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Stroke risk from atrial fibrillation

Joshua D Brown, Anand R Shewale, Jeffery C Talbert
BACKGROUND: Non-vitamin K antagonist oral anticoagulants (NOACs) are widely used for prevention of stroke secondary to nonvalvular atrial fibrillation (NVAF). Increased use of NOACs is partially a result of simplified regimens compared with warfarin, which has been associated with poor adherence and persistence to therapy. Few studies have assessed adherence to NOACs, especially using contemporary data now that multiple NOACs are available. OBJECTIVE: To evaluate adherence to NOACs in a cohort of newly diagnosed NVAF patients who are commercially insured...
November 2016: Journal of Managed Care & Specialty Pharmacy
H Wan, S Wu, J Wang, Y Yang, J Zhu, X Shao, B Huang, H Zhang
BACKGROUND/OBJECTIVES: High body mass index (BMI) is associated with increased incident atrial fibrillation (AF) and mortality rate. In patients presenting with nonvalvular AF (NVAF), the prognostic relevance of BMI remains unclear. SUBJECTS/METHODS: In this prospective observational study, a total of 1759 patients with NVAF (69.9±12.9 years old, 47.9% male) were divided into three clinical settings according to estimated stroke risks (CHADS2 score ⩽1 (low), =2 (moderate) and ⩾3 (high))...
October 26, 2016: European Journal of Clinical Nutrition
Ying Bai, Jun Zhu, Yan-Min Yang, Yan Liang, Hui-Qiong Tan, Juan Wang, Bi Huang, Han Zhang, Xing-Hui Shao
BACKGROUND: Atrial fibrillation (AF) and coronary artery disease (CAD) often coexist, however, the clinical characteristics and the impact of stable CAD on the outcomes in Chinese patients with AF has not been well understood. METHODS: Consecutive AF patients in 20 hospitals in China from November 2008 to October 2011 were enrolled. The primary endpoints included 1-year all-cause mortality, stroke, non-central nervous system (non-CNS) embolism, and major bleeding...
August 2016: Journal of Geriatric Cardiology: JGC
Benjamin A Steinberg
Atrial fibrillation (AF) is the most common cardiac arrhythmia, and conveys a significant risk of morbidity and mortality due to related stroke and systemic embolism. Oral anticoagulation (OAC) is the mainstay of thromboembolism prevention and management of anticoagulation can be challenging. For patients without significant valvular disease, decisions around anticoagulation therapy are first based on the presence of additional stroke risk factors, as measured by the CHA2DS2-VASc score. Patients with increased CHA2DS2-VASc scores (by regional guidelines) should next be evaluated to determine if they are candidates for non-vitamin K antagonist oral anticoagulant (NOAC) therapy...
October 25, 2016: Blood
C Narasimhan, Jagmohan Singh Verma, A G Ravi Kishore, Balbir Singh, Sameer Dani, Kamaldeep Chawala, Azizul Haque, Aftab Khan, Mohan Nair, Amit Vora, V Rajasekhar, Joy M Thomas, Anoop Gupta, Ajay Naik, V S Prakash, Lisa Naditch, P Gabriel Steg
BACKGROUND: Atrial fibrillation (AF) is the most common sustained arrhythmia with high risk for many cardiovascular (CV) complications. Adherence to recommended management guidelines is important to avoid complications. In India, there is little knowledge on how AF is managed in real world. METHODS: This is a cross-sectional study of patients in India enrolled in RealiseAF survey between February 2010 and March 2010 with a diagnosis of AF within the last 12 months...
September 2016: Indian Heart Journal
Anene Ukaigwe, Pragya Shrestha, Paras Karmacharya, Sarah K Hussain, Soraya Samii, Mario D Gonzalez, Deborah Wolbrette, Gerald V Naccarrelli
BACKGROUND: Apixaban is a Factor Xa inhibitor increasingly being used for stroke prevention in atrial fibrillation (AF). Although several studies have been done, the efficacy and safety of apixaban during the peri-procedural period of AF ablation remains unclear. We sought to systematically review pooled data from these various studies to evaluate thromboembolic and bleeding risks in patients undergoing catheter ablation for AF who are treated with apixaban (interrupted and uninterrupted)...
October 22, 2016: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
Inmaculada Hernandez, Kenneth J Smith, Yuting Zhang
INTRODUCTION: The comparative cost-effectiveness of all oral anticoagulants approved up to date has not been evaluated from the US perspective. The objective of this study was to compare the cost-effectiveness of edoxaban 60mg, apixaban 5mg, dabigatran 150mg, dabigatran 110mg, rivaroxaban 20mg and warfarin in stroke prevention in atrial fibrillation patients at high-risk of bleeding (defined as HAS-BLED score≥3). MATERIALS AND METHODS: We constructed a Markov state-transition model to evaluate lifetime costs and quality-adjusted life years (QALYs) with each of the six treatments from the perspective of US third-party payers...
