351
|
Giancaterino SK, Hsu JC. The Smartwatch Will See You Now. J Am Coll Cardiol 2018; 72:1433-1434. [DOI: 10.1016/j.jacc.2018.05.078] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 05/20/2018] [Indexed: 11/28/2022]
|
352
|
Heijman J, Dobrev D, Crijns HJ. Electrocardiographic characteristics associated with atrial fibrillation – What do they tell us? Int J Cardiol 2018; 266:143-144. [DOI: 10.1016/j.ijcard.2018.04.071] [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: 04/11/2018] [Accepted: 04/16/2018] [Indexed: 10/14/2022]
|
353
|
Berge T, Lyngbakken MN, Ihle-Hansen H, Brynildsen J, Pervez MO, Aagaard EN, Vigen T, Kvisvik B, Christophersen IE, Steine K, Omland T, Smith P, Røsjø H, Tveit A. Prevalence of atrial fibrillation and cardiovascular risk factors in a 63-65 years old general population cohort: the Akershus Cardiac Examination (ACE) 1950 Study. BMJ Open 2018; 8:e021704. [PMID: 30068617 PMCID: PMC6074624 DOI: 10.1136/bmjopen-2018-021704] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To investigate the sex-specific prevalence of atrial fibrillation (AF), including subclinical AF found by screening in a general population aged 63-65 years. The prevalence of cardiovascular risk factors and their association with AF will also be investigated. DESIGN Cross-sectional analysis of an observational, prospective, longitudinal, population-based cohort study. SETTING General population in Akershus county, Norway. PARTICIPANTS Women and men born in 1950. We included 3706 of 5827 eligible individuals (63.6%); 48.8% were women. METHODS All participants underwent extensive cardiovascular examinations, including 12-lead ECG. History of AF and other cardiovascular diseases were self-reported. Subsequent validation of all reported or detected AF diagnoses was performed. RESULTS Mean age was 63.9±0.7 years. Prevalence of ECG-verified AF was 4.5% (women 2.4%, men 6.4%; p<0.001), including screen-detected AF in 0.3% (women 0.1%, men 0.6%; p<0.01). Hypertension was found in 62.0% (women 57.8%, men 66.0%; p<0.001). Overweight or obesity was found in 67.6% (women 59.8%, men 74.9%; p<0.001). By multivariate logistic regression, risk factors associated with AF were height (OR 1.67 per 10 cm; 95% CI 1.26 to 2.22; p<0.001), weight (OR 1.15 per 10 kg; 95% CI 1.01 to 1.30; p=0.03), hypertension (OR 2.49; 95% CI 1.61 to 3.86; p<0.001), heart failure (OR 3.51; 95% CI 1.71 to 7.24; p=0.001), reduced estimated glomerular filtration rate (OR 2.56; 95% CI 1.42 to 4.60; p<0.01) and at least one first-degree relative with AF (OR 2.32; 95% CI 1.63 to 3.31; p<0.001), whereas male sex was not significantly associated (OR 1.00; 95% CI 0.59 to 1.68; p=0.99). CONCLUSION In this cohort from the general population aged 63-65 years, we found a higher prevalence of known AF than previously reported below the age of 65 years. The additional yield of single time point screening for AF was low. Body size and comorbidity may explain most of the sex difference in AF prevalence at this age. TRIAL REGISTRATION NUMBER NCT01555411; Results.
Collapse
Affiliation(s)
- Trygve Berge
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Magnus Nakrem Lyngbakken
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Medicine, Akershus University Hospital, Lorenskog, Norway
| | - Håkon Ihle-Hansen
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jon Brynildsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Medicine, Akershus University Hospital, Lorenskog, Norway
| | - Mohammad Osman Pervez
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Medicine, Akershus University Hospital, Lorenskog, Norway
| | - Erika Nerdrum Aagaard
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Medicine, Akershus University Hospital, Lorenskog, Norway
| | - Thea Vigen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Medicine, Akershus University Hospital, Lorenskog, Norway
| | - Brede Kvisvik
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Medicine, Akershus University Hospital, Lorenskog, Norway
| | | | - Kjetil Steine
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Medicine, Akershus University Hospital, Lorenskog, Norway
| | - Torbjørn Omland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Medicine, Akershus University Hospital, Lorenskog, Norway
| | - Pål Smith
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Medicine, Akershus University Hospital, Lorenskog, Norway
| | - Helge Røsjø
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Medicine, Akershus University Hospital, Lorenskog, Norway
| | - Arnljot Tveit
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
354
|
Kapa S, Davis DR, Park DS, Steinberg BA, Viswanathan MN, Tzou W, Madhavan M, Ceresnak SR, Wang PJ. Year in Review in Cardiac Electrophysiology. Circ Arrhythm Electrophysiol 2018; 11:e006648. [PMID: 30012874 DOI: 10.1161/circep.118.006648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Suraj Kapa
- Mayo Clinic, Rochester, MN (S.K., M.M.).
| | - Darryl R Davis
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, University of Ottawa, Canada (D.R.D.)
| | | | - Benjamin A Steinberg
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, Salt Lake City (B.A.S.)
| | - Mohan N Viswanathan
- Cardiovascular Medicine, School of Medicine, Stanford University, CA (M.N.V., P.J.W.)
| | - Wendy Tzou
- University of Colorado School of Medicine, Aurora (W.T.)
| | | | - Scott R Ceresnak
- Stanford University-Lucile Packard Children's Hospital, CA (S.R.C.)
| | - Paul J Wang
- Cardiovascular Medicine, School of Medicine, Stanford University, CA (M.N.V., P.J.W.)
| |
Collapse
|
355
|
Affiliation(s)
- Roopinder K. Sandhu
- Department of Medicine, Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Jeff S. Healey
- Department of Medicine, Division of Cardiology, Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
356
|
Li Y, Nantsupawat T, Olson M, Tholakanahalli V, Adabag S, Wang Z, Benditt DG, Li JM. A single center experience on the clinical utility evaluation of an insertable cardiac monitor. J Electrocardiol 2018; 51:583-587. [PMID: 29996994 DOI: 10.1016/j.jelectrocard.2018.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/20/2018] [Accepted: 05/08/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND The evaluation of insertable cardiac monitor (ICM) has been largely on the device performance and safety with only limited studies on the clinical utility. The aim of this study was to evaluate the clinical utility of ICM in patients with a variety of clinical presentations. METHODS A single-center retrospective study on the clinical utility, as measured by both expected and unexpected clinical useful ICM findings and the initiation of therapeutic interventions, was conducted. RESULTS Ninety-five consecutive patients (median age 68 years) received ICM Reveal LINQ™ for clinical indications of unexplained syncope (53), cryptogenic stroke (19), unexplained infrequent palpitations (14) and AF management (9). During a median follow-up of 414 days, the causes for unexplained syncope were arrhythmia-related (11.3%), arrhythmia-unrelated (32%) and undetermined (56.6%). Atrial fibrillation in patients with cryptogenic stroke was detected in 31.6% (6/19). The clinical utility occurrence was 48.4% with the expected and incidental (unexpected) clinical utility of 41% and 7.4% patients respectively. Of these, therapeutic interventions based on ICM diagnoses were initiated in 18.9% (18/95) of patients. CONCLUSIONS ICM (Reveal LINQ™) offers substantial expected and unexpected clinical utility in patients with a variety of clinical presentations. The causes of nearly one third of patients receiving ICM for unexplained syncope were unrelated to cardiac arrhythmia. Nearly one fifth of patients with newly diagnosed arrhythmia from ICM received therapeutic interventions.
