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Holmlund L, Hörnsten C, Valham F, Olsson K, Hörnsten Å, Ängerud KH. Illness Perceptions and Health-Related Quality of Life in Women and Men With Atrial Fibrillation. J Cardiovasc Nurs 2024; 39:49-57. [PMID: 37074949 DOI: 10.1097/jcn.0000000000000995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
BACKGROUND Health-related quality of life (HRQoL) is worse in patients with atrial fibrillation (AF) compared with other populations. Factors affecting HRQoL in patients with AF are not fully clarified. Illness perceptions are important determinants of disease management and may affect HRQoL. OBJECTIVE The aims of this study were to describe illness perceptions and HRQoL in women and men with AF and to explore the relationship between illness perceptions and HRQoL in patients with AF. METHODS This cross-sectional study included 167 patients with AF. Patients completed the Revised Illness Perception Questionnaire and HRQoL questionnaires: Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmias, the three-level version of the EuroQol 5-dimensional questionnaire, and EuroQol visual analog scale. Subscales of the Revised Illness Perception Questionnaire significant in correlation analysis with the Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmias HRQoL total scale were included in a multiple linear regression model. RESULTS Mean age was 68.7 ± 10.4 years, and 31.1% were women. Women reported lower personal control ( P = .039) and worse HRQoL measured with the Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmias physical subscale ( P = .047) and the EuroQol visual analog scale ( P = .044) compared with men. Illness identity ( P < .001), consequences ( P = .031), emotional representation ( P = .014), and timeline cyclical ( P = .022) were related to and adversely affected HRQoL. CONCLUSIONS This study found a relationship between illness perceptions and HRQoL. Some subscales of illness perceptions negatively affected HRQoL in patients with AF, which indicates that efforts to change illness perceptions may be helpful in improving HRQoL. Patients should be given the opportunity to talk about the disease, their symptoms, their emotions, and the consequences of the disease to enable increased HRQoL. A challenge for healthcare will be to design support for each patient based on his/her illness perceptions.
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Giannopoulos G, Antoniadis A, Vassilikos VP. Atrial Fibrillation Catheter Ablation and Psychological Distress. JAMA 2023; 330:2397. [PMID: 38147097 DOI: 10.1001/jama.2023.23120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Affiliation(s)
- Georgios Giannopoulos
- Third Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Antoniadis
- Third Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassilios P Vassilikos
- Third Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Kalman JM, Al-Kaisey A, Kistler P. Atrial Fibrillation Catheter Ablation and Psychological Distress-Reply. JAMA 2023; 330:2397. [PMID: 38147094 DOI: 10.1001/jama.2023.23123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Affiliation(s)
- Jonathan M Kalman
- Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Ahmed Al-Kaisey
- Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter Kistler
- University of Melbourne, Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia
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Minjie Z, Zhijuan X, Xinxin S, Xinzhu B, Shan Q. The effects of cognitive behavioral therapy on health-related quality of life, anxiety, depression, illness perception, and in atrial fibrillation patients: a six-month longitudinal study. BMC Psychol 2023; 11:431. [PMID: 38062475 PMCID: PMC10704769 DOI: 10.1186/s40359-023-01457-z] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) often leads to an impaired Health-Related Quality of Life (HRQoL) in many patients. Moreover, psychological factors such as depression, anxiety, and illness perception have been found to significantly correlate with HRQoL. This study aims to evaluate the long-term effectiveness of Cognitive Behavioral Therapy (CBT) in enhancing HRQoL and mitigating psychological distress among AF patients. METHODS Employing a prospective, open design with pseudo-randomization, this study encompassed pre-tests, post-treatment evaluations, and a 6-month follow-up. A total of 102 consecutive patients diagnosed with paroxysmal AF were initially enrolled. Out of these, 90 were assigned to two groups; one to receive a 10-week CBT treatment specifically focusing on anxiety, and the other to receive standard care. Outcome measures were evaluated using tools such as the Item Short Form Health Survey (SF-12), General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), University of Toronto Atrial Fibrillation Severity Scale (AFSS), and Brief Illness Perception Questionnaire (BIPQ). These assessments were conducted at pre-treatment, post-treatment, and at the 6-month follow-up mark. We explored the effectiveness of CBT using Generalized Estimating Equations (GEE). RESULTS Our analysis revealed a notable improvement in the CBT group relative to the control group. All metrics displayed consistent improvement across a 6-month duration. At the 6-month checkpoint, the CBT group exhibited a more favorable SF-12 Mental Component Score (MCS) (50.261 ± 0.758 vs. 45.208 ± 0.887, p < 0.001), reduced GAD-7 (4.150 ± 0.347 vs. 8.022 ± 0.423, p < 0.001), BIPQ (34.700 ± 0.432 vs. 38.026 ± 0.318, p < 0.001), and AFSS (9.890 ± 0.217 vs. 10.928 ± 0.218, p = 0.001) scores when compared to the TAU group. Conversely, the SF-12 PCS (44.212 ± 0.816 vs. 47.489 ± 0.960, p = 0.139) and PHQ-9 scores (8.419 ± 0.713 vs. 10.409 ± 0.741, p = 0.794) manifested no significant difference between the two groups. CONCLUSION The findings suggest that CBT is effective in improving HRQoL and reducing psychological distress among patients with AF at 6 month follow-up. This highlights the potential benefits of integrating CBT into the therapeutic regimen for AF patients. TRIAL REGISTRATION Retrospectively registered with ClinicalTrials.gov (NCT05716828). The date of registration : 5 June 2023.
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Affiliation(s)
- Zheng Minjie
- Department of Medical Psychology, Peking University People's Hospital, Beijing, China
| | - Xie Zhijuan
- Department of Medical Psychology, Peking University People's Hospital, Beijing, China
| | - Shi Xinxin
- Department of Medical Psychology, Peking University People's Hospital, Beijing, China
| | - Bai Xinzhu
- Department of Medical Psychology, Peking University People's Hospital, Beijing, China
| | - Qu Shan
- Department of Medical Psychology, Peking University People's Hospital, Beijing, China.
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Al-Kaisey AM, Parameswaran R, Bryant C, Anderson RD, Hawson J, Chieng D, Segan L, Voskoboinik A, Sugumar H, Wong GR, Finch S, Joseph SA, McLellan A, Ling LH, Morton J, Sparks P, Sanders P, Lee G, Kistler PM, Kalman JM. Atrial Fibrillation Catheter Ablation vs Medical Therapy and Psychological Distress: A Randomized Clinical Trial. JAMA 2023; 330:925-933. [PMID: 37698564 PMCID: PMC10498333 DOI: 10.1001/jama.2023.14685] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 01/25/2023] [Accepted: 07/12/2023] [Indexed: 09/13/2023]
Abstract
Importance The impact of atrial fibrillation (AF) catheter ablation on mental health outcomes is not well understood. Objective To determine whether AF catheter ablation is associated with greater improvements in markers of psychological distress compared with medical therapy alone. Design, Setting, and Participants The Randomized Evaluation of the Impact of Catheter Ablation on Psychological Distress in Atrial Fibrillation (REMEDIAL) study was a randomized trial of symptomatic participants conducted in 2 AF centers in Australia between June 2018 and March 2021. Interventions Participants were randomized to receive AF catheter ablation (n = 52) or medical therapy (n = 48). Main Outcomes and Measures The primary outcome was Hospital Anxiety and Depression Scale (HADS) score at 12 months. Secondary outcomes included follow-up assessments of prevalence of severe psychological distress (HADS score >15), anxiety HADS score, depression HADS score, and Beck Depression Inventory-II (BDI-II) score. Arrhythmia recurrence and AF burden data were also analyzed. Results A total of 100 participants were randomized (mean age, 59 [12] years; 31 [32%] women; 54% with paroxysmal AF). Successful pulmonary vein isolation was achieved in all participants in the ablation group. The combined HADS score was lower in the ablation group vs the medical group at 6 months (8.2 [5.4] vs 11.9 [7.2]; P = .006) and at 12 months (7.6 [5.3] vs 11.8 [8.6]; between-group difference, -4.17 [95% CI, -7.04 to -1.31]; P = .005). Similarly, the prevalence of severe psychological distress was lower in the ablation group vs the medical therapy group at 6 months (14.2% vs 34%; P = .02) and at 12 months (10.2% vs 31.9%; P = .01), as was the anxiety HADS score at 6 months (4.7 [3.2] vs 6.4 [3.9]; P = .02) and 12 months (4.5 [3.3] vs 6.6 [4.8]; P = .02); the depression HADS score at 3 months (3.7 [2.6] vs 5.2 [4.0]; P = .047), 6 months (3.4 [2.7] vs 5.5 [3.9]; P = .004), and 12 months (3.1 [2.6] vs 5.2 [3.9]; P = .004); and the BDI-II score at 6 months (7.2 [6.1] vs 11.5 [9.0]; P = .01) and 12 months (6.6 [7.2] vs 10.9 [8.2]; P = .01). The median (IQR) AF burden in the ablation group was lower than in the medical therapy group (0% [0%-3.22%] vs 15.5% [1.0%-45.9%]; P < .001). Conclusion and Relevance In this trial of participants with symptomatic AF, improvement in psychological symptoms of anxiety and depression was observed with catheter ablation, but not medical therapy. Trial Registration ANZCTR Identifier: ACTRN12618000062224.
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Affiliation(s)
- Ahmed M. Al-Kaisey
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia
| | - Ramanathan Parameswaran
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia
| | - Christina Bryant
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Robert D. Anderson
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Joshua Hawson
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - David Chieng
- Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia
- Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | - Louise Segan
- Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia
- Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | - Aleksandr Voskoboinik
- Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia
- Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | - Hariharan Sugumar
- Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia
- Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | - Geoffrey R. Wong
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Sue Finch
- School of Mathematics and Statistics, University of Melbourne, Melbourne, Victoria, Australia
| | - Stephen A. Joseph
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia
| | - Alex McLellan
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Liang-Han Ling
- Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia
- Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | - Joseph Morton
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Paul Sparks
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Geoffrey Lee
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter M. Kistler
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia
- Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | - Jonathan M. Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Lurz J, Ladwig KH. Benefits of Pulmonary Vein Isolation Beyond Rhythm Control: Implications for Mental Health. JAMA 2023; 330:919-920. [PMID: 37698577 DOI: 10.1001/jama.2023.6484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Affiliation(s)
- Julia Lurz
- Department of Electrophysiology, Heart Center Leipzig at University Leipzig, Leipzig, Germany
| | - Karl-Heinz Ladwig
- Department for Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
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Li PWC, Yu DSF, Yan BP. Nurse-led multi-component behavioural activation programme to improve health outcomes in patients with atrial fibrillation: a mixed-methods study and feasibility analysis. Eur J Cardiovasc Nurs 2023; 22:655-663. [PMID: 36394495 DOI: 10.1093/eurjcn/zvac104] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/19/2022] [Accepted: 11/02/2022] [Indexed: 09/06/2023]
Abstract
AIMS Patients with atrial fibrillation (AF) play passive roles in disease management. This study aimed to examine the feasibility and preliminary effects of an empowerment-based care model, titled 'the nurse-led multi-component behavioural activation (N-MBA) programme', on health-related quality of life, AF knowledge, psychological outcomes, medication adherence, and treatment decision-making in patients with AF. METHODS AND RESULTS This mixed-methods study comprised a pilot randomized controlled trial and a qualitative study. Patients with AF who had a moderate-to-high risk of stroke but were not prescribed oral anticoagulants were recruited. Forty participants were recruited and randomized in a 1:1 ratio to receive either the N-MBA programme or standard care. The 13-week programme comprised care components that prepared patients for shared decision-making, an empowerment-based educational module on AF self-care, and continuous support through telephone calls. The programme was feasible, and the overall attendance rate was 82.5%. The participants gave excellent ratings in the satisfaction survey. The N-MBA group showed greater improvements in health-related quality of life (HRQoL) and AF knowledge than the standard care group at the immediate post intervention and 6-month follow-up time points. No significant between-group changes in medication adherence, anxiety, and depression were detected. Participants in the N-MBA group actively raised concerns about AF and its treatment with their attending doctors. The qualitative data were consistent with the quantitative data, indicating that the programme built a comprehensive knowledge base of AF and self-care behaviours. CONCLUSION The N-MBA programme is feasible and acceptable to patients with AF. It improved patients' AF knowledge, treatment-related decision-making, and HRQoL. REGISTRATION ClinicalTrials.gov NCT03924739.
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Affiliation(s)
- Polly W C Li
- School of Nursing, LKS Faculty of Medicine, 5/F, HKUMed Academic Building, 3 Sassoon Road, The University of Hong Kong, Pokfulam, Hong Kong
| | - Doris S F Yu
- School of Nursing, LKS Faculty of Medicine, 5/F, HKUMed Academic Building, 3 Sassoon Road, The University of Hong Kong, Pokfulam, Hong Kong
| | - Bryan P Yan
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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Bates RW, Bailey C, Topping AE. 'Out of sync': a qualitative investigation of patients' experiences of atrial fibrillation and perceptions of weight management. BMJ Open 2022; 12:e065995. [PMID: 36343999 PMCID: PMC9644348 DOI: 10.1136/bmjopen-2022-065995] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To explore ways to enhance the design of risk factor management and weight-loss services for people with overweight/obesity and atrial fibrillation (AF). BACKGROUND AF is the most common cardiac arrhythmia, with serious consequences for health and quality of life. Some evidence indicates weight reduction in people with AF and overweight/obesity may improve symptoms. This population may require additional support with weight management due to factors associated with ageing and health. DESIGN Qualitative investigation based on semi-structured interviews. METHODS 12 adult participants (4 female, 8 male) with diagnosed AF and a current or previous body mass index >27 kg/m2 were recruited at a large tertiary cardiac referral centre in southern England between September 2020 and January 2021. Participants completed quality of life and AF symptom questionnaires using Think-Aloud technique and semi-structured interviews relating to their weight management experiences, needs and preferences. Interviews were audio recorded and analysed thematically using the Capability, Opportunity and Motivation-Behaviour model as a theoretical framework. RESULTS Three main themes were identified. Being out of rhythm explores the psychological and physical impact of AF on weight management; doing the right thing discusses participants' weight management experiences and broaching the subject explores participants' perspectives on weight management conversations with clinicians. CONCLUSIONS There was dissatisfaction with the weight management advice received from healthcare professionals including cardiologists. Participants wanted open, non-judgemental discussion of cardiac health implications of overweight/obesity supported by referral to weight management services. Improved communication including research findings regarding the benefits of weight loss as a factor in AF management might increase motivation to adhere to weight-loss advice in this population.
