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https://www.readbyqxmd.com/read/28622606/dementia-correlates-with-anticoagulation-underuse-in-older-patients-with-atrial-fibrillation
#1
Giovanni Viscogliosi, Evaristo Ettorre, Iulia Maria Chiriac
OBJECTIVES: Stroke prevention in older atrial fibrillation (AF) patients remains a challenge. This study aimed to investigate whether a dementia diagnosis is an independent correlate of lower prescription rate of oral anticoagulant treatment (OAT) in a sample of older AF patients. METHODS: Cross-sectional retrospective study. Consecutive older community-dwelling AF patients referred for a comprehensive geriatric assessment, were considered. Evaluation of physical, social and mental health, and administration of the Cumulative Illness Rating Scale (CIRS) and Barthel Index were performed...
June 8, 2017: Archives of Gerontology and Geriatrics
https://www.readbyqxmd.com/read/28612910/percutaneous-left-atrial-appendage-occlusion-procedures-in-patients-with-heart-failure
#2
Magdalena Szymała, Witold Streb, Katarzyna Mitręga, Tomasz Podolecki, Grzegorz Mencel, Tomasz Kukulski, Zbigniew Kalarus
BACKGROUND: Atrial fibrillation (AF) is the most common supraventricular tachyarrhythmia. The percutaneous left atrial appendage occlusion (LAAO) may be considered for the stroke prophylaxis in patients with nonvalvular AF (NVAF), especially in contraindications for oral anticoagulants (OAC) or high risk of bleeding. The data about implantation, safety, efficacy and follow-up are limited. Moreover, there are no studies on patients with NVAF and heart failure with severe left ventricular systolic dysfunction (left ventricular ejection fraction - LVEF ≤ 35%)...
June 14, 2017: Kardiologia Polska
https://www.readbyqxmd.com/read/28591388/incidence-and-functional-outcome-of-atrial-fibrillation-and-non-atrial-fibrillation-related-cardioembolic-stroke-in-joinville-brazil-a-population-based-study
#3
Claudio Henrique do Amaral, Augusto R Amaral, Vivian Nagel, Vanessa Venancio, Adriana Coronetti Garcia, Pedro Sc Magalhaes, Alexandre L Longo, Carla Hc Moro, Felipe I Reis, Andre D'Avila, Norberto L Cabral
Among ischemic strokes, cardioembolic (CE) stroke has the worst outcome. We measured the incidence of atrial fibrillation (AF) and non-AF related CE strokes, previous anticoagulant use, and the 90-day functional outcome. Using multiple overlapping sources, we included all CE strokes that occurred in 2015 in Joinville, Brazil. Of the 374 ischemic strokes, 23% (84) were CE. The CE age-adjusted incidence, per 1,000 person-years, was 0.14 (0.11-0.17). Of the 26 patients with known prior AF, 73% (19) were not anticoagulated, 77% (20) had a CHA2DS2VASc score ≥ 3 and 81% (21) had a HAS-BLED score < 3...
May 2017: Arquivos de Neuro-psiquiatria
https://www.readbyqxmd.com/read/28577686/atrial-fibrillation-incrementally-increases-dementia-risk-across-all-chads2-and-cha2ds2vasc-strata-in-patients-receiving-long-term-warfarin
#4
Kevin G Graves, Heidi T May, Victoria Jacobs, Tami L Bair, Scott M Stevens, Scott C Woller, Brian G Crandall, Michael J Cutler, John D Day, Charles Mallender, Jeffrey S Osborn, J Peter Weiss, T Jared Bunch
BACKGROUND: Patients with atrial fibrillation (AF) are at higher risk for developing dementia. Warfarin is a common therapy for the prevention of thromboembolism in AF, valve replacement, and thrombosis patients. The extent to which AF itself increases dementia risk remains unknown. METHODS: A total 6030 patients with no history of dementia and chronically anticoagulated with warfarin were studied. Warfarin management was provided through a Clinical Pharmacy Anticoagulation Service...
