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Vanderstuyft E, Hias J, Hellemans L, Van Aelst L, Tournoy J, Van der Linden LR. Appropriateness of antithrombotics in geriatric inpatients with atrial fibrillation: a retrospective, cross-sectional study. Eur J Hosp Pharm 2024:ejhpharm-2023-004033. [PMID: 38580430 DOI: 10.1136/ejhpharm-2023-004033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/19/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Atrial fibrillation occurs in nearly half of geriatric inpatients and is a major cause of morbidity and mortality. Suboptimal anticoagulation use is an important concern in this population. This study aimed to evaluate the appropriateness of antithrombotic therapies in this patient cohort. METHODS A retrospective analysis was conducted on the geriatric wards of a teaching hospital in Belgium, on a background of clinical pharmacy services. The first 90 atrial fibrillation patients from 2020 to 2022 were included if they received an oral anticoagulant. We assessed utilisation and appropriateness of antithrombotics at discharge, examined reasons for guideline deviations, and explored factors associated with underdosing. Temporal associations for appropriateness and type of anticoagulant (vitamin K antagonist (VKA) vs direct oral anticoagulant (DOAC)) were assessed. RESULTS The mean age of patients was 86.5 (±5.3) years and the median CHA2DS2-VASc score was 5 (interquartile range (IQR) 4-6). At discharge, 256 (94.8%) patients used a DOAC; nine (3.3%) used a VKA; one (0.4%) a DOAC-antiplatelet combination, and in four patients (1.5%) all antithrombotics were discontinued. The majority (64.4%) of patients received reduced DOAC doses with apixaban prescribed in 40.7%. In 39 (14.4%) patients, antithrombotic use was considered inappropriate, mostly without a rationale (23/39). Year 2022 (odds ratio (OR) 0.104; 95% confidence interval (CI), 0.012-0.878) was the sole determinant for underdosing. No significant differences were found with respect to appropriateness (p=0.533) or anticoagulant class (p=0.479) over time. CONCLUSION Most geriatric inpatients received a justified reduced DOAC dose. A significant proportion was managed inappropriately with underdosing (= unjustified reduced dose) being most common. Frequently no rationale was provided for deviating from trial-tested doses.
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Affiliation(s)
- Esther Vanderstuyft
- Pharmacy Department, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Julie Hias
- Pharmacy Department, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Laura Hellemans
- Pharmacy Department, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven Biomedical Sciences Group, Leuven, Belgium
| | - Lucas Van Aelst
- Department of Cardiovascular Sciences, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
- Department of Cardiology, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Jos Tournoy
- Department of Geriatric Medicine, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
- Department of Chronic Diseases, Metabolism and Ageing, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
| | - Lorenz Roger Van der Linden
- Pharmacy Department, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
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Alnami MI, Alsalim AM, Alhakeem RF, Al-Somali BA, Bahkali HA, Alhabshi HA, Alotaibi HT, Alqallaf RA, Ali S. A Survey of Saudi General Practitioners on the Use of Thromboprophylaxis Guidelines and Risk Assessment Tools in Atrial Fibrillation. Clin Pract 2023; 13:347-356. [PMID: 36961056 PMCID: PMC10037654 DOI: 10.3390/clinpract13020031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/18/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
Clinical practice guidelines advise patients with atrial fibrillation who are at risk for stroke to undergo thromboprophylaxis with oral anticoagulants. However, it is noted that guidelines are not always followed. We sought to learn how Saudi Arabian general practitioners (GPs) self-reported using risk assessment tools and atrial fibrillation clinical practice guidelines created by cardiology associations, as well as how GPs felt about the resources that were available. Through the use of a self-administered questionnaire, we carried out a cross-sectional survey. A total of two-hundred GPs participated in the study. The guidelines were frequently used when a clinical decision regarding anticoagulation therapy appeared difficult (n = 57, 28.4%). The most predominant strengths of participants' chosen clinical guidelines were clear recommendations (n = 56, 27.9%), easy-to-follow algorithms (n = 39, 16.9%), detailed recommendations supported by evidence (n = 34, 16.9%), and online availability (n = 27, 13.4%). Many respondents said they used a formal stroke risk assessment tool in addition to their clinical judgment as a GP for most decisions (60%). Most respondents preferred using the CHA2DS2-VASc (n = 106, 52.7%), CHA2DS2-VA (n = 45, 22.4%), CHADS2 (n = 35, 17.4%), and GARFIELD (n = 14, 7.0%). HAS-BLED (n = 100, 49.8%) and HEMORR2HAGES (n = 50, 24.9%) were the most frequently utilized formal tools for assessing the risk of bleeding among GPs. Over half of the participants referred to guidelines when deciding thromboprophylaxis in patients with atrial fibrillation. Additionally, many respondents used formal procedures for assessing the risks of bleeding and stroke in addition to their clinical judgement in their roles as GPs. The guideline was assessed as being extremely helpful overall by GPs who used it to make thromboprophylaxis decisions.
