David J Seiffge, David J Werring, Maurizio Paciaroni, Jesse Dawson, Steven Warach, Truman J Milling, Stefan T Engelter, Urs Fischer, Bo Norrving
BACKGROUND: About 13-26% of all acute ischaemic strokes are related to non-valvular atrial fibrillation, the most common cardiac arrhythmia globally. Deciding when to initiate oral anticoagulation in patients with non-valvular atrial fibrillation is a longstanding, common, and unresolved clinical challenge. Although the risk of early recurrent ischaemic stroke is high in this population, early oral anticoagulation is suspected to increase the risk of potentially harmful intracranial haemorrhage, including haemorrhagic transformation of the infarct...
January 2019: Lancet Neurology
Olivier Hanon, Patrick Assayag, Joel Belmin, Jean Philippe Collet, Jean Paul Emeriau, Laurent Fauchier, Françoise Forette, Patrick Friocourt, Armelle Gentric, Christophe Leclercq, Michel Komajda, Jean Yves Le Heuzey
Atrial fibrillation (AF) is a common and serious condition in the elderly. AF affects between 600,000 and one million patients in France, two-thirds of whom are aged above 75 years. AF is a predictive factor for mortality in the elderly and a major risk factor for stroke. Co-morbidities are frequent and worsen the prognosis. The management of AF in the elderly should involve a comprehensive geriatric assessment (CGA), which analyses both medical and psychosocial elements, enabling evaluation of the patient's functional status and social situation and the identification of co-morbidities...
May 2013: Archives of Cardiovascular Diseases
Benjamin A Steinberg, DaJuanicia N Holmes, Michael D Ezekowitz, Gregg C Fonarow, Peter R Kowey, Kenneth W Mahaffey, Gerald Naccarelli, James Reiffel, Paul Chang, Eric D Peterson, Jonathan P Piccini
BACKGROUND: All patients with atrial fibrillation (AF) require optimization of their ventricular rate. Factors leading to use of additional rhythm control in clinical practice have not been thoroughly defined. METHODS: The ORBIT-AF registry enrolled patients with AF from a broad range of practice settings and collected data on rate versus rhythm control, as indicated by the treating physician. Multivariable logistic regression analysis was performed to identify factors associated with each strategy...
April 2013: American Heart Journal
Benjamin A Steinberg, Sunghee Kim, Laine Thomas, Gregg C Fonarow, Bernard J Gersh, Fredrik Holmqvist, Elaine Hylek, Peter R Kowey, Kenneth W Mahaffey, Gerald Naccarelli, James A Reiffel, Paul Chang, Eric D Peterson, Jonathan P Piccini
BACKGROUND: Most patients with atrial fibrillation (AF) require rate control; however, the optimal target heart rate remains under debate. We aimed to assess rate control and subsequent outcomes among patients with permanent AF. METHODS AND RESULTS: We studied 2812 US outpatients with permanent AF in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation. Resting heart rate was measured longitudinally and used as a time-dependent covariate in multivariable Cox models of all-cause and cause-specific mortality during a median follow-up of 24 months...
September 14, 2015: Journal of the American Heart Association
Benjamin A Steinberg, Sunghee Kim, Laine Thomas, Gregg C Fonarow, Elaine Hylek, Jack Ansell, Alan S Go, Paul Chang, Peter Kowey, Bernard J Gersh, Kenneth W Mahaffey, Daniel E Singer, Jonathan P Piccini, Eric D Peterson
BACKGROUND: Physicians treating patients with atrial fibrillation (AF) must weigh the benefits of anticoagulation in preventing stroke versus the risk of bleeding. Although empirical models have been developed to predict such risks, the degree to which these coincide with clinicians' estimates is unclear. METHODS AND RESULTS: We examined 10 094 AF patients enrolled in the Outcomes Registry for Better Informed Treatment of AF (ORBIT-AF) registry between June 2010 and August 2011...
