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Varma N, Cygankiewicz I, Turakhia M, Heidbuchel H, Hu Y, Chen LY, Couderc JP, Cronin EM, Estep JD, Grieten L, Lane DA, Mehra R, Page A, Passman R, Piccini J, Piotrowicz E, Piotrowicz R, Platonov PG, Ribeiro AL, Rich RE, Russo AM, Slotwiner D, Steinberg JS, Svennberg E. 2021 ISHNE/HRS/EHRA/APHRS collaborative statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society. J Arrhythm 2021; 37:271-319. [PMID: 33850572 PMCID: PMC8022003 DOI: 10.1002/joa3.12461] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 02/06/2023] Open
Abstract
This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society describes the current status of mobile health (“mHealth”) technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self‐management are novel aspects of mHealth. The promises of predictive analytics but also operational challenges in embedding mHealth into routine clinical care are explored.
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Varma N, Cygankiewicz I, Turakhia M, Heidbuchel H, Hu Y, Chen LY, Couderc J, Cronin EM, Estep JD, Grieten L, Lane DA, Mehra R, Page A, Passman R, Piccini J, Piotrowicz E, Piotrowicz R, Platonov PG, Ribeiro AL, Rich RE, Russo AM, Slotwiner D, Steinberg JS, Svennberg E. 2021 ISHNE / HRS / EHRA / APHRS Collaborative Statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology / Heart Rhythm Society / European Heart Rhythm Association / Asia Pacific Heart Rhythm Society. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 2:7-48. [PMID: 36711170 PMCID: PMC9708018 DOI: 10.1093/ehjdh/ztab001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology / Heart Rhythm Society / European Heart Rhythm Association / Asia Pacific Heart Rhythm Society describes the current status of mobile health ("mHealth") technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self-management are novel aspects of mHealth. The promises of predictive analytics but also operational challenges in embedding mHealth into routine clinical care are explored.
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Buckley BJR, Harrison SL, Fazio-Eynullayeva E, Underhill P, Lane DA, Thijssen DHJ, Lip GYH. Association of Exercise-Based Cardiac Rehabilitation with Progression of Paroxysmal to Sustained Atrial Fibrillation. J Clin Med 2021; 10:jcm10030435. [PMID: 33498648 PMCID: PMC7865453 DOI: 10.3390/jcm10030435] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 01/07/2023] Open
Abstract
Progression of atrial fibrillation (AF) is associated with worsened prognosis for cardiovascular events and mortality. Exercise-based-cardiac rehabilitation programmes have shown preliminary promise for primary and secondary prevention of AF. Yet, such interventions are typically reserved for patients with acute coronary syndrome or undergoing revascularization. Using a retrospective cohort design, the present study investigated the association of exercise-based cardiac rehabilitation on the progression of paroxysmal to sustained AF, compared to propensity-matched controls. Patients with a diagnosis of paroxysmal AF were compared between those with and without an electronic medical record of exercise-based cardiac rehabilitation within 6-months of diagnosis. Using cox regression models, we ascertained odds of 2-year incidence for AF progression. This cohort of 9808 patients with paroxysmal AF demonstrated that exercise-based cardiac rehabilitation was associated with 26% lower odds of AF progression (odds ratio 0.74, 95% CI 0.66–0.83) compared to propensity-matched controls. This beneficial effect seemed to vary across patient subgroups. In conclusion, findings revealed that exercise-based cardiac rehabilitation was associated with significantly lower odds of progression from paroxysmal to sustained AF at 2-years follow-up compared to propensity-matched controls.
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Harrison SL, Buckley BJR, Fazio-Eynullayeva E, Underhill P, Lane DA, Lip GYH. End-Stage renal disease and 30-day mortality for adults with and without COVID-19. Eur J Intern Med 2021; 83:93-95. [PMID: 33187792 PMCID: PMC7649657 DOI: 10.1016/j.ejim.2020.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/06/2020] [Accepted: 11/08/2020] [Indexed: 11/30/2022]
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Guo Y, Lane DA, Wang L, Zhang H, Wang H, Zhang W, Wen J, Xing Y, Wu F, Xia Y, Liu T, Wu F, Liang Z, Liu F, Zhao Y, Li R, Li X, Zhang L, Guo J, Burnside G, Chen Y, Lip GYH. Mobile Health Technology to Improve Care for Patients With Atrial Fibrillation. J Am Coll Cardiol 2020; 75:1523-1534. [PMID: 32241367 DOI: 10.1016/j.jacc.2020.01.052] [Citation(s) in RCA: 178] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/14/2020] [Accepted: 01/21/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Current management of patients with atrial fibrillation (AF) is limited by low detection of AF, non-adherence to guidelines, and lack of consideration of patients' preferences, thus highlighting the need for a more holistic and integrated approach to AF management. OBJECTIVE The objective of this study was to determine whether a mobile health (mHealth) technology-supported AF integrated management strategy would reduce AF-related adverse events, compared with usual care. METHODS This is a cluster randomized trial of patients with AF older than 18 years of age who were enrolled in 40 cities in China. Recruitment began on June 1, 2018 and follow-up ended on August 16, 2019. Patients with AF were randomized to receive usual care, or integrated care based on a mobile AF Application (mAFA) incorporating the ABC (Atrial Fibrillation Better Care) Pathway: A, Avoid stroke; B, Better symptom management; and C, Cardiovascular and other comorbidity risk reduction. The primary composite outcome was a composite of stroke/thromboembolism, all-cause death, and rehospitalization. Rehospitalization alone was a secondary outcome. Cardiovascular events were assessed using Cox proportional hazard modeling after adjusting for baseline risk. RESULTS There were 1,646 patients allocated to mAFA intervention (mean age, 67.0 years; 38.0% female) with mean follow-up of 262 days, whereas 1,678 patients were allocated to usual care (mean age, 70.0 years; 38.0% female) with mean follow-up of 291 days. Rates of the composite outcome of 'ischemic stroke/systemic thromboembolism, death, and rehospitalization' were lower with the mAFA intervention compared with usual care (1.9% vs. 6.0%; hazard ratio [HR]: 0.39; 95% confidence interval [CI]: 0.22 to 0.67; p < 0.001). Rates of rehospitalization were lower with the mAFA intervention (1.2% vs. 4.5%; HR: 0.32; 95% CI: 0.17 to 0.60; p < 0.001). Subgroup analyses by sex, age, AF type, risk score, and comorbidities demonstrated consistently lower HRs for the composite outcome for patients receiving the mAFA intervention compared with usual care (all p < 0.05). CONCLUSIONS An integrated care approach to holistic AF care, supported by mHealth technology, reduces the risks of rehospitalization and clinical adverse events. (Mobile Health [mHealth] technology integrating atrial fibrillation screening and ABC management approach trial; ChiCTR-OOC-17014138).
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Abstract
Atrial fibrillation (AF) significantly increases the risk of stroke and, therefore, stroke prevention is an essential component of the management for patients with AF. This requires formal assessment of the individual risk of stroke to determine if the patient is eligible for oral anticoagulation (OAC), and if so, their risk of bleeding on OAC, before a treatment decision regarding stroke prevention is made. Risk of stroke is not homogenous; it depends on the presence or absence of risk factors. A plethora of stroke and bleeding risk factors has been identified, including common and less-well established clinical risk factors, plus imaging, urine, and blood biomarkers. Consequently, there are several stroke and bleeding risk stratification scores available and this article provides an overview of them, the risk factors included and how they are scored, and provides a critical appraisal of them. The review also discusses the debate regarding whether female sex is a risk factor or a risk modifier, and highlights the dynamic nature of both stroke and bleeding risk and the need to re-assess these risks periodically to ensure treatment is optimal to reduce the risk of adverse outcomes. This review also summarizes the recommended stroke and bleeding risk stratification scores from all current major international guidelines.