Collapse
Affiliation(s)
- Yanhui Li
- School of Clinical Medicine, Tsinghua University, Beijing 100084, PR China; Division of Cardiology, Veterans Affairs Medical Center, Minneapolis, MN 55417, USA; Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Teerapat Nantsupawat
- Division of Cardiology, Veterans Affairs Medical Center, Minneapolis, MN 55417, USA; Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Matthew Olson
- Division of Cardiology, Veterans Affairs Medical Center, Minneapolis, MN 55417, USA; Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Venkatakrishna Tholakanahalli
- Division of Cardiology, Veterans Affairs Medical Center, Minneapolis, MN 55417, USA; Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Selcuk Adabag
- Division of Cardiology, Veterans Affairs Medical Center, Minneapolis, MN 55417, USA; Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Zhong Wang
- School of Clinical Medicine, Tsinghua University, Beijing 100084, PR China; Beijing Tsinghua Changgung Hospital, Beijing 102218, PR China
| | - David G Benditt
- Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Jian-Ming Li
- Division of Cardiology, Veterans Affairs Medical Center, Minneapolis, MN 55417, USA; Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN 55455, USA.
| |
Collapse
|
357
|
Affiliation(s)
- Benjamin A Steinberg
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, Salt Lake City
| | - Jonathan P Piccini
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
- Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
358
|
Guenancia C, Garnier F, Mouhat B, Béjot Y, Maillot N, Fichot M, Fauchier L, Cottin Y. Dépistage et implications cliniques de la fibrillation atriale silencieuse. Rev Med Interne 2018; 39:574-579. [DOI: 10.1016/j.revmed.2017.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 08/24/2017] [Indexed: 12/01/2022]
|
359
|
Tomita H, Sasaki S, Hagii J, Metoki N. Covert atrial fibrillation and atrial high-rate episodes as a potential cause of embolic strokes of undetermined source: Their detection and possible management strategy. J Cardiol 2018; 72:1-9. [DOI: 10.1016/j.jjcc.2018.03.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 03/01/2018] [Indexed: 01/28/2023]
|
360
|
Mourtzinis G, Kahan T, Bengtsson Boström K, Schiöler L, Cedstrand Wallin L, Hjerpe P, Hasselström J, Manhem K. Relation Between Lipid Profile and New-Onset Atrial Fibrillation in Patients With Systemic Hypertension (From the Swedish Primary Care Cardiovascular Database [SPCCD]). Am J Cardiol 2018; 122:102-107. [PMID: 29685574 DOI: 10.1016/j.amjcard.2018.03.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/08/2018] [Accepted: 03/16/2018] [Indexed: 02/08/2023]
Abstract
The relation between dyslipidemia and atrial fibrillation (AF) development is still controversial. To assess the impact of lipid profile on new-onset AF, we followed 51,020 primary-care hypertensive patients without AF at baseline. After a mean follow-up time of 3.5 years, AF occurred in 2,389 participants (4.7%). We evaluated the association between total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, and new-onset AF. In a Poisson regression model fully adjusted for common risk factors of AF, we found that 1.0 mmol/l (39 mg/dl) increase in total cholesterol was associated with 19% lower risk of new-onset AF (95% confidence interval [CI] 9% to 28%), and 1.0 mmol/l (39 mg/dl) increase in low-density lipoprotein cholesterol was associated with 16% lower risk of new-onset AF (95% CI 3% to 27%). Gender-specific Poisson regression analyses revealed that increase in total cholesterol by 1.0 mmol/l (39 mg/dl) was found to be associated with lower risk of new-onset AF with 21% in men (95% CI 8% to 32%), and 18% in women (95% CI 1% to 31%). There was no association between high-density lipoprotein cholesterol or triglycerides and new-onset AF, neither in the whole population with respect to separate gender. In conclusion, in a large hypertensive population we found an inverse association between total cholesterol and new-onset AF for both men and women. Our results confirm previous reports of a dyslipidemia paradox, and extend these observations to the hypertensive population.
Collapse
|
361
|
What to do when patients having a high risk of new-onset atrial fibrillation are identified? Int J Cardiol 2018; 261:101-102. [PMID: 29657033 DOI: 10.1016/j.ijcard.2018.03.079] [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: 03/14/2018] [Accepted: 03/15/2018] [Indexed: 11/24/2022]
|
362
|
Boriani G, Fauchier L, Aguinaga L, Beattie JM, Blomstrom Lundqvist C, Cohen A, Dan GA, Genovesi S, Israel C, Joung B, Kalarus Z, Lampert R, Malavasi VL, Mansourati J, Mont L, Potpara T, Thornton A, Lip GYH, Gorenek B, Marin F, Dagres N, Ozcan EE, Lenarczyk R, Crijns HJ, Guo Y, Proietti M, Sticherling C, Huang D, Daubert JP, Pokorney SD, Cabrera Ortega M, Chin A. European Heart Rhythm Association (EHRA) consensus document on management of arrhythmias and cardiac electronic devices in the critically ill and post-surgery patient, endorsed by Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), Cardiac Arrhythmia Society of Southern Africa (CASSA), and Latin American Heart Rhythm Society (LAHRS). Europace 2018; 21:7-8. [DOI: 10.1093/europace/euy110] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 04/26/2018] [Indexed: 02/05/2023] Open
Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Laurent Fauchier
- Centre Hospitalier Universitaire Trousseau et Université François Rabelais, Tours, France
| | | | - James M Beattie
- Cicely Saunders Institute, King’s College London, London, UK
| | | | | | - Gheorghe-Andrei Dan
- Cardiology Department, University of Medicine and Pharmacy “Carol Davila”, Colentina University Hospital, Bucharest, Romania
| | - Simonetta Genovesi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano and Nephrology Unit, San Gerardo Hospital, Monza, Italy
| | - Carsten Israel
- Evangelisches Krankenhaus Bielefeld GmbH, Bielefeld, Germany
| | - Boyoung Joung
- Cardiology Division, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Zbigniew Kalarus
