308 research outputs found
In anticoagulated patients with af, has-bled predicted major bleeding better than chads2 and cha2ds2-vasc
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The HAS-BLED score has better prediction accuracy for major bleeding than CHADS2 or CHA2DS2-VASc scores in anticoagulated patients with atrial fibrillation. [J Am Coll Cardiol. 201
Geographical differences in thromboembolic and bleeding risks in patients with non-valvular atrial fibrillation:An ancillary analysis from the SPORTIF trials
No full textBACKGROUND: Atrial fibrillation (AF) is associated with an increased risk of stroke, and the use of oral anticoagulation reduces stroke and all-cause mortality. Geographical differences may exist in AF risk factors, risk stratification and treatment strategies.METHODS: A post-hoc subgroup analysis derived from randomized controlled trials, the SPORTIF III and V trials, studying differences between European and North American warfarin-assigned non-valvular AF patients.RESULTS: Of 3359 patients 41.6% (n=1397) were enrolled in Europe and 1962 (58.4%) from North America. CHA2DS2-VASc (p=0.002) and HAS-BLED (p<0.001) scores were higher in North Americans. Good anticoagulation control was more common in North American patients than Europeans. 1-Kaplan-Meier estimate curves show that North Americans had a lower risk of stroke/systemic embolic event (SEE) (p=0.012), but higher risk of myocardial infarction(MI) (p=0.007) and major bleeding (p<0.001), compared to Europeans. Cox multivariate analysis confirmed a lower stroke/SEE risk (p=0.008) and higher MI (p=0.014) and major bleeding risks (p<0.001) in North Americans.CONCLUSIONS: Compared to European AF patients, North Americans had better anticoagulation control and higher thromboembolic and bleeding risk profiles. At follow-up, North American patients had lower stroke/SEE risk but higher MI and major bleeding risks compared to Europeans. Further studies are needed to understand these differences and the discordance between risk profile and lower stroke/SEE rates in North American compared to European patients.</p
Edoxaban in venous thromboembolism and stroke prevention: an appraisal
No full textOral anticoagulation is the therapeutic cornerstone in preventing thromboembolic risk in both atrial fibrillation (AF) and venous thromboembolism (VTE). After decades of the sole therapeutic oral anticoagulation option being warfarin, the introduction of non-vitamin K antagonist oral anticoagulants has heralded a new era. Edoxaban is the latest addition to these available for clinical use. Edoxaban was as effective and safer than warfarin in preventing thromboembolic risk in AF patients. Similarly, edoxaban effectiveness and safety was evident when treating VTE patients to prevent recurrent VTE or VTE-related death. Therefore, edoxaban represents a valuable alternative in treating thromboembolic risk for AF and VTE patients.</p
Gendered social determinants of health and risk of major adverse outcomes in atrial fibrillation
No full textIntroduction: Atrial fibrillation (AF) is associated with an increased risk of adverse outcomes. Clinical risk factors have been identified as predictors of such outcomes, but social determinants of health (SDOH) may also play a role. We evaluated the associations between gendered SDOH (unevenly distributed between sexes) and adverse outcomes in AF. Methods: This is a retrospective cohort study using data from a European registry of AF patients from 250 centers and twenty-seven countries. Gendered SDOH included education, living status, subscales of the EQ-5D-5L questionnaire, behavioral factors, and country-level gender inequality index (GII). The primary outcome was a composite of major adverse cardiovascular events and all-cause mortality. We used multivariate logistic regression models to identify associations between SDOH and the primary outcome. Results: The study population comprised of 11,096 patients (mean age 69.2 years; 40.7 % females), with 75.6 % of patients having a high-risk CHA2DS2-VASc score. Most participants had secondary education, were physically inactive, lived in countries with gender equity and reported at least moderately elevated quality of life measures; they were less likely to live alone, smoke or drink alcohol. After adjustment for clinical factors, not having any post-secondary education (OR:1.17 95 %CI:1.05–1.28), reporting poorer health status (OR:1.08 95 %CI:1.05–1.11), living in a country with a higher GII (higher gender inequity) (OR:1.12 95 %CI:1.03–1.22 each 0.100), reporting reduced mobility (OR:1.18 95 %CI:1.02–1.38) and reduced self-care (OR:1.35;95 %CI:1.14–1.61) were independently associated with worse outcomes. Conclusions: Gendered SDOH are independently associated with adverse events in patients with AF. These factors should be considered for assessment of risk and as potential targets for interventions to improve outcomes. Condensed Abstract: Atrial fibrillation (AF) is associated with adverse outcomes and social determinants of health (SDOH), which are gendered, may predict adverse outcomes in AF. We used a registry of AF patients from 27 European countries. Multivariate logistic regressions were used to investigate the associations between gendered SDOH and the primary outcome, a composite of major adverse cardiovascular events and all-cause mortality. Several SDOH were independent predictors: no higher education (OR:1.17;95 %CI:1.05–1.28), lower health (OR:1.08;95 %CI:1.05–1.11), higher GII (OR:1.12;95 %CI:1.03–1.22 each 0.100), reduced mobility (OR:1.18;95 %CI:1.02–1.38) and reduced self-care (OR:1.35;95 %CI:1.14–1.61). Gendered SDOH are independently associated with adverse events in AF
Modelling groundwater systems: Understanding and improving groundwater quantity and quality management
No full textGroundwater is one of the most important natural resources. It is the principal source of drinking water in rural and many urban cities, and widely used for irrigation in most arid and semi-arid countries. However, recently it has become apparent that many human activities are negatively impacting both the quantity and quality of groundwater resources. In many parts of the world, groundwater resources are under increasing threat due to contamination and depletion by excessive pumping.Hydraulic EngineeringCivil Engineering and Geoscience