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Affiliation(s)
- Mohammed Ibrahim Alnami
- Pharmaceutical Care Services, King Saud Medical City, Ministry of Health, Riyadh 11196, Saudi Arabia
| | - Ali Mansoor Alsalim
- Pharmaceutical Care Services, King Saud Medical City, Ministry of Health, Riyadh 11196, Saudi Arabia
| | - Ruwaida Faisal Alhakeem
- Pharmaceutical Care Services, King Saud Medical City, Ministry of Health, Riyadh 11196, Saudi Arabia
| | | | - Haitham Ali Bahkali
- Pharmaceutical Care Services, King Saud Medical City, Ministry of Health, Riyadh 11196, Saudi Arabia
| | - Hanaa Ali Alhabshi
- Pharmaceutical Care Services, King Saud Medical City, Ministry of Health, Riyadh 11196, Saudi Arabia
| | - Hailah Talaq Alotaibi
- Pharmaceutical Care Services, King Saud Medical City, Ministry of Health, Riyadh 11196, Saudi Arabia
| | | | - Sheraz Ali
- Menzies Institute for Medical Research, University of Tasmania, Hobart 7000, Australia
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Gebreyohannes EA, Salter SM, Chalmers L, Radford J, Lee K. Use of thromboprophylaxis guidelines and risk stratification tools in atrial fibrillation: A survey of general practitioners in Australia. J Eval Clin Pract 2022; 28:483-492. [PMID: 35385183 PMCID: PMC9324914 DOI: 10.1111/jep.13685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/16/2022] [Accepted: 03/23/2022] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES Clinical guidelines produced by cardiology societies (henceforth referred to simply as 'clinical guidelines') recommend thromboprophylaxis with oral anticoagulants (OACs) in patients with atrial fibrillation (AF) who have moderate-to-high stroke risk. However, deviations from these recommendations are observed, especially in the primary healthcare setting. The primary aims of this study were to evaluate the self-reported use of AF clinical guidelines and risk stratification tools among Australian general practitioners (GPs), and their perceptions regarding the available resources. METHOD We conducted an online survey of Australian GPs. Descriptive statistics were used to summarise the findings. RESULTS Responses from 115 GPs were included for analysis. Respondents reported various ways of accessing thromboprophylaxis-related information (n = 113), including clinical guidelines (13.3%), 'Therapeutic Guidelines© ' (37.2%) and Royal Australian College of General Practitioners websites (16.8%). Of those who reported reasons against accessing information from clinical guidelines (n = 97), the most frequent issues were: too many AF guidelines to choose from (34.0%; 33/97), different guidelines for different diseases (32.0%; 31/97), time-consuming to read guidelines (21.6%; 21/97), disagreements between different guideline recommendations (20.0%; 19/97), conflict with criteria for government subsidy (17.5%; 17/97) and GPs' busy schedules (15.5%; 15/97). When assessing patients' risk of stroke (n = 112) and bleeding (n = 111), the majority of the respondents reported primarily relying on a formal stroke risk (67.0%) and bleeding risk (55.0%) assessment tools, respectively. Respondents reported using formal stroke and bleeding risk assessment tools mainly when newly initiating patients on therapy (72.4%; 76/105 and 65.3%; 65/101, respectively). CONCLUSION Among our small sample of Australian GPs, most did not access thromboprophylaxis-related information directly from AF-specific clinical guidelines developed by cardiology societies. Although the majority reported using formal stroke and bleeding assessment tools, these were typically used on OAC initiation only. More focus is needed on formal risk reassessment as clinically indicated and at regular review.