May 20, 2014: Circulation
Jared D Miller, Konstantinos N Aronis, Jonathan Chrispin, Kaustubha D Patil, Joseph E Marine, Seth S Martin, Michael J Blaha, Roger S Blumenthal, Hugh Calkins
Classically, the 3 pillars of atrial fibrillation (AF) management have included anticoagulation for prevention of thromboembolism, rhythm control, and rate control. In both prevention and management of AF, a growing body of evidence supports an increased role for comprehensive cardiac risk factor modification (RFM), herein defined as management of traditional modifiable cardiac risk factors, weight loss, and exercise. In this narrative review, we summarize the evidence demonstrating the importance of each facet of RFM in AF prevention and therapy...
December 29, 2015: Journal of the American College of Cardiology
Gregory Y H Lip, Felicita Andreotti, Laurent Fauchier, Kurt Huber, Elaine Hylek, Eve Knight, Deirdre Lane, Marcel Levi, Francisco Marín, Gualtiero Palareti, Paulus Kirchhof
In this executive summary of a Consensus Document from the European Heart Rhythm Association, endorsed by the European Society of Cardiology Working Group on Thrombosis, we comprehensively review the published evidence and propose a consensus on bleeding risk assessments in atrial fibrillation (AF) patients. The main aim of the document was to summarise 'best practice' in dealing with bleeding risk in AF patients when approaching antithrombotic therapy, by addressing the epidemiology and size of the problem, and review established bleeding risk factors...
December 2011: Thrombosis and Haemostasis
Benjamin A Steinberg, Eric D Peterson, Sunghee Kim, Laine Thomas, Bernard J Gersh, Gregg C Fonarow, Peter R Kowey, Kenneth W Mahaffey, Matthew W Sherwood, Paul Chang, Jonathan P Piccini, Jack Ansell
BACKGROUND: Temporary interruption of oral anticoagulation for procedures is often required, and some propose using bridging anticoagulation. However, the use and outcomes of bridging during oral anticoagulation interruptions in clinical practice are unknown. METHODS AND RESULTS: The Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry is a prospective, observational registry study of US outpatients with atrial fibrillation...
February 3, 2015: Circulation
Denis Roy, Mario Talajic, Stanley Nattel, D George Wyse, Paul Dorian, Kerry L Lee, Martial G Bourassa, J Malcolm O Arnold, Alfred E Buxton, A John Camm, Stuart J Connolly, Marc Dubuc, Anique Ducharme, Peter G Guerra, Stefan H Hohnloser, Jean Lambert, Jean-Yves Le Heuzey, Gilles O'Hara, Ole Dyg Pedersen, Jean-Lucien Rouleau, Bramah N Singh, Lynne Warner Stevenson, William G Stevenson, Bernard Thibault, Albert L Waldo
BACKGROUND: It is common practice to restore and maintain sinus rhythm in patients with atrial fibrillation and heart failure. This approach is based in part on data indicating that atrial fibrillation is a predictor of death in patients with heart failure and suggesting that the suppression of atrial fibrillation may favorably affect the outcome. However, the benefits and risks of this approach have not been adequately studied. METHODS: We conducted a multicenter, randomized trial comparing the maintenance of sinus rhythm (rhythm control) with control of the ventricular rate (rate control) in patients with a left ventricular ejection fraction of 35% or less, symptoms of congestive heart failure, and a history of atrial fibrillation...
June 19, 2008: New England Journal of Medicine
Tina s Tischer, Ralph Schneider, Jörg Lauschke, Catharina Nesselmann, Anke Klemm, Doreen Diedrich, Günther Kundt, Dietmar Bänsch
BACKGROUND: In patients with known atrial fibrillation (AF) different scores are utilized to estimate the risk of thromboembolic events and guide oral anticoagulation. Diagnosis of AF strongly depends on the duration of electrocardiogram monitoring. The aim of this study was to use established scores to predict the prevalence of AF. METHODS: The CHADS2- (Congestive Heart failure, hypertension, Age >75 years, Diabetes, Stroke [doubled]) and CHA2DS2VASc-score (Congestive Heart failure, hypertension, Age ≥75 years [doubled], Diabetes, Stroke [doubled], Vascular disease, Age 65-74 years, Sex category [female sex]) was calculated in 150,408 consecutive patients, referred to the University Hospital of Rostock between 2007 and 2012...
