1,721,281 research outputs found
Updating a simple clinical score predicting incident atrial fibrillation: The C2HEST score or more (mC2HEST)?
No full textUnderstanding the global burden of atrial fibrillation and regional variations:we need improvement
Full text linkThis editorial refers to 'Global variations in the prevalence, treatment, and impact of atrial fibrillation in a multinational cohort of 153,152middle-aged individuals' by P.G. Joseph et al., pp. 1523-1531
The non-vitamin K antagonist oral anticoagulants (NOACs) and extremes of body weight—a systematic literature review
No full textA tailored treatment strategy:a modern approach for stroke prevention in patients with atrial fibrillation
No full textThe main priority in atrial fibrillation (AF) management is stroke prevention, following which decisions about rate or rhythm control are focused on the patient, being primarily for management of symptoms. Given that AF is commonly associated with various comorbidities, risk factors such as hypertension, heart failure, diabetes mellitus and sleep apnoea should be actively looked for and managed in a holistic approach to AF management. The objective of this review is to provide an overview of modern AF stroke prevention with a focus on tailored treatment strategies. Biomarkers and genetic factors have been proposed to help identify 'high-risk' patients to be targeted for oral anticoagulation, but ultimately their use must be balanced against that of more simple and practical considerations for everyday use. Current guidelines have directed focus on initial identification of 'truly low-risk' patients with AF, that is those patients with a CHA2 DS2 -VASc [congestive heart failure, hypertension, age ≥75 years (two points), diabetes mellitus, stroke (two points), vascular disease, age 65-74 years, sex category] score of 0 (male) or 1 (female), who do not need any antithrombotic therapy. Subsequently, patients with ≥1 stroke risk factors can be offered effective stroke prevention, that is oral anticoagulation. The SAMe-TT2 R2 [sex female, age <60 years, medical history (>2 comorbidities), treatment (interacting drugs), tobacco use (two points), race non-Caucasian (two points)] score can help physicians make informed decisions on those patients likely to do well on warfarin (SAMe-TT2 R2 score 0-2) or those who are likely to have a poor time in therapeutic range (SAMe-TT2 R2 score >2). A clinically focused tailored approach to assessment and stroke prevention in AF with the use of the CHA2 DS2 VASc, HAS-BLED [hypertension, abnormal renal/liver function (one or two points), stroke, bleeding history or predisposition, labile international normalized ratio, elderly (>65 years) drugs/alcohol concomitantly (one or two points)] and SAMeTT2 R2 scores to evaluate stroke risk, bleeding risk and likelihood of successful warfarin therapy, respectively, is discussed.</p
Family history of atrial fibrillation and risk of cardiovascular events. a multicenter prospective cohort study
No full textBackground: To investigate the association between family history of atrial fibrillation (AF) with cardiovascular events (CVEs), major adverse cardiac events (MACE), and cardiovascular mortality. Methods: Multicenter prospective observational cohort study including 1722 nonvalvular AF patients from February 2008 to August 2019 in Italy. Family history of AF was defined as the presence of AF in a first-degree relative: Mother, father, sibling, or children. Primary outcome was a composite of CVEs including fatal/nonfatal ischemic stroke and myocardial infarction, and cardiovascular death. Second, we analyzed the association with major adverse cardiac event. Results: Mean age was 74.6±9.4 years; 44% of women. Family history of AF was detected in 368 (21.4%) patients, and 3.5% had ≥2 relatives affected by AF. Age of AF onset progressively decreased from patients without family history of AF, compared with those with single and multiple first-degree affected relatives (P<0.001). During a mean follow-up of 23.7 months (4606 patients/y) 145 CVEs (3.15%/y), 98 major adverse cardiac event (2.13%/y), and 57 cardiovascular deaths (0.97%/y) occurred. After adjustment for cardiovascular risk factors, family history of AF was associated with a higher risk of CVEs (hazard ratio, 1.524 [95% CI, 1.021-2.274], P=0.039), major adverse cardiac event (hazard ratio, 1.917 [95% CI, 1.207-3.045], P=0.006), and cardiovascular mortality (hazard ratio, 2.008 [95% CI, 1.047-3.851], P=0.036). Subgroup analysis showed that this association was modified by age, sex, and prior ischemic heart disease. Conclusions: In a cohort of elderly patients with a high atherosclerotic burden, family history of AF is evident in >20% of patients and was associated with an increased risk for CVEs and mortality. Registration: URL: Https://www.clinicaltrials.gov; Unique identifier: NCT01882114.A
Thromboembolism, mortality, and bleeding in 2,435,541 atrial fibrillation patients with and without cancer. a nationwide cohort study