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Lane DA, Dagres N, Dan GA, García Seara J, Iliodromitis K, Lenarczyk R, Lip GYH, Mansourati J, Marín F, Scherr D, Potpara TS. Antithrombotic treatment in patients with atrial fibrillation and acute coronary syndromes: results of the European Heart Rhythm Association survey. Europace 2020; 21:1116-1125. [PMID: 30874724 DOI: 10.1093/europace/euz033] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 02/11/2019] [Indexed: 12/17/2022] Open
Abstract
The management of an acute coronary syndrome (ACS) in a patient with existing atrial fibrillation (AF) often presents a management dilemma both in the acute phase and post-ACS, since the majority of AF patients will already be receiving oral anticoagulation (OAC) for stroke prevention and will require further antithrombotic treatment to reduce the risk of in-stent thrombosis or recurrent cardiac events. Current practice recommendations are based largely on consensus option as there is limited evidence from randomized controlled trials. Prior to the launch of the new European Heart Rhythm Association (EHRA) consensus document, a survey was undertaken to examine current clinical management of these patients across centres in Europe. Forty-seven centres submitted valid responses, with the majority (70.2%) being university hospitals. This EHRA survey demonstrated overall the management of ACS in AF patients is consistent with the available guidance. Most centres would use triple therapy for a short duration (4 weeks) and predominantly utilize a strategy of OAC (vitamin K antagonist, VKA or non-vitamin K antagonist oral anticoagulant, NOAC) plus aspirin and clopidogrel, followed by dual therapy [(N)OAC plus clopidogrel] until 12 months post-percutaneous coronary intervention, followed by (N)OAC monotherapy indefinitely. Where NOAC was used in combination with antiplatelet(s), the lower dose of the respective NOAC was preferred, in accordance with current recommendations.
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Harrison SL, Lane DA, Banach M, Mastej M, Kasperczyk S, Jóźwiak JJ, Lip GY, Al-Shaer B, Andrusewicz W, Andrzejczuk-Rosa M, Anusz-Gaszewska E, Bagińska A, Balawajder P, Bańka G, Barańska-Skubisz E, Barbara Przyczyna B, Bartkowiak S, Bartodziej J, Bartosiewicz M, Basałyga M, Batyra A, Bąk A, Bednarz M, Bejnar K, Bernacki W, Betiuk-Kwiatkowska M, Biegaj S, Bień M, Bilski W, Biłogan M, Biruta-Pawłowska G, Biskup A, Błaszczyk B, Błaszczyk H, Błońska-Jankowska T, Bogacka-Gancarczyk B, Bojanowska M, Bonda E, Borowik-Skwarek J, Borowska J, Bruckner J, Brzostek J, Brzuchacz M, Budzyńska M, Bulzacka-Fugiel I, Bulzak J, Bunikowski K, Cebulska A, Celka T, Cempel-Nowak E, Chechliński W, Chludzińska A, Chmiel D, Chmielewska M, Cichy M, Ciemięga A, Ciepluch A, Cieszyńska I, Czajka B, Czapla B, Czerner M, Czerwińska B, Czuryszkiewicz W, Daleka E, Dawid Z, Dąbrowska M, Dąbrowska R, Dąbrowski D, Dąbrowski M, Demczyszyn K, Dębowska-Serwińska A, Dmochowski J, Dobrzecka-Kiwior J, Dolanowska E, Dolanowski H, Dołek P, Domagała M, Domański H, Doszel A, Duda D, Dudkowska M, Dudziuk B, Dybciak P, Dymanowski M, Dziadzio-Bolek L, Eicke M, El-Hassan H, Eremus A, Fąferek-Muller M, Figura-Roguska E, Fijałkowska-Kaczmarek I, Flis M, Florczak T, Florczuk M, Foryszewska-Witan E, Frydrych W, Fugiel A, Futyma E, Gaca-Jaroszewicz A, Gajdamowicz I, Ganczarski K, Gatnar A, Gers M, Głowacki A, Głód K, Godula J, Gołąb J, Gołębiewski M, Goszczyńska E, Gościcka K, Górna-Hajduga A, Górny E, Grabowska T, Grabowski R, Graczyk-Duda A, Gromow A, Grudewicz A, Gruszecka J, Gruszka A, Gryboś J, Grzebyk J, Grzechowiak A, Grzesiak D, Grześkowiak T, Guźla A, Hachuła G, Hawel B, Hiltawska H, Honkowicz E, Ignatowicz J, Imielski K, Iwaniura A, Jagieła-Szymala A, Jalć-Sowała M, Janczylik A, Janisz E, Janiszek M, Jankiewicz-Ziobro K, Januszewska K, Jaremek A, Jaros-Urbaniak A, Jarosz J, Jarosz P, Jasiński W, Jezierska-Wasilewska M, Jędraszewski T, Jędrzejowska A, Józefowicz R, Jóźwiak J, Juźwin K, Kacprzak E, Kaczmarek-Szewczyk J, Kaczmarzyk M, Kandziora R, Kaniewski C, Karolak-Brandt L, Kasperczyk S, Kasperek-Dyląg E, Kedziora I, Kępa A, Kiciński J, Kielak-Al-Hosam J, Kiełczawa Ł, Kilimowicz P, Kitliński K, Kiwka T, Klein U, Klichowicz L, Klimowicz A, Klonowski B, Kmolek B, Kobyłko-Klepacka E, Kocoń A, Kolenda A, Kollek E, Kopeć M, Koper-Kozikowska B, Koralewska J, Korczyńska M, Korzeniewski M, Kosk A, Kotarski K, Kowalczyk E, Kowalczyk M, Kowalik I, Kozak-Błażkiewicz B, Kozik M, Kozłowska D, Kozłowska E, Kozłowska M, Kozubski T, Kózka K, Kraśnik L, Krężel T, Krochmal B, Król B, Król G, Król J, Królikowska T, Kruszewska H, Krygier-Potrykus B, Krystek W, Krzysztoń J, Kubicki T, Kuczmierczyk-El-Hassan A, Kuczyńska-Witek W, Kujda D, Kurowski A, Kurzelewska-Solarz I, Kwaczyńska M, Kwaśniak M, Kwaśniak P, Kwietniewska T, Łebek-Ordon A, Lebiedowicz A, Lejkowska-Olszewska L, Lentas M, Lesiewicz-Ksycińska A, Limanowski M, Łoniewski S, Łopata J, Łubianka B, Łukasiuk I, Łużna M, Łysiak M, Łysik B, Machowski Z, Maciaczyk-Kubiak J, Mackiewicz-Zabochnicka G, Magner-Krężel Z, Majda S, Malinowski P, Mantyka J, Marchlik E, Martyna-Ordyniec G, Marzec J, Marzec M, Matejko-Wałkiewicz R, Mazur M, Michalczak M, Michalska-Żyłka A, Michniewicz M, Mika-Staniszewska D, Mikiciuk E, Mikołajczak T, Milewski J, Miller E, Misiaszek B, Mizik-Łukowska M, Młyńczyk-Pokutycka E, Mocek M, Moczała M, Morawska-Hermanowicz M, Moryc P, Moskal A, Moskal S, Moździerz A, Moździerz P, Mrozińska M, Mrozowicz K, Mróz G, Munia T, Mura A, Muras-Skudlarska M, Murawska E, Murawski Ł, Murawski R, Musielak R, Nadaj K, Nagarnowicz W, Napierała R, Niedźwiecka M, Niemirski A, Nikiel J, Nosal M, Nowacki W, Nowak J, Nyrka M, Obst A, Ochowicz J, Ogonowska E, Oleszczyk M, Ołdakowski A, Ołowniuk-Stefaniak I, Ordowska-Rejman J, Orliński M, Osińska B, Ostańska-Burian A, Paciorkowska A, Paczkowska U, Paluch L, Pałka L, Paszko-Wojtkowska J, Paszkowska A, Pawlak-Ganczarska E, Pawlik W, Pawłowska I, Paździora M, Permiakow G, Petlic-Marendziak A, Piasecka T, Piaścińska E, Piktel A, Pilarska-Igielska A, Piotrkowska A, Piwowar-Klag K, Planer M, Plewa J, Płatkiewicz P, Płonczyńska B, Podgórska A, Polewska M, Porębska B, Porwoł P, Potakowska I, Prokop A, Przybylski J, Przybyła M, Psiuk H, Ptak K, Puzoń G, Rabiza N, Rachwalik S, Raczyńska E, Raniszewska M, Romanek-Kozik A, Rosa A, Rosa K, Rozewicz A, Rudzka-Kałwak J, Rusak J, Rutkowska D, Rybacki M, Rybińska D, Rycyk-Sadowska A, Rynda L, Rynkiewicz B, Sadowska-Krawczyk B, Sadowska-Zarzycka M, Sarnecka B, Sawalach-Tomanik E, Sidor-Drozd B, Siemieniak-Dębska M, Sieroń A, Siewniak-Zalewska B, Sikora A, Sitarska-Pawlina B, Skorupski J, Skrzypińska-Mansfeld I, Skubisz J, Skwarek R, Słodyczka M, Smentek M, Smolińska K, Solarz B, Sosnowska W, Sroka B, Stachura H, Stangreciak D, Staniak M, Stańczyk Z, Stańszczak-Ozga D, Startek E, Stefańczyk M, Stelmach R, Sternadel-Rączka E, Sternik M, Stępień J, Stocka J, Stokowska-Wojda M, Studler-Karpińska M, Suchorukow W, Sufryd W, Supłacz B, Sygacz J, Szczepański Ł, Szkandera J, Szłapa-Zellner J, Szydlarska D, Śliwa T, Śliwka J, Śmiejkowski Ł, Targońska A, Tesarska E, Tobiasz M, Tomaka J, Tomalska-Bywalec K, Tomiak E, Topczewski S, Trawińska A, Trela-Mucha L, Trojanowski D, Trzaskowska M, Trzcińska-Larska B, Trznadel-Mozul A, Ulanicka-Liwoch K, Urbanowicz M, Uthke-Kluzek A, Waczyński J, Walczak J, Warsz L, Wasyńczuk M, Wąchała-Jędras U, Wąsowicz D, Wczysła J, Wenda F, Werner-Kubicka E, Weryszko E, Węgrzynowska B, Wiaksa M, Wiankowski M, Wicherek A, Wieczorek R, Wiencek R, Wienzek-Tatara G, Wierzbicka B, Wierzbicki M, Wilczyńska B, Wilmańska D, Winiarski P, Wiszniewska-Pabiszczak A, Witkowska M, Witzling J, Wlaź A, Wojtkowiak I, Woydyłło J, Woźniak K, Wójtowicz A, Wrona J, Wrońska M, Wujkowska H, Wyrąbek J, Wysokiński O, Zakrzewski R, Zaleska-Zatkalik J, Zaleski J, Zalewska- Dybciak M, Zalewska E, Zalewska-Uchimiak B, Zawadzka-Krajewska J, Zawadzki J, Zieliński A, Zubrycka E, Żybort I, Żymełka M. Lipid levels, atrial fibrillation and the impact of age: Results from the LIPIDOGRAM2015 study. Atherosclerosis 2020; 312:16-22. [DOI: 10.1016/j.atherosclerosis.2020.08.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/04/2020] [Accepted: 08/13/2020] [Indexed: 12/22/2022]
