURObservational Research Programme Department, European Society of Cardiology, Sophia Antipolis, France
| | - Robby Nieuwlaat
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Aldo P Maggioni
- EURObservational Research Programme Department, European Society of Cardiology, Sophia Antipolis, France; ANMCO Research Center, Firenze, Italy
| | - Deirdre A Lane
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Giuseppe Boriani
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy; Cardiology Department, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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Franco J, Formiga F, Cepeda J, Llacer P, Arévalo-Lorido J, Cerqueiro J, González-Franco A, Epelde F, Manzano L, Montero Pérez-Barquero M. Influencia de la fibrilación auricular en la mortalidad de los pacientes con insuficiencia cardiaca con fracción de eyección preservada. Med Clin (Barc) 2018; 150:376-382. [DOI: 10.1016/j.medcli.2017.06.065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 06/16/2017] [Accepted: 06/22/2017] [Indexed: 10/18/2022]
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Mazurek M, Shantsila E, Lane DA, Wolff A, Proietti M, Lip GYH. Guideline-Adherent Antithrombotic Treatment Improves Outcomes in Patients With Atrial Fibrillation: Insights From the Community-Based Darlington Atrial Fibrillation Registry. Mayo Clin Proc 2017; 92:1203-1213. [PMID: 28778255 DOI: 10.1016/j.mayocp.2017.05.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 04/10/2017] [Accepted: 05/04/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess the influence of guideline-adherent vs nonadherent antithrombotic treatment (ATT) on stroke and mortality rates in an atrial fibrillation (AF) primary care population. PATIENTS AND METHODS We used the Darlington Registry cohort, which included 105,000 patients from March 31, 2012, through March 31, 2013. Guideline adherence in ATT was assessed against 2014 National Institute for Health and Care Excellence guidelines, which recommend oral anticoagulation for stroke prevention as a default management unless a truly low risk of stroke (CHA2DS2-VASc=0 in men and 1 in women) is evident. RESULTS Of 2259 patients with AF (2.15%), 36.1% were undertreated, 50.8% were guideline adherent, and 13.1% were overtreated. Oral anticoagulation was declined by 5.0% and contraindicated in 8.3%. Of 67 incident strokes (3.0%), 66 (98.5%) occurred in high-risk patients (CHA2DS2-VASc ≥2). For the high-risk cohort, 1-year stroke rates were 4.5% (95% CI, 3.2%-6.3%) for undertreatment, 1.9% (95% CI, 1.2%-2.9%) for guideline adherence, and 7.2% (95% CI, 4.4%-11.6%) for overtreatment; corresponding mortality rates were 16.1% (95% CI, 13.6%-19.0%), 8.0% (95% CI, 6.5%-9.8%), and 8.2% (95% CI, 5.2%-12.7%), respectively. On multivariable analysis, both undertreatment and overtreatment of high-risk patients were associated with significant increases in stroke rates (odds ratio [OR]=2.32; 95% CI, 1.30-3.14; P=.005 and OR=2.28; 95% CI, 1.12-4.63; P=.02, respectively). Undertreatment was also associated with a significant increase in all-cause mortality (OR=1.59; 95% CI, 1.14-2.21; P=.006). CONCLUSION Only half of all eligible patients with AF are prescribed oral anticoagulation in accordance with guideline recommendations. Guideline-adherent ATT significantly reduces the risk of stroke and improves survival.
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Affiliation(s)
- Michał Mazurek
- Institute for Cardiovascular Sciences, University of Birmingham, Birmingham, UK; Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Eduard Shantsila
- Institute for Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Deirdre A Lane
- Institute for Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Andreas Wolff
- Division of Family Practice, Chilliwack General Hospital, Chilliwack, British Columbia, Canada
| | - Marco Proietti
- Institute for Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Gregory Y H Lip
- Institute for Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
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Rivera-Caravaca JM, Esteve-Pastor MA, Roldán V, Marín F, Lip GY. Non-vitamin K antagonist oral anticoagulants: impact of non-adherence and discontinuation. Expert Opin Drug Saf 2017; 16:1051-1062. [DOI: 10.1080/14740338.2017.1351542] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- José Miguel Rivera-Caravaca
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Department of Hematology and Clinical Oncology, Hospital General Universitario Morales Meseguer, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - María Asunción Esteve-Pastor
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBER-CV, Murcia, Spain
| | - Vanessa Roldán
- Department of Hematology and Clinical Oncology, Hospital General Universitario Morales Meseguer, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - Francisco Marín
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBER-CV, Murcia, Spain