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Affiliation(s)
- Eyob Alemayehu Gebreyohannes
- Division of Pharmacy, School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Sandra M Salter
- Division of Pharmacy, School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Leanne Chalmers
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - Jan Radford
- Launceston Clinical School, Tasmanian School of Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Kenneth Lee
- Division of Pharmacy, School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia
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Gao X, Liu K, Zhao X, Lv X, Wu X, Ren C, Chen Q, Li Y. Global research trends in catheter ablation and surgical treatment of atrial fibrillation: A bibliometric analysis and science mapping. Front Surg 2022; 9:1048454. [PMID: 36684348 PMCID: PMC9852516 DOI: 10.3389/fsurg.2022.1048454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/02/2022] [Indexed: 01/09/2023] Open
Abstract
Introduction To evaluate the global research results of the catheter ablation and surgical treatment of atrial fibrillation in the past 40 years by bibliometrics, and to explore the hotspots and prospects for future development. Methods Relevant literatures were selected from the Web of Science Core Collection. VOSviewer 1.6.17, SciMAT 1.1.04, and CiteSpace 5.8.R1 were used to analyze the data objectively, deeply and comprehensively. Results As of July 14, 2021, 11,437 studies for the catheter ablation and surgical treatment of atrial fibrillation have been identified from 1980 to 2021. The Journal of Cardiovascular Electrophysiology and Circulation respectively ranked first in terms of the number of publications and the number of co-citations. A total of 6,631 institutions from 90 countries participated in the study, with USA leading the way with 3,789 documents. Cryoablation, atrial fibrosis, substrate modification, minimally invasive and access surgery will still be the research focus and frontier in the next few years. Conclusions The publication information for the catheter ablation and surgical treatment of atrial fibrillation were reviewed, including country, institution, author, journal publications, and so on. Developed countries had the advantage in this research areas, and cooperation with low-income countries should be improved. The former research hotspots in the field of catheter ablation and surgical treatment of atrial fibrillation were analyzed, and the future research direction was predicted.
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Affiliation(s)
- Xiang Gao
- Department of Cardiovascular Surgery, Gansu Provincial Hospital, Gansu University of Chinese Medicine, Lanzhou, China.,Department of Cardiovascular Surgery, Gansu Provincial Hospital, Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, China
| | - Kai Liu
- Department of Cardiovascular Surgery, Gansu Provincial Hospital, Gansu University of Chinese Medicine, Lanzhou, China
| | - Xinke Zhao
- Department of Cardiovascular Surgery, Gansu Provincial Hospital, Gansu University of Chinese Medicine, Lanzhou, China
| | - Xinfang Lv
- Department of Cardiovascular Surgery, Gansu Provincial Hospital, Gansu University of Chinese Medicine, Lanzhou, China
| | - Xue Wu
- Department of Cardiovascular Surgery, Gansu Provincial Hospital, Gansu University of Chinese Medicine, Lanzhou, China
| | - Chunzhen Ren
- Department of Cardiovascular Surgery, Gansu Provincial Hospital, Gansu University of Chinese Medicine, Lanzhou, China
| | - Qilin Chen
- Department of Cardiovascular Surgery, Gansu Provincial Hospital, Gansu University of Chinese Medicine, Lanzhou, China
| | - Yingdong Li
- Department of Cardiovascular Surgery, Gansu Provincial Hospital, Gansu University of Chinese Medicine, Lanzhou, China