- SMDZ in Zabrze, Medical University of Silesia, Katowice; Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland
| | | | - Vincenzo L Malavasi
- Cardiology Division, Department of Nephrologic, Cardiac, Vascular Diseases, Azienda ospedaliero-Universitaria di Modena, Modena, Italy
| | - Jacques Mansourati
- University Hospital of Brest and University of Western Brittany, Brest, France
| | - Lluis Mont
- Arrhythmia Section, Cardiovascular Clínical Institute, Hospital Clinic, Universitat Barcelona, Barcelona, Spain
| | - Tatjana Potpara
- School of Medicine, Belgrade University, Belgrade, Serbia
- Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | | | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, UK
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | | | | | | | - Radosław Lenarczyk
- Department of Cardiology, Congenital Heart Disease and Electrotherapy, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Harry J Crijns
- Cardiology Maastricht UMC+ and Cardiovascular Research Institute Maastricht, Netherlands
| | - Yutao Guo
- Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Marco Proietti
- Institute of Cardiovascular Sciences, University of Birmingham, UK
- Department of Internal Medicine and Medical Specialties, Sapienza-University of Rome, Rome, Italy
| | | | - Dejia Huang
- Cardiology Division, Department of Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | | | - Sean D Pokorney
- Electrophysiology Section, Division of Cardiology, Duke University, Durham, NC, USA
| | - Michel Cabrera Ortega
- Department of Arrhythmia and Cardiac Pacing, Cardiocentro Pediatrico William Soler, Boyeros, La Havana Cuba
| | - Ashley Chin
- Department of Medicine, Groote Schuur Hospital, University of Cape Town, South Africa
| | | |
Collapse
|
363
|
Effectiveness of a nongovernmental organization-led large-scale community atrial fibrillation screening program using the smartphone electrocardiogram: An observational cohort study. Heart Rhythm 2018; 15:1306-1311. [PMID: 29890321 DOI: 10.1016/j.hrthm.2018.06.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Opportunistic screening for atrial fibrillation (AF) in patients older than 65 years is currently recommended. OBJECTIVE We aim to examine the effectiveness of a nongovernmental organization-led community-based AF screening program carried out by trained layperson volunteers. METHODS AF screening was performed using a smartphone electrocardiogram in 11,574 participants. RESULTS Among all participants, smartphone electrocardiograms were interpretable in 10,735 citizens (92.8%; 8564 female citizens [79.8%]; mean age 78.6 ± 8.1 years). Two hundred forty-four participants (2.3%; 95% confidence interval [CI] 2-2.6%; 172 female participants [70.5%]; mean age 79.5 ± 7.9 years) had AF and were advised over phone by a nurse to seek medical attention. Newly diagnosed AF was found in 74 participants (0.69%; 95% CI 0.54-0.84%) with a mean CHA2DS2-VASc score of 3.9 ± 1.5. Thirty-six of them (48%; 95% CI 36.6-59.4%) were asymptomatic. The number needed to screen for 1 newly diagnosed AF was 145. Telephone follow-up of participants with AF was conducted 9 months after screening. Of 72 participants with newly diagnosed AF and indicated for oral anticoagulation, 47 (65.3%; 95% CI 54.3-76.3%) sought medical attention, 17 (23.6%; 95% CI 13.8-33.4%) received oral anticoagulants, and 16 (22.2%; 95% CI 12.6-31.8%) had 100% compliance. The number needed to screen for 1 appropriately treated newly diagnosed AF was 671. CONCLUSION This nongovernmental organization-led community-based AF screening program is effective in identifying citizens with newly diagnosed AF. However, the effectiveness of the program in subsequently leading them to receive appropriate oral anticoagulation therapy is weakened by the lack of a more structured downstream management pathway.
Collapse
|
364
|
Poh MZ, Poh YC, Chan PH, Wong CK, Pun L, Leung WWC, Wong YF, Wong MMY, Chu DWS, Siu CW. Diagnostic assessment of a deep learning system for detecting atrial fibrillation in pulse waveforms. Heart 2018; 104:1921-1928. [PMID: 29853485 DOI: 10.1136/heartjnl-2018-313147] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/20/2018] [Accepted: 04/09/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To evaluate the diagnostic performance of a deep learning system for automated detection of atrial fibrillation (AF) in photoplethysmographic (PPG) pulse waveforms. METHODS We trained a deep convolutional neural network (DCNN) to detect AF in 17 s PPG waveforms using a training data set of 149 048 PPG waveforms constructed from several publicly available PPG databases. The DCNN was validated using an independent test data set of 3039 smartphone-acquired PPG waveforms from adults at high risk of AF at a general outpatient clinic against ECG tracings reviewed by two cardiologists. Six established AF detectors based on handcrafted features were evaluated on the same test data set for performance comparison. RESULTS In the validation data set (3039 PPG waveforms) consisting of three sequential PPG waveforms from 1013 participants (mean (SD) age, 68.4 (12.2) years; 46.8% men), the prevalence of AF was 2.8%. The area under the receiver operating characteristic curve (AUC) of the DCNN for AF detection was 0.997 (95% CI 0.996 to 0.999) and was significantly higher than all the other AF detectors (AUC range: 0.924-0.985). The sensitivity of the DCNN was 95.2% (95% CI 88.3% to 98.7%), specificity was 99.0% (95% CI 98.6% to 99.3%), positive predictive value (PPV) was 72.7% (95% CI 65.1% to 79.3%) and negative predictive value (NPV) was 99.9% (95% CI 99.7% to 100%) using a single 17 s PPG waveform. Using the three sequential PPG waveforms in combination (<1 min in total), the sensitivity was 100.0% (95% CI 87.7% to 100%), specificity was 99.6% (95% CI 99.0% to 99.9%), PPV was 87.5% (95% CI 72.5% to 94.9%) and NPV was 100% (95% CI 99.4% to 100%). CONCLUSIONS In this evaluation of PPG waveforms from adults screened for AF in a real-world primary care setting, the DCNN had high sensitivity, specificity, PPV and NPV for detecting AF, outperforming other state-of-the-art methods based on handcrafted features.
