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Reduction of strokes from atrial fibrillation

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https://www.readbyqxmd.com/read/29316564/primary-prevention-of-stroke-in-chronic-kidney-disease-patients-a-scientific-update
#1
Stefana Catalina Bilha, Alexandru Burlacu, Dimitrie Siriopol, Luminita Voroneanu, Adrian Covic
BACKGROUND: Although chronic kidney disease (CKD) is an independent risk factor for stroke, official recommendations for the primary prevention of stroke in CKD are generally lacking. SUMMARY: We searched PubMed and ISI Web of Science for randomised controlled trials, observational studies, reviews, meta-analyses and guidelines referring to measures of stroke prevention or to the treatment of stroke-associated risk factors (cardiovascular disease in general and atrial fibrillation (AF), arterial hypertension or carotid artery disease in particular) among the CKD population...
January 9, 2018: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/29300888/telemonitoring-based-feedback-improves-adherence-to-non-vitamin-k-antagonist-oral-anticoagulants-intake-in-patients-with-atrial-fibrillation
#2
Lien Desteghe, Johan Vijgen, Pieter Koopman, Dagmara Dilling-Boer, Joris Schurmans, Paul Dendale, Hein Heidbuchel
Aims: To evaluate the effect of telemonitoring on adherence to non-vitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation (AF) patients. Methods and results: A randomized, single-blind, crossover, controlled trial in 48 AF patients on once or twice daily (OD or BID) NOAC. The Medication Event Monitoring System tracked NOAC intake during three phases of 3 months each: daily telemonitoring, telemonitoring with immediate telephone feedback in case of intake errors, and an observation phase without daily transmissions...
January 2, 2018: European Heart Journal
https://www.readbyqxmd.com/read/29260237/-anticoagulation-in-geriatric-patients-with-atrial-fibrillation-with-what-and-for-whom-no-more
#3
REVIEW
P Bahrmann, M Christ
Based on established risk scores, such as the CHA2DS2-VASc score, the indications for oral anticoagulation are given for patients over 65 years old with atrial fibrillation and even more so for patients over 75 years old. Before beginning anticoagulation a geriatric assessment for evaluation of the cognitive ability, the activities of daily living and the risk of falling should be made because of the known complications of anticoagulation. Geriatric patients with non-valvular atrial fibrillation (AF) are increasingly being treated with non-vitamin K antagonist oral anticoagulants (NOAC) to prevent ischemic stroke...
December 19, 2017: Herz
https://www.readbyqxmd.com/read/29248163/estimated-absolute-effects-on-efficacy-and-safety-outcomes-of-using-non-vitamin-k-antagonist-oral-anticoagulants-in-real-world-atrial-fibrillation-patients-a-comparison-with-optimally-acenocoumarol-anticoagulated-patients
#4
María Asunción Esteve-Pastor, José Miguel Rivera-Caravaca, Vanessa Roldán, Vicente Vicente, Giulio Francesco Romiti, Imma Romanazzi, Marco Proietti, Mariano Valdés, Francisco Marín, Gregory Y H Lip
BACKGROUND: Non-vitamin K antagonist oral anticoagulants (NOACs) have been proposed as an alternative to vitamin K antagonists (VKA) for atrial fibrillation (AF) patients. Some studies have proposed that well-managed warfarin therapy is still a valid alternative as efficacious as NOACs but the potential impact and absolute effect of NOACs in "real world" optimally management of VKA AF patients is unknown. PURPOSE: To estimate the potential absolute benefit in clinical outcome rates if the optimally anticoagulated "real-world" AF patients with acenocoumarol had been treated with NOACs...
December 14, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/29228158/percutaneous-left-atrial-appendage-occlusion-in-atrial-fibrillation-patients-with-a-contraindication-to-oral-anticoagulation-a-focused-review
#5
Marin Nishimura, Shiv Sab, Ryan R Reeves, Jonathan C Hsu
Stroke is the most feared complication of atrial fibrillation (AF). Although oral anticoagulation with non-vitamin K antagonist and non-vitamin K antagonist oral anticoagulants (NOACs) have been established to significantly reduce risk of stroke, real-world use of these agents are often suboptimal due to concerns for adverse events including bleeding from both patients and clinicians. Particularly in patients with previous serious bleeding, oral anticoagulation may be contraindicated. Left atrial appendage occlusion (LAAO), mechanically targeting the source of most of the thrombi in AF, holds an immense potential as an alternative to OAC in management of stroke prophylaxis...
