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Stroke risk from atrial fibrillation

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https://www.readbyqxmd.com/read/29667208/the-use-of-cardiac-ct-alone-to-exclude-left-atrial-thrombus-before-atrial-fibrillation-ablation-efficiency-safety-and-cost-analysis
#1
Wassim Mosleh, Ali Sheikh, Zaid Said, Mohamed A Abdel-Aal, Siri Gadde, Tanvi Shah, Michael F Wilson, Hiroko Beck, Chee Kim, Umesh C Sharma
BACKGROUND: Atrial fibrillation (AF) is a growing financial burden on the healthcare system. Cardiac computed tomographic angiography (CCTA) is needed for pulmonary vein mapping before AF ablation (AFA). CCTA has shown to be an alternative to transesophageal echocardiogram (TEE) to rule-out left atrial appendage thrombus (LAAT) pre-AFA. We aim to examine the safety, cost-effectiveness, and time-efficiency of utilizing CCTA alone to rule out LAAT before AFA. METHODS: We prospectively screened patients with paroxysmal AF undergoing cryoablation...
April 17, 2018: Pacing and Clinical Electrophysiology: PACE
https://www.readbyqxmd.com/read/29666603/long-term-factors-associated-with-falls-and-fractures-poststroke
#2
Emma J Foster, Raphae S Barlas, Joao H Bettencourt-Silva, Allan B Clark, Anthony K Metcalf, Kristian M Bowles, John F Potter, Phyo K Myint
Background: Risk factors for poststroke falls and fractures remain poorly understood. This study aimed to evaluate which factors increased risk of these events after stroke. Methods: Data from 7,267 hospitalized stroke patients were acquired from the Norfolk and Norwich University Hospital Stroke Register from 2003-2015. The impacts of multiple patient level and stroke characteristics and comorbidities on post-discharge falls and fractures were assessed. Univariate and multivariable models were constructed, adjusting for multiple confounders, using binary logistic regression for short-term analysis (up to 1-year post-discharge) and Cox-proportional hazard models for longer term analysis (1-3, 3-5, and 0-10 years follow-up)...
2018: Frontiers in Neurology
https://www.readbyqxmd.com/read/29661944/atrial-fibrillation-burden-moving-beyond-atrial-fibrillation-as-a-binary-entity-a-scientific-statement-from-the-american-heart-association
#3
REVIEW
Lin Y Chen, Mina K Chung, Larry A Allen, Michael Ezekowitz, Karen L Furie, Pamela McCabe, Peter A Noseworthy, Marco V Perez, Mintu P Turakhia
Our understanding of the risk factors and complications of atrial fibrillation (AF) is based mostly on studies that have evaluated AF in a binary fashion (present or absent) and have not investigated AF burden. This scientific statement discusses the published literature and knowledge gaps related to methods of defining and measuring AF burden, the relationship of AF burden to cardiovascular and neurological outcomes, and the effect of lifestyle and risk factor modification on AF burden. Many studies examine outcomes by AF burden classified by AF type (paroxysmal versus nonparoxysmal); however, quantitatively, AF burden can be defined by longest duration, number of AF episodes during a monitoring period, and the proportion of time an individual is in AF during a monitoring period (expressed as a percentage)...
April 16, 2018: Circulation
https://www.readbyqxmd.com/read/29657060/characteristics-and-outcomes-of-ischemic-stroke-in-patients-with-known-atrial-fibrillation-or-atrial-fibrillation-diagnosed-after-stroke
#4
Cheng-Yang Hsieh, Cheng-Han Lee, Darren Philbert Wu, Sheng-Feng Sung
BACKGROUND: It is unclear whether ischemic stroke patients with known atrial fibrillation (KAF) had different outcomes than those with atrial fibrillation diagnosed after stroke (AFDAS). We aimed to explore the characteristics and outcomes in ischemic stroke patients with KAF or AFDAS. METHODS: Consecutive patients hospitalized between 2000 and 2012 for first-ever stroke along with atrial fibrillation, either diagnosed before or during the stroke hospitalization, were identified from a nationwide claims database in Taiwan...