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Ivany E, Lane DA. Patient Satisfaction: A Key Component in Increasing Treatment Adherence and Persistence. Thromb Haemost 2020; 121:255-257. [PMID: 33124024 DOI: 10.1055/s-0040-1718734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Lane DA. Homelessness: a ‘cause of the causes’ of cardiovascular disease? BRITISH HEART JOURNAL 2020; 106:1456-1457. [DOI: 10.1136/heartjnl-2020-317224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Guo Y, Lane DA, Chen Y, Lip GYH. Regular Bleeding Risk Assessment Associated with Reduction in Bleeding Outcomes: The mAFA-II Randomized Trial. Am J Med 2020; 133:1195-1202.e2. [PMID: 32289310 DOI: 10.1016/j.amjmed.2020.03.019] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND The mobile atrial fibrillation application (mAFA-II) randomized trial reported that a holistic management strategy supported by mobile health reduced atrial fibrillation-related adverse outcomes. The present study aimed to assess whether regular reassessment of bleeding risk using the Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile international normalized ratio, Elderly, Drugs or alcohol (HAS-BLED) score would improve bleeding outcomes and oral anticoagulant (OAC) uptake. METHODS Bleeding risk (HAS-BLED score) was monitored prospectively using mAFA, and calculated as 30 days, days 31-60, days 61-180, and days 181-365. Clinical events and OAC changes in relation to the dynamic monitoring were analyzed. RESULTS We studied 1793 patients with atrial fibrillation (mean, standard deviation, age 64 years, 24 years, 32.5% female). Comparing baseline and 12 months, the proportion of atrial fibrillation patients with HAS-BLED ≥3 decreased (11.8% vs 8.5%, P = .008), with changes in use of concomitant nonsteroidal antiinflammatory drugs/antiplatelets, renal dysfunction, and labile international normalized ratio contributing to the decreased proportions of patients with HAS-BLED ≥3 (P < .05). Among 1077 (60%) patients who had 4 bleeding risk assessments, incident bleeding events decreased significantly from days 1-30 to days 181-365 (1.2% to 0.2%, respectively, P < .001). Total OAC usage increased from 63.4% to 70.2% (Ptrend < .001). Compared with atrial fibrillation patients receiving usual care (n = 1136), bleeding events were significantly lower in atrial fibrillation patients with dynamic monitoring of their bleeding risk (mAFA vs usual care, 2.1%, 4.3%, P = .004). OAC use decreased significantly by 25% among AF patients receiving usual care, when comparing baseline to 12 months (P < .001). CONCLUSION Dynamic risk monitoring using the HAS-BLED score, together with holistic App-based management using mAFA-II reduced bleeding events, addressed modifiable bleeding risks, and increased uptake of OACs.
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Vitolo M, Proietti M, Harrison S, Lane DA, Potpara TS, Boriani G, Lip GYH. The Euro Heart Survey and EURObservational Research Programme (EORP) in atrial fibrillation registries: contribution to epidemiology, clinical management and therapy of atrial fibrillation patients over the last 20 years. Intern Emerg Med 2020; 15:1183-1192. [PMID: 32557091 DOI: 10.1007/s11739-020-02405-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/08/2020] [Indexed: 12/17/2022]
Abstract
Management of atrial fibrillation (AF) may be challenging in clinical practice. Given the complexity of AF patients and the continuous advances in AF clinical management, there is a need for standardized programmes aimed at collecting so-called 'real-world clinical practice data' regarding the epidemiology, diagnostic/therapeutic/management practices and assessing adherence to guidelines. Over the past 20 years, the number of registries and surveys based on real-world AF patients has been dramatically increased. In Europe, based on the Euro Heart Survey (EHS) and the EURObservational Research Programme (EORP), a large series of studies based on these prospective, observational, large-scale multicentre registries on AF have been published. This narrative review gives an overview of these two projects on AF led by the European Society of Cardiology, focusing mainly on the contribution that these studies have provided to AF management and patient outcomes. Both the EHS and the EORP registries have collected a large amount of data regarding contemporary clinical practice, and despite some limitations, mainly related to their observational nature, these registries have contributed to our knowledge and clinical management of AF patients.
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Domek M, Gumprecht J, Ding WY, Lip GYH, Lane DA. Practice-derived data on non-vitamin K antagonist oral anticoagulant therapy to complement observations from randomized trials. Eur Heart J Suppl 2020; 22:I1-I12. [PMID: 33093817 PMCID: PMC7556745 DOI: 10.1093/eurheartj/suaa100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Anticoagulation is fundamental in the management of patients with atrial fibrillation (AF). The study aims to provide a comparative review of the major phase III randomized clinical trials (RCTs) and real-world data (RWD) from reliable, high-grade Phase IV studies that assess the efficacy and safety of non-vitamin K antagonist oral anticoagulants (NOACs) vs. vitamin K antagonists (VKAs). Observational studies based on nationwide or health insurance database records on the use of NOACs vs. VKAs in patients with AF were included. We performed a comparison of the efficacy and safety characteristics associated with NOACs vs. VKAs in RCTs and RWD. Although RCTs provide strong support for evidence-based practice, RWD may be used to reflect the broader picture of various clinical settings, provide supplementary insight and fulfil knowledge gaps. Both study types confirmed the safety and efficacy of NOACs in preventing stroke and thromboembolism in patients with AF. In comparison to VKAs, NOACs were associated with reduced risk of ischaemic events and lower rates of adverse events such as major bleeding or intracranial haemorrhage. Administration of NOACs might be associated with increased risk of dose-related gastrointestinal bleeding and myocardial ischaemic events, especially in the early treatment period after switching from VKAs. Special care should be taken in challenging clinical situations like severe renal or hepatic impairment when the treatment regimen needs to be considered individually. Randomized clinical trial and RWD studies are complementary and present comparable findings, affirming that NOACs are safe and effective for anticoagulation of patients with AF in daily clinical practice.