June 2017: American Heart Journal
https://www.readbyqxmd.com/read/28565887/safety-and-efficacy-of-catheter-based-left-atrial-appendage-closure-in-patients-with-contraindications-for-long-term-anticoagulation
#5
Adrian Seidel, Abdul S Parwani, Florian Krackhardt, Martin Huemer, Philipp Attanasio, Wilhelm Haverkamp, Burkert Pieske, Leif-Hendrik Boldt
BACKGROUND: Percutaneous left atrial appendage closure (LAAC) and the role of post interventional anticoagulation often evokes controversy in daily practice. This study aimed to evaluate LAAC in patients with non-rheumatic atrial fibrillation, high thromboembolic risk and contraindications for long-term anticoagulation in a clinical scenario. METHODS AND RESULTS: Between 2010-2015, LAAC was attempted in 118 patients (47 women). Devices were successfully implanted in 95% (Watchman™ device n=97, St...
May 31, 2017: Minerva Cardioangiologica
https://www.readbyqxmd.com/read/28553875/assessment-of-the-left-atrial-appendage-morphology-in-patients-aafter-ischemic-stroke-the-assam-study-protocol
#6
Jakub Baran, Ilona Michałowska, Ilona Kowalik, Piotr Kułakowski
Stroke remains the most dangerous and frightening complication of atrial fibrillation (AF). Causal relationship between ischemic stroke and atrial arrhythmias such as AF or atrial flutter has been well established. Numerous factors predisposing to peripheral embolism in patients with AF have been well established and included in the CHA2DS2Vasc score. Although proper anticoagulation minimizes the risk attributable to "known" risk factors, stroke may still occur. Thus, "unknown" risk factors may play an important role in stroke risk stratification in patients with AF...
May 29, 2017: Kardiologia Polska
https://www.readbyqxmd.com/read/28546017/delayed-left-atrial-appendage-contrast-filling-in-computed-tomograms-after-percutaneous-left-atrial-appendage-occlusion
#7
Yeong-Min Lim, Jung-Sun Kim, Tae-Hoon Kim, Jae-Sun Uhm, Chi Young Shim, Boyoung Joung, Geu-Ru Hong, Moon-Hyoung Lee, Yang-Soo Jang, Hui-Nam Pak
BACKGROUND: The gold standard for the follow-up of left atrial appendage occlusion (LAAO) is performing transesophageal echocardiogram (TEE) at 45 days after LAAO; however, the duration for complete LAA seal-off after percutaneous LAAO is unknown in humans. We retrospectively evaluated the LAA contrast-filling (CF) rate in follow-up cardiac computed tomography (CT) scans after LAAO. METHODS: We included 35 patients (age 67.5±10.9 years, CHA2DS2VASc 4.2±1.6, HAS-BLED 3...
May 22, 2017: Journal of Cardiology
https://www.readbyqxmd.com/read/28514878/anticoagulant-cessation-following-atrial-fibrillation-ablation-limits-of-the-ecg-guided-approach
#8
Matteo Anselmino, Chiara Rovera, Giovanni Marchetto, Federico Ferraris, Davide Castagno, Fiorenzo Gaita
Long-term cessation of oral anticoagulation (OAC) following successful catheter or surgical ablation of atrial fibrillation (AF) is debated. Usually, in the presence of sinus rhythm at serial ECG recordings, the CHADS2, CHA2DS2VASc, and HAS-BLED scores are adopted to guide decision regarding OAC management. Areas covered: The safety of OAC cessation in patients without recurrent AF but with historically elevated risk for thromboembolism remains largely unknown. Taking the cue from two clinical cases, we provide an updated summary of the latest evidence regarding how to manage OAC after a successful atrial fibrillation ablation...