October 15, 2016: Thrombosis Research
Linda Norton, Angela Tsiperfal, Kelly Cook, Ani Bagdasarian, John Varady, Manali Shah, Paul Wang
Sustained growth in the arrhythmia population at Stanford Health Care led to an independent nurse practitioner-run outpatient direct current cardioversion (DCCV) program in 2012. DCCVs performed by a medical doctor, a nurse practitioner under supervision, or nurse practitioners from 2009 to 2014 were compared for safety and efficacy. A retrospective review of the electronic medical records system (Epic) was performed on biodemographic data, cardiovascular risk factors, medication history, procedural data, and DCCV outcomes...
September 15, 2016: American Journal of Cardiology
Jingwen Tan, Shuiqing Liu, Jodi B Segal, G Caleb Alexander, Mara McAdams-DeMarco
BACKGROUND: Patients with end stage renal disease (ESRD), including stage 5 chronic kidney disease (CKD), hemodialysis (HD) and peritoneal dialysis (PD), are at high risk for stroke-related morbidity, mortality and bleeding. The overall risk/benefit balance of warfarin treatment among patients with ESRD and AF remains unclear. METHODS: We systematically reviewed the associations of warfarin use and stroke outcome, bleeding outcome or mortality in patients with ESRD and AF...
October 21, 2016: BMC Nephrology
Viraj Suvarna
Stroke prevention in atrial fibrillation (AF) has reached an exciting phase with a plethora of newer, potentially more efficacious and safer agents being introduced for physicians to select from. Dabigatran belongs to a class of anticoagulants called direct thrombin inhibitors, while rivaroxaban, apixaban, and edoxaban are direct Factor Xa inhibitors. Purely from a therapeutic endpoint perspective-based on the action of anticoagulants in reducing cardioembolic stroke-in clinical trials, one should look at whether a new anticoagulant in patients with AF prevents ischemic stroke...
October 2016: Journal of the Association of Physicians of India
Kishan A Manani, Kim Christensen, Nicholas S Peters
Atrial fibrillation (AF) increases the risk of stroke by a factor of 4-5 and is the most common abnormal heart rhythm. The progression of AF with age, from short self-terminating episodes to persistence, varies between individuals and is poorly understood. An inability to understand and predict variation in AF progression has resulted in less patient-specific therapy. Likewise, it has been a challenge to relate the microstructural features of heart muscle tissue (myocardial architecture) with the emergent temporal clinical patterns of AF...
October 2016: Physical Review. E
Anders Nissen Bonde, Gregory Y H Lip, Anne-Lise Kamper, Emil L Fosbøl, Laila Staerk, Nicholas Carlson, Christian Torp-Pedersen, Gunnar Gislason, Jonas Bjerring Olesen
BACKGROUND AND PURPOSE: We sought to determine the risk of stroke/thromboembolism and bleeding associated with reduced renal function in patients with atrial fibrillation and the risk of stroke and bleeding associated with warfarin treatment in specific estimated glomerular filtration rate (eGFR) groups. METHODS: We conducted a register-based cohort study and included patients discharged with nonvalvular atrial fibrillation from 1997 to 2011 with available eGFR...
October 6, 2016: Stroke; a Journal of Cerebral Circulation
Giovanni Filardo, Gorav Ailawadi, Benjamin D Pollock, Briget da Graca, Danielle M Sass, Teresa K Phan, Debbie E Montenegro, Vinod Thourani, Ralph Damiano
BACKGROUND: New-onset atrial fibrillation (AF) after coronary artery bypass graft surgery (CABG) is associated with increased morbidity and poorer long-term survival. Although many studies show differences in outcome in women versus men after CABG, little is known about the sex-specific incidence and characteristics of post-CABG AF. METHODS AND RESULTS: Overall, 11 236 consecutive patients without preoperative AF underwent isolated CABG from 2002 to 2010 at 4 US academic medical centers and 1 high-volume specialty cardiac hospital...
October 18, 2016: Circulation. Cardiovascular Quality and Outcomes
F Lanas, C Castro, C Vallejos, L Bustos, C de La Puente, M Velasquez, C Zaror
: Nonvalvular atrial fibrillation (NVAF) is a risk factor for ischemic stroke and systemic embolism. New oral anticoagulants are currently available. OBJECTIVE: to assess the incremental cost-utility ratio (ICUR) for apixaban versus acenocoumarol in patients treated in Chile's public health system. STUDY DESIGN AND SETTING: We assessed cost-utility from the payer perspective with a lifetime Markov model. Epidemiologic characteristics, costs, and utilities were obtained from a Chilean cohort; data were completed with information from international literature...