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Harrison SL, Fazio-Eynullayeva E, Lane DA, Underhill P, Lip GYH. Comorbidities associated with mortality in 31,461 adults with COVID-19 in the United States: A federated electronic medical record analysis. PLoS Med 2020; 17:e1003321. [PMID: 32911500 PMCID: PMC7482833 DOI: 10.1371/journal.pmed.1003321] [Citation(s) in RCA: 269] [Impact Index Per Article: 67.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/07/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND At the beginning of June 2020, there were nearly 7 million reported cases of coronavirus disease 2019 (COVID-19) worldwide and over 400,000 deaths in people with COVID-19. The objective of this study was to determine associations between comorbidities listed in the Charlson comorbidity index and mortality among patients in the United States with COVID-19. METHODS AND FINDINGS A retrospective cohort study of adults with COVID-19 from 24 healthcare organizations in the US was conducted. The study included adults aged 18-90 years with COVID-19 coded in their electronic medical records between January 20, 2020, and May 26, 2020. Results were also stratified by age groups (<50 years, 50-69 years, or 70-90 years). A total of 31,461 patients were included. Median age was 50 years (interquartile range [IQR], 35-63) and 54.5% (n = 17,155) were female. The most common comorbidities listed in the Charlson comorbidity index were chronic pulmonary disease (17.5%, n = 5,513) and diabetes mellitus (15.0%, n = 4,710). Multivariate logistic regression analyses showed older age (odds ratio [OR] per year 1.06; 95% confidence interval [CI] 1.06-1.07; p < 0.001), male sex (OR 1.75; 95% CI 1.55-1.98; p < 0.001), being black or African American compared to white (OR 1.50; 95% CI 1.31-1.71; p < 0.001), myocardial infarction (OR 1.97; 95% CI 1.64-2.35; p < 0.001), congestive heart failure (OR 1.42; 95% CI 1.21-1.67; p < 0.001), dementia (OR 1.29; 95% CI 1.07-1.56; p = 0.008), chronic pulmonary disease (OR 1.24; 95% CI 1.08-1.43; p = 0.003), mild liver disease (OR 1.26; 95% CI 1.00-1.59; p = 0.046), moderate/severe liver disease (OR 2.62; 95% CI 1.53-4.47; p < 0.001), renal disease (OR 2.13; 95% CI 1.84-2.46; p < 0.001), and metastatic solid tumor (OR 1.70; 95% CI 1.19-2.43; p = 0.004) were associated with higher odds of mortality with COVID-19. Older age, male sex, and being black or African American (compared to being white) remained significantly associated with higher odds of death in age-stratified analyses. There were differences in which comorbidities were significantly associated with mortality between age groups. Limitations include that the data were collected from the healthcare organization electronic medical record databases and some comorbidities may be underreported and ethnicity was unknown for 24% of participants. Deaths during an inpatient or outpatient visit at the participating healthcare organizations were recorded; however, deaths occurring outside of the hospital setting are not well captured. CONCLUSIONS Identifying patient characteristics and conditions associated with mortality with COVID-19 is important for hypothesis generating for clinical trials and to develop targeted intervention strategies.
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Lane DA, McMahon N, Gibson J, Weldon JC, Farkowski MM, Lenarczyk R, Watkins CL, Dilaveris P, Caiani EG, Potpara TS. Mobile health applications for managing atrial fibrillation for healthcare professionals and patients: a systematic review. Europace 2020; 22:euaa269. [PMID: 32853369 DOI: 10.1093/europace/euaa269] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/15/2020] [Indexed: 02/24/2024] Open
Abstract
AIMS A plethora of mobile health applications (m-health apps) to support healthcare are available for both patients and healthcare professionals (HCPs) but content and quality vary considerably and few have undergone formal assessment. The aim is to systematically review the literature on m-health apps for managing atrial fibrillation (AF) that examine the impact on knowledge of AF, patient and HCP behaviour, patients' quality-of-life, and user engagement. METHODS AND RESULTS MEDLINE, EMBASE, CINAHL, and PsychInfo were searched from 1 January 2005 to 5 September 2019, with hand-searching of clinical trial registers and grey literature. Studies were eligible for inclusion if they reported changes in any of the following: (i) knowledge of AF; (ii) provider behaviour (e.g. guideline adherence); (iii) patient behaviour (e.g. medication adherence); (iv) patient quality-of-life; and (v) user engagement. Two reviewers independently assessed articles for eligibility. A narrative review was undertaken as included studies varied widely in their design, interventions, comparators, and outcomes. Seven studies were included; six m-health apps aimed at patients and one at HCPs. Mobile health apps ranged widely in design, features, and method of delivery. Four studies reported patient knowledge of AF; three demonstrated significant knowledge improvement post-intervention or compared to usual care. One study reported greater HCP adherence to oral anticoagulation guidelines after m-health app implementation. Two studies reported on patient medication adherence and quality-of-life; both showed improved quality-of-life post-intervention but only one observed increased adherence. Regarding user engagement, five studies reported patient perspectives on usability, three on acceptability, and one on feasibility; overall all m-health apps were rated positively. CONCLUSION Mobile health apps demonstrate improvements in patient knowledge, behaviour, and quality of life. Studies formally evaluating the impact of m-health on HCP behaviour are scarce and larger-scale studies with representative patient cohorts, appropriate comparators, and longer-term assessment of the impact of m-health apps are warranted.
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Guo Y, Lane DA, Chen Y, Lip GYH. Letter by Guo et al Regarding Article, "SUPPORT-AF II: Supporting Use of Anticoagulants Through Provider Profiling of Oral Anticoagulant Therapy for Atrial Fibrillation". Circ Cardiovasc Qual Outcomes 2020; 13:e006635. [PMID: 32375505 DOI: 10.1161/circoutcomes.120.006635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Zulkifly H, Cheli P, Lutchman I, Bai Y, Lip GYH, Lane DA. Anticoagulation control in different ethnic groups receiving vitamin K antagonist therapy for stroke prevention in atrial fibrillation. Thromb Res 2020; 192:12-20. [PMID: 32416364 DOI: 10.1016/j.thromres.2020.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/18/2020] [Accepted: 04/02/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Efficacy and safety of vitamin K antagonists (VKAs) is optimised in atrial fibrillation (AF) patients when the International Normalised Ratio (INR) is 2.0-3.0. Anticoagulation control comparing different ethnic groups is limited, although epidemiological studies suggest poorer INR control in non-white cohorts. METHODS VKA control was assessed retrospectively by time-in-the-therapeutic range (TTR) (Rosendaal method) and percentage INR-in-range (PINRR) in 991 White, Afro-Caribbean and South-Asian AF patients [overall mean (SD) age 71.6 (9.4) years; 55% male; mean (SD) CHA2DS2-VASc score 3.4 (1.6)] over a median (IQR) follow-up of 5.2 (3.2-7.0) years. RESULTS Compared to Whites, mean (SD) TTR and PINRR were significantly lower in South-Asians [TTR 67.9% vs. 60.5%; PINRR 58.8% vs. 51.6%, respectively] and Afro-Caribbeans [TTR 67.9% vs. 61.3%; PINRR 58.8% vs. 53.1%, respectively], despite similar INR monitoring intensity. Logistic regression revealed non-white ethnicity [OR 2.62; 95% Confidence Interval [CI] (1.67-4.10) and OR 3.47 (1.44-8.34)] and anaemia [OR 1.65 (1.00-2.70) and OR 6.27 (1.89-20.94)] as independent predictors of both TTR and PINRR < 70%, respectively. At follow-up, 329 (33.2%) patients experienced ≥1 major adverse clinical event. Cardiovascular hospitalisation was significantly higher among South-Asians (32.3%) compared to the Whites and Afro-Caribbeans (21.3% vs 25.6% respectively). CONCLUSIONS Ethnic disparities in quality of anticoagulation control are evident, with South-Asians and Afro-Caribbeans having poorer control compared to Whites, despite similar intensity INR monitoring. Non-white ethnicity remained the strongest independent predictor of poor TTR and PINRR. Interventions to improve anticoagulation control need to be implemented, particularly targeting ethnic minority patients.