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Quintens C, Van der Linden L, Meeusen K, Nijns E, Willems R, Spriet I. Development and validation of a Screening Tool to Evaluate and Warrant Anticoagulation Treatment prior to Discharge in inpatients with Atrial Fibrillation (STEWAR xD-AF). Int J Med Inform 2021; 154:104555. [PMID: 34438318 DOI: 10.1016/j.ijmedinf.2021.104555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/10/2021] [Accepted: 08/15/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Anticoagulation is highly effective for stroke prevention in atrial fibrillation (AF), reducing the risk by about 64%. Despite overwhelming evidence in support of anticoagulation, up to 40% of AF patients remain untreated. We aimed to develop and validate STEWARxD-AF: a Screening Tool to Evaluate and Warrant Anticoagulation Treatment prior to Discharge in Atrial Fibrillation. MATERIALS AND METHODS STEWARxD-AF was developed by integrating information extracted from the electronic health record (EHR). A stepwise decision process was applied, based on AF diagnosis, estimated CHA2DS2-VASc-score and anticoagulant use. A priority score was assigned accordingly, ranging from 0 (no risk) to 5 (highest risk of undertreatment). A cross-sectional study was performed to assess the accuracy of STEWARxD-AF. Criterion and tool validity were ascertained by determining sensitivity and specificity, compared to a manual check of the EHR in an inpatient sample (n = 800). Consistency regarding the priority score was determined by estimating Cohen's kappa. RESULTS A tool to screen for un(der)treated AF was developed and embedded into the EHR. Sensitivity and specificity for AF diagnosis were 98.4% and 87.6%, respectively. Overall sensitivity and specificity for identification of a CHA2DS2-VASc-score ≥ 2 was 97.7% and 72.7%. Sensitivity and specificity to determine the presence of anticoagulant treatment was at least 87.8% and 97.1% There was good agreement for the priority score (κ 0.74 (unweighted); 0.66 (weighted)). CONCLUSIONS STEWARxD-AF was able to identify untreated AF inpatients reliably and with a high sensitivity. Nearly no patients were missed. We will now implement this AF-screening tool in clinical practice to improve the use of anticoagulation and reduce the risk of stroke.
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Affiliation(s)
- Charlotte Quintens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium; Pharmacy Department, University Hospitals Leuven, Leuven, Belgium.
| | - Lorenz Van der Linden
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium; Pharmacy Department, University Hospitals Leuven, Leuven, Belgium.
| | - Kaat Meeusen
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium.
| | - Egon Nijns
- Department of Information Technology, University Hospitals Leuven, Leuven, Belgium.
| | - Rik Willems
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.
| | - Isabel Spriet
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium; Pharmacy Department, University Hospitals Leuven, Leuven, Belgium.
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Gebreyohannes EA, Salter S, Chalmers L, Bereznicki L, Lee K. Non-adherence to Thromboprophylaxis Guidelines in Atrial Fibrillation: A Narrative Review of the Extent of and Factors in Guideline Non-adherence. Am J Cardiovasc Drugs 2021; 21:419-433. [PMID: 33369718 DOI: 10.1007/s40256-020-00457-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 01/24/2023]
Abstract
Atrial fibrillation is the most common arrhythmia. It increases the risk of thromboembolism by up to fivefold. Guidelines provide evidence-based recommendations to effectively mitigate thromboembolic events using oral anticoagulants while minimizing the risk of bleeding. This review focuses on non-adherence to contemporary guidelines and the factors associated with guideline non-adherence. The extent of guideline non-adherence differs according to geographic region, healthcare setting, and risk stratification tools used. Guideline adherence has gradually improved over recent years, but a significant proportion of patients are still not receiving guideline-recommended therapy. Physician-related and patient-related factors (such as patient refusals, bleeding risk, older age, and recurrent falls) also contribute to guideline non-adherence, especially to undertreatment. Quality improvement initiatives that focus on undertreatment, especially in the primary healthcare setting, may help to improve guideline adherence.
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Affiliation(s)
- Eyob Alemayehu Gebreyohannes
- Division of Pharmacy, School of Allied Health, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia.