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Affiliation(s)
- Rachel Wendy Bates
- School of Nursing and Midwifery, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
- John Radcliffe Hospital, Oxford, UK
| | - Cara Bailey
- School of Nursing and Midwifery, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - A E Topping
- School of Nursing and Midwifery, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
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Wang J, Lai Y, Jiang C, Bai Y, Xu B, Du X, Dong J, Ma C. Feasibility and Validity of Cambridge Neuropsychological Test Automated Battery in Mild Cognitive Impairment Screening for Patients with Atrial Fibrillation. Comput Math Methods Med 2022; 2022:1527292. [PMID: 35178112 PMCID: PMC8847012 DOI: 10.1155/2022/1527292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/06/2022] [Accepted: 01/25/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is associated with the worsening of cognitive function. Strategies that are both convenient and reliable for cognitive screening of AF patients remain underdeveloped. We aimed to analyze the sensitivity and specificity of computerized cognitive screening strategies using subtests from Cambridge Neuropsychological Test Automated Battery (CANTAB) in AF patients. METHODS The Multitasking Test (MTT), Rapid Visual Information Processing (RVP), and Paired Associates Learning (PAL) subtests from CANTAB were performed in 105 AF patients. Traditional standard neuropsychological tests were used as a reference standard. Cognitive screening models using different CANTAB subtests were established using multivariable logistic regression. Further stepwise regression using the Akaike Information Criterion (AIC) was applied to optimize the models. Receiver operating characteristic curve analyses were used to study the sensitivity and specificity of these models. RESULTS Fifty-eight (55%) patients were diagnosed with mild cognitive impairment (MCI). MTT alone had reasonable sensitivity (82.8%) and specificity (74.5%) for MCI screening, while RVP (sensitivity 72.4%, specificity 70.2%) and PAL (sensitivity 70.7%, specificity 57.4%) were less effective. Stepwise regression of all available variables revealed that a combination of MTT and RVP brought about higher specificity (sensitivity 82.8%, specificity 85.8%), while PAL was not included in the optimal model. Moreover, adding education to the models did not result in improved validity for MCI screening. CONCLUSION The CANTAB subtests are feasible and effective strategies for MCI screening among AF patients independent of patients' education levels. Hence, they are practical for cardiologists or general practitioners.
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Affiliation(s)
- Jia Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
| | - Yiwei Lai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
| | - Chao Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
| | - Yu Bai
- Faculty of Science, The University of Sydney, Sydney, Australia
| | - Baolei Xu
- Department of Neurology, Beijing Anzhen Hospital, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
| | - Jianzeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, Beijing, China
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Wheelock KM, Kratz A, Lathkar-Pradhan S, Najarian K, Gryak J, Li Z, Oral H, Clauw DJ, Nallamothu BK, Ghanbari H. Association between symptoms, affect and heart rhythm in patients with persistent or paroxysmal atrial fibrillation: an ambulatory pilot study. Am Heart J 2021; 241:1-5. [PMID: 34157300 DOI: 10.1016/j.ahj.2021.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 06/03/2021] [Indexed: 11/19/2022]
Abstract
Symptoms in atrial fibrillation are generally assumed to correspond to heart rhythm; however, patient affect - the experience of feelings, emotion or mood - is known to frequently modulate how patients report symptoms but this has not been studied in atrial fibrillation. In this study, we investigated the relationship between affect, symptoms and heart rhythm in patients with paroxysmal or persistent atrial fibrillation. We found that presence of negative affect portended reporting of more severe symptoms to the same or greater extent than heart rhythm.
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Affiliation(s)
| | - Anna Kratz
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical School
| | - Sangeeta Lathkar-Pradhan
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical School
| | - Kayvan Najarian
- Department of Emergency Medicine, University of Michigan Medical School
| | - Jonathan Gryak
- Department of Emergency Medicine, University of Michigan Medical School
| | - Zhi Li
- Department of Emergency Medicine, University of Michigan Medical School
| | - Hakan Oral
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School
| | - Daniel J Clauw
- Department of Internal Medicine, Division of Rheumatology, University of Michigan Medical School
| | - Brahmajee K Nallamothu
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical School
| | - Hamid Ghanbari
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical School.
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Kamath CC, Giblon R, Kunneman M, Lee AI, Branda ME, Hargraves IG, Sivly AL, Bellolio F, Jackson EA, Burnett B, Gorr H, Torres Roldan VD, Spencer-Bonilla G, Shah ND, Noseworthy PA, Montori VM, Brito JP. Cost Conversations About Anticoagulation Between Patients With Atrial Fibrillation and Their Clinicians: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2116009. [PMID: 34255051 PMCID: PMC8278261 DOI: 10.1001/jamanetworkopen.2021.16009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
IMPORTANCE How patients with atrial fibrillation (AF) and their clinicians consider cost in forming care plans remains unknown. OBJECTIVE To identify factors that inform conversations regarding costs of anticoagulants for treatment of AF between patients and clinicians and outcomes associated with these conversations. DESIGN, SETTING, AND PARTICIPANTS This cohort study of recorded encounters and participant surveys at 5 US medical centers (including academic, community, and safety-net centers) from the SDM4AFib randomized trial compared standard AF care with and without use of a shared decision-making (SDM) tool. Included patients were considering anticoagulation treatment and were recruited by their clinicians between January 30, 2017, and June 27, 2019. Data were analyzed between August and November 2019. MAIN OUTCOMES AND MEASURES The incidence of and factors associated with cost conversations, and the association of cost conversations with patients' consideration of treatment cost burden and their choice of anticoagulation. RESULTS A total of 830 encounters (out of 922 enrolled participants) were recorded. Patients' mean (SD) age was 71.0 (10.4) years; 511 patients (61.6%) were men, 704 (86.0%) were White, 303 (40.9%) earned between $40 000 and $99 999 in annual income, and 657 (79.2%) were receiving anticoagulants. Clinicians' mean (SD) age was 44.8 (13.2) years; 75 clinicians (53.2%) were men, and 111 (76%) practiced as physicians, with approximately half (69 [48.9%]) specializing in either internal medicine or cardiology. Cost conversations occurred in 639 encounters (77.0%) and were more likely in the SDM arm (378 [90%] vs 261 [64%]; OR, 9.69; 95% CI, 5.77-16.29). In multivariable analysis, cost conversations were more likely to occur with female clinicians (66 [47%]; OR, 2.85; 95% CI, 1.21-6.71); consultants vs in-training clinicians (113 [75%]; OR, 4.0; 95% CI, 1.4-11.1); clinicians practicing family medicine (24 [16%]; OR, 12.12; 95% CI, 2.75-53.38]), internal medicine (35 [23%]; OR, 3.82; 95% CI, 1.25-11.70), or other clinicians (21 [14%]; OR, 4.90; 95% CI, 1.32-18.16) when compared with cardiologists; and for patients with an annual household income between $40 000 and $99 999 (249 [82.2%]; OR, 1.86; 95% CI, 1.05-3.29) compared with income below $40 000 or above $99 999. More patients who had cost conversations reported cost as a factor in their decision (244 [89.1%] vs 327 [69.0%]; OR 3.66; 95% CI, 2.43-5.50), but cost conversations were not associated with the choice of anticoagulation agent. CONCLUSIONS AND RELEVANCE Cost conversations were common, particularly for middle-income patients and with female and consultant-level primary care clinicians, as well as in encounters using an SDM tool; they were associated with patients' consideration of treatment cost burden but not final treatment choice. With increasing costs of care passed on to patients, these findings can inform efforts to promote cost conversations in practice. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02905032.
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Affiliation(s)
- Celia C. Kamath
- Robert D. and Patricia E. Kern Center for the Science of HealthCare Delivery, Mayo Clinic, Rochester, Minnesota
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Rachel Giblon
- Robert D. and Patricia E. Kern Center for the Science of HealthCare Delivery, Mayo Clinic, Rochester, Minnesota
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Marlene Kunneman
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Alexander I. Lee
- Robert D. and Patricia E. Kern Center for the Science of HealthCare Delivery, Mayo Clinic, Rochester, Minnesota
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Megan E. Branda
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
- Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, Denver, Aurora
| | - Ian G. Hargraves
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Angela L. Sivly
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
| | | | - Elizabeth A. Jackson
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham
| | - Bruce Burnett
- Thrombosis Clinic and Anticoagulation Services, Park Nicollet Health Services, St Lois Park, Minnesota
| | - Haeshik Gorr
- Division of General Internal Medicine, Hennepin Health, Minneapolis, Minnesota
| | - Victor D. Torres Roldan
- Robert D. and Patricia E. Kern Center for the Science of HealthCare Delivery, Mayo Clinic, Rochester, Minnesota
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
| | | | - Nilay D. Shah
- Robert D. and Patricia E. Kern Center for the Science of HealthCare Delivery, Mayo Clinic, Rochester, Minnesota
| | - Peter A. Noseworthy
- Robert D. and Patricia E. Kern Center for the Science of HealthCare Delivery, Mayo Clinic, Rochester, Minnesota
- Heart Rhythm Services, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Victor M. Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
- Department of Endocrinology, Mayo Clinic, Rochester, Minnesota
| | - Juan P. Brito
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
- Department of Endocrinology, Mayo Clinic, Rochester, Minnesota
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12
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Varona JF, Seguí-Ripoll JM, Lozano-Duran C, Cuadrado-Gómez LM, Montagud-Moncho JB, Ramos-Guerrero A, Mirete-Ferrer JC, Donado E, García-Alegría J. Health-related quality of life in nonvalvular atrial fibrillation patients with controlled or uncontrolled anticoagulation status. Health Qual Life Outcomes 2020; 18:383. [PMID: 33308246 PMCID: PMC7731734 DOI: 10.1186/s12955-020-01563-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 09/14/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND There is a dearth of evidence regarding Health-Related Quality of Life (HRQoL) in nonvalvular atrial fibrillation (NVAF) patients undergoing oral anticoagulation therapy. Our objective was to describe HRQoL in NVAF patients on oral anticoagulation, focusing on uncontrolled patients on vitamin K antagonists (VKAs) versus controlled patients on VKAs or non-vitamin K antagonist oral anticoagulants (NOACs), in a real-world setting. Additionally, we assessed the clinical characteristics of patients with uncontrolled anticoagulation. METHODS An observational, multicentre, and cross-sectional study, enrolling 38 Spanish Hospitals' Internal Medicine Departments. HRQoL was assessed using the validated Spanish version of the Sawicki questionnaire. High self-perceived HRQoL was indicated by high scores in the general treatment satisfaction and self-efficacy dimensions, and by low scores in the strained social network, daily hassles and distress dimensions. RESULTS Five hundred and one patients were included for assessment. Mean scores ± SD were closer to a high perceived HRQoL in controlled than uncontrolled patients for the five dimensions of the questionnaire: 4.9 ± 1.0 versus 3.6 ± 1.3 for general treatment satisfaction; 4.3 ± 1.0 versus 3.6 ± 1.0 for self-efficacy, 3.1 ± 0.9 versus 3.9 ± 1.1 for strained social network, 2.1 ± 0.8 versus 3.0 ± 1.0 for daily hassles and 1.8 ± 0.9 versus 2.6 ± 1.2 for distress. CONCLUSIONS HRQoL in patients with controlled anticoagulant status treated with NOACs or VKAs was better than in patients with uncontrolled anticoagulant status. This seems to indicate that anticoagulation control status influences perception of HRQoL, highlighting the importance of its evaluation when assessing HRQoL in NVAF patients.