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Proietti M, Romiti GF, Olshansky B, Lane DA, Lip GYH. Comprehensive Management With the ABC (Atrial Fibrillation Better Care) Pathway in Clinically Complex Patients With Atrial Fibrillation: A Post Hoc Ancillary Analysis From the AFFIRM Trial. J Am Heart Assoc 2020; 9:e014932. [PMID: 32370588 PMCID: PMC7660878 DOI: 10.1161/jaha.119.014932] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background For patients with atrial fibrillation, a comprehensive care approach based on the Atrial fibrillation Better Care (ABC) pathway can reduce the occurrence of adverse outcomes. The aim of this paper was to investigate if an approach based on the ABC pathway is associated with a reduced risk of adverse events in “clinically complex” atrial fibrillation patients, including those with multiple comorbidities, polypharmacy, and prior hospitalizations. Methods and Results We performed a post hoc analysis of the AFFIRM (Atrial Fibrillation Follow‐up Investigation of Rhythm Management) trial. The principal outcome was the composite of all‐cause hospitalization and all‐cause death. An integrated care approach (ABC group) was used in 3.8% of the multimorbidity group, 4.0% of the polypharmacy group, and 4.8%, of the hospitalized groups. In all “clinically complex” groups, the cumulative risk of the composite outcome was significantly lower in patients managed consistent with the ABC pathway versus non‐ABC pathway‐adherent (all P<0.05). Cox regression analysis showed a reduction of composite outcomes in ABC pathway‐adherent versus non‐ABC pathway‐adherent for multimorbidity (hazard ratio [HR], 0.61, 95% CI, 0.44–0.85), polypharmacy (HR, 0.68, 95% CI, 0.47–1.00), and hospitalization (HR, 0.59, 95% CI, 0.42–0.85) groups. Secondary analyses showed that the higher number of ABC criteria fulfilled the larger associated reduction in relative risk, even for secondary outcomes considered. Conclusions Use of an ABC consistent pathway is associated with fewer major adverse events in patients with atrial fibrillation who have multiple comorbidities, use of polypharmacy, and prior hospitalization.
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Guo Y, Lane DA, Chen Y, Lip GYH. Mobile health technology facilitates population screening and integrated care management in patients with atrial fibrillation. Eur Heart J 2020; 41:1617-1619. [PMID: 32357234 DOI: 10.1093/eurheartj/ehaa161] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Vitolo M, Lane DA, Boriani G, Lip GYH. The importance of adherence and persistence with oral anticoagulation treatment in patients with atrial fibrillation. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2020; 7:f81-f83. [PMID: 32324229 DOI: 10.1093/ehjcvp/pvaa020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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McMahon NE, Bangee M, Benedetto V, Bray EP, Georgiou RF, Gibson JME, Lane DA, Al-Khalidi AH, Chatterjee K, Chauhan U, Clegg AJ, Lightbody CE, Lip GYH, Sekhar A, Watkins CL. Etiologic Workup in Cases of Cryptogenic Stroke: A Systematic Review of International Clinical Practice Guidelines. Stroke 2020; 51:1419-1427. [PMID: 32279620 PMCID: PMC7185056 DOI: 10.1161/strokeaha.119.027123] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Supplemental Digital Content is available in the text. Identifying the etiology of acute ischemic stroke is essential for effective secondary prevention. However, in at least one third of ischemic strokes, existing investigative protocols fail to determine the underlying cause. Establishing etiology is complicated by variation in clinical practice, often reflecting preferences of treating clinicians and variable availability of investigative techniques. In this review, we systematically assess the extent to which there exists consensus, disagreement, and gaps in clinical practice recommendations on etiologic workup in acute ischemic stroke.
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Guo Y, Lip GYH, Lane DA. Lifestyle and risk factor modification for reduction of atrial fibrillation: We could do more. Trends Cardiovasc Med 2020; 30:387-388. [PMID: 32276083 DOI: 10.1016/j.tcm.2020.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 10/24/2022]
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Ding WY, Harrison SL, Lane DA, Lip GYH. Considerations when choosing an appropriate bleeding risk assessment tool for patients with atrial fibrillation. J Thromb Haemost 2020; 18:788-790. [PMID: 32233026 DOI: 10.1111/jth.14738] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 01/12/2020] [Indexed: 12/11/2022]
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Harrison SL, Lane DA, Guo Y, Lip GYH. The potential for photoplethysmographic (PPG)-based smart devices in atrial fibrillation detection. Expert Rev Med Devices 2020; 17:253-255. [PMID: 32138559 DOI: 10.1080/17434440.2020.1740085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Proietti M, Lane DA. The Compelling Issue of Nonvitamin K Antagonist Oral Anticoagulant Adherence in Atrial Fibrillation Patients: A Systematic Need for New Strategies. Thromb Haemost 2020; 120:369-371. [PMID: 32135563 DOI: 10.1055/s-0040-1702231] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Ding WY, Harrison S, Gupta D, Lip GYH, Lane DA. Stroke and Bleeding Risk Assessments in Patients With Atrial Fibrillation: Concepts and Controversies. Front Med (Lausanne) 2020; 7:54. [PMID: 32154260 PMCID: PMC7047213 DOI: 10.3389/fmed.2020.00054] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 02/05/2020] [Indexed: 12/20/2022] Open
Abstract
Risk assessments are an important element in the management of patients with atrial fibrillation (AF). In this review, we aim to discuss the concepts and controversies surrounding the various risk factors for stroke and bleeding in AF. Indeed, there are a variety of clinical, electrical, biological, and genetic markers to guide stroke and bleeding risk assessments in AF. The more common factors have been used to formulate risk stratification scores. Some risk factors have shown promise, but others remain less well-defined. Our aim is to discuss concepts and controversies surrounding current evidence of risk factors for stroke and bleeding assessments in AF.
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Montalescot G, Brotons C, Cosyns B, Crijns HJ, D'Angelo A, Drouet L, Eberli F, Lane DA, Besse B, Chan A, Vicaut E, Darius H. Educational Impact on Apixaban Adherence in Atrial Fibrillation (the AEGEAN STUDY): A Randomized Clinical Trial. Am J Cardiovasc Drugs 2020; 20:61-71. [PMID: 31243691 PMCID: PMC6978445 DOI: 10.1007/s40256-019-00356-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Introduction Adherence to non-vitamin-K oral anticoagulants (NOACs) may be lower than to vitamin K antagonists because NOACs do not require routine monitoring. Objective We assessed the impact of an educational program on adherence and persistence with apixaban in patients with non-valvular atrial fibrillation (NVAF). Methods Patients with NVAF eligible for NOACs with one or more stroke risk factor (prior stroke/transient ischemic attack, age ≥ 75 years, hypertension, diabetes, or symptomatic heart failure) were randomized (1:1) to standard of care (SOC) or SOC with additional educational (information booklet, reminder tools, virtual clinic access). The primary outcome was adherence to apixaban (2.5 or 5 mg twice daily) at 24 weeks. Patients receiving the educational program were re-randomized (1:1) to continue the program for 24 further weeks or to switch to secondary SOC. Implementation adherence and persistence were reassessed at 48 weeks. Results In total, 1162 patients were randomized (SOC, 583; educational program, 579). Mean implementation adherence ± standard deviation (SD) at 24 weeks was 91.6% ± 17.1 for SOC and 91.9% ± 16.1 for the educational program arm; results did not differ significantly between groups at any time-point. At 48 weeks, implementation adherence was 90.4% ± 18.0, 90.1% ± 18.6, and 89.3% ± 18.1 for continued educational program, SOC, and secondary SOC, respectively; and corresponding persistence was 86.1% (95% confidence interval [CI] 81.3–89.7), 85.2% (95% CI 81.5–88.2), and 87.8% (95% CI 83.4–91.1). Serious adverse events were similar across groups. Conclusion High implementation adherence and persistence with apixaban were observed in patients with NVAF receiving apixaban. The educational program did not show additional benefits. Clinical trial registration This study is registered at ClinicalTrials.gov [NCT01884350]. Electronic supplementary material The online version of this article (10.1007/s40256-019-00356-2) contains supplementary material, which is available to authorized users.