| | - Sandra Salter
- Division of Pharmacy, School of Allied Health, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia
| | - Leanne Chalmers
- School of Pharmacy and Biomedical Sciences, Curtin University, Perth, WA, Australia
| | - Luke Bereznicki
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS, Australia
| | - Kenneth Lee
- Division of Pharmacy, School of Allied Health, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS, Australia
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7
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Santala OE, Lipponen JA, Jäntti H, Rissanen TT, Halonen J, Kolk I, Pohjantähti‐Maaroos H, Tarvainen MP, Väliaho E, Hartikainen J, Martikainen T. Necklace-embedded electrocardiogram for the detection and diagnosis of atrial fibrillation. Clin Cardiol 2021; 44:620-626. [PMID: 33629410 PMCID: PMC8119818 DOI: 10.1002/clc.23580] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/04/2021] [Accepted: 02/11/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the major cause of stroke since approximately 25% of all strokes are of cardioembolic-origin. The detection and diagnosis of AF are often challenging due to the asymptomatic and intermittent nature of AF. HYPOTHESIS A wearable electrocardiogram (ECG)-device could increase the likelihood of AF detection. The aim of this study was to evaluate the feasibility and reliability of a novel, consumer-grade, single-lead ECG recording device (Necklace-ECG) for screening, identifying and diagnosing of AF both by a cardiologist and automated AF-detection algorithms. METHODS A thirty-second ECG was recorded with the Necklace-ECG device from two positions; between the palms (palm) and between the palm and the chest (chest). Simultaneously registered 3-lead ECGs (Holter) served as a golden standard for the final rhythm diagnosis. Two cardiologists interpreted independently in a blinded fashion the Necklace-ECG recordings from 145 patients (66 AF and 79 sinus rhythm, SR). In addition, the Necklace-ECG recordings were analyzed with an automatic AF detection algorithm. RESULTS Two cardiologists diagnosed the correct rhythm of the interpretable Necklace-ECG with a mean sensitivity of 97.2% and 99.1% (palm and chest, respectively) and specificity of 100% and 98.5%. The automatic arrhythmia algorithm detected the correct rhythm with a sensitivity of 94.7% and 98.3% (palm and chest) and specificity of 100% of the interpretable measurements. CONCLUSIONS The novel Necklace-ECG device is able to detect AF with high sensitivity and specificity as evaluated both by cardiologists and an automated AF-detection algorithm. Thus, the wearable Necklace-ECG is a new, promising method for AF screening. CLINICAL TRIAL REGISTRATION Study was registered in the ClinicalTrials.gov database (NCT03753139).
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Affiliation(s)
- Onni E. Santala
- School of MedicineUniversity of Eastern FinlandKuopioFinland
| | - Jukka A. Lipponen
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
| | - Helena Jäntti
- Center for Prehospital Emergency CareKuopio University HospitalKuopioFinland
| | | | - Jari Halonen
- School of MedicineUniversity of Eastern FinlandKuopioFinland
- Heart CenterKuopio University HospitalKuopioFinland
| | - Indrek Kolk
- Heart CenterKuopio University HospitalKuopioFinland
| | | | - Mika P. Tarvainen
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
- Department of Clinical Physiology and Nuclear MedicineKuopio University HospitalKuopioFinland
| | | | - Juha Hartikainen
- School of MedicineUniversity of Eastern FinlandKuopioFinland
- Heart CenterKuopio University HospitalKuopioFinland
| | - Tero Martikainen
- Department of Emergency CareKuopio University HospitalKuopioFinland
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Castro-Clavijo JA, Quintero S, Valderrama F, Diaztagle JJ, Ortega J. Prevalencia de fibrilación auricular en pacientes hospitalizados por Medicina interna. REVISTA COLOMBIANA DE CARDIOLOGÍA 2020. [DOI: 10.1016/j.rccar.2019.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Moons P. Flash mob studies: a novel method to accelerate the research process. Eur J Cardiovasc Nurs 2020; 20:175-178. [PMID: 33849059 DOI: 10.1093/eurjcn/zvaa020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/02/2020] [Indexed: 12/11/2022]
Abstract
Because the time between study conception and dissemination of findings generally takes long, efforts to reduce this lag are important. A solution to accelerate the research process can be found in flash mob research. This is a method to study clinically relevant questions on a large scale in a very short course of time. The research question and the set-up of the study should be exciting. Doing so, it attracts a large 'mob' of people who collect the data. Consequently, the generalizability of flash mob studies may be higher than that of traditional research studies.