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Affiliation(s)
| | - José Miguel Seguí-Ripoll
- Hospital San Juan de Alicante, San Juan de Alicante, Alicante Spain
- Department of Clinical Medicine, Miguel Hernández University, Elche, Alicante Spain
| | | | | | | | | | | | - Esther Donado
- Boehringer-Ingelheim, Sant Cugat del Vallés, Barcelona Spain
| | | | - the REQUOL Study Group
- Hospital HM Montepríncipe, Boadilla del Monte, Madrid Spain
- Hospital San Juan de Alicante, San Juan de Alicante, Alicante Spain
- Department of Clinical Medicine, Miguel Hernández University, Elche, Alicante Spain
- Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid Spain
- Hospital Francesc de Borja, Gandía, Valencia Spain
- Hospital San Juan de Dios del Aljarafe, Bormujos, Seville Spain
- Hospital de Torrevieja, Torrevieja, Alicante Spain
- Boehringer-Ingelheim, Sant Cugat del Vallés, Barcelona Spain
- Hospital Costa del Sol, A-7, Km 187, 29603 Marbella, Malaga Spain
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13
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Terricabras M, Mantovan R, Jiang CY, Betts TR, Chen J, Deisenhofer I, Macle L, Morillo CA, Haverkamp W, Weerasooriya R, Albenque JP, Nardi S, Menardi E, Novak P, Sanders P, Verma A. Association Between Quality of Life and Procedural Outcome After Catheter Ablation for Atrial Fibrillation: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2020; 3:e2025473. [PMID: 33275151 PMCID: PMC7718606 DOI: 10.1001/jamanetworkopen.2020.25473] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
IMPORTANCE Catheter ablation is effective in reducing atrial fibrillation (AF), but the association of ablation for AF with quality of life is unclear. OBJECTIVE To evaluate whether the procedural outcome of ablation for AF is associated with quality of life (QOL) measures. DESIGN, SETTING, AND PARTICIPANTS This was a prespecified secondary analysis of the Substrate and Trigger Ablation for Reduction of Atrial Fibrillation-Part II (STAR AF II) prospective randomized clinical trial, which compared 3 strategies for ablation of persistent AF. This analysis included 549 of the 589 patients enrolled in the trial who underwent ablation. Enrollment occurred at 35 centers in Europe, Canada, Australia, China, and Korea from November 2010 to July 2012. Data for the current study were analyzed on December 11, 2019. INTERVENTIONS Patients underwent AF ablation with 1 of 3 ablation strategies: (1) pulmonary vein isolation (PVI), (2) PVI plus complex fractionated electrograms, or (3) PVI plus linear lesions. MAIN OUTCOMES AND MEASURES Quality of life was assessed at baseline and at 6, 12, and 18 months after ablation for AF using the 36-Item Short Form Health Survey and the EuroQol Health-Related Quality of Life 5-Dimension 3-Level questionnaire. Scores were also converted to a physical health component score (PCS) and a mental health component score (MCS). Individual AF burden was calculated by the total time with AF from Holter monitors and the percentage of transtelephonic monitor recordings showing AF. RESULTS Among the 549 patients included in this secondary analysis, QOL was assessed in 466 (85%) at baseline and at 6, 12, and 18 months after ablation for AF. The mean (SD) age of the study population was 60 (9) years; 434 (79%) individuals were men, and 417 (76%) had continuous AF for 6 months or more before ablation. The AF burden significantly decreased from a mean (SD) of 82% (36%) before ablation to 6.6% (23%) after ablation (P < .001). Significant improvements in mean (SD) PCS (68.3 [20.7] to 82.5 [18.6]) and MCS (35.3 [8.6] to 37.5 [7.6]) occurred 18 months after ablation (P < .05 for both). Significant QOL improvement occurred in all 3 study arms and regardless of AF recurrence, defined as AF episodes lasting more than 30 seconds: for no recurrence, mean (SD) PCS increased from 66.5 (20.9) to 79.1 (19.4) and MCS from 35.3 (8.7) to 37.7 (7.7); for recurrence, mean (SD) PCS increased from 70.2 (20.4) to 86.4 (16.8) and MCS from 35.3 (8.6) to 37.1 (7.4) (P < .05 for all). When outcome was defined by AF burden reduction, in patients with less than 70% reduction in AF burden, the increase in PCS was significantly less than in those with greater than 70% reduction, and only 3 of 8 subscales showed significant improvement. CONCLUSIONS AND RELEVANCE In this secondary analysis, decreases in AF burden after ablation for AF were significantly associated with improvements in QOL. Quality of life changes were significantly associated with the percentage of AF burden reduction after ablation. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01203748.
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Affiliation(s)
- Maria Terricabras
- Department of Cardiology, Southlake Regional Health Centre, University of Toronto, Newmarket, Ontario, Canada
| | - Roberto Mantovan
- Department of Cardiology, Santa Maria dei Battuti Hospital, Conegliano, Italy
| | - Chen-yang Jiang
- Department of Cardiology, Sir Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Timothy R. Betts
- Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom
| | - Jian Chen
- Department of Cardiology, Haukeland University Hospital, Bergen, Norway
| | | | | | - Carlos A. Morillo
- Department of Cardiology, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Wilhelm Haverkamp
- Department of Cardiology, Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Rukshen Weerasooriya
- Department of Cardiology, Hollywood Private Hospital, Perth, Western Australia, Australia
| | | | - Stefano Nardi
- Department of Cardiology, Pineta Grande Hospital, Castel Volturno, Italy
| | - Endrj Menardi
- Department of Cardiology, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Paul Novak
- Department of Cardiology, Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - Prashanthan Sanders
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Atul Verma
- Department of Cardiology, Southlake Regional Health Centre, University of Toronto, Newmarket, Ontario, Canada
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14
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Abu HO, Saczynski JS, Mehawej J, Tisminetzky M, Kiefe CI, Goldberg RJ, McManus DD. Clinically Meaningful Change in Quality of Life and Associated Factors Among Older Patients With Atrial Fibrillation. J Am Heart Assoc 2020; 9:e016651. [PMID: 32875941 PMCID: PMC7726984 DOI: 10.1161/jaha.120.016651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Among older patients with atrial fibrillation, there are limited data examining clinically meaningful changes in quality of life (QoL). We examined the extent of, and factors associated with, clinically meaningful change in QoL over 1‐year among older adults with atrial fibrillation. Methods and Results Patients from cardiology, electrophysiology, and primary care clinics in Massachusetts and Georgia were enrolled in a cohort study (2015–2018). The Atrial Fibrillation Effect on Quality‐of‐Life questionnaire was used to assess overall QoL and across 3 subscales: symptoms, daily activities, and treatment concern. Clinically meaningful change in QoL (ie, difference between 1‐year and baseline QoL score) was categorized as either a decline (≤−5.0 points), no clinically meaningful change (−5.0 to +5.0 points), or an increase (≥+5.0 points). Ordinal logistic models were used to examine factors associated with QoL changes. Participants (n=1097) were on average 75 years old, 48% were women, and 87% White. Approximately 40% experienced a clinically meaningful increase in QoL and 1 in every 5 patients experienced a decline in QoL. After multivariable adjustment, women, non‐Whites, those who reported depressive and anxiety symptoms, fair/poor self‐rated health, low social support, heart failure, or diabetes mellitus experienced clinically meaningful declines in QoL. Conclusions These findings provide insights to the magnitude of, and factors associated with, clinically meaningful change in QoL among older patients with atrial fibrillation. Assessment of comorbidities and psychosocial factors may help identify patients at high risk for declining QoL and those who require additional surveillance to maximize important clinical and patient‐centered outcomes.
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Affiliation(s)
- Hawa O. Abu
- Division of Cardiovascular MedicineDepartment of MedicineUniversity of Massachusetts Medical SchoolWorcesterMA
| | - Jane S. Saczynski
- Department of Pharmacy and Health Systems SciencesSchool of PharmacyNorth Eastern UniversityBostonMA
| | - Jordy Mehawej
- Division of Cardiovascular MedicineDepartment of MedicineUniversity of Massachusetts Medical SchoolWorcesterMA
| | - Mayra Tisminetzky
- Division of Geriatrics and Meyers Primary Care InstituteDepartment of MedicineUniversity of Massachusetts Medical SchoolWorcesterMA
- Department of Population and Quantitative Health SciencesUniversity of Massachusetts Medical SchoolWorcesterMA
| | - Catarina I. Kiefe
- Department of Population and Quantitative Health SciencesUniversity of Massachusetts Medical SchoolWorcesterMA
| | - Robert J. Goldberg
- Department of Population and Quantitative Health SciencesUniversity of Massachusetts Medical SchoolWorcesterMA
| | - David D. McManus
- Division of Cardiovascular MedicineDepartment of MedicineUniversity of Massachusetts Medical SchoolWorcesterMA
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15
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Abu HO, Saczynski JS, Ware J, Mehawej J, Paul T, Awad H, Bamgbade BA, Pierre-Louis IC, Tisminetzky M, Kiefe CI, Goldberg RJ, McManus DD. Impact of comorbid conditions on disease-specific quality of life in older men and women with atrial fibrillation. Qual Life Res 2020; 29:3285-3296. [PMID: 32656722 DOI: 10.1007/s11136-020-02578-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Accepted: 07/02/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Older persons with atrial fibrillation (AF) experience significant impairment in quality of life (QoL), which may be partly attributable to their comorbid diseases. A greater understanding of the impact of comorbidities on QoL could optimize patient-centered care among older persons with AF. OBJECTIVE To assess impairment in disease-specific QoL due to comorbid conditions in older adults with AF. METHODS Patients aged ≥ 65 years diagnosed with AF were recruited from five medical centers in Massachusetts and Georgia between 2015 and 2018. At 1 year of follow-up, the Quality of Life Disease Impact Scale-for Multiple Chronic Conditions was used to provide standardized assessment of patient self-reported impairment in QoL attributable to 34 comorbid conditions grouped in 10 clusters. RESULTS The mean age of study participants (n = 1097) was 75 years and 48% were women. Overall, cardiometabolic, musculoskeletal, and pulmonary conditions were the most prevalent comorbidity clusters. A high proportion of participants (82%) reported that musculoskeletal conditions exerted the greatest impact on their QoL. Men were more likely than women to report that osteoarthritis and stroke severely impacted their QoL. Patients aged < 75 years were more likely to report that obesity, hip/knee joint problems, and fibromyalgia extremely impacted their QoL than older participants. CONCLUSIONS Among older persons with AF, while cardiometabolic diseases were highly prevalent, musculoskeletal conditions exerted the greatest impact on patients' disease-specific QoL. Understanding the extent of impairment in QoL due to underlying comorbidities provides an opportunity to develop interventions targeted at diseases that may cause significant impairment in QoL.
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Affiliation(s)
- Hawa O Abu
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
| | - Jane S Saczynski
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, MA, USA
| | - John Ware
- John Ware Research Group, Watertown, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jordy Mehawej
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Tenes Paul
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Hamza Awad
- Departments of Community Medicine and Internal Medicine, Mercer University School of Medicine, Macon, GA, USA
| | - Benita A Bamgbade
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, MA, USA
| | - Isabelle C Pierre-Louis
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, MA, USA
| | - Mayra Tisminetzky
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
- Division of Geriatrics, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Catarina I Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Robert J Goldberg
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - David D McManus
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
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16
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Hong KL, Babiolakis C, Zile B, Bullen M, Haseeb S, Halperin F, Hohl CM, Magee K, Sandhu RK, Tian SY, Kennedy A, Lobban T, Mariano Z, Dorian P, Angaran P, Evans M, Leong-Sit P, Glover BM. Canada-wide mixed methods analysis evaluating the reasons for inappropriate emergency department presentation in patients with a history of atrial fibrillation: the multicentre AF-ED trial. BMJ Open 2020; 10:e033482. [PMID: 32303514 PMCID: PMC7201301 DOI: 10.1136/bmjopen-2019-033482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 02/14/2020] [Accepted: 03/12/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The primary objective of this study was to ascertain the reasons for emergency department (ED) attendance among patients with a history of atrial fibrillation (AF). DESIGN Appropriate ED attendance was defined by the requirement for an electrical or chemical cardioversion and/or an attendance resulting in hospitalisation or administration of intravenous medications for ventricular rate control. Quantitative and qualitative responses were recorded and analysed using descriptive statistics and content analysis, respectively. Random effects logistic regression was performed to estimate the OR of inappropriate ED attendance based on clinically relevant patient characteristics. PARTICIPANTS Participants ≥18 years with a documented history of AF were approached in one of eight centres partaking in the study across Canada (Ontario, Nova Scotia, Alberta and British Columbia). RESULTS Of the 356 patients enrolled (67±13, 45% female), the majority (271/356, 76%) had inappropriate reasons for presentation and did not require urgent ED treatment. Approximately 50% of patients(172/356, 48%) were driven to the ED due to symptoms, while the remainder presented on the basis of general fear or anxiety (67/356, 19%) or prior medical advice (117/356, 33%). Random effects logistic regression analysis showed that patients with a history of congestive heart failure were significantly more likely to seek urgent care for appropriate reasons (p=0.03). Likewise, symptom-related concerns for ED presentation were significantly less likely to result in inappropriate visitation (p=0.02). When patients were surveyed on alternatives to ED care, the highest proportion of responses among both groups was in favour of specialised rapid assessment outpatient clinics (186/356, 52%). Qualitative content analysis confirmed these results. CONCLUSIONS Improved education focused on symptom management and alleviating disease-related anxiety as well as the institution of rapid access arrhythmias clinics may reduce the need for unnecessary healthcare utilisation in the ED and subsequent hospitalisation. TRIAL REGISTRATION NUMBER NCT03127085.