Collapse
Affiliation(s)
| | | | - Pak-Hei Chan
- Division of Cardiology, Department of Medicine, University of Hong Kong, Hong Kong
| | - Chun-Ka Wong
- Division of Cardiology, Department of Medicine, University of Hong Kong, Hong Kong
| | - Louise Pun
- Department of Family Medicine and Primary Healthcare, Hong Kong East Cluster, Hospital Authority, Hong Kong
| | - Wangie Wan-Chiu Leung
- Department of Family Medicine and Primary Healthcare, Hong Kong East Cluster, Hospital Authority, Hong Kong
| | - Yu-Fai Wong
- Department of Family Medicine and Primary Healthcare, Hong Kong East Cluster, Hospital Authority, Hong Kong
| | - Michelle Man-Ying Wong
- Department of Family Medicine and Primary Healthcare, Hong Kong East Cluster, Hospital Authority, Hong Kong
| | - Daniel Wai-Sing Chu
- Department of Family Medicine and Primary Healthcare, Hong Kong East Cluster, Hospital Authority, Hong Kong
| | - Chung-Wah Siu
- Division of Cardiology, Department of Medicine, University of Hong Kong, Hong Kong
| |
Collapse
|
365
|
Opportunistic pulse checks in primary care to improve recognition of atrial fibrillation: a retrospective analysis of electronic patient records. Br J Gen Pract 2018; 68:e388-e393. [PMID: 29784865 DOI: 10.3399/bjgp18x696605] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 02/05/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is an important and modifiable risk factor for stroke. Earlier identification may reduce stroke-related morbidity and mortality. Trial evidence shows that opportunistic pulse regularity checks in individuals aged ≥65 years increases detection of AF. However, this is not currently recommended by the National Screening Programme or implemented by most clinical commissioning groups (CCGs). AIM To evaluate the impact of a systematic programme to promote pulse regularity checks, the programme's uptake in general practice, and the prevalence of AF. DESIGN AND SETTING Retrospective analysis of electronic primary care patient records in three east London CCGs (City and Hackney, Newham, and Tower Hamlets) over 10 years. METHOD Rates of pulse regularity checks and prevalence of AF in individuals aged ≥65 years were compared from the pre-intervention period, 2007-2011, to the post-intervention period, 2012-2017. RESULTS Across the three CCGs, rates of pulse regularity checks increased from a mean of 7.3% pre-intervention to 66.4% post-intervention, achieving 93.1% (n = 58 722) in the final year. Age-standardised prevalence of AF in individuals aged ≥65 years increased significantly from a pre-intervention mean of 61.4/1000 to a post-intervention mean of 64.5/1000. There was a significant increase in a post-intervention trend to a final-year mean of 67.3/1000: an improvement of 9.6% (5.9/1000) with 790 additional new cases identified. CONCLUSION Organisational alignment, standardised data entry, peer-performance dashboards, and financial incentives rapidly and generally increased opportunistic screening with pulse regularity checks. This was associated with a significant increase in detection and prevalence of AF and is of public health importance.
Collapse
|
366
|
Affiliation(s)
- Arnaud Bisson
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours 37044, France
| | - Alexandre Bodin
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours 37044, France
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours 37044, France
| |
Collapse
|
367
|
Yan BP, Lai WHS, Chan CKY, Chan SCH, Chan LH, Lam KM, Lau HW, Ng CM, Tai LY, Yip KW, To OTL, Freedman B, Poh YC, Poh MZ. Contact-Free Screening of Atrial Fibrillation by a Smartphone Using Facial Pulsatile Photoplethysmographic Signals. J Am Heart Assoc 2018; 7:JAHA.118.008585. [PMID: 29622592 PMCID: PMC6015414 DOI: 10.1161/jaha.118.008585] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND We aimed to evaluate a novel method of atrial fibrillation (AF) screening using an iPhone camera to detect and analyze photoplethysmographic signals from the face without physical contact by extracting subtle beat-to-beat variations of skin color that reflect the cardiac pulsatile signal. METHODS AND RESULTS Patients admitted to the cardiology ward of the hospital for clinical reasons were recruited. Simultaneous facial and fingertip photoplethysmographic measurements were obtained from 217 hospital inpatients (mean age, 70.3±13.9 years; 71.4% men) facing the front camera and with an index finger covering the back camera of 2 independent iPhones before a 12-lead ECG was recorded. Backdrop and background light intensity was monitored during signal acquisition. Three successive 20-second (total, 60 seconds) recordings were acquired per patient and analyzed for heart rate regularity by Cardiio Rhythm (Cardiio Inc, Cambridge, MA) smartphone application. Pulse irregularity in ≥1 photoplethysmographic readings or 3 uninterpretable photoplethysmographic readings were considered a positive AF screening result. AF was present on 12-lead ECG in 34.6% (n=75/217) patients. The Cardiio Rhythm facial photoplethysmographic application demonstrated high sensitivity (95%; 95% confidence interval, 87%-98%) and specificity (96%; 95% confidence interval, 91%-98%) in discriminating AF from sinus rhythm compared with 12-lead ECG. The positive and negative predictive values were 92% (95% confidence interval, 84%-96%) and 97% (95% confidence interval, 93%-99%), respectively. CONCLUSIONS Detection of a facial photoplethysmographic signal to determine pulse irregularity attributable to AF is feasible. The Cardiio Rhythm smartphone application showed high sensitivity and specificity, with low negative likelihood ratio for AF from facial photoplethysmographic signals. The convenience of a contact-free approach is attractive for community screening and has the potential to be useful for distant AF screening.
Collapse
Affiliation(s)
- Bryan P Yan
- Division of Cardiology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong and Prince of Wales Hospital, Hong Kong SAR, China
| | - William H S Lai
- Division of Cardiology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong and Prince of Wales Hospital, Hong Kong SAR, China
| | - Christy K Y Chan
- Division of Cardiology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong and Prince of Wales Hospital, Hong Kong SAR, China
| | | | - Lok-Hei Chan
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ka-Ming Lam
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ho-Wang Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chak-Ming Ng
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Lok-Yin Tai
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kin-Wai Yip
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Olivia T L To
- Division of Cardiology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong and Prince of Wales Hospital, Hong Kong SAR, China
| | - Ben Freedman
- Heart Research Institute Charles Perkins Centre, and Concord Hospital Cardiology University of Sydney, Australia
| | | | | |
Collapse
|
368
|
Augusto JB, Fernandes A, de Freitas PT, Gil V, Morais C. Predictors of de novo atrial fibrillation in a non-cardiac intensive care unit. Rev Bras Ter Intensiva 2018; 30:166-173. [PMID: 29995081 PMCID: PMC6031411 DOI: 10.5935/0103-507x.20180022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 01/15/2018] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To assess the predictors of de novo atrial fibrillation in patients in a non-cardiac intensive care unit. METHODS A total of 418 hospitalized patients were analyzed between January and September 2016 in a non-cardiac intensive care unit. Clinical characteristics, interventions, and biochemical markers were recorded during hospitalization. In-hospital mortality and length of hospital stay in the intensive care unit were also evaluated. RESULTS A total of 310 patients were included. The mean age of the patients was 61.0 ± 18.3 years, 49.4% were male, and 23.5% presented de novo atrial fibrillation. The multivariate model identified previous stroke (OR = 10.09; p = 0.016) and elevated levels of pro-B type natriuretic peptide (proBNP, OR = 1.28 for each 1,000pg/mL increment; p = 0.004) as independent predictors of de novo atrial fibrillation. Analysis of the proBNP receiver operating characteristic curve for prediction of de novo atrial fibrillation revealed an area under the curve of 0.816 (p < 0.001), with a sensitivity of 65.2% and a specificity of 82% for proBNP > 5,666pg/mL. There were no differences in mortality (p = 0.370), but the lengths of hospital stay (p = 0.002) and stay in the intensive care unit (p = 0.031) were higher in patients with de novo atrial fibrillation. CONCLUSIONS A history of previous stroke and elevated proBNP during hospitalization were independent predictors of de novo atrial fibrillation in the polyvalent intensive care unit. The proBNP is a useful and easy- and quick-access tool in the stratification of atrial fibrillation risk.