June 2017: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/28497899/replacing-warfarin-with-a-novel-oral-anticoagulant-risk-of-recurrent-bleeding-and-stroke-in-patients-with-warfarin-ineligible-or-failure-in-patients-with-atrial-fibrillation-the-roar-study
#9
Mohit K Turagam, Valay Parikh, Muhammad R Afzal, Rakesh Gopinathannair, Madhav Lavu, Arun Kanmanthareddy, Jayasree Pillarisetti, Madhu Reddy, Donita Atkins, Sudharani Bommana, Melissa Jaeger, Courtney Jeffery, Sanghamitra Mohanty, Pasquale Santangeli, Jie Cheng, Luigi Di Biase, Calambur Narasimhan, Andrea Natale, Dhanunjaya Lakkireddy
BACKGROUND: A significant proportion of patients treated with warfarin for atrial fibrillation (AF) become warfarin ineligible (WI) due to major bleeding events (MBE) or systemic thromboembolism (STE). We report a large multicenter real-world experience of the use of direct oral antagonists (DOACs) in these WI patients. METHODS: We report the outcomes of 263 WI patients treated with DOACs. The primary objective was to evaluate clinical outcomes of STE and MBE with DOACs...
May 12, 2017: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/28485276/left-atrial-appendage-occlusion-versus-standard-medical-care-in-patients-with-atrial-fibrillation-and-intracerebral-hemorrhage-a-propensity-score-matched-follow-up-study
#10
Jens Erik Nielsen-Kudsk, Søren Paaske Johnsen, Per Wester, Dorte Damgaard, Juhani Airaksinen, Juha Lund, Ole De Backer, Sami Pakarinen, Jacob Odenstedt, Saila Vikman, Magnus Settergren, Ole Kongstad, Mårten Rosenqvist, Derk W Krieger
AIMS: The aim of this study was to investigate the prognosis in patients with atrial fibrillation (AF) and intracerebral hemorrhage (ICH) having a left atrial appendage occlusion (LAAO) versus patients receiving standard medical therapy. METHODS AND RESULTS: A total of 151 patients from the Nordic countries with AF and previous ICH who underwent LAAO using the Amplatzer Cardiac Plug or the Amplatzer Amulet were compared to a propensity score matched group of 151 patients receiving standard medical therapy...
May 9, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28466408/incidence-and-predictors-of-silent-cerebral-thromboembolic-lesions-after-catheter-ablation-for-atrial-fibrillation-in-patients-treated-with-direct-oral-anticoagulants
#11
Atsushi Doi, Masahiko Takagi, Jun Kakihara, Yusuke Hayashi, Hiroaki Tatsumi, Kohei Fujimoto, Kenichi Sugioka, Minoru Yoshiyama
There are few reports about the incidence and predictors of silent cerebral thromboembolic lesions (SCLs) after atrial fibrillation (AF) ablation in patients treated with direct oral anticoagulants (DOACs). The purpose of this study is to evaluate the incidence and predictors of SCLs after AF ablation with cerebral magnetic resonance imaging (C-MRI) in patients treated with DOACs. We enrolled 117 consecutive patients who underwent first AF ablation and received DOACs, including apixaban, dabigatran, edoxaban, and rivaroxaban...
May 2, 2017: Heart and Vessels
https://www.readbyqxmd.com/read/28454807/clinical-decision-support-for-stroke-prevention-in-atrial-fibrillation-cds-af-rationale-and-design-of-a-cluster-randomized-trial-in-the-primary-care-setting
#12
Lars O Karlsson, Staffan Nilsson, Emmanouil Charitakis, Magnus Bång, Gustav Johansson, Lennart Nilsson, Magnus Janzon
BACKGROUND: Atrial fibrillation (AF) is associated with substantial morbidity, in particular stroke. Despite good evidence for the reduction of stroke risk with anticoagulant therapy, there remains a significant undertreatment. The main aim of the current study is to investigate whether a clinical decision support tool for stroke prevention (CDS) integrated in the electronic health record can improve adherence to guidelines for stroke prevention in patients with AF. METHODS: We will conduct a cluster randomized trial where 43 primary care clinics in the county of Östergötland, Sweden (population 444,347), will be randomized to be part of the CDS intervention or serve as controls...