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Affiliation(s)
- Kathryn Lauren Hong
- Department of Cardiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Brigita Zile
- Department of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Milena Bullen
- Department of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Sohaib Haseeb
- Department of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Frank Halperin
- Department of Cardiology, Interior Health Authority, Kelowna, Province of British Columbia, Canada
| | - Corinne M Hohl
- Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kirk Magee
- Department of Emergency Medicine, Nova Scotia Health Authority, Halifax, Province of Nova Scotia, Canada
| | - Roopinder K Sandhu
- Department of Cardiology, University of Alberta, Edmonton, Western Canada, Canada
| | - Simon Yu Tian
- Department of Cardiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ashley Kennedy
- Wilkes Honors College, Florida Atlantic University, Boca Raton, Florida, USA
| | - Trudie Lobban
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Zana Mariano
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paul Dorian
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paul Angaran
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marilyn Evans
- Division of Cardiology, London Health Sciences Centre, London, Ontario, Canada
| | - Peter Leong-Sit
- Division of Cardiology, London Health Sciences Centre, London, Ontario, Canada
| | - Benedict M Glover
- Department of Cardiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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17
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Diener HC, Hart RG, Koudstaal PJ, Lane DA, Lip GYH. Atrial Fibrillation and Cognitive Function: JACC Review Topic of the Week. J Am Coll Cardiol 2020; 73:612-619. [PMID: 30732716 DOI: 10.1016/j.jacc.2018.10.077] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 10/14/2018] [Accepted: 10/30/2018] [Indexed: 12/15/2022]
Abstract
Numerous vascular risk factors and vascular diseases contribute to cognitive impairment and dementia. Many studies and registries show an association of atrial fibrillation (AF) with cognitive impairment, cognitive decline, and dementia. This is true for vascular dementia and Alzheimer's disease. The assumed multifactorial mechanisms include ischemic stroke, both apparent and silent, cerebral microinfarcts, cerebral hemorrhage, and reduced cerebral blood flow. A number of retrospective observational and prospective studies support that anticoagulation in patients with AF may reduce the risk of cognitive decline and dementia. This holds for both vitamin K antagonists (e.g., warfarin) and direct oral anticoagulants. However, it still remains unproven if anticoagulation reduces cognitive decline and dementia in AF patients based on randomized trials.
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Affiliation(s)
- Hans-Christoph Diener
- Department of Neurology, University Hospital Essen and University Duisburg-Essen, Germany.
| | - Robert G Hart
- Population Health Research Institute/McMaster University, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada
| | - Peter J Koudstaal
- Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - 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
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18
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Wingerter R, Steiger N, Burrows A, Estes NAM. Impact of Lifestyle Modification on Atrial Fibrillation. Am J Cardiol 2020; 125:289-297. [PMID: 31761147 DOI: 10.1016/j.amjcard.2019.10.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 07/17/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 12/15/2022]
Abstract
Atrial Fibrillation (AF) is the most common arrhythmia in adults, and the rapid increase in AF prevalence has been classified by experts as an epidemic. The mechanisms of AF are complex and incompletely understood. While many aspects of management are now based on high quality evidence, other clinical decisions are based on experience and judgment. This article provides an up to date review relating to lifestyle modification and its effect on AF to inform clinical treatment. This comprehensive review used PubMed and Google Scholar to perform keyword searches of articles published between 1998 and the present, with the exception of the 1978 "Holiday Heart" article. Robust data has emerged identifying multiple risk factors for development of AF, including age, sex, hypertension, diabetes mellitus, obesity, alcohol consumption, exercise, and obstructive sleep apnea. Recent evidence indicates that lifestyle modification has a significant role in mitigating the risk and burden of AF. In conclusion, based on the available evidence, an interdisciplinary approach to lifestyle modification will likely reduce risk and/or symptom burden of AF.
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Affiliation(s)
- Rebecca Wingerter
- College of Medicine at University of Central Florida, Orlando, Florida
| | | | | | - N A Mark Estes
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Ikemura N, Spertus JA, Kimura T, Mahaffey K, Piccini JP, Inohara T, Ueda I, Tanimoto K, Suzuki M, Nakamura I, Akaishi M, Mitamura H, Fukuda K, Takatsuki S, Kohsaka S. Cohort profile: patient characteristics and quality-of-life measurements for newly-referred patients with atrial fibrillation-Keio interhospital Cardiovascular Studies-atrial fibrillation (KiCS-AF). BMJ Open 2019; 9:e032746. [PMID: 31857312 PMCID: PMC6936990 DOI: 10.1136/bmjopen-2019-032746] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Besides the high rates of morbidity and mortality, atrial fibrillation (AF) is also associated with impairment of quality-of-life (QOL). However, reports covering non-selected AF population within Asian countries remain scarce. The objective of the Keio interhospital Cardiovascular Studies-atrial fibrillation (KiCS-AF) registry is to clarify the baseline and QOL profiles of the AF patients at the time of initial referral to identify areas for improvement and country-specific gaps. PARTICIPANTS The KiCS-AF registry is a multicentre, prospective cohort study designed to specifically recruit AF patients newly referred to the 11 network hospitals within the Kanto area of Japan. The registry completed its enrolment in June 2018. All patients were requested to answer the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire both at baseline and 1 year, with planned clinical follow-up for 5 years. The registry also assessed individual treatment strategies including rate and rhythm control, stroke prophylaxis, and their impacts on patient-reported QOL. FINDINGS TO DATE As of December 2016, 2464 AF patients were registered; their mean age was 67.1 years (SD, 11.7), majority (69.7%; n=1717) were men and 49.2% presented with paroxysmal AF. The mean CHA2DS2-VASc (cardiac failure or dysfunction, hypertension, age ≥75 years, diabetes, stroke including vascular disease, age 65-74 years, and sex category [female]) score was 2.3 (SD, 1.6) and oral anticoagulant therapy was used for 88.6% of patients with CHA2DS2-VASc scores ≥2. The median AFEQT-overall summary score was 79.1 (IQR, 66.6-89.1). Roughly 50% had significantly impaired QOL (ie, AFEQT <80) at baseline. Currently, 2307 eligible patients (93.6%) have completed the 1-year follow-up, of which 2072 patients (89.8%) answered the second AFEQT questionnaire. FUTURE PLANS The KiCS-AF allowed for extensive investigation of AF-related QOL in a non-selected population with long-term follow-up using a rigorously validated QOL assessment tool. Almost half of patients had impaired QOL at baseline. Further investigations aimed at providing care and improving patient-reported QOL are required.
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Affiliation(s)
- Nobuhiro Ikemura
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - John A Spertus
- Cardiovascular Research, Department of Biomedical and Health Informatics, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Takehiro Kimura
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Kenneth Mahaffey
- Stanford Center for Clinical Research, Stanford University School of Medicine, Stanford, California, USA
| | - Jonathan P Piccini
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Taku Inohara
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
- Division of Cardiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Ikuko Ueda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Kojiro Tanimoto
- Department of Cardiology, National Hospital Organisation Tokyo Medical Center, Meguro-ku, Tokyo, Japan
| | - Masahiro Suzuki
- Department of Cardiology, National Hospital Organization Saitama Hospital, Wako, Japan
| | - Iwao Nakamura
- Department of Cardiology, Hino Shiritsu Byoin, Hino, Tokyo, Japan
| | - Makoto Akaishi
- Department of Cardiology, Tokai University Tokyo Hospital, Shibuya-ku, Tokyo, Japan
| | - Hideo Mitamura
- Department of Cardiology, Tachikawa Hospital, Tachikawa, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Seiji Takatsuki
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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Gisi B, Althouse AD, Mathier AS, Pusateri A, Rollman BL, LaRosa A, Magnani JW. The unmeasured burden: Contribution of depression and psychological stress to patient-reported outcomes in atrial fibrillation. Int J Cardiol 2019; 302:75-80. [PMID: 31837900 DOI: 10.1016/j.ijcard.2019.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/24/2019] [Accepted: 12/02/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Patient-reported outcomes are routinely assessed in atrial fibrillation (AF) to evaluate efficacy of treatment and as clinical trial outcomes. The relation of depression to such measures has had limited study in AF. METHODS In a cohort receiving treatment for AF, we assessed depression with the Patient Health Questionniare-9 (PHQ; 0-4, normal range; 5-9, mild depression; ≥10 moderate depression). We related depression to disease-specific quality of life with the AF Effect on QualiTy of life (AFEQT, range 0-100) and the Global Perceived Stress Scale (GPPS, range 0-24) in multivariable-adjusted models. RESULTS In 260 individuals (age 71.7 ± 10.1, 44.6% women) with AF, 51 (26.1%) had PHQ scores ≥5 and 17 (6.5%) ≥10. AFEQT scores decreased progressively with depression severity (normal range PHQ, 81.4 ± 14.1; mild depression, 65.8 ± 17.1; moderate depression, 50.6 ± 19.3). Individuals without depression had lower GPPS scores (3.0 ± 2.6) than those with mild (4.9 ± 2.5) or moderate (8.9 ± 4.0) depression. In multivariable-adjusted models mild depression was associated with a 12.1-point (95% confidence interval [CI], -17.2 to -6.9) decrease in AFEQT and 1.9-point (95% CI, 1.1 to 2.7) increase in GPSS, while moderate depression a 27.7-point (95% CI, -35.5 to -19.8) decrease in AFEQT and 5.5-point (95% CI, 4.2 to 6.8) increase in GPSS, relative to normal range PHQ. Regression analyses confirmed significant correlations between depression and AFEQT and GPPS scores in multivariable-adjusted models. CONCLUSIONS We determined that depression is associated with a step-wise, progressively adverse change in patient-centered outcomes in individuals with AF. Our findings suggest the importance of assessing depression in the evaluation of AF. Subject term list: health services, atrial fibrillation, risk factors.
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Affiliation(s)
- Brittany Gisi
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrew D Althouse
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Abigail S Mathier
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Bruce L Rollman
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Center for Behavioral Health and Smart Technology, Pittsburgh, PA, USA
| | - Anna LaRosa
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jared W Magnani
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Division of Cardiology, UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, USA.
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Zhang MJ, Norby FL, Lutsey PL, Mosley TH, Cogswell RJ, Konety SH, Chao T, Shah AM, Solomon SD, Alonso A, Chen LY. Association of Left Atrial Enlargement and Atrial Fibrillation With Cognitive Function and Decline: The ARIC-NCS. J Am Heart Assoc 2019; 8:e013197. [PMID: 31766970 PMCID: PMC6912953 DOI: 10.1161/jaha.119.013197] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 09/06/2019] [Indexed: 12/24/2022]
Abstract
Background Atrial fibrillation (AF) is associated with cognitive decline. Whether left atrial enlargement (LAE), a critical substrate for AF, is also associated is less well established. Therefore, we assessed the association of LAE and AF with cognitive decline in the ARIC-NCS (Atherosclerosis Risk in Communities Neurocognitive Study). Methods and Results Participants (n=3391; mean age, 75±5 years; 59% women) underwent cognitive tests and 2-dimensional echocardiograms at visit 5 (2011-2013) and follow-up cognitive tests at visit 6 (2016-2017). LAE was defined as left atrium volume index ≥34 mL/m2. AF was ascertained using study ECGs and hospitalization discharge codes. We assessed the association of AF and LAE with (a) cognitive domain scores at visit 5 and (b) cognitive domain score changes between visit 5 and visit 6. At visit 5, compared with the reference group (without AF, normal left atrium), participants with LAE and AF had significantly lower global cognition (Z score, -0.24; 95% CI, -0.38 to -0.10), whereas participants with AF and without LAE and participants with LAE and without AF did not have lower global cognition. In longitudinal analysis, compared with the reference group, participants with AF but without LAE had significantly greater decline in global cognition (Z score, -0.13; 95% CI, -0.21 to -0.06). However, LAE, with or without AF, was not associated with greater cognitive decline. Conclusion Although LAE with AF was significantly associated with lower cognitive function in cross-sectional analysis, LAE, with or without AF, was not associated with greater cognitive decline over 5 years, highlighting the importance of evaluating longitudinal cognitive function. Future studies should have longer follow-up and evaluate left atrium function.
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Affiliation(s)
- Michael J. Zhang
- Cardiovascular DivisionDepartment of MedicineUniversity of Minnesota Medical SchoolMinneapolisMN
| | - Faye L. Norby
- Division of Epidemiology and Community HealthSchool of Public HealthUniversity of MinnesotaMinneapolisMN
| | - Pamela L. Lutsey
- Division of Epidemiology and Community HealthSchool of Public HealthUniversity of MinnesotaMinneapolisMN
| | - Thomas H. Mosley
- The MIND Center,University of Mississippi Medical CenterJacksonMS
| | - Rebecca J. Cogswell
- Cardiovascular DivisionDepartment of MedicineUniversity of Minnesota Medical SchoolMinneapolisMN
| | - Suma H. Konety
- Cardiovascular DivisionDepartment of MedicineUniversity of Minnesota Medical SchoolMinneapolisMN
| | - Tze‐Fan Chao
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiTaiwan
| | - Amil M. Shah
- Department of MedicineBrigham and Women's HospitalBostonMA
| | | | - Alvaro Alonso
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGA
| | - Lin Y. Chen
- Cardiovascular DivisionDepartment of MedicineUniversity of Minnesota Medical SchoolMinneapolisMN
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AlTurki A, Maj JB, Marafi M, Donato F, Vescovo G, Russo V, Proietti R. The Role of Cardiovascular and Metabolic Comorbidities in the Link between Atrial Fibrillation and Cognitive Impairment: An Appraisal of Current Scientific Evidence. ACTA ACUST UNITED AC 2019; 55:medicina55120767. [PMID: 31801224 PMCID: PMC6956022 DOI: 10.3390/medicina55120767] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/01/2019] [Accepted: 11/23/2019] [Indexed: 12/11/2022]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice with implications on long-term outcomes. Metabolic disorders including diabetes mellitus and obesity are independent predictors of atrial fibrillation and present therapeutic targets to reduce both the incidence and duration burden of atrial fibrillation. The presence of pericardial fat in direct contact with cardiac structures, as well the subsequent release of proinflammatory cytokines, may play an important role in this connection. Atrial fibrillation is an independent predictor of cognitive impairment and dementia. While clinical stroke is a major contributor, other factors such as cerebral hypoperfusion and microbleeds play important roles. New evidence suggests that atrial fibrillation and cognitive impairment may be downstream events of atrial cardiomyopathy, which may be caused by several factors including metabolic syndrome, obesity, and obstructive sleep apnea. The mechanisms linking these comorbidities to cognitive impairment are not yet fully elucidated. A clearer understanding of the association of AF with dementia and cognitive impairment is imperative. Future studies should focus on the predictors of cognitive impairment among those with AF and aim to understand the potential mechanisms underlying these associations. This would inform strategies for the management of AF aiming to prevent continued cognitive impairment.