June 15, 2018: International Journal of Cardiology
https://www.readbyqxmd.com/read/29656278/anxiety-depression-and-adverse-clinical-outcomes-in-patients-with-atrial-fibrillation-starting-warfarin-cardiovascular-research-network-wave-study
#5
Christine Baumgartner, Dongjie Fan, Margaret C Fang, Daniel E Singer, Daniel M Witt, John R Schmelzer, Marc S Williams, Jerry H Gurwitz, Sue Hee Sung, Alan S Go
BACKGROUND: Anxiety and depression are associated with worse outcomes in several cardiovascular conditions, but it is unclear whether they affect outcomes in atrial fibrillation (AF). In a large diverse population of adults with AF, we evaluated the association of diagnosed anxiety and/or depression with stroke and bleeding outcomes. METHODS AND RESULTS: The Cardiovascular Research Network WAVE (Community-Based Control and Persistence of Warfarin Therapy and Associated Rates and Predictors of Adverse Clinical Events in Atrial Fibrillation and Venous Thromboembolism) Study included adults with AF newly starting warfarin between 2004 and 2007 within 5 health delivery systems in the United States...
April 14, 2018: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29655505/midterm-outcome-of-transcatheter-versus-surgical-aortic-valve-replacement-in-low-to-intermediate-risk-patients-a-meta-analysis-of-randomized-controlled-trials
#6
Yanwei Wang, Yijiang Zhou, Li Zhang, Jianhua Zhu
BACKGROUND: Current guidelines recommend transcatheter aortic valve replacement (TAVR) in patients with severe symptomatic aortic stenosis (AS) who are not suitable for conventional surgical aortic valve replacement (SAVR). In light of the recent trend in performing TAVR in patients with lower risk profile, we assessed the midterm outcome comparing TAVR and SAVR for the treatment of patients with severe AS at low to intermediate risk. METHODS: PubMed, EBSCO, and Cochrane CENTRAL were systematically searched for randomized controlled trials that reported the clinical outcomes of TAVR versus SAVR in patients at low to intermediate surgical risk with at least 2 years of follow-up...
June 2018: Journal of Cardiology
https://www.readbyqxmd.com/read/29652731/obesity-and-cardiovascular-risk-a-call-for-action-from-the-european-society-of-hypertension-working-group-of-obesity-diabetes-and-the-high-risk-patient-and-european-association-for-the-study-of-obesity-part-b-obesity-induced-cardiovascular-disease-early-prevention
#7
Vasilios Kotsis, Konstantinos Tsioufis, Christina Antza, Gino Seravalle, Antonio Coca, Cristina Sierra, Empar Lurbe, Stella Stabouli, Bojan Jelakovic, Josep Redon, Pau Redon, Peter M Nilsson, Jens Jordan, Dragan Micic, Nicholas Finer, Deborah R Leitner, Hermann Toplak, Lale Tokgozoglu, Vasilios Athyros, Moses Elisaf, Theodosios D Filippatos, Guido Grassi
: Obesity predisposes for atrial fibrillation, heart failure, sudden cardiac death, renal disease and ischemic stroke, which are the main causes of cardiovascular hospitalization and mortality. As obesity and the cardiovascular effects on the vessels and the heart start early in life, even from childhood, it is important for health policies to prevent obesity very early before the disease manifestation emerge. Key roles in the prevention are strategies to increase physical exercise, reduce body weight and to prevent or treat hypertension, lipids disorders and diabetes earlier and efficiently to prevent cardiovascular complications...
