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Guenoun M, Cohen S, Villaceque M, Sharareh A, Schwartz J, Hoffman O, Dib JC, Ouazana L, Assouline S, Parrens E, Garban T, Pradeau V, Guedj-Meynier D, Lequeux B, Cohen C, Durand P, Dievart F, Dhanjal TS, Sabouret P, Lellouche N. Characteristics of patients with atrial fibrillation treated with direct oral anticoagulants and new insights into inappropriate dosing: results from the French National Prospective Registry: PAFF. Europace 2023; 25:euad302. [PMID: 37801642 PMCID: PMC10590101 DOI: 10.1093/europace/euad302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/14/2023] [Indexed: 10/08/2023] Open
Abstract
AIMS Since the introduction of direct oral anticoagulant (DOAC) for atrial fibrillation (AF) therapy, inappropriate and/or underdosing of these drugs has been a major clinical challenge. We evaluated the characteristics of patients with AF treated with inappropriate and low-dose DOACs. METHODS AND RESULTS Patients with AF treated with inappropriate and low-dose DOACs from October 2021 to December 2021 were evaluated from the French National Prospective Registry (PAFF). We evaluated 1890 patients with AF receiving DOACs (apixaban 55%, dabigatran 7%, and rivaroxaban 38%). Inappropriate dosing was noted in 18% of the population. Patients with appropriate dosing had less comorbidities: younger age (75 ± 10 vs. 82 ± 8 years old, P < 0.0001), reduced chronic renal failure (26 vs. 61%, P < 0.0001), and lower CHA2DS2VASc and HASBLED scores (3 ± 2 vs. 4 ± 3, P < 0.0001; 2 ±1 vs. 2 ± 2, P < 0.0001), respectively. In multivariate analysis, older age (P < 0.0001) and a higher CHA2DS2VASc score (P = 0.0056) were independently associated with inappropriate DOAC dosing. Among 472 patients (27%) treated with low-dose rivaroxaban or apixaban, 46% were inappropriately underdosed. Patients inappropriately underdosed were younger (82.3 ± 8.4 vs. 85.9 ± 5.9 years, P < 0.0001) with less chronic renal disease (47 vs. 98%, P < 0.0001). However, these patients had higher rates of prior haemorrhagic events (18 vs. 10%, P = 0.01), clopidogrel use (11 vs. 3%, P = 0.0002), and apixaban prescription (74 vs. 50%, P < 0.0001). CONCLUSION Within this large registry, DOACs were associated with inappropriate dosing in 18% of cases. Independent predictors of inappropriate dosing were high CHA2DS2VASc scores and older age. Moreover, 46% of patients treated with low-dose DOACs were inappropriately underdosed and more frequently in patients treated with apixaban.
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Affiliation(s)
- Maxime Guenoun
- Almaviva Santé, Marseille, France
- College National des Cardiologues Français, Paris, France
| | - Serge Cohen
- College National des Cardiologues Français, Paris, France
| | | | - Ali Sharareh
- College National des Cardiologues Français, Paris, France
| | | | | | | | - Leon Ouazana
- College National des Cardiologues Français, Paris, France
| | | | - Eric Parrens
- College National des Cardiologues Français, Paris, France
- Clinique Tivoli-Ducos, Bordeaux, France
| | - Thierry Garban
- College National des Cardiologues Français, Paris, France
| | | | | | - Benoit Lequeux
- College National des Cardiologues Français, Paris, France
| | | | - Philippe Durand
- College National des Cardiologues Français, Paris, France
- Institut Arnaud Tzanck, Saint Laurent du Var, France
| | | | - Tarvinder S Dhanjal
- Department of Cardiac Electrophysiology, University of Warwick, Gibbet Hill, Coventry, UK
| | - Pierre Sabouret
- College National des Cardiologues Français, Paris, France
- Department of Cardiology, AP-HP, University Hospital Pitie-Salpetriere, Paris, France
| | - Nicolas Lellouche
- Department of Cardiology, AP-HP, University Hospital Henri Mondor, 51, Avenue du Maréchal de Lattre de Tassigny, Creteil 94000, France
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Halimi F, Sabouret P, Huberman JP, Cohen S, Ouazana L, Hoffman O, Assouline S, Guedj-Meynier D, Schwartz J, Weiss P, Lafont C, Lellouche N. Atrial fibrillation diagnosis by a systematic 14-day continuous ECG-Holter in patients with high cardiovascular risk and clinical palpitation: the prospective AFTER study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Atrial Fibrillation (AF) is asymptomatic in 20–30% of cases. New technologic tools for continuous ECG monitoring have been developed to detect and potentially treat AF in specific population with high cardiovascular risk.