December 8, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/29188888/late-life-body-mass-index-rapid-weight-loss-apolipoprotein-e-%C3%AE%C2%B54-and-the-risk-of-cognitive-decline-and-incident-dementia
#6
S P Bell, D Liu, L R Samuels, A S Shah, K A Gifford, T J Hohman, A L Jefferson
OBJECTIVES: To examine the effect of late-life body mass index (BMI) and rapid weight loss on incident mild cognitive impairment (MCI) and Alzheimer's disease (AD). DESIGN: Prospective longitudinal cohort study. SETTING: National Alzheimer's Coordinating Center (NACC) Uniform Data Set, including 34 past and current National Institute on Aging-funded AD Centers across the United States. PARTICIPANTS: 6940 older adults (n=5061 normal cognition [NC]; n=1879 MCI)...
2017: Journal of Nutrition, Health & Aging
https://www.readbyqxmd.com/read/29173608/the-relationship-between-cardiologist-care-and-clinical-outcomes-in-patients-with-new-onset-atrial-fibrillation
#7
Sheldon M Singh, Feng Qiu, Lauren Webster, Peter C Austin, Dennis T Ko, Jack V Tu, Harindra C Wijeysundera
BACKGROUND: Increased mortality is well described in patients with atrial fibrillation (AF), primarily related to death from cardiovascular causes. One may hypothesize that cardiology care may be associated with a reduction in cardiovascular deaths in patients with AF, thereby improving their overall survival. The aim of this study was to assess the association between cardiologist care and clinical outcomes, including all-cause mortality, in patients with new-onset AF. METHODS: This was a retrospective population-level, propensity score-matched cohort study of patients aged 20-80 years with new-onset AF presenting to an emergency department in Ontario, Canada between 2010 and 2012...
December 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/29167388/real-world-use-of-apixaban-for-stroke-prevention-in-atrial-fibrillation-a-systematic-review-and-meta-analysis
#8
Marco Proietti, Imma Romanazzi, Giulio Francesco Romiti, Alessio Farcomeni, Gregory Y H Lip
BACKGROUND AND PURPOSE: The use of oral anticoagulant therapy for stroke prevention in atrial fibrillation has been transformed by the availability of the nonvitamin K antagonist oral anticoagulants. Real-world studies on the use of nonvitamin K antagonist oral anticoagulants would help elucidate their effectiveness and safety in daily clinical practice. Apixaban was the third nonvitamin K antagonist oral anticoagulants introduced to clinical practice, and increasing real-world studies have been published...
November 22, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29165583/modelling-projections-for-the-risks-related-with-atrial-fibrillation-in-east-asia-a-focus-on-ischaemic-stroke-and-death
#9
Ying Bai, Shi-Dong Guo, Alena Shantsila, Gregory Y H Lip
Aims: In the Far East, there has generally been low uptake of oral anticoagulants (OACs) using vitamin K antagonists (VKA, e.g. warfarin) for stroke prevention in atrial fibrillation (AF), but OAC use has been increasing more recently, with the introduction of the non-vitamin K antagonist oral anticoagulants (NOACs). To explore the risks of ischaemic stroke (IS) and death related to AF in East Asia using modelling projections. Methods and results: We performed a modelling analysis of possible trends of IS and death rates in AF patients from the time period of only VKA use to current increasing trends of NOAC use projecting until 2050 in East Asia...
November 20, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/29153246/usefulness-of-the-american-heart-association-s-life-simple-7-to-predict-the-risk-of-atrial-fibrillation-from-the-reasons-for-geographic-and-racial-differences-in-stroke-regards-study
#10
Parveen K Garg, Wesley T O'Neal, Adedotun Ogunsua, Evan L Thacker, George Howard, Elsayed Z Soliman, Mary Cushman
The American Heart Association has identified metrics of ideal cardiovascular (CV) health known as Life's Simple 7 (LS7). We determined the prospective relationship between the LS7 and the incident atrial fibrillation (AF) in a biracial cohort. The REasons for Geographic And Racial Differences in Stroke (REGARDS) study enrolled non-Hispanic black and white adults 45 years or older. This analysis included 9,576 REGARDS participants (mean age 63 ± 8.4 years; 57% women; 30% black) who were free of AF at baseline and completed a follow-up examination 9...