April 12, 2018: Journal of Hypertension
https://www.readbyqxmd.com/read/29650978/percutaneous-closure-of-left-atrial-appendage-significantly-affects-lipidome-metabolism
#8
G Yücel, M Behnes, C Barth, A Wenke, B Sartorius, K Mashayekhi, B Yazdani, T Bertsch, J Rusnak, A Saleh, U Hoffmann, C Fastner, S Lang, X Zhou, K Sattler, M Borggrefe, I Akin
Patients with non-valvular atrial fibrillation (AF) and a high risk for oral anticoagulation can be treated by percutaneous implantation of left atrial appendage occlusion devices (LAAC) to reduce the risk of cardio-embolic stroke. This study evaluates whether LAAC may influence lipid metabolism, which has never been investigated before. Patients with successful LAAC were included consecutively. Venous peripheral blood samples of patients were collected immediately before (T0, baseline) and 6 months after (T1, mid-term) LAAC...
April 12, 2018: Scientific Reports
https://www.readbyqxmd.com/read/29650382/therapeutic-decisions-in-atrial-fibrillation-for-stroke-prevention-the-role-of-aversion-to-ambiguity-and-physicians-risk-preferences
#9
Luciano A Sposato, Devin Stirling, Gustavo Saposnik
BACKGROUND: Knowledge-to-action gaps influence therapeutic decisions in atrial fibrillation (AF). Physician-related factors are common, but the least studied. We evaluated the prevalence and determinants of physician-related factors and knowledge-to-action gaps among physicians involved in the management of AF patients. DESIGN: In this cross-sectional study, participants from 6 South American countries recruited during an educational program answered questions regarding 16 case scenarios of patients with AF and completed experiments assessing 3 outcome measures: therapeutic inertia, herding, and errors in risk stratification knowledge translated into action (ERSKTA) based on commonly used stratification tools (Congestive heart failure, Hypertension, Age ≥75 years (double), Diabetes mellitus, previous Stroke/transient ischemic attack/thromboembolism (double), Vascular disease, Age 65-74 years, and female gender (score of 0 for males and 1 for female) (CHA2 DS2 -VASc) and Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, and previous Stroke/transient ischemic attack (double) (CHADS2 ))...
April 9, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29644412/patent-foramen-ovale-closure-versus-medical-therapy-for-prevention-of-recurrent-cryptogenic-embolism-updated-meta-analysis-of-randomized-clinical-trials
#10
Brunilda Alushi, Alexander Lauten, Salvatore Cassese, Roisin Colleran, Stefanie Schüpke, Himanshu Rai, Heribert Schunkert, Bernhard Meier, Ulf Landmesser, Adnan Kastrati
BACKGROUND: We performed an updated meta-analysis of all randomized-controlled trials (RCTs) comparing patent foramen ovale (PFO) closure with medical therapy for prevention of recurrent ischemic stroke. METHODS AND RESULTS: We searched Medline, EMBASE, and Cochrane databases, and proceedings of international meetings for RCTs of patients with cryptogenic stroke and PFO comparing percutaneous PFO closure versus medical therapy for prevention of recurrent ischemic stroke...
April 11, 2018: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
https://www.readbyqxmd.com/read/29642709/thromboembolism-and-mortality-in-the-tasmanian-atrial-fibrillation-study
#11
Endalkachew Admassie, Leanne Chalmers, Luke R Bereznicki
BACKGROUND: Although utilization of anticoagulation in patients with atrial fibrillation (AF) has increased in recent years, contemporary data regarding thromboembolism and mortality incidence rates are limited outside of clinical trials. This study aimed to investigate the impact of the direct oral anticoagulants (DOACs) on the clinical outcomes of patients with AF included in the Tasmanian Atrial Fibrillation Study. METHODS: The medical records of all patients with a primary or secondary diagnosis of AF who presented to public hospitals in Tasmania, Australia, between 2011 and 2015, were retrospectively reviewed...