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Affiliation(s)
- Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, Box 7001, B-3000, Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
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Farinola N, Caughey GE, Bell JS, Johns S, Hauta-Aho M, Shakib S. Influence of stroke and bleeding risk on prescribing of oral anticoagulants in older inpatients; has the availability of direct oral anticoagulants changed prescribing? Ther Adv Drug Saf 2017; 9:113-121. [PMID: 29387336 DOI: 10.1177/2042098617747835] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 11/17/2017] [Indexed: 11/16/2022] Open
Abstract
Background Little is known about changes in prescribing practices in Australia since the introduction of the direct oral anticoagulants (DOACs). Our objective was to examine if the availability of DOACs has coincided with a change in prescribing of oral anticoagulants in older hospital inpatients with regard to risk factors for stroke and bleeding. Methods A prospective observational study was conducted between October 2012 and August 2015 of inpatients aged over 60 years initiated on an oral anticoagulant in a large metropolitan, tertiary referral, public teaching hospital in Australia. Treatment groups were patients who commenced an oral anticoagulant prior to inclusion of DOACs on the formulary and those who commenced after the introduction of DOACs. Subgroup analyses were conducted in patients with atrial fibrillation (AF). Differences in clinical characteristics and risk for stroke and bleeding were calculated using the CHADS2 and HAS-BLED scores, respectively, were examined. Results A total of 289 patients were included. Inpatients prescribed an oral anticoagulant after the introduction of DOACs were significantly older, a greater proportion were female and more likely to have had a prior stroke. This was associated with a statistically higher CHADS2 score in the post-DOAC group. Similar findings were observed when limiting the sample to patients with AF. Patients with AF who were at greatest likelihood of having a bleeding event were less likely to be treated with a DOAC. Conclusion Since the introduction of the DOACs, patients who may have previously received no therapy or suboptimal treatment were now more likely to be receiving anticoagulation, suggesting an appropriate change in prescribing practice.
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Affiliation(s)
- Nicholas Farinola
- Department of Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, Australia
| | - Gillian E Caughey
- Department of Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, Australia
| | - J Simon Bell
- School of Pharmacy and Medical Sciences, University of South Australia, South Australia, Australia
| | - Sally Johns
- Department of Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, Australia
| | - Milka Hauta-Aho
- Department of Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, Australia
| | - Sepehr Shakib
- Department of Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, Australia
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Petit-Monéger A, Thiessard F, Jouhet V, Noize P, Berdaï D, Kret M, Sitta R, Salmi LR, Saillour-Glénisson F. Development and validation of hospital information system-generated indicators of the appropriateness of oral anticoagulant prescriptions in hospitalised adults: the PACHA study protocol. BMJ Open 2017; 7:e016488. [PMID: 28860229 PMCID: PMC5589008 DOI: 10.1136/bmjopen-2017-016488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION The appropriateness of oral anticoagulant prescriptions is a major challenge to improve quality and safety of care. As indicators of the appropriateness of oral anticoagulant prescriptions are lacking, the aim of the study is to develop and validate a panel of such indicators, in hospitalised adults, from the hospital information system of two university hospitals in France. METHODS AND ANALYSIS The study will be carried out in four steps: (1) a literature review to identify indicators of the appropriateness of oral anticoagulant prescriptions and their conditions of appropriateness; (2) a Delphi consensus method to assess the potential utility and operational implementation of the selected indicators; (3) techniques of medical data search to implement indicators from the hospital information system and; (4) a cross-sectional study to assess the ability of indicators to detect inappropriate oral anticoagulant prescriptions, performance of medical data search techniques for tracking or retrieving information and the ability of tools to be transferred into other institutions. The fourth step will include up to 80 patient hospital stays for each indicator, depending on the prevalence of inappropriate prescriptions estimated in interim analyses. ETHICS AND DISSEMINATION This work addresses the current lack of quality indicators of the appropriateness of oral anticoagulant prescriptions. We aim to develop and validate such indicators for integrating them into hospital clinical practice, as part of a structured approach to improve quality and safety of care. As each hospital information system is different, we will propose tools transferable to other healthcare institutions to allow an automated construction of these indicators. The PACHA study protocol was approved by institutional review boards and ethics committees (CPP Sud-Ouest et Outre Mer III-DC 2016/119; CPP Ile-de-France II-CDW_2016_0014). REGISTRATION DETAILS Clinical Trial.gov registration: NCT02898090.