October 15, 2016: Journal of Clinical Epidemiology
Ömer Erküner, Roy Claessen, Ron Pisters, Germaine Schulmer, Roos Ramaekers, Laura Sonneveld, Elton Dudink, Theo Lankveld, Ione Limantoro, Bob Weijs, Laurent Pison, Yuri Blaauw, Cees B de Vos, Harry Jgm Crijns
BACKGROUND: Patients undergoing elective electrical cardioversion (ECV) for atrial fibrillation have a temporarily increased risk of thromboembolism. Current guidelines recommend adequate anticoagulation for ≥3 consecutive weeks precardioversion, i.e. consecutive INR values 2.0-3.0 in patients with vitamin K antagonists (VKA). We aimed to evaluate the occurrence and impact of subtherapeutic INRs precardioversion and to study factors associated with these unwanted fluctuations. METHODS: We recruited 346 consecutive patients undergoing elective ECV in the Maastricht University Medical Centre between 2008 and 2013...
October 11, 2016: International Journal of Cardiology
Steven Swiryn, Michael V Orlov, David G Benditt, John P DiMarco, Donald M Lloyd-Jones, Edward Karst, Fujian Qu, Mara T Slawsky, Melanie Turkel, Albert L Waldo
BACKGROUND: The RATE Registry (Registry of Atrial Tachycardia and Atrial Fibrillation Episodes) is a prospective, outcomes-oriented registry designed to document the prevalence of atrial tachycardia and/or fibrillation (AT/AF) of any duration in patients with pacemakers and implantable cardioverter defibrillators (ICDs) and evaluate associations between rigorously adjudicated AT/AF and predefined clinical events, including stroke. The appropriate clinical response to brief episodes of AT/AF remains unclear...
October 18, 2016: Circulation
Michael L James, Margueritte Cox, Ying Xian, Eric E Smith, Deepak L Bhatt, Phillip J Schulte, Adrian Hernandez, Gregg C Fonarow, Lee H Schwamm
BACKGROUND: Compared to ischemic stroke, sex differences in response to intracerebral hemorrhage (ICH) are largely unexplored, and their potential interactions with patient age have not been examined. This study hypothesized that risk for poor outcome is greater in women with increasing age. METHODS AND RESULTS: The Get With The Guidelines(®)-Stroke database was used to assess differences between men and women with ICH. Data from 192,826 ICH patients admitted from January 1, 2009 through March 31, 2014 to 1,728 fully participating sites were analyzed using logistic regression to test interactions between age/sex and outcome...
October 18, 2016: Journal of Women's Health
Sun-Wook Kim, Sol-Ji Yoon, Jung-Yeon Choi, Min-Gu Kang, Kwang-Il Kim, Cheol-Ho Kim
OBJECTIVE: Atrial fibrillation is the common arrhythmia in the elderly, and the average age of atrial fibrillation patients is rising. Elderly patients with atrial fibrillation have high incidence of thromboembolic complication and increasing age is associated with stroke severity. Assessing CHADS-VASc score is pivotal to evaluate substantial morbidity and mortality, especially regarding the increased risk of stroke. In addition, considering bleeding risk with HAS-BLED score is important to balance the benefit against the risk of bleeding...
September 2016: Journal of Hypertension
Jürgen Bohlender, Jürg Nussberger, Beate Bohlender
OBJECTIVE: In elderly hypertensive patients, systolic blood pressure (sBP) goals recommended by US and European guidelines (ESH) for the initiation of treatment are more liberal than in younger patients because of an increased risk of treatment-associated side-effects and hypotension. Carotid stenosis increases with age and poses a risk of brain ischemia if hypotension occurs. Its relevance for the routine care of elderly hypertensives, however, remains unclear. We analyzed data on precerebral artery morphology and BP evolution from a survey of aged hospitalized patients...
September 2016: Journal of Hypertension
Søren Due Andersen, Torben Bjerregaard Larsen, Anders Gorst-Rasmussen, Yousef Yavarian, Gregory Y H Lip, Flemming W Bach
BACKGROUND: Nearly one in 5 patients with ischemic stroke will invariably experience a second stroke within 5 years. Stroke risk stratification schemes based solely on clinical variables perform only modestly in non-atrial fibrillation (AF) patients and improvement of these schemes will enhance their clinical utility. Cerebral white matter hyperintensities are associated with an increased risk of incident ischemic stroke in the general population, whereas their association with the risk of ischemic stroke recurrence is more ambiguous...
October 18, 2016: Cerebrovascular Diseases
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