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Diener HC, Hart RG, Koudstaal PJ, Lane DA, Lip GYH. Atrial Fibrillation and Cognitive Function: JACC Review Topic of the Week. J Am Coll Cardiol 2020; 73:612-619. [PMID: 30732716 DOI: 10.1016/j.jacc.2018.10.077] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 10/14/2018] [Accepted: 10/30/2018] [Indexed: 12/15/2022]
Abstract
Numerous vascular risk factors and vascular diseases contribute to cognitive impairment and dementia. Many studies and registries show an association of atrial fibrillation (AF) with cognitive impairment, cognitive decline, and dementia. This is true for vascular dementia and Alzheimer's disease. The assumed multifactorial mechanisms include ischemic stroke, both apparent and silent, cerebral microinfarcts, cerebral hemorrhage, and reduced cerebral blood flow. A number of retrospective observational and prospective studies support that anticoagulation in patients with AF may reduce the risk of cognitive decline and dementia. This holds for both vitamin K antagonists (e.g., warfarin) and direct oral anticoagulants. However, it still remains unproven if anticoagulation reduces cognitive decline and dementia in AF patients based on randomized trials.
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Bray EP, McMahon NE, Bangee M, Al-Khalidi AH, Benedetto V, Chauhan U, Clegg AJ, Georgiou RF, Gibson J, Lane DA, Lip GYH, Lightbody E, Sekhar A, Chatterjee K, Watkins CL. Etiologic workup in cases of cryptogenic stroke: protocol for a systematic review and comparison of international clinical practice guidelines. Syst Rev 2019; 8:331. [PMID: 31847884 PMCID: PMC6918649 DOI: 10.1186/s13643-019-1247-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 11/26/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Stroke is a leading cause of death and disability worldwide. Identifying the aetiology of ischaemic stroke is essential in order to initiate appropriate and timely secondary prevention measures to reduce the risk of recurrence. For the majority of ischaemic strokes, the aetiology can be readily identified, but in at least 30% of cases, the exact aetiology cannot be determined using existing investigative protocols. Such strokes are classed as 'cryptogenic' or as a stroke of unknown origin. However, there exists substantial variation in clinical practice when investigating cases of seemingly cryptogenic stroke, often reflecting local service availability and the preferences of treating clinicians. This variation in practice is compounded by the lack of international consensus as to the optimum level and timing of investigations required following a stroke. To address this gap, we aim to systematically review and compare recommendations in evidence-based clinical practice guidelines (CPGs) that relate to the assessment and investigation of the aetiology of ischaemic stroke, and any subsequent diagnosis of cryptogenic stroke. METHOD We will search for CPGs using electronic databases (MEDLINE, Health Management Information Consortium (HMIC), EMBASE, and CINAHL), relevant websites and search engines (e.g. guideline specific websites, governmental, charitable, and professional practice organisations) and hand-searching of bibliographies and reference lists. Two reviewers will independently screen titles, abstracts and CPGs using a pre-defined relevance criteria form. From each included CPG, we will extract definitions and terms for cryptogenic stroke; recommendations related to assessment and investigation of the aetiology of stroke, including the grade of recommendations and underpinning evidence. The quality of the included CPGs will be assessed using the AGREE II (Appraisal of Guidelines for Research and Evaluation) tool. Recommendations across the CPGs will be summarised descriptively highlighting areas of convergence and divergence between CPGs. DISCUSSION To our knowledge, this will be the first review to systematically compare recommendations of international CPGs on investigating the aetiology of ischaemic stroke. The findings will allow for a better understanding of international perspectives on the optimum level of investigations required following a stroke and thus contribute to achieving greater international consensus on best practice in this important and complex area. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019127822.
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Harrison SL, Lane DA, Lip GYH. Reducing risk of adverse cardiovascular and renal outcomes for patients with atrial fibrillation and type 2 diabetes. Eur J Heart Fail 2019; 22:136-138. [PMID: 31820530 DOI: 10.1002/ejhf.1685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Katritsis DG, Boriani G, Cosio FG, Hindricks G, Jais P, Josephson ME, Keegan R, Kim YH, Knight BP, Kuck KH, Lane DA, Lip GYH, Malmborg H, Oral H, Pappone C, Themistoclakis S, Wood KA, Blomström-Lundqvist C. European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardiaca y Electrofisiologia (SOLAECE). Eur Heart J 2019; 39:1442-1445. [PMID: 27856499 DOI: 10.1093/eurheartj/ehw455] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 09/12/2016] [Indexed: 11/14/2022] Open
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Huppertz N, Lip GYH, Lane DA. Validation of the modified Microlife blood pressure monitor in patients with paroxysmal atrial fibrillation. Clin Res Cardiol 2019; 109:802-809. [PMID: 31701215 PMCID: PMC7308245 DOI: 10.1007/s00392-019-01567-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/23/2019] [Indexed: 11/29/2022]
Abstract
AIMS Undiagnosed atrial fibrillation (AF) accounts for 6% of all strokes, therefore early detection and treatment of the arrhythmia are paramount. Previous research has illustrated that the Microlife WatchBPO3 AFIB, an automated blood pressure (BP) monitor with an inbuilt AF algorithm, accurately detects permanent AF. Currently, limited data exist on whether the modified BP monitor is able to detect paroxysmal AF (PAF). Therefore, this study aims to assess the accuracy of the Microlife WatchBPO3 AFIB monitor to detect PAF against a pacemaker reference standard over a 24-h period. METHODS AND RESULTS Forty-eight patients with a pacemaker implanted for sick sinus syndrome and previously documented fast AF participated. Sensitivity of the atrial pacemaker lead was set to allow detection of signals of ≥ 0.5 mV. Patients engaged in their normal daily routine whilst wearing the modified BP monitor. The modified BP monitor demonstrated an overall sensitivity of 76.0% and specificity of 80.8% for detecting PAF. This sensitivity and specificity increased to 100% and 83.1%, respectively, for patients that achieved more than 80% successful BP readings. Compared to day-time readings, night-time readings also demonstrated a lower proportion of movement artefact (14.4% vs. 3.4%), and therefore, a higher sensitivity and specificity of 100% and 84.9%, respectively, for detecting PAF. CONCLUSION The Microlife WatchBPO3 AFIB device has an acceptable diagnostic accuracy to detect PAF; however, movement artefact affects the accuracy of the readings. This modified BP monitor may potentially be useful as a screening tool for AF in patients at high risk of developing stroke.
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Miyazawa K, Ogawa H, Mazurek M, Shantsila E, Lane DA, Wolff A, Akao M, Lip GYH. Guideline-Adherent Treatment for Stroke and Death in Atrial Fibrillation Patients From UK and Japanese AF Registries. Circ J 2019; 83:2434-2442. [PMID: 31694989 DOI: 10.1253/circj.cj-19-0546] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Guideline-adherent antithrombotic treatment (ATT) reduces the risk of stroke and death in patients with atrial fibrillation (AF). However, the effect of ATT adherence among different ethnicities remains uncertain. We compared the prognosis of AF patients in Japan and the UK according to guideline adherence status.Methods and Results:We compared the clinical characteristics and outcomes of AF patients from the Fushimi AF registry (Japan; n=4,239) and the Darlington AF registry (UK; n=2,259). ATT adherence was assessed against the Japanese Circulation Society Guidelines and UK National Institute for Health and Care Excellence guidelines. The rates of guideline-adherent ATT were 58.6% and 50.8% in the Fushimi and Darlington registries, respectively. There was no significant difference in 1-year stroke rates between Fushimi and Darlington (2.6% vs. 3.0%, P=0.342). On multivariate logistic regression analysis, non-guideline adherent-ATT was significantly associated with an increased risk of stroke (odds ratio [OR]: 1.69, 95% confidence interval [CI]: 1.21-2.34, P=0.002 for undertreatment, OR: 2.13, 95% CI: 1.19-3.80, P=0.010 for overtreatment). No significant interaction for ATT and the 2 populations was found in the incidence of stroke, all-cause death, and the composite outcome. CONCLUSIONS Approximately half of the AF patients received optimal ATT according to guideline recommendations, which was associated with a lower risk of stroke. Furthermore, there was no interaction for the 2 populations and the influence of ATT adherence.