December 2014: Pacing and Clinical Electrophysiology: PACE
Victoria Jacobs, Heidi T May, Tami L Bair, Brian G Crandall, Michael Cutler, John D Day, J Peter Weiss, Jeffrey S Osborn, Joseph B Muhlestein, Jeffrey L Anderson, Charles Mallender, T Jared Bunch
BACKGROUND: Risk stratification tools are needed to select the right candidates for catheter ablation of atrial fibrillation (AF). Both the CHADS2 and CHA2DS2-VASc scores have utility in predicting AF-related outcomes and guiding anticoagulation treatment. OBJECTIVE: We sought to determine whether these risk scores predict long-term outcomes after AF ablation and whether one risk score provides comparatively superior performance. METHODS: CHADS2 and CHA2DS2-VASc scores were calculated in 2179 patients who underwent a first ablation procedure for AF enrolled in the Intermountain Heart Collaborative Study...
April 2015: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Sana M Al-Khatib, Nancy M Allen LaPointe, Ranee Chatterjee, Matthew J Crowley, Matthew E Dupre, David F Kong, Renato D Lopes, Thomas J Povsic, Shveta S Raju, Bimal Shah, Andrzej S Kosinski, Amanda J McBroom, Gillian D Sanders
BACKGROUND: The comparative effectiveness of treatments for atrial fibrillation (AF) is uncertain. PURPOSE: To evaluate the comparative effectiveness of rate- and rhythm-control therapies. DATA SOURCES: English-language studies in PubMed, EMBASE, and the Cochrane Database of Systematic Reviews between January 2000 and November 2013. STUDY SELECTION: Two reviewers independently screened citations to identify comparative studies that assessed rate- or rhythm-control therapies in patients with AF...
June 3, 2014: Annals of Internal Medicine
Morten Lamberts, Gregory Y H Lip, Morten Lock Hansen, Jesper Lindhardsen, Jonas Bjerring Olesen, Jakob Raunsø, Anne-Marie Schjerning Olsen, Per Kragh Andersen, Thomas Alexander Gerds, Emil L Fosbøl, Christian Torp-Pedersen, Gunnar H Gislason
BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are assumed to increase bleeding risk, but their actual relation to serious bleeding in patients with atrial fibrillation (AF) who are receiving antithrombotic medication is unknown. OBJECTIVE: To investigate the risk for serious bleeding and thromboembolism associated with ongoing NSAID and antithrombotic therapy. DESIGN: Observational cohort study. SETTING: Nationwide registries...
November 18, 2014: Annals of Internal Medicine
Craig T January, L Samuel Wann, Joseph S Alpert, Hugh Calkins, Joaquin E Cigarroa, Joseph C Cleveland, Jamie B Conti, Patrick T Ellinor, Michael D Ezekowitz, Michael E Field, Katherine T Murray, Ralph L Sacco, William G Stevenson, Patrick J Tchou, Cynthia M Tracy, Clyde W Yancy
No abstract text is available yet for this article.
December 2, 2014: Circulation
Peter M Okin, Casper N Bang, Kristian Wachtell, Darcy A Hille, Sverre E Kjeldsen, Björn Dahlöf, Richard B Devereux
BACKGROUND: Prevalent atrial fibrillation (AF) is associated with a higher sudden cardiac death (SCD) rate in some populations, and incident AF predicts increased mortality risk in the general population and after myocardial infarction. However, the relationship of SCD to new-onset AF is unclear. METHODS AND RESULTS: The relationship of SCD to new-onset AF was evaluated in 8831 hypertensive patients with electrocardiographic left ventricular hypertrophy with no history of AF, in sinus rhythm on their baseline electrocardiogram, randomly assigned to losartan- or atenolol-based treatment...