Collapse
Affiliation(s)
- João Bicho Augusto
- Serviço de Cardiologia, Hospital Professor Doutor Fernando
Fonseca - Lisboa, Portugal
| | - Ana Fernandes
- Unidade de Cuidados Intensivos Polivalente, Hospital Professor
Doutor Fernando Fonseca - Lisboa, Portugal
| | - Paulo Telles de Freitas
- Unidade de Cuidados Intensivos Polivalente, Hospital Professor
Doutor Fernando Fonseca - Lisboa, Portugal
| | - Victor Gil
- Unidade Cardiovascular, Hospital dos Lusíadas - Lisboa,
Portugal
| | - Carlos Morais
- Serviço de Cardiologia, Hospital Professor Doutor Fernando
Fonseca - Lisboa, Portugal
| |
Collapse
|
369
|
Use of oral anticoagulants in patients with atrial fibrillation and renal dysfunction. Nat Rev Nephrol 2018; 14:337-351. [PMID: 29578207 DOI: 10.1038/nrneph.2018.19] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Atrial fibrillation (AF) and chronic kidney disease (CKD) are increasingly prevalent in the general population and share common risk factors such as older age, hypertension and diabetes mellitus. The presence of CKD increases the risk of incident AF, and, likewise, AF increases the risk of CKD development and/or progression. Both conditions are associated with substantial thromboembolic risk, but patients with advanced CKD also exhibit a paradoxical increase in bleeding risk. In the landmark randomized clinical trials that compared non-vitamin K antagonist oral anticoagulants (NOACs) with warfarin for thromboprophylaxis in patients with AF, the efficacy and safety of NOACs in patients with mild-to-moderate CKD were similar to those in patients without CKD. Dose adjustment of NOACs as per the prescribing label is required in this population. Owing to limited trial data, evidence-based recommendations for the management of patients with AF and severe CKD or end-stage renal disease on dialysis are lacking. Observational cohort studies have reported conflicting results, and the management of these particularly vulnerable patients remains challenging and requires careful assessment of stroke and bleeding risk and, where appropriate, use of warfarin with good-quality anticoagulation control.
Collapse
|
370
|
Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation 2018; 137:e67-e492. [PMID: 29386200 DOI: 10.1161/cir.0000000000000558] [Citation(s) in RCA: 4425] [Impact Index Per Article: 737.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
371
|
Gorenek B, Boriani G, Dan GA, Fauchier L, Fenelon G, Huang H, Kudaiberdieva G, Lip GYH, Mahajan R, Potpara T, Ramirez JD, Vos MA, Marin F, Blomstrom-Lundqvist C, Rinaldi A, Bongiorni MG, Sciaraffia E, Nielsen JC, Lewalter T, Zhang S, Gutiérrez O, Fuenmayor A. European Heart Rhythm Association (EHRA) position paper on arrhythmia management and device therapies in endocrine disorders, endorsed by Asia Pacific Heart Rhythm Society (APHRS) and Latin American Heart Rhythm Society (LAHRS). Europace 2018; 20:895-896. [DOI: 10.1093/europace/euy051] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 02/25/2018] [Indexed: 12/18/2022] Open
Affiliation(s)
| | - Giuseppe Boriani
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gheorge-Andrei Dan
- University of Medicine and Pharmacy “Carol Davila”, Colentina University Hospital, Bucharest, Romania
| | - Laurent Fauchier
- Centre Hospitalier Universitaire Trousseau et Université François Rabelais, Tours, France
| | | | - He Huang
- Renmin Hospital of Wuhan University, Wuhan, China
| | | | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Rajiv Mahajan
- The University of Adelaide, Lyell McEwin Hospital, Royal Adelaide Hospital and SAHMRI, Adelaide, Australia
| | - Tatjana Potpara
- School of Medicine, Belgrade University; Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | | | | | | | | | | | | | | | | | | | - Shu Zhang
- Beijing Fuwai Hospital, Beijing, China
| | | | - Abdel Fuenmayor
- Electrophysiology and Arrhythmia Section, Cardiovascular Research Institute, University Hospital of The Andes, Avenida 16 de Septiembre, Mérida 5101, Venezuela
| | | |
Collapse
|
372
|
Veale EL, Stewart AJ, Mathie A, Lall SK, Rees-Roberts M, Savickas V, Bhamra SK, Corlett SA. Pharmacists detecting atrial fibrillation (PDAF) in primary care during the influenza vaccination season: a multisite, cross-sectional screening protocol. BMJ Open 2018; 8:e021121. [PMID: 29540425 PMCID: PMC5857694 DOI: 10.1136/bmjopen-2017-021121] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Atrial fibrillation (AF) affects >6% of people aged 65 years or older. Left undetected and untreated, patients may develop significant cardiovascular complications and have a fivefold increased risk of suffering a stroke. For 40% of all sufferers, AF can be asymptomatic. Every year in the UK, £2.2 billion is spent on AF-related strokes, so there is an urgent need to improve early detection of AF. This study aims to determine the feasibility of using trained clinical pharmacists based in general practices, to screen for AF, using pulse palpation and a single-lead ECG device on participants aged 65 years or older, attending influenza vaccination clinics. METHODS AND ANALYSIS Seven clinical pharmacists will be trained by a cardiologist to pulse palpate and record single-lead ECGs using the AliveCor Kardia Mobile device. Quantitative analysis will assess the accuracy and ability of the clinical pharmacist to identify pulse irregularities using pulse palpation and to record and interpret a single-lead ECG. The level of agreement of pulse irregularities detected by pulse palpation will be compared with those detected by the single-lead ECG device, as will the level of agreement between the cardiologist and the device's interpretation of the ECG. The proportion of people identified with AF (confirmed by the cardiologist) will be determined. Additional demographic data will be obtained from all participants through a questionnaire. Qualitative data will be captured from the participants, from the clinical pharmacists and from the general practitioners and practice staff to determine their views on this method of AF screening. We aim to recruit 600 participants across general practices within Kent. ETHICS AND DISSEMINATION This protocol was approved by the London-Riverside Research Ethics committee. The findings of this study will be disseminated through forums including, but not limited to, peer-reviewed journals, national and international conferences.
Collapse
Affiliation(s)
- Emma L Veale
- Medway School of Pharmacy, University of Kent and University of Greenwich, Chatham Maritime, Kent, United Kingdom
| | | | - Alistair Mathie
- Medway School of Pharmacy, University of Kent and University of Greenwich, Chatham Maritime, Kent, United Kingdom
| | | | | | - Vilius Savickas
- Medway School of Pharmacy, University of Kent and University of Greenwich, Chatham Maritime, Kent, United Kingdom
| | - Sukvinder K Bhamra
- Medway School of Pharmacy, University of Kent and University of Greenwich, Chatham Maritime, Kent, United Kingdom
| | - Sarah A Corlett
- Medway School of Pharmacy, University of Kent and University of Greenwich, Chatham Maritime, Kent, United Kingdom
| |
Collapse
|
373
|
Jaakkola J, Jaakkola S, Lahdenoja O, Hurnanen T, Koivisto T, Pänkäälä M, Knuutila T, Kiviniemi TO, Vasankari T, Airaksinen KEJ. Mobile Phone Detection of Atrial Fibrillation With Mechanocardiography: The MODE-AF Study (Mobile Phone Detection of Atrial Fibrillation). Circulation 2018. [PMID: 29526834 DOI: 10.1161/circulationaha.117.032804] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jussi Jaakkola
- Heart Center, Turku University Hospital and University of Turku, Finland (J.J., S.J., T.O.K., T.V., K.E.J.A.)