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Ritchie LA, Penson PE, Lane DA. Warfarin Therapy and Improved Anticoagulation Control by Patient Self-Management. Thromb Haemost 2019; 119:1550-1552. [PMID: 31564055 DOI: 10.1055/s-0039-1696982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Fanikos J, Murwin D, Gruenenfelder F, Tartakovsky I, França LR, Reilly PA, Kermer P, Wowern FV, Lane DA, Butcher K. Global Use of Idarucizumab in Clinical Practice: Outcomes of the RE-VECTO Surveillance Program. Thromb Haemost 2019; 120:27-35. [DOI: 10.1055/s-0039-1695771] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AbstractIdarucizumab was approved for the reversal of dabigatran in 2015. We investigated whether postapproval usage patterns of idarucizumab in a real-world setting reflect those observed in the pivotal trials. No safety or efficacy data were collected in this medical record-based observational study. RE-VECTO, a global postapproval, international, surveillance program, involved hospital pharmacies in countries where idarucizumab was licensed and dispensed (August 2016–June 2018). Characteristics of sites prescribing idarucizumab and of eligible patients (≥ 18 years old and receiving idarucizumab regardless of prior oral anticoagulant use), as well as idarucizumab utilization data, were collected and analyzed descriptively. Sixty-one sites enrolled 359 patients. Most pharmacies (85.2%) were centralized, and the median idarucizumab units stocked per hospital was 2.0 (interquartile range, 1.0–3.0). Almost three-quarters of patients were elderly (74.9% aged > 70 years), and only four (1.1%) had received idarucizumab before. Nearly all patients were treated with dabigatran (97.5%). There was a low frequency of unapproved dabigatran dosage regimens (3.3%). Life-threatening or uncontrolled bleeding was the most frequent indication for idarucizumab (57.7%), followed by emergency surgery/urgent procedure (35.9%). Of the life-threatening bleeding events, the most frequent were gastrointestinal tract (44.4%) and intracranial (38.6%). Most patients (95.0%) were given the full dose of two vials (2 × 2.5 g) of idarucizumab initially, and very few (1.7%) received a second dose. Of those patients requiring emergency or scheduled/planned surgery/procedures, 25.5% underwent gastrointestinal and/or abdominal surgery/procedures. Real-world usage patterns of idarucizumab provide valuable insights into emergency reversal strategies. Off-label use was minimal.
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Lane DA, Lip GYH. Integrated care for the management of atrial fibrillation: what are the key components and important outcomes? Europace 2019; 21:1759-1761. [DOI: 10.1093/europace/euz211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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137
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Guo Y, Lane DA, Wang L, Chen Y, Lip GYH. Mobile Health (mHealth) technology for improved screening, patient involvement and optimising integrated care in atrial fibrillation: The mAFA (mAF-App) II randomised trial. Int J Clin Pract 2019; 73:e13352. [PMID: 31002434 DOI: 10.1111/ijcp.13352] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 04/14/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Current management of patients with atrial fibrillation (AF) is limited by low detection of AF, non-adherence to guidelines and lack of consideration of patient's preferences, thus highlighting the need for a holistic and integrated approach to AF management. This study aims to determine whether a mHealth technology-supported AF integrated management strategy will reduce AF-related adverse events. METHODS/DESIGN The mAFA II trial is a prospective, cluster randomised controlled trial. The 40 sites will be randomised to mAFA-integrated care intervention or usual care arms. Prior to randomisation, study sites will be paired to be matched in size and the proportion of study eligible patients. All AF patients aged over 18 years old with CHA2 DS2 -VASc score ≥ 2 will be enrolled. Assuming a composite adverse event rate of 10% pre-intervention, reduced to 5% after intervention, we aim to recruit 3660 patients assuming a 10% loss to follow-up. The primary study endpoint is a composite of stroke/thromboembolism, all-cause death and rehospitalisation. Ancillary analyses would determine patient-related outcome measures, health economics and cost effectiveness, as well as an embedded qualitative study. DISCUSSION The mAFA II trial will provide evidence for an integrated care approach to holistic AF care, supported by mobile health technology to improve screening, patient involvement and optimisation of management.
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Højen AA, Søgaard M, Melgaard L, Lane DA, Sørensen EE, Goldhaber SZ, Larsen TB. Psychotropic drug use following venous thromboembolism versus diabetes mellitus in adolescence or young adulthood: a Danish nationwide cohort study. BMJ Open 2019; 9:e026159. [PMID: 31092651 PMCID: PMC6530366 DOI: 10.1136/bmjopen-2018-026159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Critical and chronic illness in youth such as diabetes can lead to impaired mental health. Despite the potentially traumatic and life-threatening nature of venous thromboembolism (VTE), the long-term mental health of adolescents and young adults with VTE is unclear. We compared the long-term mental health of adolescents and young adults with VTE versus adolescents and young adults with insulin-dependent diabetes mellitus (IDDM) using psychotropic drug purchase as proxy for mental health. DESIGN Nationwide registry-based cohort study. SETTING Denmark 1997-2015. PARTICIPANTS All patients aged 13-33 years with an incident diagnosis of VTE (n=5065) or IDDM (n=6609). EXPOSURE First time primary hospital diagnosis of VTE or IDDM. PRIMARY AND SECONDARY OUTCOME MEASURES Adjusted absolute risk and risk difference at 1 and 5 years follow-up for first psychotropic drug purchase comparing patients with VTE and patients with IDDM. RESULTS The absolute 1 year risk of psychotropic drug use was 6.2% among VTE patients versus 3.6% among patients with IDDM, at 5 years this was 19.3%-14.7%, respectively. After adjusting for the effect of sex, age and risk factors for VTE this corresponded to a 1 year risk differences of 1.9% (95 % CI 0.1% to 3.3%). At 5 years follow-up the risk difference was 1.9% (95% CI 0.5% to 3.3%). CONCLUSION One-fifth of adolescents and young adults with incident VTE had claimed a prescription for a psychotropic drug within 5 years, a risk comparable to that of young patients with IDDM.