Purpose
We aimed to evaluate the prevalence and the management of AF diagnosed in patients with no previous documented AF but with a high cardiovascular risk and clinical palpitation undergoing systematic 14-day continuous ECG-Holter monitoring and associated characteristics.
Methods
Patients were prospectively enrolled from December 2019 to December 2021 in this multicentered study, sponsored by the French National College of Cardiology. Patients needed to meet the following criteria: CHA2DS2VASc score ≥3 in women >2 in men associated with clinical palpitation without previous documented arrhythmia, particularly AF. Exclusion criteria were: previous documented AF, participation to another study that could interfere with the current study, pregnancy, previous skin intolerance to ECG-Holter electrodes. Included patients underwent a 14-day monitoring Holter-ECG to detect cardiac arrhythmia, particularly AF. Patients' characteristics, type of arrythmias and management of detected AF were described.
Results
Among the 336 included patients, 39% were men, median age was 73 [64.5–78] years, 71.5% had hypertension and 46.5% had a previous history of stroke. AF was detected in 14% of patients, among which 23.4% in the first 24 hours monitoring. In univariate analyses, older age (p=0.045) was significantly associated with AF, and a trend was observed regarding male gender (p=0.067) and less antiplatelet therapy (p=0.058). Patients with diagnosed AF had a prescription of anticoagulation therapy in 90% of cases consisting in apixaban and rivaroxaban for 72% and 28% respectively. Antiarrhythmic drugs were administered in 90% of AF patients and 13% underwent AF ablation.
Conclusions
The systematic AF screening of selected patients based on CHA2DS2VASc score ≥3 in women >2 in men associated with palpitations allows to diagnose AF in 14% of the population with a 14-day continuous ECG-Holter. This strategy seems efficient as it induced the prescription of anticoagulation and antiarrhythmic therapy in 90% of individuals.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): NATIONAL COLLEGE OF FRENCH CARDIOLOGISTS
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Affiliation(s)
- F Halimi
- Private Hopital of Parly II, Rythmology , Le Chesnay , France
| | - P Sabouret
- Hospital Pitie-Salpetriere , Paris , France
| | - J P Huberman
- National College of French Cardiologists, Cardiology , Paris , France
| | - S Cohen
- National College of French Cardiologists, Cardiology , Paris , France
| | - L Ouazana
- National College of French Cardiologists, Cardiology , Paris , France
| | - O Hoffman
- National College of French Cardiologists, Cardiology , Paris , France
| | - S Assouline
- National College of French Cardiologists, Cardiology , Paris , France
| | - D Guedj-Meynier
- National College of French Cardiologists, Cardiology , Paris , France
| | - J Schwartz
- National College of French Cardiologists, Cardiology , Paris , France
| | - P Weiss
- National College of French Cardiologists, Cardiology , Paris , France
| | - C Lafont
- University Hospital Henri Mondor, Public Health , Creteil , France
| | - N Lellouche
- University Hospital Henri Mondor, Rythmology Department , Creteil , France
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Reach G, Guedj-Meynier D, Darné B, Herpin D. [Factors associated with medication non-adherence in uncontrolled hypertensive males and females: ODACE study]. Ann Cardiol Angeiol (Paris) 2015; 64:222-226. [PMID: 26047871 DOI: 10.1016/j.ancard.2015.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 04/28/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The aim of this study was (1) to measure adherence in males and females with uncontrolled hypertension, and (2) to identify factors associated with non-adherence to antihypertensive medication. PATIENTS AND METHODS Each general practitioner (GP) should include the first two male and the first two female patients with uncontrolled treated hypertension. Adherence to antihypertensive treatment was estimated by the GP and using the French League Against High blood pressure (FLAH) self-administered questionnaire. A stepwise logistic regression analysis was used to identify factors associated with non-adherence on the FLAH scale, independently in males and in females. RESULTS A total of 1630 males and 1612 females were included in the analysis. Adherence to treatment was significantly better in females or when estimated by the GP. Lack of motivation was the first factor associated with poor adherence in both sexes. Considering hypertension as a simple anomaly and not a disease that can lead to cardiac or cerebral disorders was the second common parameter in both sexes. Other common factors were: having monthly periods of financial difficulties in facing his/her needs and absence of regular screening for colon cancer. CONCLUSION Adherence to treatment is better in uncontrolled hypertensive females. Poor adherence is mainly associated with non-clinical factors. The lack of motivation is the most important element.