| | - Samuli Jaakkola
- Heart Center, Turku University Hospital and University of Turku, Finland (J.J., S.J., T.O.K., T.V., K.E.J.A.)
| | - Olli Lahdenoja
- Department of Future Technologies, University of Turku, Finland (O.L., T.H., T.K., M.P., T.K.)
| | - Tero Hurnanen
- Department of Future Technologies, University of Turku, Finland (O.L., T.H., T.K., M.P., T.K.)
| | - Tero Koivisto
- Department of Future Technologies, University of Turku, Finland (O.L., T.H., T.K., M.P., T.K.)
| | - Mikko Pänkäälä
- Department of Future Technologies, University of Turku, Finland (O.L., T.H., T.K., M.P., T.K.)
| | - Timo Knuutila
- Department of Future Technologies, University of Turku, Finland (O.L., T.H., T.K., M.P., T.K.)
| | - Tuomas O Kiviniemi
- Heart Center, Turku University Hospital and University of Turku, Finland (J.J., S.J., T.O.K., T.V., K.E.J.A.)
| | - Tuija Vasankari
- Heart Center, Turku University Hospital and University of Turku, Finland (J.J., S.J., T.O.K., T.V., K.E.J.A.)
| | - K E Juhani Airaksinen
- Heart Center, Turku University Hospital and University of Turku, Finland (J.J., S.J., T.O.K., T.V., K.E.J.A.)
| |
Collapse
|
374
|
Affiliation(s)
- Jordi Heijman
- From the Department of Cardiology, Cardiovascular Research Institute Maastricht, Faculty of Health, Medicine, and Life Sciences, Maastricht University, The Netherlands (J.H.); Department of Medicine, Montreal Heart Institute and Université de Montréal, Canada (J.-B.G., S.N.); University Hospital of Saint-Étienne, University Jean Monnet, Saint-Étienne, France (J.-B.G.); Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen (D.D., S.N.); and
| | - Jean-Baptiste Guichard
- From the Department of Cardiology, Cardiovascular Research Institute Maastricht, Faculty of Health, Medicine, and Life Sciences, Maastricht University, The Netherlands (J.H.); Department of Medicine, Montreal Heart Institute and Université de Montréal, Canada (J.-B.G., S.N.); University Hospital of Saint-Étienne, University Jean Monnet, Saint-Étienne, France (J.-B.G.); Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen (D.D., S.N.); and
| | - Dobromir Dobrev
- From the Department of Cardiology, Cardiovascular Research Institute Maastricht, Faculty of Health, Medicine, and Life Sciences, Maastricht University, The Netherlands (J.H.); Department of Medicine, Montreal Heart Institute and Université de Montréal, Canada (J.-B.G., S.N.); University Hospital of Saint-Étienne, University Jean Monnet, Saint-Étienne, France (J.-B.G.); Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen (D.D., S.N.); and
| | - Stanley Nattel
- From the Department of Cardiology, Cardiovascular Research Institute Maastricht, Faculty of Health, Medicine, and Life Sciences, Maastricht University, The Netherlands (J.H.); Department of Medicine, Montreal Heart Institute and Université de Montréal, Canada (J.-B.G., S.N.); University Hospital of Saint-Étienne, University Jean Monnet, Saint-Étienne, France (J.-B.G.); Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen (D.D., S.N.); and
| |
Collapse
|
375
|
Diagnostic decision support systems for atrial fibrillation based on a novel electrocardiogram approach. J Electrocardiol 2018; 51:252-259. [DOI: 10.1016/j.jelectrocard.2017.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Indexed: 11/19/2022]
|
376
|
Zink MD, Marx N, Crijns HJGM, Schotten U. Opportunities and challenges of large-scale screening for atrial fibrillation. Herzschrittmacherther Elektrophysiol 2018; 29:57-61. [PMID: 29313142 PMCID: PMC5846832 DOI: 10.1007/s00399-017-0550-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 12/12/2017] [Indexed: 11/28/2022]
Abstract
Atrial fibrillation (AF) is a common arrhythmia and is highly associated with stroke and cardiovascular morbidity. As many AF episodes remain subclinical (SCAF), large-scale AF screening is considered a desirable approach for the treatment and prevention of cardioembolic stroke. Newly available single-lead ECG devices have provided promising results in the diagnosis of SCAF and treatment by nonvitamin K antagonist drugs appears to be safe and effective. Nevertheless, a further gain in knowledge is needed to clarify the different types of AF. This may help to define how or if a patient should be treated in the context of outcome and cost effectiveness. This review summarizes the results of recent research in this field and focuses on single-lead, discontinuous single time-point, community-based comprehensive-screening-based AF management. We want to conclude that progress in ECG diagnosis and anticoagulation therapy has prepared the ground to establish large-scale AF screening. The remaining question, however, is which patients should be screened and what therapy should be initiated in case of AF.
Collapse
Affiliation(s)
- Matthias Daniel Zink
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands
- Department of Cardiology, Pneumology, Angiology and Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Nikolaus Marx
- Department of Cardiology, Pneumology, Angiology and Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Harry J G M Crijns
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ulrich Schotten
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands.
- Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| |
Collapse
|
377
|
Chan NY. Systematic Screening for Atrial Fibrillation in the Community: Evidence and Obstacles. Arrhythm Electrophysiol Rev 2018; 7:39-42. [PMID: 29636971 PMCID: PMC5889810 DOI: 10.15420/aer.2017.47.2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/01/2018] [Indexed: 11/04/2022] Open
Abstract
With an ageing population globally, the burden of atrial fibrillation (AF) and its consequent complication of stroke and risk of mortality will continue to increase. Although opportunistic screening for AF by pulse check or ECG rhythm strip for people >65 years of age is currently recommended, data are now emerging that demonstrate the possible benefits of systematic community screening. Such screening is capable of identifying previously undiagnosed AF in 0.5-3.0 % of all those screened. The effectiveness of screening programmes will be markedly weakened by the lack of a structured downstream management pathway, making it a mandatory component in any AF screening programme for the general population. Different tools, especially smartphone-based devices, have made AF screening in the community more feasible. However, the sensitivities and positive predictive values of the current versions of automated diagnostic algorithms for AF have to be improved further to increase the cost-efficiency of screening programmes.