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Proietti M, Lane DA, Boriani G, Lip GY. Stroke Prevention, Evaluation of Bleeding Risk, and Anticoagulant Treatment Management in Atrial Fibrillation Contemporary International Guidelines. Can J Cardiol 2019; 35:619-633. [DOI: 10.1016/j.cjca.2019.02.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/15/2019] [Accepted: 02/15/2019] [Indexed: 12/17/2022] Open
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Quinn TJ, Lane DA. Anticoagulation for Atrial Fibrillation in Older Adults—Using Big Data for Big Questions. Thromb Haemost 2019; 119:855-857. [DOI: 10.1055/s-0039-1688482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Dagres N, Chao TF, Fenelon G, Aguinaga L, Benhayon D, Benjamin EJ, Bunch TJ, Chen LY, Chen SA, Darrieux F, de Paola A, Fauchier L, Goette A, Kalman J, Kalra L, Kim YH, Lane DA, Lip GYH, Lubitz SA, Márquez MF, Potpara T, Pozzer DL, Ruskin JN, Savelieva I, Teo WS, Tse HF, Verma A, Zhang S, Chung MK. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on arrhythmias and cognitive function: what is the best practice? Europace 2019; 20:1399-1421. [PMID: 29562326 DOI: 10.1093/europace/euy046] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 02/22/2018] [Indexed: 01/24/2023] Open
Abstract
Abstract
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Lip GYH, Lane DA. The Liverpool Centre for Cardiovascular Science. Eur Heart J 2019; 40:957-958. [DOI: 10.1093/eurheartj/ehz107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Arnar DO, Mairesse GH, Boriani G, Calkins H, Chin A, Coats A, Deharo JC, Svendsen JH, Heidbüchel H, Isa R, Kalman JM, Lane DA, Louw R, Lip GYH, Maury P, Potpara T, Sacher F, Sanders P, Varma N, Fauchier L, Haugaa K, Schwartz P, Sarkozy A, Sharma S, Kongsgård E, Svensson A, Lenarczyk R, Volterrani M, Turakhia M, Obel IWP, Abello M, Swampillai J, Kalarus Z, Kudaiberdieva G, Traykov VB, Dagres N, Boveda S, Vernooy K, Kalarus Z, Kudaiberdieva G, Mairesse GH, Kutyifa V, Deneke T, Hastrup Svendsen J, Traykov VB, Wilde A, Heinzel FR. Management of asymptomatic arrhythmias: a European Heart Rhythm Association (EHRA) consensus document, endorsed by the Heart Failure Association (HFA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), Cardiac Arrhythmia Society of Southern Africa (CASSA), and Latin America Heart Rhythm Society (LAHRS). Europace 2019; 21:844–845. [DOI: 10.1093/europace/euz046] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 02/24/2019] [Indexed: 12/22/2022] Open
Abstract
AbstractAsymptomatic arrhythmias are frequently encountered in clinical practice. Although studies specifically dedicated to these asymptomatic arrhythmias are lacking, many arrhythmias still require proper diagnostic and prognostic evaluation and treatment to avoid severe consequences, such as stroke or systemic emboli, heart failure, or sudden cardiac death. The present document reviews the evidence, where available, and attempts to reach a consensus, where evidence is insufficient or conflicting.
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Lip GY, Banerjee A, Boriani G, Chiang CE, Fargo R, Freedman B, Lane DA, Ruff CT, Turakhia M, Werring D, Patel S, Moores L. Antithrombotic Therapy for Atrial Fibrillation. Chest 2018; 154:1121-1201. [DOI: 10.1016/j.chest.2018.07.040] [Citation(s) in RCA: 481] [Impact Index Per Article: 80.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/11/2018] [Accepted: 07/24/2018] [Indexed: 02/08/2023] Open
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Gorenek B, Pelliccia A, Benjamin EJ, Boriani G, Crijns HJ, Fogel RI, Van Gelder IC, Halle M, Kudaiberdieva G, Lane DA, Larsen TB, Lip GYH, Løchen ML, Marín F, Niebauer J, Sanders P, Tokgozoglu L, Vos MA, Van Wagoner DR, Fauchier L, Savelieva I, Goette A, Agewall S, Chiang CE, Figueiredo M, Stiles M, Dickfeld T, Patton K, Piepoli M, Corra U, Marques-Vidal PM, Faggiano P, Schmid JP, Abreu A. European Heart Rhythm Association (EHRA)/European Association of Cardiovascular Prevention and Rehabilitation (EACPR) position paper on how to prevent atrial fibrillation endorsed by the Heart Rhythm Society (HRS) and Asia Pacific Heart Rhythm Society (APHRS). Europace 2018; 19:190-225. [PMID: 28175283 DOI: 10.1093/europace/euw242] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Katritsis DG, Boriani G, Cosio FG, Hindricks G, Jaïs P, Josephson ME, Keegan R, Kim YH, Knight BP, Kuck KH, Lane DA, Lip GYH, Malmborg H, Oral H, Pappone C, Themistoclakis S, Wood KA, Blomström-Lundqvist C, Gorenek B, Dagres N, Dan GA, Vos MA, Kudaiberdieva G, Crijns H, Roberts-Thomson K, Lin YJ, Vanegas D, Caorsi WR, Cronin E, Rickard J. European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardiaca y Electrofisiologia (SOLAECE). Europace 2018; 19:465-511. [PMID: 27856540 DOI: 10.1093/europace/euw301] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Proietti M, Laroche C, Nieuwlaat R, Crijns HJGM, Maggioni AP, Lane DA, Boriani G, Lip GYH. Increased burden of comorbidities and risk of cardiovascular death in atrial fibrillation patients in Europe over ten years: A comparison between EORP-AF pilot and EHS-AF registries. Eur J Intern Med 2018; 55:28-34. [PMID: 29778588 DOI: 10.1016/j.ejim.2018.05.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/13/2018] [Accepted: 05/09/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND In 2002, the European Society of Cardiology conducted the Euro Heart Survey (EHS), while in 2014concluded 1-year follow-up of the EURObservational Research Programme AF (EORP-AF) Pilot Registry. METHODS We analysed differences in clinical profiles, therapeutic approaches and outcomes between these two cohorts after propensity score matching (PSM). RESULTS After PSM, 5206 patients were analysed. In EORP-AF there were more elderly patients than EHS (p < .001). EORP-AF patients were more burdened with cardiovascular (CV) and non-CV comorbidities, with a higher proportion of patients with high thromboembolic risk. EORP-AF patients used more oral-anticoagulant (OAC) (p < .001). At 1-year follow-up EORP-AF patients had lower risk for thromboembolic and CV events, readmission for AF and other CV reasons (all p < .001), showing conversely a higher risk for CV death (p = .015). Kaplan-Meier curves showed that EORP-AF patients had higher risk for CV death (p < .0001) and all-cause death (p = .0019). Cox regression confirmed that EORP-AF patients were at higher risk for CV death (p = .021). CONCLUSIONS We found significant changes in AF epidemiology over a decade in Europe, with older patients, more burdened with comorbidities. A greater use of OAC was found. Despite a reduction in risk for thromboembolic events, a high risk of CV-related death was still evident.
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Ayetey H, Shantsila A, Li YG, Lane DA, Lip GYH. 113Mean blood pressures and visit to visit blood pressure variation as predictors of clinical outcomes in malignant hypertension: the west Birmingham malignant hypertension project. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Proietti M, Laroche C, Popescu MI, Tello-Montoliu A, Garcia-Bolao I, Lane DA, Maggioni AP, Lip GYH, Boriani G. P3446Regional variation in quality of anticoagulation control among european patients with atrial fibrillation: the EORP-AF general long-term registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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van Boven HH, Reitsma PH, Rosendaal FR, Bayston TA, Chowdhury V, Borg JY, Bauer KA, Scharrer I, Conard J, Lane DA. Factor V Leiden (FV R506Q) in Families with Inherited Antithrombin Deficiency. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1650289] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryWe investigated the presence of the gene mutation of factor V, FV R506Q or factor V Leiden, responsible for activated protein C resistance, in DNA samples of 127 probands and 188 relatives from 128 families with antithrombin deficiency. The factor V mutation was identified in 18 families. Nine families were available to assess the mode of inheritance and the clinical relevance of combined defects.The factor V and antithrombin genes both map to chromosome 1. Segregation of the defects on opposite chromosomes was observed in three families. Co-segregation with both defects on the same chromosome was demonstrated in four families. In one family a de novo mutation of the antithrombin gene and in another a crossing-over event were the most likely explanations for the observed inheritance patterns.In six families with type I or II antithrombin deficiency (reactive site or pleiotropic effect), 11 of the 12 individuals with both antithrombin deficiency and the factor V mutation developed thrombosis. The median age of their first thrombotic episode was 16 years (range 0-19); this is low compared with a median age of onset of 26 years (range 20-49) in 15 of 30 carriers with only a defect in the antithrombin gene. One of five subjects with only factor V mutation experienced thrombosis at 40 years of age. In three families with type II heparin binding site deficiencies, two of six subjects with combined defects experienced thrombosis; one was homozygous for the heparin binding defect.Our results show that, when thrombosis occurs at a young age in antithrombin deficiency, the factor V mutation is a likely additional risk factor. Co-segregation of mutations in the antithrombin and factor V genes provides a molecular explanation for severe thrombosis in several generations. The findings support that combinations of genetic risk factors underly differences in thrombotic risk in families with thrombophilia.
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