May 2017: American Heart Journal
https://www.readbyqxmd.com/read/28438308/cardiovascular-outcomes-with-surgical-left-atrial-appendage-exclusion-in-patients-with-atrial-fibrillation-who-underwent-valvular-heart-surgery-from-the-national-inpatient-sample-database
#13
Ayman Elbadawi, Odunayo Olorunfemi, Gbolahan O Ogunbayo, Marwan Saad, Islam Y Elgendy, Zainab Arif, Haytham Badran, Deola Saheed, Hamdy M A Ahmed, Mohan Rao
Left atrial appendage (LAA) exclusion is a commonly performed procedure to reduce the embolic events in patients with atrial fibrillation (AF) who underwent cardiac surgeries. Our study aimed to evaluate the in-hospital outcomes of LAA exclusion in patients with AF who underwent valvular heart surgeries. We queried the Nationwide Inpatient Sample Database from 1998 to 2013 for patients with the International Classification of Diseases, Ninth Edition, Clinical Modification, diagnosis codes for AF and underwent any valvular heart surgery...
June 15, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28402476/silent-atrial-fibrillation-in-pacemaker-early-post-implantation-period-an-unintentionally-provoked-situation
#14
Juan Benezet-Mazuecos, José Antonio Iglesias, Marcelino Cortés, José Manuel Rubio, Juan José de la Vieja, Ana Del Río, Pepa Sanchez-Borque, Ángel Miracle, Jerónimo Farré
Aims: Atrial high-rate episodes (AHREs) compatible with silent AF detected in pacemakers (PM) are related to an increased risk of stroke and silent ischaemic brain lesions (IBL) on CT scan. AHREs soon after PM implantation could be related with the procedure itself and the prognosis might be different. Methods and results: We analysed the incidence of AHREs >5 min and the presence of silent IBL in 110 patients (56% men, aged 75 ± 9 year-old) with PM and no history of AF, in relation to time from implantation (≤3 months vs...
April 10, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/28274576/long-term-follow-up-of-probands-with-brugada-syndrome
#15
Carlo de Asmundis, Giacomo Mugnai, Gian-Battista Chierchia, Juan Sieira, Giulio Conte, Moises Rodriguez-Mañero, Gudrun Pappaert, Jens Czapla, Jan Nijs, Mark La Meir, Ruben Casado, Erwin Ströker, Valentina De Regibus, Pedro Brugada
This study analyzes the natural history of a large cohort of probands with Brugada syndrome (BrS) to assess the predictive value of different clinical and electrocardiographic parameters for the development of ventricular fibrillation (VF) or sudden cardiac death (SCD) during a long-term follow-up. Baseline characteristics of 289 consecutive probands (203 men; mean age 45 ± 16 years) with a Brugada type 1 electrocardiogram were analyzed. After a mean follow-up of 10.1 ± 4.6 years, 29 malignant arrhythmias occurred...
May 1, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28245798/left-atrial-appendage-morphology-and-risk-of-stroke-following-pulmonary-vein-isolation-for-drug-refractory-atrial-fibrillation-in-low-cha2ds2vasc-risk-patients
#16
Faith R Kelly, Robert A Hull, Takor B Arrey-Mbi, Michael U Williams, Joshua S Lee, Ahmad M Slim, Dustin M Thomas
BACKGROUND: Cardiac CT angiography (CCTA) has become an important adjunct in the structural assessment of the pulmonary veins (PV) prior to pulmonary vein isolation (PVI). Published data is conflicting regarding a relationship between left atrial appendage (LAA) and the risk of ischemic stroke (CVA) following PVI. We investigated the associations of volumetric and morphologic left atrial (LA) and LAA measurements for CVA following PVI. METHODS: We retrospectively reviewed 332 consecutive patients with drug refractory atrial fibrillation who obtained cardiac CT angiogram (CCTA) prior to PVI...