October 19, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/29150698/surgical-techniques-for-left-atrial-appendage-exclusion
#11
REVIEW
Sacha P Salzberg, Maximilian Y Emmert, Etem Caliskan
The increasing prevalence of atrial fibrillation with the aging population and its associated major morbidity and mortality due to thromboembolic stroke have resulted in intensive research on stroke prevention or stroke risk reduction strategies. Several surgical techniques for left atrial appendage (LAA) occlusion have evolved over the past decades. Surgeons have been using different techniques leading to highly variable and, in particular, poor data on outcomes. LAA closure is performed either as a concomitant procedure during open-heart surgery or as a stand-alone surgical procedure as part of minimally invasive (mini-thoracotomy or thoracoscopy) arrhythmia surgery...
November 17, 2017: Herzschrittmachertherapie & Elektrophysiologie
https://www.readbyqxmd.com/read/29148156/long-term-outcomes-for-different-surgical-strategies-to-treat-left-ventricular-outflow-tract-obstruction-in-hypertrophic-cardiomyopathy
#12
Richard Collis, Oliver Watkinson, Constantinos O'Mahony, Oliver P Guttmann, Antonis Pantazis, Maria Tome-Esteban, Victor Tsang, Venkatachalam Chandrasekaran, Christopher G A McGregor, Perry M Elliott
AIMS: Surgical intervention is used to treat dynamic left ventricular outflow tract obstruction (LVOTO) in hypertrophic cardiomyopathy. This study assesses the effect of different surgical strategies on long-term mortality and morbidity. METHODS AND RESULTS: In total, 347 patients underwent surgical intervention for LVOTO (1988-2015). Group A (n = 272) underwent septal myectomy; Group B (n = 33), septal myectomy and mitral valve (MV) repair; Group C (n = 22), myectomy and MV replacement; and Group D (n = 20), MV replacement alone...
November 16, 2017: European Journal of Heart Failure
https://www.readbyqxmd.com/read/29122636/clinical-outcomes-and-history-of-fall-in-patients-with-atrial-fibrillation-treated-with-oral-anticoagulation-insights-from-the-aristotle-trial
#13
Meena P Rao, Dragos Vinereanu, Daniel M Wojdyla, John H Alexander, Dan Atar, Elaine M Hylek, Michael Hanna, Lars Wallentin, Renato D Lopes, Bernard J Gersh, Christopher B Granger
PURPOSE: We assessed outcomes among anticoagulated patients with atrial fibrillation (AF) and a history of falling, and whether the benefits of apixaban versus warfarin are consistent in this population. METHODS: Of the 18,201 patients in ARISTOTLE, 16,491 had information about history of falling - 753 with history of falling and 15,738 without history of falling. The primary efficacy outcome was stroke or systemic embolism; the primary safety outcome was major bleeding...
November 6, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/29117873/implementation-of-an-emergency-department-atrial-fibrillation-and-flutter-pathway-improves-rates-of-appropriate-anticoagulation-reduces-length-of-stay-and-thirty-day-revisit-rates-for-congestive-heart-failure
#14
David Barbic, Chris DeWitt, Devin Harris, Robert Stenstrom, Eric Grafstein, Crane Wu, Cristian Vadeanu, Brett Heilbron, Jenelle Haaf, Stanley Tung, Dan Kalla, Julian Marsden, Jim Christenson, Frank Scheuermeyer
OBJECTIVES: An evidence-based emergency department (ED) atrial fibrillation and flutter (AFF) pathway was developed to improve care. The primary objective was to measure rates of new anticoagulation (AC) on ED discharge for AFF patients who were not AC correctly upon presentation. METHODS: This is a pre-post evaluation from April to December 2013 measuring the impact of our pathway on rates of new AC and other performance measures in patients with uncomplicated AFF solely managed by emergency physicians...
November 9, 2017: CJEM
https://www.readbyqxmd.com/read/29106834/-left-atrial-appendage-closure-and-embolic-events
#15
M Akodad, P Garot
Atrial fibrillation (AF) is frequent and responsible for embolic events. Currently, the gold standard to prevent such embolic events is anticoagulant therapy with vitamin K antagonist (VKA) or direct oral anticoagulant in nonvalvular AF. Recently, left atrial appendage closure was proposed as an alternative to anticoagulant inpatient with high embolic risk and contraindication to anticoagulant therapy. Data from randomized trials were consistent with a non-inferiority of left atrial appendage closure in comparison to VKA in terms of stroke and cardiovascular death...