Frailty prevalence and impact on outcomes in patients with atrial fibrillation: A systematic review and meta-analysis of 1,187,000 patients
No full textFrailty is a clinical syndrome characterized by a reduced physiologic reserve, increased vulnerability to stressors and an increased risk of adverse outcomes. People with atrial fibrillation (AF) are often burdened by frailty due to biological, clinical, and social factors. The prevalence of frailty, its management and association with major outcomes in AF patients are still not well quantified. We systematically searched PubMed and EMBASE, from inception to September 13th, 2021, for studies reporting the prevalence of frailty in AF patients. The study was registered in PROSPERO (CRD42021235854). 33 studies were included in the systematic review (n = 1,187,651 patients). The frailty pooled prevalence was 39.7 % (95 %CI=29.9 %-50.5 %, I-2 =100 %), while meta-regression analyses showed it is influenced by age, history of stroke, and geographical location. Meta-regression analyses showed that OAC prescription was influenced by study-level mean age, baseline thromboembolic risk, and study setting. Frail AF patients were associated with a higher risk of all-cause death (OR=5.56, 95 %CI=3.46-8.94), ischemic stroke (OR=1.59, 95 %CI=1.00-2.52), and bleeding (OR=1.64, 95 %CI=1.11-2.41), when compared to robust individuals. In this systematic review and meta-analysis, the prevalence of frailty was high in patients with AF. Frailty may influence the prognosis and management of AF patients, thus requiring person-tailored interventions in a holistic or integrated approach to AF care
Mobile health-technology integrated care in atrial fibrillation patients with heart failure:A report from the mAFA-II randomized clinical trial
No full textBackground: To assess the effect of mobile health (mHealth) technology-implemented ‘Atrial fibrillation Better Care’ (ABC) pathway-approach (mAFA intervention) in AF patients with Heart Failure (HF). Methods: From the Mobile Health Technology for Improved Screening and Optimized Integrated Care in AF (mAFA-II) cluster randomized trial, we evaluated the effect of mAFA intervention on the risk of major outcomes in patients with HF using Inverse Probability of Treatment Weighting. Primary outcome was the composite outcome of stroke/thromboembolism, all-cause death, and rehospitalization. The effect of mAFA and the interaction with HF at baseline was assessed through Cox-regressions. Results: Among the 3,324 patients originally enrolled in the trial, 714 (21.5%; mean age: 72.7±13.1 years; 39.9% females) had HF. The effect of mAFA intervention on the primary outcome was consistent in patients with and without HF (Hazard Ratio, (HR): 0.59, 95% Confidence Interval (CI): 0.29-1.22 vs. HR: 0.40, 95%CI: 0.21-0.76, p for interaction=0.438); similar findings were found for rehospitalisations and bleeding events. A trend towards lower efficacy of mAFA in HF patients was observed for all-cause death, while the risk of the composite outcome of ‘recurrent AF, HF and acute coronary syndrome’ was higher among AF-HF patients allocated to mAFA (p for interaction: <0.001). Conclusion: A mHealth-technology implemented ABC pathway provides consistent effects on the risks of primary outcome, rehospitalisation and bleeding, in AF patients both with and without HF. However, AF-HF patients may need tailored approaches to improve their overall prognosis, specifically to reduce the risk of recurrent AF, HF and acute coronary syndrome.</p
Data assimilation in particle models for groundwater contamination
No full textElectrical Engineering, Mathematics and Computer Scienc
Time in therapeutic range and major adverse outcomes in atrial fibrillation patients undergoing percutaneous coronary intervention:The Atrial Fibrillation Undergoing Coronary Artery Stenting (AFCAS) registry
No full textBackground Combination of oral anticoagulation (OAC) and antiplatelets is used in atrial fibrillation (AF) patients undergoing percutaneous coronary intervention and stent (PCI-S) procedure but is associated with increased bleeding when triple antithrombotic therapy (TAT) is used. Our aim was to analyze the impact of time in therapeutic range (TTR) on outcomes, in patients prescribed with TAT. Methods Ancillary analysis from the AFCAS registry in patients assigned to TAT. TTR was calculated with Rosendaal method. Outcomes were analyzed according to TTR tertiles (T1 [≤56.8%] vs. T2 [56.9–93.8%] vs. T3 [≥93.9%]). Major bleeding was the primary outcome. Results Of 963 patients enrolled, 470(48.8%) were prescribed with TAT at discharge and qualified for this analysis. Median [IQR] TTR was 80.0% [45.3–100%]. After 359 [341–370] days, major bleeding rates were progressively lower with increasing TTR tertiles (T1 vs. T2 vs. T3: 10.3% vs. 4.7% vs. 2.3%, P = .006). Kaplan–Meier analysis demonstrated a progressively lower risk for major bleeding across tertiles (P = .006). Patients in the highest TTR tertile had a non-significant lower risk for major adverse coronary and cerebrovascular events (MACCE) (log-rank: 4.905, P = .086). Cox regression analysis showed that T2 and T3 were inversely associated with major bleeding (hazard ratio [HR]:0.39, P = .050 and HR: 0.21, P = .005). Continuous TTR was inversely associated with major bleeding (HR: 0.98, P < .001). For MACCE, adjusted Cox analysis found a non-significant lower risk for T3 (HR: 0.64, P = .128). Conclusions In AF patients undergoing PCI-S prescribed TAT, good quality anticoagulation control (as reflected by TTR) was closely related to bleeding outcomes during follow-up. Despite some suggestive trends for an inverse relationship between TTR and MACCE, no definitive conclusions can be drawn, and further large studies are needed.</p
Antithrombotic Treatment in Patients With Heart Failure and Associated Atrial Fibrillation and Vascular Disease
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