February 28, 2017: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/28238569/guideline-adherent-therapy-for-stroke-prevention-in-atrial-fibrillation-in-different-health-care-settings-results-from-ramses-study
#17
Özcan Başaran, Volkan Dogan, Murat Biteker, Fatma Özpamuk Karadeniz, Ahmet İlker Tekkesin, Yasin Çakıllı, Ceyhan Türkkan, Mehmet Hamidi, Vahit Demir, Mustafa Ozan Gürsoy, Müjgan Tek Öztürk, Gökhan Aksan, Sabri Seyis, Mehmet Ballı, Mehmet Hayri Alıcı, Serdar Bozyel, Cevat Kırma
OBJECTIVE: No studies have been conducted in Turkey to compare the quality of stroke prevention therapies provided in different healthcare settings in patients with atrial fibrillation (AF). Therefore, we aimed to evaluate possible differences between secondary (SH) and tertiary hospital (TH) settings in the effectiveness of implementing AF treatment strategies. METHODS: Baseline characteristics of 6273 patients with non-valvular AF enrolled in the RAMSES (ReAl-life Multicentre Survey Evaluating Stroke Prevention Strategies in Turkey) study were compared...
May 2017: European Journal of Internal Medicine
https://www.readbyqxmd.com/read/28237286/comparison-of-has-bled-and-has-bed-versus-chads2-and-cha2ds2vasc-stroke-and-bleeding-scores-in-patients-with-atrial-fibrillation
#18
MULTICENTER STUDY
Daniela Poli, Emilia Antonucci, Vittorio Pengo, Sophie Testa, Gualtiero Palareti
Anticoagulation is recommended in patients with atrial fibrillation (AF) for stroke prevention, and the bleeding risk associated suggests the need for a bleeding risk stratification. HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio (INR), elderly >65 years, drugs/alcohol concomitantly) score includes "labile INR" referred to quality of anticoagulation. However, in naïve patients, this item is not available. In addition, stroke and bleeding risk prediction scores shared several risk factors...
April 1, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28135707/changes-in-oral-anticoagulant-treatment-rates-in-atrial-fibrillation-before-and-after-the-introduction-of-direct-oral-anticoagulants
#19
Rashmee U Shah, Austin B Rupp, Danielle Mowery, Mingyuan Zhang, Greg Stoddard, Vikrant Deshmukh, Bruce E Bray, Rachel Hess, Matthew T Rondina
BACKGROUND: Direct oral anticoagulants (DOACs) have the potential to improve stroke prevention among atrial fibrillation (AF) patients. We sought to determine if oral anticoagulation (OAC) treatment rates have increased since the approval of DOACs. METHODS: We identified 6,688 patients with AF at an academic medical center from January 2008 to June 2015. We examined OAC prescription rates over time and according to CHA2DS2VASc score using multivariable Poisson regression models, with an interaction term between risk score and year of AF diagnosis...
2016: Neuroepidemiology
https://www.readbyqxmd.com/read/28129663/risk-stratification-models-in-atrial-fibrillation
#20
Farhan Shahid, Gregory Y H Lip
Atrial fibrillation (AF) is associated with an increased risk of stroke compared with the general population. AF-related stroke confers a higher mortality and morbidity risk, and thus, early detection and assessment for the initiation of effective stroke prevention with oral anticoagulation are crucial. Simple and practical risk assessment tools are essential to facilitate stroke and bleeding risk assessment in busy clinics and wards to aid decision making. At present, the CHA2DS2VASc score is recommended by guidelines as the most simple and practical method of assessing stroke risk in AF patients...
July 2017: Seminars in Thrombosis and Hemostasis
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