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Affiliation(s)
- Ahmed AlTurki
- Division of Cardiology, McGill University Health Center, Montreal, QC H3G1A4, Canada;
- Correspondence: ; Tel.: +1-514-934-1934; Fax: +1-514-934-8569
| | - Jakub B. Maj
- Division of Cardiology, McGill University Health Center, Montreal, QC H3G1A4, Canada;
| | - Mariam Marafi
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, Montreal, QC H3A2B4, Canada;
| | - Filippo Donato
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, 35121 Padua, Italy; (F.D.); (G.V.); (R.P.)
| | - Giovanni Vescovo
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, 35121 Padua, Italy; (F.D.); (G.V.); (R.P.)
| | - Vincenzo Russo
- Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”-Monaldi Hospital, 80131 Naples, Italy;
| | - Riccardo Proietti
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, 35121 Padua, Italy; (F.D.); (G.V.); (R.P.)
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Risom SS, Fevejle Cromhout P, Overgaard D, Hastrup Svendsen J, Kikkenborg Berg S. Effect of Rehabilitation on Sleep Quality After Ablation for Atrial Fibrillation: Data From a Randomized Trial. J Cardiovasc Nurs 2019; 33:261-268. [PMID: 29271795 PMCID: PMC5908260 DOI: 10.1097/jcn.0000000000000476] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Low sleep quality is common in patients with atrial fibrillation (AF). Positive effects of cardiac rehabilitation on patients treated for AF with ablation have been found, but whether cardiac rehabilitation affects sleep quality is unknown. The objectives of this study were to investigate (1) differences in sleep quality between cardiac rehabilitation and usual care groups and (2) whether other factors could affect sleep quality. METHODS From the randomized CopenHeartRFA trial, 210 patients treated for AF with ablation were included. A rehabilitation program consisting of physical exercise and psychoeducational consultations was tested. Sleep quality was measured with the Pittsburg Sleep Quality Index (PSQI) questionnaire before intervention and at the end of intervention. Anxiety, depression, and European Heart Rhythm Association scores were assessed. RESULTS No difference between groups in sleep quality was found (PSQI global mean [SD] score, 6.60 [3.61] points for the cardiac rehabilitation group [n = 83] and 6.08 [3.60] points for the usual care group [n = 90]; P = .34), although improvements in sleep quality were noted in both groups. Sleep latency, duration, and efficiency were significant by type of AF at 1 month. Anxiety, depression, and higher European Heart Rhythm Association scores at 4 months were associated with a higher PSQI global mean score at the end of intervention. CONCLUSION The rehabilitation program showed no effect on sleep quality. A large proportion of patients reported poor sleep quality, and patients reporting anxiety, depression, or AF symptoms described worse sleep quality compared with patients who did not experience anxiety, depression, or AF symptoms. More research in the field is warranted.
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Affiliation(s)
- Signe Stelling Risom
- Signe Stelling Risom, PhD, RN Postdoc, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, and Faculty of Health and Technology, Institute of Nursing, Metropolitan University College, Copenhagen, Denmark. Pernille Fevejle Cromhout, MSc, RN PhD Student, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark. Dorthe Overgaard, PhD, RN Docent, Faculty of Health and Technology, Institute of Nursing, Metropolitan University College, Copenhagen, Denmark. Jesper Hastrup Svendsen, MD, DMSc Professor, The Heart Centre, Rigshospitalet, Copenhagen University Hospital; Faculty of Health and Medical Sciences, University of Copenhagen; and The Danish National Research Foundation Centre for Cardiac Arrhythmia, Copenhagen, Denmark. Selina Kikkenborg Berg, PhD, MScN, RN Senior Researcher, The Heart Centre, Rigshospitalet, Copenhagen University Hospital; Faculty of Health and Medical Sciences, University of Copenhagen; and Institute of Public Health, University of Southern Denmark, Odense, Denmark
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Collecchia G. [Atrial fibrillation and the sentinel watch.]. Recenti Prog Med 2019; 110:521-523. [PMID: 31808431 DOI: 10.1701/3265.32326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The Apple Watch 4 is a wearable device whose advertising launch made a lot of noise, not only for technological advances in general, but above all because the latest version is able to record an electrocardiogram. The device signals to the wearer the possible presence of atrial fibrillation, an arrhythmia that is often difficult to identify. There is also the possibility that the increased engagement of citizens causes excessive confidence in self-monitoring and in "do-it-yourself" diagnoses. Therefore medical experts are needed, who educate the user for a correct use, avoiding the risk of false positives and consequent false alarms. Currently, methodologically rigorous studies are lacking to validate the use of the device to integrate the traditional diagnostic tools.
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Affiliation(s)
- Giampaolo Collecchia
- Medico di medicina generale, Massa; Comitato di Etica Clinica, Azienda USL Toscana Nord Ovest, Centro Studi e Ricerche in Medicina Generale, Monza (Milano)
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Li YM, Jiang C, He L, Li XX, Hou XX, Chang SS, Lip GY, Du X, Dong JZ, Ma CS. Sex Differences in Presentation, Quality of Life, and Treatment in Chinese Atrial Fibrillation Patients: Insights from the China Atrial Fibrillation Registry Study. Med Sci Monit 2019; 25:8011-8018. [PMID: 31738742 PMCID: PMC6825395 DOI: 10.12659/msm.919366] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
<strong>BACKGROUND</strong> There is a growing recognition of sex-related disparities in atrial fibrillation (AF). However, limited data is available in Chinese AF patients. <strong>MATERIAL AND METHODS</strong> We compared symptoms, quality of life (QoL), and treatment of AF according to sex from the China AF Registry study. <strong>RESULTS</strong> We studied 14 723 patients with non-valvular AF, of whom 5645 patients (38.3%) were female. Women were older than men (67.5±10.6 vs. 62.2±12.2). Compared to men, women had more comorbidities and a higher proportion of CHA₂DS₂-VASC score ≥2. Women with AF experienced more severe or disabling symptoms than men (33.7% vs. 22.9% in age <75 group; 40.3% vs. 28.7% in age ≥75 group; both P<0.0001). After multivariate analysis, women with AF still had lower QoL (OR 0.69; 95%CI, 0.63-0.76; P<0.0001). Women tended to have lower rates of ablation and rhythm-control drug use in those aged <75 years. Oral anticoagulant use was low and had no sex difference in AF patients with a CHA₂DS₂-VASC score ≥2. <strong>CONCLUSIONS</strong> In Chinese AF patients, women were older and more symptomatic, and had worse QoL. Despite all these differences, women tended to receive less rhythm-control treatment in those aged <75 years. Oral anticoagulant was substantially underused in high stroke risk patients, regardless of sex.
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Affiliation(s)
- Yan-Ming Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, P.R. China
- Department of Cardiology, Beijing Tongren Hospital, Capital Medical University, Beijing, P.R. China
| | - Chao Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, P.R. China
| | - Liu He
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, P.R. China
| | - Xin-Xu Li
- Chinese Center for Disease Control and Prevention, Beijing, P.R. China
| | - Xiao-Xia Hou
- Department of Cardiology, Beijing Tongren Hospital, Capital Medical University, Beijing, P.R. China
| | - San-Shuai Chang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, P.R. China
| | - Gregory Y.H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, U.K
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, P.R. China
- Heart Health Research Center, Beijing, P.R. China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, P.R. China
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, P.R. China
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Yong QG, Cao P, Yang H, Bai YY, Cao J. [Related factors affecting the level of anxiety in the patients with atrial fibrillation]. Zhongguo Ying Yong Sheng Li Xue Za Zhi 2019; 35:473-475. [PMID: 31894689 DOI: 10.12047/j.cjap.5468.2019.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Hwang C. Calculated Decisions: HAS-BLED Score for Major Bleeding Risk. Emerg Med Pract 2019; 21:CD3-CD4. [PMID: 31386321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 07/15/2019] [Indexed: 06/10/2023]
Abstract
The HAS-BLED score estimates the risk of major bleeding for patients on anticoagulation, in order to assess risks and benefits in the care of patients with atrial fibrillation.
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Affiliation(s)
- Calvin Hwang
- Department of Orthopaedic Surgery, Stanford University, Palo Alto, CA
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28
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Mourad AP, Aslani P, D'Souza M, Brieger D. The acceptability of a direct oral anticoagulant monitoring regimen among patients with atrial fibrillation: a pilot study. Int J Clin Pharm 2019; 41:682-686. [PMID: 31016680 DOI: 10.1007/s11096-019-00830-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/09/2018] [Accepted: 04/10/2019] [Indexed: 12/17/2022]
Abstract
Background The direct oral anticoagulants (DOACs) offer several advantages over warfarin in the management atrial fibrillation, including the provision of fixed dosing without a requirement for regular monitoring. Recently however the subject of DOAC monitoring has been probed after several post-hoc analyses demonstrated an association between plasma levels and efficacy and safety events. Objective The aim of this pilot study was to explore the acceptability of DOAC plasma monitoring amongst patients with atrial fibrillation and the factors that may influence these attitudes. Method A simple DOAC monitoring schedule based on the dabigatran pharmacokinetic profile was developed. A cross-sectional survey was distributed to patients with atrial fibrillation asking them to indicate their likelihood of taking a particular DOAC subjected to plasma monitoring. Results Thirty patients participated in the study. Most patients (63.3%) favoured taking a DOAC subjected to monitoring under the proposed schedule, citing increased efficacy and reduced toxicity as the reasons for their response. Conclusion There is some suggestion that atrial fibrillation patients may in fact favour taking a DOAC subjected to infrequent monitoring if this enhanced safety and efficacy.
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Affiliation(s)
- Ali P Mourad
- Sydney Medical School, The University of Sydney, Edward Ford Building A27, Sydney, NSW, 2006, Australia.
| | - Parisa Aslani
- Faculty of Pharmacy, University of Sydney, Sydney, Australia
| | - Mario D'Souza
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, Australia
| | - David Brieger
- Sydney Medical School, The University of Sydney, Edward Ford Building A27, Sydney, NSW, 2006, Australia
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, Australia
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Affiliation(s)
- Justin A Chen
- From the Departments of Psychiatry (J.A.C., C.M.C., S.R.B.) and Medicine (L.M.P.), Massachusetts General Hospital, and the Departments of Psychiatry (J.A.C., C.M.C., S.R.B.) and Medicine (L.M.P.), Harvard Medical School - both in Boston
| | - Leon M Ptaszek
- From the Departments of Psychiatry (J.A.C., C.M.C., S.R.B.) and Medicine (L.M.P.), Massachusetts General Hospital, and the Departments of Psychiatry (J.A.C., C.M.C., S.R.B.) and Medicine (L.M.P.), Harvard Medical School - both in Boston
| | - Christopher M Celano
- From the Departments of Psychiatry (J.A.C., C.M.C., S.R.B.) and Medicine (L.M.P.), Massachusetts General Hospital, and the Departments of Psychiatry (J.A.C., C.M.C., S.R.B.) and Medicine (L.M.P.), Harvard Medical School - both in Boston
| | - Scott R Beach
- From the Departments of Psychiatry (J.A.C., C.M.C., S.R.B.) and Medicine (L.M.P.), Massachusetts General Hospital, and the Departments of Psychiatry (J.A.C., C.M.C., S.R.B.) and Medicine (L.M.P.), Harvard Medical School - both in Boston
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Miyazaki M, Nakashima A, Nakamura Y, Sakamoto Y, Matsuo K, Goto M, Uchiyama M, Okamura K, Mitsutake R, Urata H, Kamimura H, Imakyure O. Association between medication adherence and illness perceptions in atrial fibrillation patients treated with direct oral anticoagulants: An observational cross-sectional pilot study. PLoS One 2018; 13:e0204814. [PMID: 30265710 PMCID: PMC6161891 DOI: 10.1371/journal.pone.0204814] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 09/15/2018] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The aim of this study was to examine the association between medication adherence and illness perceptions, and to explore the factors associated with poor medication adherence in atrial fibrillation (AF) patients receiving direct oral anticoagulants (DOACs) in a real-world clinical setting. METHODS An observational cross-sectional pilot study was conducted at a single Japanese university hospital. One hundred and twenty-nine patients who were diagnosed with AF and who were taking DOACs were recruited from outpatients between January 4th and April 25th, 2017. We evaluated medication adherence to DOACs using the Morisky Medication Adherence Scale-8 (MMAS-8) and illness perceptions using the Brief Illness Perception Questionnaire (BIPQ). The patients' characteristics and clinical data were collected from electronic medical records. RESULTS Ninety-nine (76.7%) patients (male, n = 74; mean age, 71.4±9.8 years) participated in this study. According to the MMAS-8, 21 (21.2%) of the patients were classified into the poor adherence group (MMAS-8 score of <6), and 78 (78.8%) were classified into the good adherence group (MMAS-8 score of 6-8). A multivariate logistic regression analysis revealed that age (per year, odds ratio [OR] 0.912, 95% confidence interval [CI] 0.853-0.965, p = 0.001), a history of warfarin use (OR 0.181, 95% CI 0.033-0.764, p = 0.019), duration of DOAC exposure (per 100 days, OR 1.245, 95% CI 1.084-1.460, p = 0.001), and the BIPQ emotional response score (per 1 point, OR 1.235, 95% CI 1.015-1.527, p = 0.035) were significantly associated with poor medication adherence in AF patients receiving DOACs. CONCLUSION Poor medication adherence to DOACs was strongly associated with a stronger emotional response (i.e. stronger feelings of anger, anxiety, and depression), as well as younger age, the absence of a history of warfarin treatment, and longer DOAC exposure. Further evaluation of the factors associated with medication adherence in AF patients and the development and execution of strategies for improving poor adherence are warranted in the real-world clinical setting.