No full textBackground: The number of patients with atrial fibrillation (AF) and cancer is rapidly increasing in clinical practice. The impact of cancer on clinical outcomes in this patient population is unclear, as is the performance of the HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol) and CHA2DS2-VASc (Congestive Heart Failure, Hypertension, Age ≥ 75 years, Diabetes Mellitus, Stroke or Transient Ischemic Attack, Vascular Disease, Age 65 to 74 Years, Sex Category) scores. Methods: This was an observational, retrospective cohort study including 2,435,541 adults hospitalized with AF. The authors investigated the incidence rates (IRs) of all-cause and cardiovascular mortality, ischemic stroke, major bleeding, and intracranial hemorrhage (ICH) according to the presence of cancer and cancer types. Results: Overall, 399,344 (16.4%) had cancer, with the most common cancers being metastatic, prostatic, colorectal, lung, breast, and bladder. During a mean follow-up of 2.0 years, cancer increased all-cause mortality (hazard ratio [HR], 2.00; 95% confidence interval [CI], 1.99-2.01). The IR of ischemic stroke was higher with pancreatic cancer (2.8%/y), uterine cancer (2.6%/y), and breast cancer (2.6%/y), whereas it was lower with liver/lung cancer (1.9%/y) and leukemia/myeloma (2.0%/y), in comparison with noncancer patients (2.4%/y). Cancer increased the risk of major bleeding (HR, 1.27; 95% CI, 1.26-1.28) and ICH (HR, 1.07; 95% CI, 1.05-1.10). Leukemia, liver cancer, myeloma, and metastatic cancers showed the highest IRs for major bleeding/ICH. Major bleeding and ICH rates progressively increased with the HAS-BLED score, which showed generally good predictivity with C indexes > 0.70 for all cancer types. The CHA2DS2-VASc score's predictivity was slightly lower in AF patients with cancer. Conclusions: Cancer increased all-cause mortality, major bleeding, and ICH risk in AF patients. The association between cancer and ischemic stroke differed among cancer types, and in some types, the risk of bleeding seemed to exceed the thromboembolic risk
Atrial high-rate episodes and thromboembolism in patients without atrial fibrillation. the west birmingham atrial fibrillation project
No full textBackground: Patients with cardiac implantable electronic device (CIED) developing atrial high-rate episodes (AHRE) have a significant risk of thromboembolic events (TEs), but risk factors have been scarcely investigated. Objectives: To analyze risk factors for TEs in a contemporary cohort of patients with CIED. Methods: Consecutive non-AF patients without anticoagulation at baseline were followed up after the CIED implantation. The role of newly-developed AHRE and other risk factors for TEs were analyzed using a time-dependent Cox regression model and Kaplan-Meier analysis with log-rank tests. Results: A total of 594 CIED patients were followed up for a mean of 4.2 years: 175 developed AHRE (29.5%; incident rate [IR] 8.80% per patient-year). Of those, 33 experienced TEs (5.5%; IR 1.38% per patient-year). Incidence of TEs was low in patients with a CHA 2 DS 2 -VASc score < 2 (male)/<3 (female) (AHRE vs. no-AHRE, 0.60% vs. 0.00% per patient-year, p = 0.469) and high in those with score ≥ 2 (male)/≥3 (female) (AHRE vs. no-AHRE, 2.12% vs. 1.36% per patient-year, p = 0.209), regardless of the AHRE presence. AHRE was not significantly associated with TEs (hazard ratio [HR], 1.46 [0.64–3.33]). There was no temporal relationship between AHRE and TEs. Baseline CHA 2 DS 2 -VASc score was independently associated with TEs (HR, 1.41 [1.13–1.75]) on multivariate analysis, but not AHRE. Conclusions: Thromboembolic risk in patients with CIED is mainly driven by comorbidity burden, i.e., CHA 2 DS 2 -VASc score, rather than AHRE per se. Decision-making on stroke prevention needs to focus on comorbidity burden and not merely on the presence or absence of AHRE in CIED patients
Effects of atrial fibrillation and chronic kidney disease on major adverse cardiovascular events
No full textAtrial fibrillation (AF) is strongly linked to chronic kidney disease (CKD) and both of these conditions contribute to poor cardiovascular outcomes. We evaluated the impact of renal failure on major adverse cardiovascular events (MACE) in AF, and predictive value of the 2MACE score in this post-hoc analysis of the AMADEUS trial. The primary endpoint was MACE (composite of myocardial infarction, cardiac revascularisation and cardiovascular mortality). Secondary endpoints included the composite of stroke, major bleeding and non-cardiovascular mortality, and each of the specific outcomes separately. Of the 4,554 patients, 1,526 (33.5%) were females and the median age was 71 (IQR 64 to 77) years. There were 3,838 (84.3%) non-CKD and 716 (15.7%) CKD patients. The incidence of cardiovascular and non-cardiovascular mortality were 1.41% and 2.44% per 100 patient-years, respectively. There was no significant difference in crude study endpoints between the groups. Multivariable regression analysis found no association between CKD and MACE (HR 1.03 [95% CI, 0.45 to 2.34]). The c-index of the 2MACE score for MACE was 0.65 (95% CI, 0.59 to 0.71, p <0.001). In the presence of CKD, each additional point of the 2MACE score contributed to a greater risk of MACE (HR 3.17 [95% CI, 1.28 to 7.85] vs 1.48 [95% CI, 1.17 to 1.87] in the non-CKD group). In conclusion, the 2MACE score may be a useful tool for clinical risk stratification of high-risk AF patients with CKD and those at high MACE risk could be targeted for more intensive cardiovascular prevention strategies. The presence of CKD was not found to be independently associated with MACE in AF patients
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