October 26, 2017: Annales de Cardiologie et D'angéiologie
https://www.readbyqxmd.com/read/29105666/-low-or-reduced-semantics-of-the-doses-of-new-oral-anticoagulants
#16
Andrea Rubboli
The four new oral anticoagulants (NOACs) dabigatran, rivaroxaban, apixaban and edoxaban are marketed in two doses each for the prevention of stroke and/or systemic thromboembolism in non-valvular atrial fibrillation (NVAF). The meaning and indications for use of the lower dose compared with the higher dose are, however, different between the thrombin-inhibitor dabigatran on the one hand and the activated factor X (Xa) inhibitors on the other. These differences stem from the different design of the registration studies where NOACs were compared with warfarin for the prevention of stroke and/or systemic thromboembolism in patients with NVAF...
September 2017: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/29103847/5-year-outcomes-after-left%C3%A2-atrial%C3%A2-appendage-closure-from-the-prevail-and-protect-af-trials
#17
Vivek Y Reddy, Shephal K Doshi, Saibal Kar, Douglas N Gibson, Matthew J Price, Kenneth Huber, Rodney P Horton, Maurice Buchbinder, Petr Neuzil, Nicole T Gordon, David R Holmes
BACKGROUND: The PROTECT AF (WATCHMAN Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillation) trial demonstrated that left atrial appendage closure (LAAC) with the Watchman device (Boston Scientific, St. Paul, Minnesota) was equivalent to warfarin for preventing stroke in atrial fibrillation, but had a high rate of complications. In a second randomized trial, PREVAIL (Evaluation of the WATCHMAN LAA Closure Device in Patients With Atrial Fibrillation Versus Long Term Warfarin Therapy), the complication rate was low...
November 4, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29101289/the-efficacy-and-safety-of-the-use-of-non-vitamin-k-antagonist-oral-anticoagulants-in-patients-with-non-valvular-atrial-fibrillation-and-concomitant-aspirin-therapy-a-meta-analysis-of-randomized-trials
#18
Naoual Bennaghmouch, Anne J W M de Veer, Kerstin Bode, Bakhtawar K Mahmoodi, Willem J M Dewilde, Gregory Y H Lip, Martina Brueckmann, Eva Kleine, Jurriën M Ten Berg
Background -Current guidelines recommend non-vitamin-K antagonist oral anticoagulants (NOACs) as the first choice therapy in patients with non-valvular atrial fibrillation, as these drugs have several benefits over the vitamin-K antagonists (VKA). It is unknown whether these benefits remain when NOACs have to be combined with aspirin therapy. To assess the efficacy and safety of NOACs compared with VKA in patients with AF and concomitant aspirin therapy, we conducted a systematic review and study based meta-analysis of published randomized controlled trials (RCTs)...
November 3, 2017: Circulation
https://www.readbyqxmd.com/read/29089455/echocardiographic-risk-factors-for-stroke-and-outcomes-in-patients-with-atrial-fibrillation-anticoagulated-with-apixaban-or-warfarin
#19
Dragos Vinereanu, Renato D Lopes, Hillary Mulder, Bernard J Gersh, Michael Hanna, Pedro G M de Barros E Silva, Dan Atar, Lars Wallentin, Christopher B Granger, John H Alexander
BACKGROUND AND PURPOSE: Few data exist on the long-term outcomes of patients with spontaneous echo contrast (SEC), left atrial/left atrial appendage (LA/LAA) thrombus, and complex aortic plaque (CAP), in patients with atrial fibrillation receiving oral anticoagulation. We explored the relationship between these 3 echocardiographic findings and clinical outcomes, and the comparative efficacy and safety of apixaban and warfarin for each finding. METHODS: Patients from the ARISTOTLE trial (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) with SEC, LA/LAA thrombus, or CAP diagnosed by either transthoracic or transesophageal echocardiography were compared with patients with none of these findings on transesophageal echocardiography...
October 31, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29040518/challenges-in-comparing-the-non-vitamin-k-antagonist-oral-anticoagulants-for-atrial-fibrillation-related-stroke-prevention
#20
A John Camm, Keith A A Fox, Eric Peterson
The aim of this review is to provide context for meta-analyses interpreting data from phase III stroke prevention studies of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with non-valvular atrial fibrillation (NVAF). Differences between the four phase III NOAC stroke prevention studies in patients with NVAF (ROCKET AF, ARISTOTLE, RE-LY, and ENGAGE AF), their potential impact on outcomes, and inter-study differences were evaluated, as well as the potential role of real-world evidence in evaluating NOACs in this setting...
October 13, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
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