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Affiliation(s)
- Motoyasu Miyazaki
- Department of Pharmacy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Akio Nakashima
- Department of Pharmacy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Yoshihiko Nakamura
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yuya Sakamoto
- Department of Pharmacy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Koichi Matsuo
- Department of Pharmacy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Miwa Goto
- Department of Pharmacy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Masanobu Uchiyama
- Department of Pharmacy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Keisuke Okamura
- Department of Cardiovascular Diseases, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Ryoko Mitsutake
- Department of Cardiovascular Diseases, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Hidenori Urata
- Department of Cardiovascular Diseases, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | | | - Osamu Imakyure
- Department of Pharmacy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
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Rewiuk K, Wizner B, Klich-Rączka A, Więcek A, Mossakowska M, Chudek J, Szybalska A, Broczek K, Zdrojewski T, Grodzicki T. Atrial fibrillation independently linked with depression in community-dwelling older population. Results from the nationwide PolSenior project. Exp Gerontol 2018; 112:88-91. [PMID: 30219348 DOI: 10.1016/j.exger.2018.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 08/15/2018] [Accepted: 09/10/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Depression is a frequently observed comorbid condition in patients with cardiovascular diseases. In contrast to coronary heart disease and heart failure there is a limited amount of published data concerning the increased prevalence of depression among patients with atrial fibrillation (AF). Therefore, we decided to assess the prevalence of depression in Polish community-dwelling older patients with a history of AF. METHODS The data were collected as part of the nationwide PolSenior project (2007-2012). Out of 4979 individuals (age range 65-104 years), data on self-reported history of AF were available for 4677 (93.9%). Finally, 4049 participants without suspected moderate or severe dementia in Mini Mental State Examination test were assessed with the 15-item Geriatric Depression Scale (GDS), and a score of 6 points and more was regarded as suspected depression. RESULTS Mean age (±SD) of the study population was 78.1 (±8.3) years; 52% were males. The history of AF was reported by 788 (19.5%) subjects. In the univariate analysis a self-reported AF history was associated with 42% increase of suspected depression (41% vs 29%; P < 0.001). In multivariate logistic regression AF remained an independent predictor of depression (OR = 1.69; 95%CI: 1.43-2.00), stronger than heart failure, diabetes or coronary heart disease. CONCLUSIONS In community-dwelling geriatric Polish population AF is associated with higher prevalence of depression. This association is independent from the demographic factors, disabilities and comorbidities (including history of stroke).
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Affiliation(s)
- K Rewiuk
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland.
| | - B Wizner
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
| | - A Klich-Rączka
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
| | - A Więcek
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Silesia, Katowice, Poland
| | - M Mossakowska
- International Institute of Molecular and Cell Biology, Warsaw, Poland
| | - J Chudek
- Department of Pathophysiology, Medical University of Silesia, Katowice, Poland
| | - A Szybalska
- International Institute of Molecular and Cell Biology, Warsaw, Poland
| | - K Broczek
- Clinic of Geriatrics, Medical University of Warsaw, Warsaw, Poland
| | - T Zdrojewski
- Department of Arterial Hypertension and Diabetology, Medical University of Gdansk, Gdańsk, Poland
| | - T Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
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32
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Kirchhof P, Haeusler KG, Blank B, De Bono J, Callans D, Elvan A, Fetsch T, Van Gelder IC, Gentlesk P, Grimaldi M, Hansen J, Hindricks G, Al-Khalidi HR, Massaro T, Mont L, Nielsen JC, Nölker G, Piccini JP, De Potter T, Scherr D, Schotten U, Themistoclakis S, Todd D, Vijgen J, Di Biase L. Apixaban in patients at risk of stroke undergoing atrial fibrillation ablation. Eur Heart J 2018; 39:2942-2955. [PMID: 29579168 PMCID: PMC6110196 DOI: 10.1093/eurheartj/ehy176] [Citation(s) in RCA: 155] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 03/09/2018] [Accepted: 03/14/2018] [Indexed: 02/02/2023] Open
Abstract
Aims It is recommended to perform atrial fibrillation ablation with continuous anticoagulation. Continuous apixaban has not been tested. Methods and results We compared continuous apixaban (5 mg b.i.d.) to vitamin K antagonists (VKA, international normalized ratio 2-3) in atrial fibrillation patients at risk of stroke a prospective, open, multi-centre study with blinded outcome assessment. Primary outcome was a composite of death, stroke, or bleeding (Bleeding Academic Research Consortium 2-5). A high-resolution brain magnetic resonance imaging (MRI) sub-study quantified acute brain lesions. Cognitive function was assessed by Montreal Cognitive Assessment (MoCA) at baseline and at end of follow-up. Overall, 674 patients (median age 64 years, 33% female, 42% non-paroxysmal atrial fibrillation, 49 sites) were randomized; 633 received study drug and underwent ablation; 335 undertook MRI (25 sites, 323 analysable scans). The primary outcome was observed in 22/318 patients randomized to apixaban, and in 23/315 randomized to VKA {difference -0.38% [90% confidence interval (CI) -4.0%, 3.3%], non-inferiority P = 0.0002 at the pre-specified absolute margin of 0.075}, including 2 (0.3%) deaths, 2 (0.3%) strokes, and 24 (3.8%) ISTH major bleeds. Acute small brain lesions were found in a similar number of patients in each arm [apixaban 44/162 (27.2%); VKA 40/161 (24.8%); P = 0.64]. Cognitive function increased at the end of follow-up (median 1 MoCA unit; P = 0.005) without differences between study groups. Conclusions Continuous apixaban is safe and effective in patients undergoing atrial fibrillation ablation at risk of stroke with respect to bleeding, stroke, and cognitive function. Further research is needed to reduce ablation-related acute brain lesions.
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Affiliation(s)
- Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, and SWBH and UHB NHS Trusts, IBR 136, Wolfson Drive, Birmingham, UK
- SWBH NHS Trust, Birmingham, UK
- University Hospitals Birmingham, Birmingham, UK
- Atrial Fibrillation NETwork Association (AFNET), Germany, Münster
| | - Karl Georg Haeusler
- Atrial Fibrillation NETwork Association (AFNET), Germany, Münster
- Center for Stroke Research Berlin & Department of Neurology, Charité – Universitätsmedizin Berlin, Germany
| | - Benjamin Blank
- Atrial Fibrillation NETwork Association (AFNET), Germany, Münster
| | - Joseph De Bono
- Institute of Cardiovascular Sciences, University of Birmingham, and SWBH and UHB NHS Trusts, IBR 136, Wolfson Drive, Birmingham, UK
- University Hospitals Birmingham, Birmingham, UK
| | | | - Arif Elvan
- Isala Heart Center Zwolle, Zwolle, The Netherlands
| | | | - Isabelle C Van Gelder
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Massimo Grimaldi
- Ospedale Generale Regionale F. Miulli, Acquaviva delle Fonti, Italy
| | | | | | - Hussein R Al-Khalidi
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, USA
| | - Tyler Massaro
- Duke Clinical Research Institute (DCRI), Durham, NC, USA
| | - Lluis Mont
- Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain
| | | | - Georg Nölker
- Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Jonathan P Piccini
- Duke Clinical Research Institute (DCRI), Durham, NC, USA
- Division of Cardiology Duke University Medical Center, Duke University, Durham, NC, USA
| | | | - Daniel Scherr
- Department of Cardiology, Medical University Graz, Austria
| | - Ulrich Schotten
- Atrial Fibrillation NETwork Association (AFNET), Germany, Münster
- Department of Physiology, University Maastricht, Maastricht, Netherlands
| | | | - Derick Todd
- Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Johan Vijgen
- Jessa Ziekenhuis, Campus Virga Jesse, Hasselt, Belgium
| | - Luigi Di Biase
- Albert Einstein College of Medicine, at Montefiore Hospital, New York, USA
- Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin, TX, USA
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Larochelle J, Brais C, Blais L, Perreault S, Farand P, Letemplier G, Beauchesne MF. Patients' Perception of Newly Initiated Oral Anticoagulant Treatment for Atrial Fibrillation: an Observational Study. J Gen Intern Med 2018; 33:1239-1241. [PMID: 29700791 PMCID: PMC6082223 DOI: 10.1007/s11606-018-4457-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Josiane Larochelle
- Institut universitaire de gériatrie de Sherbrooke, Sherbrooke, Québec, Canada
| | - Caroline Brais
- Hôpital du Haut-Richelieu, Saint-Jean-sur-Richelieu, Québec, Canada
| | - Lucie Blais
- Faculté de pharmacie, Université de Montréal, C.P. 6128, succ Centre-Ville, Montréal, Québec, H3C 3J7, Canada
- Centre de recherche, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
| | - Sylvie Perreault
- Faculté de pharmacie, Université de Montréal, C.P. 6128, succ Centre-Ville, Montréal, Québec, H3C 3J7, Canada
| | - Paul Farand
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Geneviève Letemplier
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Marie-France Beauchesne
- Faculté de pharmacie, Université de Montréal, C.P. 6128, succ Centre-Ville, Montréal, Québec, H3C 3J7, Canada.
- Centre de recherche, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada.
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada.
- Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada.
- Centre de recherche , Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada.
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Son YJ, Seo EJ. Impact of Sociodemographic and Clinical Factors on Health-Related Quality of Life in Older Adults With Atrial Fibrillation. Res Gerontol Nurs 2018; 11:207-215. [PMID: 29767807 DOI: 10.3928/19404921-20180511-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/02/2018] [Indexed: 11/20/2022]
Abstract
Atrial fibrillation (AF) is more prevalent in older adults than other populations and affects health-related quality of life (HRQoL). However, few studies have investigated HRQoL and clinical factors in older adults with AF. The aim of the current cross-sectional study was to describe HRQoL using an AF-specific QoL instrument and identify factors influencing HRQoL in Korean older adults with AF. Data from 205 patients diagnosed with AF in a tertiary hospital were analyzed. Patients' mean age was 74.24 years and 43.9% of patients were female. The total HRQoL score was 49.6 of 100. The lowest score was in the physical dimension of HRQoL. Concern about lethal complications from AF was an essential concept related to QoL. In multiple linear regression, age and gender were significant predictors for the physical dimension of HRQoL. Gender and comorbidity were significant factors for the sexual activity dimension. Health care providers should help improve the HRQoL of older adults with AF by reducing physical burdens and concerns about health-related complications. [Res Gerontol Nurs. 2018; 11(4):207-215.].
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Kaufman BG, Kim S, Pieper K, Allen LA, Gersh BJ, Naccarelli GV, Ezekowitz MD, Fonarow GC, Mahaffey KW, Singer DE, Chan PS, Freeman JV, Ansell J, Kowey PR, Rieffel JA, Piccini J, Peterson E, O'Brien EC. Disease understanding in patients newly diagnosed with atrial fibrillation. Heart 2018; 104:494-501. [PMID: 28790169 PMCID: PMC5861387 DOI: 10.1136/heartjnl-2017-311800] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/07/2017] [Accepted: 07/12/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To describe self-reported disease understanding for newly diagnosed patients with atrial fibrillation (AF) and assess (1) how disease understanding changes over the first 6 months after diagnosis and (2) the relationship between patient understanding of therapies at baseline and treatment receipt at 6 months among treatment-naïve patients. METHODS We analysed survey data from SATELLITE (Survey of Patient Knowledge and Personal Priorities for Treatment), a substudy of patients with new-onset AF enrolled in the national Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT) II registry across 56 US sites. Patients were surveyed at the baseline and 6-month follow-up clinic visits using Likert scales. RESULTS Among 1004 baseline survey responses, patients' confidence in their understanding of rhythm control, ablation, anticoagulation and cardioversion was suboptimal, with 'high' understanding ranging from 8.5% for left atrial appendage closure to 71.3% for rhythm therapy. Of medical history and demographic factors, education level was the strongest predictor of reporting 'high' disease understanding. Among the 786 patients with 6-month survey data, significant increases in the proportion reporting high understanding were observed (p<0.05) only for warfarin and direct oral anticoagulants (DOACs). With the exception of ablation, high understanding for a given therapeutic option was not associated with increased use of that therapy at 6 months. CONCLUSIONS About half of patients with new-onset AF understood the benefits of oral anticoagulant at the time of diagnosis and understanding improved over the first 6 months. However, understanding of AF treatment remains suboptimal at 6 months. Our results suggest a need for ongoing patient education. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov. Identifier: NCT01701817.