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Affiliation(s)
- Aurélie Petit-Monéger
- CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, Bordeaux, France
- University of Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Frantz Thiessard
- CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, Bordeaux, France
- University of Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Vianney Jouhet
- CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, Bordeaux, France
- University of Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Pernelle Noize
- University of Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
- CHU de Bordeaux, Pôle de santé publique, Service de Pharmacologie Médicale, Bordeaux, France
| | - Driss Berdaï
- CHU de Bordeaux, Pôle de santé publique, Service de Pharmacologie Médicale, Bordeaux, France
| | - Marion Kret
- CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, Bordeaux, France
| | - Rémi Sitta
- CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, Bordeaux, France
| | - Louis-Rachid Salmi
- CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, Bordeaux, France
- University of Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Florence Saillour-Glénisson
- CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, Bordeaux, France
- University of Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
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12
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Cheng X, Zhou X, Song S, Wu M, Baolatejiang R, Lu Y, Li Y, Zhang W, Lv W, Ye Y, Zhou Q, Wang H, Zhang J, Xing Q, Tang B. Ethnicity and anticoagulation management of hospitalized patients with atrial fibrillation in northwest China. Sci Rep 2017; 7:45884. [PMID: 28393880 PMCID: PMC5385550 DOI: 10.1038/srep45884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 03/02/2017] [Indexed: 02/02/2023] Open
Abstract
The therapeutic management and health challenges caused by atrial fibrillation (AF) differ between different groups. The purpose of this study was to investigate the clinical features of patients hospitalized with AF and to explore the use of anticoagulation treatments in Han and Uygur patients in Xinjiang, northwest China. Data were collected from a retrospective descriptive study involving patients hospitalized at 13 hospitals in Xinjiang, China from Jul 1, 2014 to Jun 31, 2015. Anticoagulation management was measured according to guideline-recommended risk scores. A total of 4,181 patients with AF were included (mean age 69.5 ± 11.7 years, 41.4% females; 71.5% Han, 28.5% Uygur). The prevalence of AF in Uygur individuals may occur earlier than in Han individuals (mean age 64.9 vs 71.3, P < 0.001). Most of the hospitalized patients with AF had a high risk of stroke (CHA2DS2-VASc score ≥2; 80.6% Han vs 73.7% Uygur, P < 0.05); this risk was especially high in elderly patients. In AF patients, the application of anticoagulants according to the guidelines is far from expected, and the underutilization of anticoagulants exists in both ethnic groups.
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Affiliation(s)
- Xinchun Cheng
- Pacing and Electrophysiological Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China.,Cardre health care No. 4 department, The people's hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, 830054, China
| | - Xianhui Zhou
- Pacing and Electrophysiological Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China
| | - Shifei Song
- The First Department of Cardiology, Hospital of Xinjiang Production &Construction Corps, Urumqi, Xinjiang, 830054, China
| | - Min Wu
- Pacing and Electrophysiological Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China
| | - Roza Baolatejiang
- Pacing and Electrophysiological Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China
| | - Yanmei Lu
- Pacing and Electrophysiological Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China
| | - Yaodong Li
- Pacing and Electrophysiological Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China
| | - Wenhui Zhang
- Pacing and Electrophysiological Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China
| | - Wenkui Lv
- Pacing and Electrophysiological Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China
| | - Yuanzheng Ye
- Pacing and Electrophysiological Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China
| | - Qina Zhou
- Pacing and Electrophysiological Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China
| | - Hongli Wang
- Pacing and Electrophysiological Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China
| | - Jianghua Zhang
- Pacing and Electrophysiological Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China
| | - Qiang Xing
- Pacing and Electrophysiological Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China
| | - Baopeng Tang
- Pacing and Electrophysiological Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China
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13
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Desteghe L, Raymaekers Z, Lutin M, Vijgen J, Dilling-Boer D, Koopman P, Schurmans J, Vanduynhoven P, Dendale P, Heidbuchel H. Performance of handheld electrocardiogram devices to detect atrial fibrillation in a cardiology and geriatric ward setting. Europace 2016; 19:29-39. [PMID: 26893496 DOI: 10.1093/europace/euw025] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 01/21/2016] [Indexed: 11/12/2022] Open
Abstract