January 1, 2018: Journal of Cardiovascular Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/29628278/left-atrial-dilatation-a-target-organ-damage-in-young-to-middle-age-hypertensive-patients-the-campania-salute-network
#12
Costantino Mancusi, Grazia Canciello, Raffaele Izzo, Silvia Damiano, Maria Gabriella Grimaldi, Nicola de Luca, Giovanni de Simone, Bruno Trimarco, Maria-Angela Losi
BACKGROUND: Left atrial (LA) volume is a predictor of outcome in hypertension. It is unclear whether or not this effect depends on coexisting target organ damage (TOD). PURPOSE: To investigate whether LA volume predicts outcome independently of TOD [left ventricular (LV) hypertrophy (LVH) and/or carotid plaque] in a registry of hypertensive treated patients. METHODS: From the Campania Salute Network registry, we selected 5844 young adult hypertensive patients <65 years old (mean age 50 ± 9 years, 41% women, 8% diabetic) without prevalent CV or valvular heart disease more than mild, with normal LV ejection fraction, stage III or less CKD and available follow-up...
March 27, 2018: International Journal of Cardiology
https://www.readbyqxmd.com/read/29627355/contemporary-reviews-in-critical-care-medicine-atrial-fibrillation-in-the-intensive-care-unit
#13
REVIEW
Nicholas A Bosch, Jonathan Cimini, Allan J Walkey
Atrial fibrillation (AF) is the most common arrhythmia encountered in the intensive care unit. Pre-existing AF is highly prevalent among older patients with chronic conditions who are at risk for critical illness, while new-onset AF can be triggered by accelerated atrial remodeling and arrhythmogenic triggers encountered during critical illness. The acute loss of atrial systole and onset of rapid ventricular rates that characterize new-onset AF often lead to decreased cardiac output and hemodynamic compromise...
April 5, 2018: Chest
https://www.readbyqxmd.com/read/29626048/dabigatran-persistence-and-adherence-in-new-zealand-a-nationwide-retrospective-observational-study
#14
Paul Harper, Daryl Pollock, Matt Stephens
OBJECTIVE: To determine the effect of age and gender on persistence and adherence in patients taking dabigatran for atrial fibrillation. DESIGN: A retrospective observational study over 4 years using refill prescription data from the National Pharmaceutical Database. SETTING: All patients in New Zealand who received dabigatran from July 2011 to September 2015. POPULATION: 43 339 people filled at least one prescription of dabigatran...
April 5, 2018: BMJ Open
https://www.readbyqxmd.com/read/29623408/-thromboembolism-prophylaxis-in-old-age
#15
Gabriele Röhrig, Gerald Kolb
Anticoagulation in geriatric patients is challenging regarding the risk of bleeding complications and thromboembolic problems. Age, comorbidities, such as renal insufficiency and polymedication have a vital impact on bleeding and thromboembolic risks; however, age is not an exclusion criterion for withholding anticoagulation. Age is the main risk factor for deep vein thrombosis and atrial fibrillation becomes more relevant with aging. Older patients with atrial fibrillation have a particularly high risk of having a stroke...
April 5, 2018: Zeitschrift Für Gerontologie und Geriatrie
https://www.readbyqxmd.com/read/29622591/safety-and-efficacy-of-novel-oral-anticoagulants-versus-warfarin-in-medicare-beneficiaries-with-atrial-fibrillation-and-valvular-heart-disease
#16
Alexandros Briasoulis, Chakradhari Inampudi, Emmanuel Akintoye, Paulino Alvarez, Sidakpal Panaich, Mary Vaughan-Sarrazin
BACKGROUND: We examined a large community-based sample of patients with atrial fibrillation (AF) and valvular heart disease (VHD) (excluding prosthetic valves) with a goal to compare outcomes among patients with AF, with and without VHD, taking warfarin, dabigatran, and rivaroxaban. METHODS AND RESULTS: We identified Medicare beneficiaries enrolled in Medicare Part D benefit plan from 2011 to 2013 with newly diagnosed AF (18 137 patients with VHD [dabigatran, 1979; rivaroxaban, 2027; warfarin, 14 131] and 85 596 patients without VHD [dabigatran, 13 522; rivaroxaban, 14 257; warfarin, 57 817])...