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Affiliation(s)
| | - Sunghee Kim
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Karen Pieper
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Larry A Allen
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | | | | | - Gregg C Fonarow
- Division of Cardiology, University of California, Los Angeles, California, USA
| | - Kenneth W Mahaffey
- Stanford Center for Clinical Research, School of Medicine, Stanford, California, USA
| | - Daniel E Singer
- Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Paul S Chan
- Department of Cardiovascular Research, St. Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - James V Freeman
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jack Ansell
- Hofstra Northwell School of Medicine, New York, New York, USA
| | - Peter R Kowey
- Jefferson Medical College, Philadelphia, Pennsylvania, USA
- Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | | | | | - Eric Peterson
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Emily C O'Brien
- Duke Clinical Research Institute, Durham, North Carolina, USA
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Gaugler JE. Managing Health Conditions in Older Adulthood: Barriers, Facilitators, and Solutions. J Appl Gerontol 2018; 36:1051-1053. [PMID: 29327662 DOI: 10.1177/0733464817721544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Coyne KS, Edvardsson N, Rydén A. Development and Validation of the AFImpact: An Atrial Fibrillation-Specific Measure of Patient-Reported Health-Related Quality of Life. Value Health 2017; 20:1355-1361. [PMID: 29241895 DOI: 10.1016/j.jval.2017.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 06/09/2017] [Accepted: 06/13/2017] [Indexed: 05/15/2023]
Abstract
BACKGROUND Improvement in health-related quality of life is a key therapeutic goal of disease management in atrial fibrillation (AF). OBJECTIVES To describe the development of the AFImpact, an AF-specific health-related quality-of-life patient-reported outcome measure. METHODS Development and validation of the AFImpact comprised a qualitative stage, consisting of a literature review and concept elicitation interviews (91 patients with AF), item generation, and cognitive debriefing (30 patients with AF), and a quantitative stage, consisting of evaluation of the instrument's psychometric properties (313 patients with AF). Preliminary responsiveness to change was assessed in 118 patients undergoing cardioversion. RESULTS On the basis of the literature review and concept elicitation interviews, 75 items were generated. Factor analyses guided a reduction to 18 items. Three domains were confirmed: vitality (7 items), emotional distress (8 items), and sleep (3 items). The 18-item AFImpact demonstrated high item convergent and discriminant validity. Cronbach α coefficients showed high internal consistency reliability. Test-retest reliability of individual items in stable patients (n = 33) was satisfactory, with intraclass correlation coefficients ranging from 0.61 to 0.86. All three AFImpact domain scores differentiated patients who reported different levels of overall health, thereby supporting known-groups validity. Scores for each item improved after cardioversion, with effect sizes ranging from -0.19 to -0.65. CONCLUSIONS Psychometric evaluations support the reliability and validity of the AFImpact as a patient-reported outcome instrument to measure the impact of AF, with preliminary results in patients undergoing cardioversion supporting responsiveness to change.
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Affiliation(s)
| | - Nils Edvardsson
- Sahlgrenska Academy at the Sahlgrenska University Hospital, Göteborg, Sweden
| | - Anna Rydén
- AstraZeneca Gothenburg, Mölndal, Sweden.
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Proietti M, Recchia A, Riva E, Lucca U, Tettamanti M, Mannucci PM, Nobili A. Relationship between atrial fibrillation and cognitive decline in individuals aged 80 and older. Eur J Intern Med 2017; 46:6-10. [PMID: 28803036 DOI: 10.1016/j.ejim.2017.08.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 07/25/2017] [Accepted: 08/08/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) and dementia are largely prevalent and incident in progressively older subjects, suggesting a link between the two conditions. While in the general population there are several findings supporting a causal relationship between AF and dementia, it is unclear whether or not this association is still present in individuals aged 80 and older. RESULTS So far, the few studies that analysed this issue did not provide enough evidence supporting the causative role of AF in increasing the risk of cognitive decline or dementia in patients aged 80 and older. Conversely, a relevant role of optimal anticoagulation control in determining a significant reduction in the risk of cognitive decline is suggested, in AF subjects aged 80years or older. CONCLUSIONS Further data, coming from population-based studies specifically investigating very old individuals and based upon large samples and comprehensive cognitive assessments, are needed to fully elucidate the relationship between AF and dementia in very old individuals.
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Affiliation(s)
- Marco Proietti
- Department of Neuroscience, Laboratory of Quality Assessment of Geriatric Therapies and Services, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy; University of Birmingham Institute of Cardiovascular Sciences, Birmingham, United Kingdom
| | - Angela Recchia
- Department of Neuroscience, Laboratory of Geriatric Neuropsychiatry, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Emma Riva
- Department of Neuroscience, Laboratory of Geriatric Neuropsychiatry, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Ugo Lucca
- Department of Neuroscience, Laboratory of Geriatric Neuropsychiatry, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Mauro Tettamanti
- Department of Neuroscience, Laboratory of Geriatric Neuropsychiatry, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Pier Mannuccio Mannucci
- Scientific Direction, IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Milan, Italy
| | - Alessandro Nobili
- Department of Neuroscience, Laboratory of Quality Assessment of Geriatric Therapies and Services, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
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Affiliation(s)
- Lori A Roscoe
- a Department of Communication , University of South Florida
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40
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Abstract
BACKGROUND For both patients and clinicians, differences between older and new anticoagulants have major implications for treatment selection, day-to-day management of therapy and adherence. AIMS To explore patients' preferences for warfarin versus direct oral anticoagulant (DOAC) therapy. METHODS Mixed-method study involving anticoagulated older patients admitted to hospital. Part A comprised a vignette-based questionnaire; patients were asked whether they preferred Medicine A (warfarin) or Medicine B (DOAC). Part B interviews explored patients' satisfaction with their current anticoagulant. Responses were thematically analysed. RESULTS Forty patients participated: 23 warfarin-treated, 17 DOAC-treated. Collectively, Parts A and B identified that most patients were satisfied with their current therapy (warfarin or DOAC), expressing reluctance to change to alternatives. Among patients who were able to numerically rate their satisfaction with therapy, most were 'satisfied' with their current anticoagulant, although warfarin-treated patients were slightly less 'satisfied' (median score 3.5) than those on DOACs (median score 5.0). Despite this, warfarin-treated patients still preferred their current therapy (over DOACs) due to familiarity and the security of regular international normalised ratio (INR) monitoring; those who preferred DOACs cited previous warfarin-related bleeding and unstable INRs as key reasons. DOAC-treated patients who preferred warfarin perceived regular monitoring as a major advantage; only those having had negative experiences with warfarin clearly preferred DOACs. CONCLUSION Most patients accepted their currently prescribed anticoagulant, be it warfarin or DOACs. Features of specific anticoagulants, such as regular monitoring with warfarin, were perceived variably - some patients cited them as advantages and others as disadvantages. The clearest preference identified was for the agent already being taken.
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Affiliation(s)
- Beata Bajorek
- 1 Graduate School of Health, University of Technology Sydney, Broadway, NSW, Australia
- 4 Department of Pharmacy, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Brooke Saxton
- 1 Graduate School of Health, University of Technology Sydney, Broadway, NSW, Australia
| | | | - Clara K Chow
- 2 Pharmacy Department, Westmead Hospital, Westmead, NSW, Australia
- 3 The George Institute for Global Health, University of Sydney, Camperdown, NSW, Australia
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Soliman EZ, Zhang ZM, Judd S, Howard VJ, Howard G. Comparison of Risk of Atrial Fibrillation Among Employed Versus Unemployed (from the REasons for Geographic and Racial Differences in Stroke Study). Am J Cardiol 2017; 120:1298-1301. [PMID: 28822561 DOI: 10.1016/j.amjcard.2017.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/07/2017] [Accepted: 07/07/2017] [Indexed: 11/30/2022]
Abstract
Involuntary unemployment due to job loss has been associated with increased risk of cardiovascular events. Whether it also is associated with increased risk of atrial fibrillation (AF) is currently unknown. Therefore, we examined this association in 8,812 participants residing mainly in the Southeastern United States (mean age 58.1 ± 7.8 years; 63.2%; women; 43.2% black) with data on employment status who were enrolled in the REasons for Geographic And Racial Differences in Stroke study between 2003 and 2007 after excluding those with voluntary unemployment (retiree, homemakers, and students). AF was identified by electrocardiogram and past medical history at the same period. The cross-sectional association between status and type of unemployment with AF was examined in multivariable logistic regression models. Additional analysis in 4,273 participants without baseline AF and with data on incident AF collected in a follow-up visit occurred after a median of 9.4 years from baseline was also conducted. In a model adjusted for socio-demographics, health insurance, income, perceived stress, and cardiovascular risk factors, unemployment was associated with 60% increased odds of AF (odds ratio [95% confidence interval] 1.60 (1.24, 2.07)). This association was consistent in subgroups stratified by median age, gender, race, education, income, and health insurance status. Similarly, unemployment was associated with AF in those without AF at baseline who developed incident AF (odds ratio [95% confidence interval] 1.54 (1.04, 2.37)). In conclusion, involuntary unemployment is associated with increased risk of AF. This may call for considering socioeconomic determinants such as unemployment as part of the preventive strategies for AF.
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Affiliation(s)
- Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
| | - Zhu-Ming Zhang
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Suzanne Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - George Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
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Zweiker D, Zweiker R, Winkler E, Roesch K, Schumacher M, Stepan V, Krippl P, Bauer N, Heine M, Reicht G, Zweiker G, Sprenger M, Watzinger N. Association between subjective risk perception and objective risk estimation in patients with atrial fibrillation: a cross-sectional study. BMJ Open 2017; 7:e018242. [PMID: 28951417 PMCID: PMC5623506 DOI: 10.1136/bmjopen-2017-018242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Oral anticoagulation (OAC) is state-of-the-art therapy for atrial fibrillation (AF), the most common arrhythmia worldwide. However, little is known about the perception of patients with AF and how it correlates with risk scores used by their physicians. Therefore, we correlated patients' estimates of their own stroke and bleeding risk with the objectively predicted individual risk using CHA2DS2-VASc and HAS-BLED scores. DESIGN Cross-sectional prevalence study using convenience sampling and telephone follow-up. SETTINGS Eight hospital departments and one general practitioner in Austria. Patients' perception of stroke and bleeding risk was opposed to commonly used risk scoring. PARTICIPANTS Patients with newly diagnosed AF and indication for anticoagulation. MAIN OUTCOME MEASURES Comparison of subjective risk perception with CHA2DS2-VASc and HAS-BLED scores showing possible discrepancies between subjective and objective risk estimation. Patients' judgement of their own knowledge on AF and education were also correlated with accuracy of subjective risk appraisal. RESULTS Ninety-one patients (age 73±11 years, 45% female) were included in this study. Subjective stroke and bleeding risk estimation did not correlate with risk scores (ρ=0.08 and ρ=0.17). The majority of patients (57%) underestimated the individual stroke risk. Patients feared stroke more than bleeding (67% vs 10%). There was no relationship between accurate perception of stroke and bleeding risks and education level. However, we found a correlation between the patients' judgement of their own knowledge of AF and correct assessment of individual stroke risk (ρ=0.24, p=0.02). During follow-up, patients experienced the following events: death (n=5), stroke (n=2), bleeding (n=1). OAC discontinuation rate despite indication was 3%. CONCLUSIONS In this cross-sectional analysis of OAC-naive patients with AF, we found major differences between patients' perceptions and physicians' assessments of risks and benefits of OAC. To ensure shared decision-making and informed consent, more attention should be given to evidence-based and useful communication strategies. TRIAL REGISTRATION NUMBER NCT03061123.
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Affiliation(s)
- David Zweiker
- Division of Cardiology, Department of Internal Medicine, Medizinische University Graz, Graz, Steiermark, Austria
| | - Robert Zweiker
- Division of Cardiology, Department of Internal Medicine, Medizinische University Graz, Graz, Steiermark, Austria
| | - Elisabeth Winkler
- Division of Cardiology, Department of Internal Medicine, Medizinische University Graz, Graz, Steiermark, Austria
| | - Konstantina Roesch
- Division of Cardiology, Department of Internal Medicine, Medizinische University Graz, Graz, Steiermark, Austria
| | - Martin Schumacher
- Department of Internal Medicine, Hospital Barmherzige Brueder Marschallgasse, Graz, Steiermark, Austria
| | - Vinzenz Stepan
- Department of Internal Medicine, Hospital Elisabethinen, Graz, Austria
| | - Peter Krippl
- Department of Internal Medicine, LKH Fürstenfeld, Krankenhausverbund Feldbach, Fürstenfeld, Austria
| | - Norbert Bauer
- Department of Internal Medicine, LKH Hartberg, Steiermark, Austria
| | - Martin Heine
- Department of Neurology, LKH Feldbach, Krankenhausverbund Feldbach-Fürstenfeld, Feldbach, Steiermark, Austria
| | - Gerhard Reicht
- Department of Internal Medicine, Krankenhaus Barmherzige Bruder Graz-Eggenberg, Graz, Steiermark, Austria
| | - Gudrun Zweiker
- General Practitioner Dr. Gudrun Zweiker, Straden, Austria
| | - Martin Sprenger
- Department of Social Medicine and Epidemiology, Medical University of Graz, Steiermark, Austria
| | - Norbert Watzinger
- Department of Internal Medicine, Landeskrankenhaus Feldbach, Feldbach, Steiermark, Austria
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43
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Singh-Manoux A, Fayosse A, Sabia S, Canonico M, Bobak M, Elbaz A, Kivimäki M, Dugravot A. Atrial fibrillation as a risk factor for cognitive decline and dementia. Eur Heart J 2017; 38:2612-2618. [PMID: 28460139 PMCID: PMC5837240 DOI: 10.1093/eurheartj/ehx208] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 03/08/2017] [Accepted: 04/24/2017] [Indexed: 11/12/2022] Open
Abstract
AIMS To assess whether AF is a risk factor for cognitive dysfunction we used prospective data on AF, repeat cognitive scores, and dementia incidence in adults followed over 45 to 85 years. METHODS AND RESULTS Data are drawn from the Whitehall II study, N = 10 308 at study recruitment in 1985. A battery of cognitive tests was administered four times (1997-2013) to 7428 participants (414 cases of AF), aged 45-69 years in 1997. Compared with AF-free participants, those with longer exposure to AF (5, 10, or 15 years) experienced faster cognitive decline after adjustment for sociodemographic, behavioural, and chronic diseases (P for trend = 0.01). Incident stroke or coronary heart disease individually did not explain the excess cognitive decline; however, this relationship was impacted when considering them together (P for trend 0.09). Analysis of incident dementia (N = 274/9302 without AF; N = 50/912 with AF) showed AF was associated with higher risk of dementia in Cox regression adjusted for sociodemographic factors, health behaviours and chronic diseases [hazard ratio (HR): 1.87; 95% confidence interval (CI): 1.37, 2.55]. Multistate models showed AF to increase risk of dementia in those free of stroke (HR: 1.67; 95% CI: 1.17, 2.38) but not those free of stroke and coronary heart disease (HR: 1.29; 95% CI: 0.74, 2.24) over the follow-up. CONCLUSION In adults aged 45-85 years AF is associated with accelerated cognitive decline and higher risk of dementia even at ages when AF incidence is low. At least in part, this was explained by incident cardiovascular disease in patients with AF.