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Affiliation(s)
- G Reach
- Service d'endocrinologie diabétologie maladies métaboliques, hôpital Avicenne & EA 3412, université Paris 13, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, 125, route de Stalingrad, 93000 Bobigny, France.
| | | | - B Darné
- Monitoring Force Group, 38, rue Jean-Mermoz, bâtiment D, 78604 Maisons-Laffitte cedex, France
| | - D Herpin
- Service de cardiologie, centre hospitalier et universitaire de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
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Blacher J, Peroz-Froz J, Huberman JP, Ferrini M, Jullien G, Guenoun M, Guedj-Meynier D. Ambulatory hypertensive patients treated by cardiologists in France. Arch Cardiovasc Dis 2013; 106:86-92. [DOI: 10.1016/j.acvd.2012.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 11/02/2012] [Accepted: 11/13/2012] [Indexed: 01/13/2023]
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Mounier-Vehier C, Simon T, Guedj-Meynier D, Ferrini M, Ghannad E, Hubermann JP, Jullien G, Poncelet P, Achouba A, Quéré S, Guenoun M. Gender-related differences in the management of hypertension by cardiologists: the PARITE study. Arch Cardiovasc Dis 2012; 105:271-80. [PMID: 22709468 DOI: 10.1016/j.acvd.2012.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Revised: 03/10/2012] [Accepted: 03/15/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Several studies have shown gender differences in the management of cardiovascular risk factors and diseases. Whether the management of hypertension by cardiologists in France differs according to patient gender has not been fully investigated. AIMS The main objective of this cross-sectional, multicentre study was to examine the management according to gender of hypertensive patients by office-based cardiologists in France. METHODS Cardiologists were asked to include consecutively two men and two women attending a routine consultation for essential hypertension. Therapeutic management was evaluated by comparing cardiovascular investigations in the preceding 6 months and hypertension control according to gender and the patients' global cardiovascular risk. RESULTS Overall, data from 3440 adult patients (53% men) referred to 654 cardiologists were analysed. Hypertension was uncontrolled in 76% of both men and women and 69% were at high global cardiovascular risk (75% of men, 62% of women; P<0.001). Significantly fewer cardiovascular investigations had been performed in the preceding 6 months in women (22.6% vs 44.2% in men; P<0.001). The treatment regimen was changed by the cardiologist in approximately 50% of patients regardless of gender or global cardiovascular risk. CONCLUSIONS The PARITE study shows that in French office-based cardiology practice, the antihypertensive regimen is adjusted as often in female as in male patients. However, the results suggest that there is room for improvement in the investigation of cardiovascular disease in women. Healthcare providers could be encouraged to implement established guidelines on the prevention of cardiovascular disease in women.
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Affiliation(s)
- Claire Mounier-Vehier
- Pôle cardiovasculaire et pulmonaire, médecine vasculaire et hypertension artérielle, faculté Henri-Warembourg, université de Lille, CHRU de Lille, France.
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Driss AB, Guenoun M, Malergue MC, Jourdain P, Paganelli F, Meurin P, Tabet JY, Guedj-Meynier D. 050 Left ventricular systolic dysfunction in patients with coronary artery disease and normal electrocardiogram: results from INDYCE registry. Archives of Cardiovascular Diseases Supplements 2011. [DOI: 10.1016/s1878-6480(11)70052-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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