AIMS To determine the usability, accuracy, and cost-effectiveness of two handheld single-lead electrocardiogram (ECG) devices for atrial fibrillation (AF) screening in a hospital population with an increased risk for AF. METHODS AND RESULTS Hospitalized patients (n = 445) at cardiological or geriatric wards were screened for AF by two handheld ECG devices (MyDiagnostick and AliveCor). The performance of the automated algorithm of each device was evaluated against a full 12-lead or 6-lead ECG recording. All ECGs and monitor tracings were also independently reviewed in a blinded fashion by two electrophysiologists. Time investments by nurses and physicians were tracked and used to estimate cost-effectiveness of different screening strategies. Handheld recordings were not possible in 7 and 21.4% of cardiology and geriatric patients, respectively, because they were not able to hold the devices properly. Even after the exclusion of patients with an implanted device, sensitivity and specificity of the automated algorithms were suboptimal (Cardiology: 81.8 and 94.2%, respectively, for MyDiagnostick; 54.5 and 97.5%, respectively, for AliveCor; Geriatrics: 89.5 and 95.7%, respectively, for MyDiagnostick; 78.9 and 97.9%, respectively, for AliveCor). A scenario based on automated AliveCor evaluation in patients without AF history and without an implanted device proved to be the most cost-effective method, with a provider cost to identify one new AF patient of €193 and €82 at cardiology and geriatrics, respectively. The cost to detect one preventable stroke per year would be €7535 and €1916, respectively (based on average CHA2DS2-VASc of 3.9 ± 2.0 and 5.0 ± 1.5, respectively). Manual interpretation increases sensitivity, but decreases specificity, doubling the cost per detected patient, but remains cheaper than sole 12-lead ECG screening. CONCLUSION Using AliveCor or MyDiagnostick handheld recorders requires a structured screening strategy to be effective and cost-effective in a hospital setting. It must exclude patients with implanted devices and known AF, and requires targeted additional 12-lead ECGs to optimize specificity. Under these circumstances, the expenses per diagnosed new AF patient and preventable stroke are reasonable.
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Affiliation(s)
- Lien Desteghe
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium .,Heart Center Hasselt, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Zina Raymaekers
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium
| | - Mark Lutin
- Department of geriatrics, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Johan Vijgen
- Heart Center Hasselt, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
| | | | - Pieter Koopman
- Heart Center Hasselt, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Joris Schurmans
- Heart Center Hasselt, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
| | | | - Paul Dendale
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium.,Heart Center Hasselt, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Hein Heidbuchel
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium.,Heart Center Hasselt, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
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14
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Jawad-Ul-Qamar M, Kirchhof P. Almanac 2015: atrial fibrillation research in Heart. Heart 2016; 102:573-80. [PMID: 26791994 PMCID: PMC4819630 DOI: 10.1136/heartjnl-2015-307809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 11/26/2015] [Indexed: 01/21/2023] Open
Abstract
Atrial fibrillation continues to attract interest in the cardiovascular community and in Heart. Over 60 original research and review papers published in Heart in 2014–2015 cover various aspects of atrial fibrillation, from associated conditions and precipitating factors to new approaches to management. Here, we provide an overview of articles on atrial fibrillation published in Heart in 2014–2015, highlighting new developments, emerging concepts and novel approaches to treatment.
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Affiliation(s)
- Muhammad Jawad-Ul-Qamar
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK SWBH NHS Trust, Birmingham, UK
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK SWBH NHS Trust, Birmingham, UK UHB NHS Trust, Birmingham, UK Atrial Fibrillation NETwork (AFNET), Münster, Germany Department of Cardiovascular Medicine, Hospital of the University of Münster, Münster, Germany
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15
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Berti D, Van Vlasselaer X, Moons P, Heidbuchel H. Prioritized outcomes to evaluate the effectiveness of atrial fibrillation disease management: A systematic review and Delphi study. Int J Cardiol 2016; 202:500-3. [DOI: 10.1016/j.ijcard.2015.09.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 09/19/2015] [Accepted: 09/24/2015] [Indexed: 11/30/2022]
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16
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Antman EM. Saving and Improving Lives in the Information Age: Presidential Address at the American Heart Association 2014 Scientific Sessions. Circulation 2015; 131:2238-42. [PMID: 26099959 DOI: 10.1161/cir.0000000000000224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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