April 2013: Circulation. Arrhythmia and Electrophysiology
Inmaculada Hernandez, Seo Hyon Baik, Antonio Piñera, Yuting Zhang
IMPORTANCE: It remains unclear whether dabigatran etexilate mesylate is associated with higher risk of bleeding than warfarin sodium in real-world clinical practice. OBJECTIVE: To compare the risk of bleeding associated with dabigatran and warfarin using Medicare data. DESIGN, SETTING, AND PARTICIPANTS: In this retrospective cohort study, we used pharmacy and medical claims in 2010 to 2011 from a 5% random sample of Medicare beneficiaries...
January 2015: JAMA Internal Medicine
Shadi Kalantarian, Hakan Ay, Randy L Gollub, Hang Lee, Kallirroi Retzepi, Moussa Mansour, Jeremy N Ruskin
BACKGROUND: Atrial fibrillation (AF) is a common cause of stroke. Silent cerebral infarctions (SCIs) are known to occur in the presence and absence of AF, but the association between these disorders has not been well-defined. PURPOSE: To estimate the association between AF and SCIs and the prevalence of SCIs in stroke-free patients with AF. DATA SOURCES: Searches of MEDLINE, PsycINFO, Cochrane Library, CINAHL, and EMBASE from inception to 8 May 2014 without language restrictions and manual screening of article references...
November 4, 2014: Annals of Internal Medicine
Michiel Coppens, John W Eikelboom, Robert G Hart, Salim Yusuf, Gregory Y H Lip, Paul Dorian, Olga Shestakovska, Stuart J Connolly
AIMS: The CHA(2)DS(2)-VASc score is a modification of the CHADS(2) score that aims to improve stroke risk prediction in patients with atrial fibrillation (AF) by adding three risk factors: age 65-74, female sex, and history of vascular disease. Whereas previous evaluations of the CHA(2)DS(2)-VASc score included all AF patients, the aim of this analysis was to evaluate its discriminative ability only in those patients for whom recommendations on antithrombotic treatment are uncertain (i...
January 2013: European Heart Journal
S Apostolakis, D A Lane, H Buller, G Y H Lip
Many of the risk factors for stroke in atrial fibrillation (AF) are also important risk factors for bleeding. Wetested the hypothesis that the CHADS2 and CHA2DS2-VASc scores (used for stroke risk assessment) could be used to predict serious bleeding, and that these scores would compare well against the HAS-BLED score, which is a specific risk score designed for bleeding risk assessment. From the AMADEUS trial, we focused on the trial's primary safety outcome for serious bleeding, which was "any clinically relevant bleeding"...
November 2013: Thrombosis and Haemostasis
Jonas Bjerring Olesen, Christian Torp-Pedersen, Morten Lock Hansen, Gregory Y H Lip
North American and European guidelines on atrial fibrillation (AF) are conflicting regarding the classification of patients at low/intermediate risk of stroke. We aimed to investigate if the CHA2DS2-VASc score improved risk stratification of AF patients with a CHADS2 score of 0-1. Using individual-level-linkage of nationwide Danish registries 1997-2008, we identified patients discharged with AF having a CHADS2 score of 0-1 and not treated with vitamin K antagonist or heparin. In patients with a CHADS2 score of 0, 1, and 0-1, rates of stroke/ thromboembolism were determined according to CHA2DS2-VASc score, and the risk associated with increasing CHA2DS2-VASc score was estimated in Cox regression models adjusted for year of inclusion and antiplatelet therapy...
June 2012: Thrombosis and Haemostasis
2014-11-03 01:11:19
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