April 5, 2018: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29622587/efficacy-and-safety-of-apixaban-dabigatran-rivaroxaban-and-warfarin-in-asians-with-nonvalvular-atrial-fibrillation
#17
Yi-Hsin Chan, Lai-Chu See, Hui-Tzu Tu, Yung-Hsin Yeh, Shang-Hung Chang, Lung-Sheng Wu, Hsin-Fu Lee, Chun-Li Wang, Chang-Fu Kuo, Chi-Tai Kuo
BACKGROUND: Whether non-vitamin K antagonist oral anticoagulants (NOACs) are superior to warfarin among Asians with nonvalvular atrial fibrillation remains unclear. METHODS AND RESULTS: In this nationwide retrospective cohort study collected from Taiwan National Health Insurance Research Database, there were 5843, 20 079, 27 777, and 19 375 nonvalvular atrial fibrillation patients taking apixaban, dabigatran, rivaroxaban and warfarin, respectively, from June 1, 2012 to December 31, 2016...
April 5, 2018: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29622509/impact-of-bmi-on-clinical-outcomes-of-noac-therapy-in-daily-care-results-of-the-prospective-dresden-noac-registry-nct01588119
#18
L Tittl, S Endig, S Marten, A Reitter, I Beyer-Westendorf, J Beyer-Westendorf
Direct acting non-Vitamin K antagonist oral anticoagulants (NOAC) are characterized by a fixed dosing regimen. Despite the potential for relative underdosing due to large distribution volumes, dose adjustments for patients with high body mass index (BMI) are not recommended. Since efficacy and safety data in obese patients are scarce, we evaluated the impact of BMI on clinical outcomes in daily care patients treated with NOAC for stroke prevention in atrial fibrillation or venous thromboembolism. Using prospectively collected data from a non-interventional registry, cardiovascular (CV), major bleeding events (MB) and all-cause mortality were evaluated according to BMI classes...
March 14, 2018: International Journal of Cardiology
https://www.readbyqxmd.com/read/29622287/financial-implications-and-impact-of-pre-existing-atrial-fibrillation-on-in-hospital-outcomes-in-patients-who-underwent-transcatheter-aortic-valve-implantation-from-the-national-inpatient-database
#19
Hossam Abubakar, Ahmed S Yassin, Emmanuel Akintoye, Khalid Bakhit, Mohit Pahuja, Mohamed Shokr, Randy Lieberman, Luis Afonso
The objective of this study was to evaluate the financial implications and the impact of pre-existing atrial fibrillation (AF) on in-hospital outcomes in patients who underwent transcatheter aortic valve implantation (TAVI) using the Nationwide Inpatient Sample (NIS) database. We identified patients who underwent TAVI from 2011 to 2014. The primary end point was the effect of pre-existing AF on in-hospital mortality. Secondary end points included periprocedural cardiac complications, stroke, and hemorrhage requiring transfusion...
March 14, 2018: American Journal of Cardiology
https://www.readbyqxmd.com/read/29622159/device-related-thrombosis-after-percutaneous-left-atrial-appendage-occlusion-for-atrial-fibrillation
#20
Laurent Fauchier, Alexandre Cinaud, François Brigadeau, Antoine Lepillier, Bertrand Pierre, Selim Abbey, Marjaneh Fatemi, Frederic Franceschi, Paul Guedeney, Peggy Jacon, Olivier Paziaud, Sandrine Venier, Jean Claude Deharo, Daniel Gras, Didier Klug, Jacques Mansourati, Gilles Montalescot, Olivier Piot, Pascal Defaye
BACKGROUND: Transcatheter left atrial appendage (LAA) occlusion is an alternative strategy for stroke prevention in patients with atrial fibrillation (AF). OBJECTIVES: This study sought to determine the incidence, predictors, and prognosis of thrombus formation on devices in patients with AF who were treated with LAA closure. METHODS: The study retrospectively analyzed data from patients treated with 2 LAA closure devices seen in 8 centers in France from February 2012 to January 2017...
April 10, 2018: Journal of the American College of Cardiology
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