| | - Gregory Y.H. Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Mazurek M, Shantsila E, Lane DA, Wolff A, Proietti M, Lip GYH. Secondary Versus Primary Stroke Prevention in Atrial Fibrillation: Insights From the Darlington Atrial Fibrillation Registry. Stroke 2017; 48:2198-2205. [PMID: 28679859 DOI: 10.1161/strokeaha.116.016146] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 05/22/2017] [Accepted: 06/06/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Although patients with atrial fibrillation (AF) who experienced an acute stroke are at high risk for recurrence, many patients are untreated or treated suboptimally for stroke prevention. The objective of this study is to compare clinical outcomes of AF patients with versus without previous stroke in relation to guideline-adherent antithrombotic treatment in a contemporary primary care population. METHODS Community cohort of 105 000 patients from 11 general practices in Darlington, England, was used to assess AF stroke prevention strategies against 2014 National Institute for Health and Care Excellence guidelines. RESULTS Overall, 2259 (2.15%) patients with AF were identified, of which 18.9% constituted a secondary prevention cohort. For secondary prevention, antithrombotic treatment was guideline adherent in 56.3%, 18.9% were overtreated, and 24.8% undertreated; corresponding proportions for primary prevention were 49.5%, 11.7%, and 38.8%, respectively. One-year stroke rates were 8.6% and 1.6% for secondary and primary prevention, respectively (P<0.001); corresponding all-cause mortality rates were 9.8% and 9.4%, respectively (P=0.79). On multivariable analysis, lack of antithrombotic treatment guideline adherence was associated with increased stroke risk for primary prevention (odds ratio, 2.95; 95% confidence interval, 1.26-6.90; P=0.013 for undertreatment); for secondary prevention, lack of guideline adherence was associated with increased risk of recurrent stroke (odds ratio, 2.80; 95% confidence interval, 1.25-6.27; P=0.012 for overtreatment) and all-cause death (odds ratio, 2.75; 95% confidence interval, 1.33-5.69; P=0.006 for undertreatment). CONCLUSIONS Only approximately half of eligible patients with AF are prescribed oral anticoagulation in line with guidelines. Guideline-adherent antithrombotic treatment significantly reduces the risk of stroke among primary prevention patients and both risk of recurrent stroke and death in patients with previous stroke.
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Affiliation(s)
- Michał Mazurek
- From the University of Birmingham Institute for Cardiovascular Sciences, City Hospital, United Kingdom (M.M., E.S., D.A.L., M.P., G.Y.H.L.); Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Zabrze, Poland (M.M.); and Division of Family Practice, Chilliwack General Hospital, British Columbia, Canada (A.W.)
| | - Eduard Shantsila
- From the University of Birmingham Institute for Cardiovascular Sciences, City Hospital, United Kingdom (M.M., E.S., D.A.L., M.P., G.Y.H.L.); Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Zabrze, Poland (M.M.); and Division of Family Practice, Chilliwack General Hospital, British Columbia, Canada (A.W.)
| | - Deirdre A Lane
- From the University of Birmingham Institute for Cardiovascular Sciences, City Hospital, United Kingdom (M.M., E.S., D.A.L., M.P., G.Y.H.L.); Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Zabrze, Poland (M.M.); and Division of Family Practice, Chilliwack General Hospital, British Columbia, Canada (A.W.)
| | - Andreas Wolff
- From the University of Birmingham Institute for Cardiovascular Sciences, City Hospital, United Kingdom (M.M., E.S., D.A.L., M.P., G.Y.H.L.); Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Zabrze, Poland (M.M.); and Division of Family Practice, Chilliwack General Hospital, British Columbia, Canada (A.W.)
| | - Marco Proietti
- From the University of Birmingham Institute for Cardiovascular Sciences, City Hospital, United Kingdom (M.M., E.S., D.A.L., M.P., G.Y.H.L.); Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Zabrze, Poland (M.M.); and Division of Family Practice, Chilliwack General Hospital, British Columbia, Canada (A.W.)
| | - Gregory Y H Lip
- From the University of Birmingham Institute for Cardiovascular Sciences, City Hospital, United Kingdom (M.M., E.S., D.A.L., M.P., G.Y.H.L.); Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Zabrze, Poland (M.M.); and Division of Family Practice, Chilliwack General Hospital, British Columbia, Canada (A.W.).
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Huikuri HV. Editorial Commentary: Atrial fibrillation: Challenges and opportunities. Trends Cardiovasc Med 2017. [PMID: 28623083 DOI: 10.1016/j.tcm.2017.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Heikki V Huikuri
- Research Unit of Internal Medicine, Medical Research Center, University Central Hospital of Oulu, University of Oulu, P.O. Box 5000, Oulu 90014, Finland.
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Causes of death in atrial fibrillation: Challenges and opportunities. Trends Cardiovasc Med 2017; 27:494-503. [PMID: 28602539 DOI: 10.1016/j.tcm.2017.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 04/28/2017] [Accepted: 05/02/2017] [Indexed: 11/20/2022]
Abstract
Atrial fibrillation (AF) is an age-related arrhythmia associated with several co-morbidities and significant mortality. Most AF patients are in need of anticoagulation due to increased risk of stroke. Despite anticoagulation, AF patients still have a significant risk of death (about 5%/y). Approximately half of deaths in AF are due to heart-related causes (i.e., sudden death, heart failure, and myocardial infarction), one-third of deaths are due to non-vascular causes (i.e., cancer, respiratory diseases, and infections) and the remaining AF patients die from stroke or hemorrhage (about 6% each), or other causes. This review describes current situations related to causes of death in AF, the challenges in the management of AF (e.g., frequent presence of cardiovascular risk factors and co-morbidities, physicians adherence to clinical guidelines and patients adherence to cardiovascular medications in AF) as well as the opportunities for intervention.
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