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Affiliation(s)
- Archana Singh-Manoux
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay., Hôpital Paul Brousse, Bât 15/16, 16 Avenue Paul Vaillant Couturier, VILLEJUIF CEDEX, 94807, France
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Aurore Fayosse
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay., Hôpital Paul Brousse, Bât 15/16, 16 Avenue Paul Vaillant Couturier, VILLEJUIF CEDEX, 94807, France
| | - Séverine Sabia
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay., Hôpital Paul Brousse, Bât 15/16, 16 Avenue Paul Vaillant Couturier, VILLEJUIF CEDEX, 94807, France
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Marianne Canonico
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay., Hôpital Paul Brousse, Bât 15/16, 16 Avenue Paul Vaillant Couturier, VILLEJUIF CEDEX, 94807, France
| | - Martin Bobak
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Alexis Elbaz
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay., Hôpital Paul Brousse, Bât 15/16, 16 Avenue Paul Vaillant Couturier, VILLEJUIF CEDEX, 94807, France
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Aline Dugravot
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay., Hôpital Paul Brousse, Bât 15/16, 16 Avenue Paul Vaillant Couturier, VILLEJUIF CEDEX, 94807, France
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44
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Kang Y, Bahler R. Health-Related Quality of Life in Patients Newly Diagnosed with Atrial Fibrillation. Eur J Cardiovasc Nurs 2017; 3:71-6. [PMID: 15053890 DOI: 10.1016/j.ejcnurse.2003.12.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [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: 07/21/2003] [Revised: 11/20/2003] [Accepted: 12/03/2003] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Atrial fibrillation is the most common sustained cardiac rhythm disturbance encountered in clinical practice. Despite its high prevalence and the associated high number of hospital admissions, few studies document the actual impact of atrial fibrillation on the patient. PURPOSE The purpose of this study was to describe the health-related quality of life (HRQOL) and to examine the impact of seriousness of illness on HRQOL in patients newly diagnosed with atrial fibrillation. METHODS AND RESULTS A descriptive correlational and cross-sectional survey study included 81 subjects newly diagnosed with atrial fibrillation within 6 months prior to data collection through face-to-face interview by the Atrial Fibrillation Symptom Frequency and severity checklist (SCL) and the short form-36 health survey (SF-36). As the variables for HRQOL, subjects' perception of both physical health and mental health was poorer than that of general US population. The seriousness of illness had a significant inverse relationship with HRQOL, including both physical health and mental health. CONCLUSION The findings of this study indicated that the HRQOL in patients newly diagnosed with atrial fibrillation was significantly impaired and the subjective seriousness of illness had a pivotal impact on HRQOL in atrial fibrillation.
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Affiliation(s)
- Younhee Kang
- Department of Nursing, College of Medicine, Kyungpook National University, 101 Dong In 2-Ga, Chung-Gu, Daegu 700-422, South Korea.
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45
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Patel SI, Cherington C, Scherber R, Barr K, McLemore R, Morisky DE, Cha S, Mookadam F, Shamoun F. Assessment of Patient Adherence to Direct Oral Anticoagulant vs Warfarin Therapy. J Osteopath Med 2017; 117:7-15. [PMID: 28055097 DOI: 10.7556/jaoa.2017.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
CONTEXT Direct oral anticoagulants (DOACs) may be as effective as, and at times safer than, warfarin. Because DOACs do not require regular serum level monitoring, patients' interaction with the health care system may be reduced. To the authors' knowledge, although studies have evaluated warfarin adherence, few studies have evaluated the real-world adherence to DOACs. OBJECTIVE To evaluate whether a difference exists between medication adherence of patients taking DOACs vs patients taking warfarin. METHODS The electronic medical records of the Anticoagulation Clinic database at Mayo Clinic in Scottsdale, Arizona, were reviewed. Inclusion criteria were adults taking DOACs and a matching cohort taking warfarin between January 1, 2011, and December 30, 2013. The Morisky Medication Adherence Scale-8 item, a validated medication adherence tool, was used to evaluate adherence in both cohorts, and the qualitative covariates were analyzed using ordinal logistic regression. RESULTS Of 324 surveys that were sent, 110 patients (34.0%) responded. Most patients took DOACs for atrial fibrillation, and few took DOACs for venous thromboembolism. Overall, 60 of 66 patients (90.9%) in the DOAC group and 42 of 44 patients (95.5%) in the warfarin group reported medium or high adherence. Difference in adherence scores between the 2 groups was not statistically significant (P=.8). CONCLUSION Similar adherence was noted between DOACs and warfarin regardless of the frequency of serum level monitoring.
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46
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Dalteg T, Benzein E, Sandgren A, Malm D, Årestedt K. Associations of Emotional Distress and Perceived Health in Persons With Atrial Fibrillation and Their Partners Using the Actor-Partner Interdependence Model. J Fam Nurs 2016; 22:368-391. [PMID: 27385260 DOI: 10.1177/1074840716656815] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Individual behavior affects and is affected by other people. The aim of this study was to examine if emotional distress in patients with atrial fibrillation (AF) and their spouses was associated with their own and their partner's perceived health. Participants included 91 dyads of patients and their spouses. Emotional distress was measured using the Hospital Anxiety and Depression Scale and perceived health was measured with the Short Form 36 Health Survey. The Actor-Partner Interdependence Model was used for dyad-level analyses of associations, using structural equation modeling. Higher levels of anxiety and depression were associated with lower levels of perceived health in patients and spouses. Higher levels of depression in patients were associated with lower levels of vitality in spouses and vice versa. As AF patients and their spouses influence each other, health-care interventions should consider the dyad to address dyadic dynamics. This may benefit the health of the individual patient and of the couple.
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Affiliation(s)
| | - Eva Benzein
- Linnaeus University, Växjö, Sweden Linnaeus University, Kalmar, Sweden
| | - Anna Sandgren
- Linnaeus University, Växjö, Sweden Linnaeus University, Kalmar, Sweden
| | - Dan Malm
- Jönköping University, Sweden County Hospital Ryhov, Jönköping, Sweden
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47
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Piers RJ, Nishtala A, Preis SR, DeCarli C, Wolf PA, Benjamin EJ, Au R. Association between atrial fibrillation and volumetric magnetic resonance imaging brain measures: Framingham Offspring Study. Heart Rhythm 2016; 13:2020-4. [PMID: 27417740 DOI: 10.1016/j.hrthm.2016.07.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND The increased risk of stroke and cognitive impairment associated with atrial fibrillation (AF) is well documented. However, there is a paucity of research investigating the relations between AF and brain morphology. OBJECTIVE The purpose of this study was to investigate the association between AF and brain volume measures on magnetic resonance imaging (MRI). METHODS The study sample included stroke- and dementia-free participants who attended the Framingham Heart Study offspring cohort 7th examination cycle (1999-2005) and underwent contemporaneous MRI. We examined the association between prevalent AF and brain volume measures (total cerebral volume, frontal lobe volume, temporal lobe volume, temporal horn volume, hippocampal volume, and white matter hyperintensity volume) with linear regression. We first adjusted models for age and sex, and then for vascular risk factors and APOE4. RESULTS We studied 2144 individuals (mean age 61.8 ± 9.3 years; 54% women); 73 participants (3.4%) had prevalent AF at the time of MRI. In age- and sex-adjusted models, AF was inversely associated with total cerebral brain volume, frontal brain volume, and temporal brain volume. After further adjustment for vascular risk factors and APOE4, AF remained associated with frontal brain volume. CONCLUSION After accounting for vascular risk factor burden, prevalent AF was associated with lobar indexes of vascular brain aging but not with expected white matter changes.
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Affiliation(s)
- Ryan J Piers
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts; The Framingham Heart Study, Framingham, Massachusetts
| | - Arvind Nishtala
- Department of Medicine, University of California, San Francisco, California
| | - Sarah R Preis
- The Framingham Heart Study, Framingham, Massachusetts; Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Charles DeCarli
- Department of Neurology, University of California, Davis, California
| | - Philip A Wolf
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts; The Framingham Heart Study, Framingham, Massachusetts
| | - Emelia J Benjamin
- The Framingham Heart Study, Framingham, Massachusetts; Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Rhoda Au
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts; The Framingham Heart Study, Framingham, Massachusetts.
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48
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Wang ZZ, Du X, Wang W, Tang RB, Luo JG, Li C, Chang SS, Liu XH, Sang CH, Yu RH, Long DY, Wu JH, Bai R, Liu N, Ruan YF, Dong JZ, Ma CS. Long-Term Persistence of Newly Initiated Warfarin Therapy in Chinese Patients With Nonvalvular Atrial Fibrillation. Circ Cardiovasc Qual Outcomes 2016; 9:380-7. [PMID: 27382087 DOI: 10.1161/circoutcomes.115.002337] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 09/27/2015] [Accepted: 05/18/2016] [Indexed: 01/28/2023]
Abstract
Background—
Despite its therapeutic efficacy, warfarin is extremely underused in Chinese patients with nonvalvular atrial fibrillation (AF). Whether the nonpersistence of warfarin treatment contributes to its underuse is not known. The aims of this study were to determine nonpersistence rates of newly started warfarin treatment in Chinese patients with nonvalvular AF and to identify the factors associated with discontinuation of the treatment.
Methods and Results—
We identified 1461 patients with nonvalvular AF enrolled in the Chinese Atrial Fibrillation Registry (CAFR) who newly started on warfarin therapy in the period between August 1, 2011, and June 30, 2014. During a follow-up of 426±232 days, 22.1% of patients discontinued warfarin within 3 months, 44.4% within 1 year, and 57.6% within 2 years of initiation of therapy. Patients with no or partial insurance coverage had a higher likelihood to discontinue warfarin than those with full insurance coverage (adjusted hazard ratio 1.65, 95% confidence interval [1.03–2.64];
P
=0.038 and 1.66 [1.13–2.42];
P
=0.009, respectively). Paroxysmal AF (1.56 [1.28–1.92];
P
<0.0001), no prior stroke/transient ischemic attack/thromboembolism (1.60 [1.24–2.05];
P
=0.0003), and no dyslipidemia (1.34 [1.06–1.70];
P
=0.016) were also found to be independent predictors for nonpersistence of warfarin therapy.
Conclusions—
Nonpersistence of warfarin treatment becomes a serious problem for stroke prevention in Chinese patients with nonvalvular AF. Our findings can be used to identify patients who require closer attention or to develop better management strategy for oral anticoagulation therapy.
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Affiliation(s)
- Zhi-Zun Wang
- From the Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xin Du
- From the Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Wei Wang
- From the Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Ri-Bo Tang
- From the Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Jing-Guang Luo
- From the Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Chao Li
- From the Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - San-Shuai Chang
- From the Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xiao-Hui Liu
- From the Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Cai-Hua Sang
- From the Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Rong-Hui Yu
- From the Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - De-Yong Long
- From the Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Jia-Hui Wu
- From the Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Rong Bai
- From the Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Nian Liu
- From the Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Yan-Fei Ruan
- From the Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Jian-Zeng Dong
- From the Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Chang-Sheng Ma
- From the Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
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49
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Abstract
The aim of this descriptive, correlational, and cross-sectional survey was to explore uncertainty in patients with atrial fibrillation and to examine the relationships between uncertainty and its antecedents, including education, social support, and perceived seriousness of illness in patients newly diagnosed with atrial fibrillation. The theoretical framework of the study was Mishel’s middle-range nursing theory of uncertainty in illness. A convenience sample of 81 participants recruited from two academic medical centers over 10 months was interviewed. Uncertainty was moderately high in patients with atrial fibrillation compared to other clinical populations. Among antecedents of uncertainty, higher education was significantly associated with less uncertainty (= -.21 to -.25). Except for tangible support, persons with greater social supports perceived less uncertainty (= -.25 to -.27), and individuals with greater perceived seriousness of illness reported greater uncertainty (= .30 to .33).
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Affiliation(s)
- Younhee Kang
- College of Nursing Science, Ewha Womans University, Seoul, Korea.
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50
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Arnheim K. [Fear of severe bleeding mostly not justified]. MMW Fortschr Med 2016; 158:66. [PMID: 27119707 DOI: 10.1007/s15006-016-7826-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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