Collapse
Affiliation(s)
- Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret HospitalHong Kong, China
| |
Collapse
|
378
|
Boriani G, Glotzer TV, Ziegler PD, De Melis M, Mangoni di S. Stefano L, Sepsi M, Landolina M, Lunati M, Lewalter T, Camm AJ. Detection of new atrial fibrillation in patients with cardiac implanted electronic devices and factors associated with transition to higher device-detected atrial fibrillation burden. Heart Rhythm 2018; 15:376-383. [DOI: 10.1016/j.hrthm.2017.11.007] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Indexed: 11/30/2022]
|
379
|
Poppe KK, Doughty RN, Harwood M, Barber PA, Harrison J, Jackson R, Wells S. Identification, risk assessment, and management of patients with atrial fibrillation in a large primary care cohort. Int J Cardiol 2018; 254:119-124. [DOI: 10.1016/j.ijcard.2017.11.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/02/2017] [Accepted: 11/13/2017] [Indexed: 11/28/2022]
|
380
|
Kotecha D, Breithardt G, Camm AJ, Lip GYH, Schotten U, Ahlsson A, Arnar D, Atar D, Auricchio A, Bax J, Benussi S, Blomstrom-Lundqvist C, Borggrefe M, Boriani G, Brandes A, Calkins H, Casadei B, Castellá M, Chua W, Crijns H, Dobrev D, Fabritz L, Feuring M, Freedman B, Gerth A, Goette A, Guasch E, Haase D, Hatem S, Haeusler KG, Heidbuchel H, Hendriks J, Hunter C, Kääb S, Kespohl S, Landmesser U, Lane DA, Lewalter T, Mont L, Nabauer M, Nielsen JC, Oeff M, Oldgren J, Oto A, Pison L, Potpara T, Ravens U, Richard-Lordereau I, Rienstra M, Savelieva I, Schnabel R, Sinner MF, Sommer P, Themistoclakis S, Van Gelder IC, Vardas PE, Verma A, Wakili R, Weber E, Werring D, Willems S, Ziegler A, Hindricks G, Kirchhof P. Integrating new approaches to atrial fibrillation management: the 6th AFNET/EHRA Consensus Conference. Europace 2018; 20:395-407. [PMID: 29300976 DOI: 10.1093/europace/eux318] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 09/20/2017] [Indexed: 12/20/2022] Open
Abstract
There are major challenges ahead for clinicians treating patients with atrial fibrillation (AF). The population with AF is expected to expand considerably and yet, apart from anticoagulation, therapies used in AF have not been shown to consistently impact on mortality or reduce adverse cardiovascular events. New approaches to AF management, including the use of novel technologies and structured, integrated care, have the potential to enhance clinical phenotyping or result in better treatment selection and stratified therapy. Here, we report the outcomes of the 6th Consensus Conference of the Atrial Fibrillation Network (AFNET) and the European Heart Rhythm Association (EHRA), held at the European Society of Cardiology Heart House in Sophia Antipolis, France, 17-19 January 2017. Sixty-two global specialists in AF and 13 industry partners met to develop innovative solutions based on new approaches to screening and diagnosis, enhancing integration of AF care, developing clinical pathways for treating complex patients, improving stroke prevention strategies, and better patient selection for heart rate and rhythm control. Ultimately, these approaches can lead to better outcomes for patients with AF.
Collapse
Affiliation(s)
- Dipak Kotecha
- Institute of Cardiovascular Sciences, University of Birmingham, B15 2TT Birmingham, UK
| | - Günter Breithardt
- Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
| | - A John Camm
- St George's University of London, London, UK
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, B15 2TT Birmingham, UK
| | - Ulrich Schotten
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
- School for Cardiovascular Diseases, Maastricht University, The Netherlands
| | | | - David Arnar
- The National University Hospital, Reykjavik, Iceland
| | - Dan Atar
- Oslo University Hospital, Oslo, Norway
| | | | - Jeroen Bax
- Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | | | | | | | | | - Manuel Castellá
- Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Winnie Chua
- Institute of Cardiovascular Sciences, University of Birmingham, B15 2TT Birmingham, UK
| | - Harry Crijns
- University Hospital Maastricht, Maastricht, The Netherlands
| | | | - Larissa Fabritz
- Institute of Cardiovascular Sciences, University of Birmingham, B15 2TT Birmingham, UK
- University Hospital Münster, Münster, Germany
| | | | | | - Andrea Gerth
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
- Ludwig-Maximilians-University, Munich, Germany
| | - Andreas Goette
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
- St Vincenz Krankenhaus, Paderborn, Germany
| | - Eduard Guasch
- Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Doreen Haase
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
| | | | - Karl Georg Haeusler
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
- Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Craig Hunter
- Boehringer Ingelheim Pharma GmbH & Co. KG, Germany
| | - Stefan Kääb
- Ludwig-Maximilians University Clinic, Munich, Germany & DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | | | - Ulf Landmesser
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
- HaeuslerCharité-Universitätsmedizin Berlin, Berlin, Germany
| | - Deirdre A Lane
- Institute of Cardiovascular Sciences, University of Birmingham, B15 2TT Birmingham, UK
| | - Thorsten Lewalter
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
- Hospital-Munich Thalkirchen, Munich, Germany
| | - Lluís Mont
- Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Michael Nabauer
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
- Ludwig-Maximilians-University, Munich, Germany
| | | | - Michael Oeff
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
- Städtisches Klinikum Brandenburg, Brandenburg, Germany
| | - Jonas Oldgren
- Department of Cardiology, Institution of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Ali Oto
- Department of Cardiology, Memorial Ankara Hospital, Ankara, Turkey
| | - Laurent Pison
- Maastricht University, Medical Center, Maastricht, The Netherlands
| | - Tatjana Potpara
- School of Medicine, University of Belgrade, Clinical Centre of Serbia, Belgrade, Serbia
| | - Ursula Ravens
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
- University Heart Center Freiburg, Freiburg, Germany
| | | | - Michiel Rienstra
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Moritz F Sinner
- Ludwig-Maximilians University Clinic, Munich, Germany & DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Philipp Sommer
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | | | - Isabelle C Van Gelder
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Atul Verma
- Division of Cardiology, Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada
| | - Reza Wakili
- Ludwig-Maximilians-University, Munich, Germany
| | | | - David Werring
- Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | | | - André Ziegler
- Roche Diagnostics International Ltd, Rotkreuz, Switzerland
| | | | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, B15 2TT Birmingham, UK
- Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
| |
Collapse
|
381
|
Delaney JA, Yin X, Fontes JD, Wallace ER, Skinner A, Wang N, Hammill BG, Benjamin EJ, Curtis LH, Heckbert SR. Hospital and clinical care costs associated with atrial fibrillation for Medicare beneficiaries in the Cardiovascular Health Study and the Framingham Heart Study. SAGE Open Med 2018; 6:2050312118759444. [PMID: 29511541 PMCID: PMC5826000 DOI: 10.1177/2050312118759444] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 01/22/2018] [Indexed: 01/19/2023] Open
Abstract
Background Atrial fibrillation is increasingly prevalent as the US population ages and is associated with significant morbidity and mortality. Care for patients with atrial fibrillation can be costly, US health care costs are comparatively high, and there are few cost estimates available that incorporate detailed measurement of comorbidities and their effects on costs. Methods and Results In the Cardiovascular Health Study and the Framingham Heart Study, participants aged 65 years or older with newly diagnosed atrial fibrillation were matched on age and follow-up time to referents free of atrial fibrillation. The total clinical and hospital medical costs paid by Medicare Parts A and B (drug costs from Medicare Part D costs were not included) in the year prior to diagnosis (or matching) were compared with costs in the following year. Estimates were adjusted for other medical conditions and adjusted to 2009 dollars. In the Cardiovascular Health Study, 513 participants were diagnosed with new-onset atrial fibrillation and survived 30 days post-atrial fibrillation diagnosis, and 513 referents (as a control cohort) were identified, with a mean age of 77 years. In the Framingham Heart Study, we identified 336 participants diagnosed with atrial fibrillation, who survived 30 days post-atrial fibrillation diagnosis and matched these participants to 336 referents. We compared these new-onset atrial fibrillation participants with referents, using a difference in difference design to account for both time trends and differences between the two groups. The adjusted incremental cost for participants with atrial fibrillation, compared with referents, was US$18,060 (95% confidence interval: US$14,965-US$21,155) in the Cardiovascular Health Study and US$20,012 (95% confidence interval: US$15,057-US$24,966) in the Framingham Heart Study. The pooled estimate was US$18,601 (95% confidence interval: US$15,981-US$21,234). Conclusion Atrial fibrillation was associated with increased costs in the year after diagnosis in two community-based cohorts, even after careful accounting for age, time period, and systematically measured comorbidities.
Collapse
Affiliation(s)
- Joseph Ac Delaney
- Cardiovascular Health Research Unit and Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Xiaoyan Yin
- Boston University School of Medicine, Boston, MA, USA.,Framingham Heart Study, NHLBI and Boston University, Boston, MA, USA
| | | | - Erin R Wallace
- Cardiovascular Health Research Unit and Department of Epidemiology, University of Washington, Seattle, WA, USA
| | | | - Na Wang
- Boston University School of Medicine, Boston, MA, USA
| | | | - Emelia J Benjamin
- Boston University School of Medicine, Boston, MA, USA.,Framingham Heart Study, NHLBI and Boston University, Boston, MA, USA.,Boston University School of Public Health, Boston, MA, USA
| | | | - Susan R Heckbert
- Cardiovascular Health Research Unit and Department of Epidemiology, University of Washington, Seattle, WA, USA
| |
Collapse
|
382
|
Patel PJ, Katz R, Borovskiy Y, Killian A, Levine JM, McNaughton NW, Callans D, Supple G, Dixit S, Epstein AE, Marchlinski FE, Deo R. Race and stroke in an atrial fibrillation inception cohort: Findings from the Penn Atrial Fibrillation Free study. Heart Rhythm 2018; 15:487-493. [PMID: 29475795 DOI: 10.1016/j.hrthm.2017.11.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND Stroke may be the initial manifestation of atrial fibrillation (AF). Limited studies, however, have evaluated racial differences in stroke before the diagnosis of AF. OBJECTIVE We assessed racial differences in strokes that occurred before and after AF diagnosis in the Penn Atrial Fibrillation Free study. METHODS The Penn Atrial Fibrillation Free study consists of 56,835 patients from the University of Pennsylvania Health System who were free of AF at the index visit. We developed an inception cohort of 3507 patients with incident AF and without any remote history of stroke. RESULTS Among the AF inception cohort, there were 538 patients with ischemic strokes and 54 with hemorrhagic strokes. Nearly half (n = 254; 47%) of the ischemic strokes occurred within a 6-month period before the diagnosis of AF. Of these, the majority of strokes occurred either on the day of (n = 158) or within a 7-day period before (n = 30) the diagnosis of incident AF. The remaining 284 (53%) ischemic strokes occurred a median of 3.6 years (interquartile range 1.9-5.4 years) after AF diagnosis. Compared with whites, blacks had an independently higher risk of having an ischemic stroke either before (adjusted odds ratio 1.37; 95% confidence interval 1.03-1.81) or after (adjusted hazard ratio 1.67; 95% confidence interval 1.30-2.14) AF diagnosis. CONCLUSION In the population with incident AF, nearly half of the ischemic strokes occurred before the diagnosis of AF. Compared with whites, blacks had a higher risk of developing an ischemic stroke that persisted whether the stroke occurred in the period either before or after AF diagnosis.
Collapse
Affiliation(s)
- Parin J Patel
- Division of Cardiology, St. Vincent Medical Group, Indianapolis, Indiana
| | - Ronit Katz
- Kidney Research Institute, University of Washington, Seattle, Washington
| | - Yuliya Borovskiy
- Section of Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anthony Killian
- Section of Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joshua M Levine
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nelson W McNaughton
- Section of Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Callans
- Section of Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory Supple
- Section of Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sanjay Dixit
- Section of Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew E Epstein
- Section of Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Francis E Marchlinski
- Section of Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rajat Deo
- Section of Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
| |
Collapse
|
383
|
Staszewsky L, Pasina L, Musazzi UM, Latini R. Screening for unknown atrial fibrillation in older people: a feasibility study in community pharmacies. Eur Geriatr Med 2018; 9:113-115. [PMID: 34654276 DOI: 10.1007/s41999-017-0010-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 11/14/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Atrial fibrillation (AF) is the most common heart arrhythmia. It is associated with an increased risk of morbidity and mortality and its prevalence rises with age. The arrhythmia is often asymptomatic, and systematic AF screening could help identify asymptomatic individuals to implement therapeutic and preventive strategies. The main study aims were to test the technical feasibility and citizens' acceptance of a freely offered service in older people using community pharmacies. MATERIALS AND METHODS During 2 months, a 30-s single-lead electrocardiogram (ECG) with a telemedicine device was used for screening in 20 pharmacies in a mixed rural-urban health district of Northern Italy. RESULTS A total of 289/335 older adults 70 years old or more agreed to participate in the study. A cardiologist considered 80% of the ECG tracings readable and unknown AF was identified in 1.3%. CONCLUSIONS The screening scheme appears technically feasible and acceptable both to professionals and citizens/participants. Training the pharmacists could ensure broader participation and substantially improve the pharmacies' overall performance.
Collapse
Affiliation(s)
- Lidia Staszewsky
- Laboratory of Clinical Pharmacology, Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa 19, 20156, Milan, Italy.
| | - L Pasina
- Laboratory of Quality Assessment of Geriatric Therapies and Services, Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - U M Musazzi
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, Milan, Italy.,Associazione Giovani Farmacisti (AGiFar) della Provincia di Lecco, Lecco, Italy
| | - R Latini
- Laboratory of Clinical Pharmacology, Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa 19, 20156, Milan, Italy
| | | |
Collapse
|
384
|
Boriani G, Laroche C, Diemberger I, Fantecchi E, Meeder J, Kurpesa M, Baluta MM, Proietti M, Tavazzi L, Maggioni AP, Lip GYH. Overweight and obesity in patients with atrial fibrillation: Sex differences in 1-year outcomes in the EORP-AF General Pilot Registry. J Cardiovasc Electrophysiol 2018; 29:566-572. [DOI: 10.1111/jce.13428] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/13/2017] [Accepted: 01/02/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Giuseppe Boriani
- Cardiology Department; University of Modena and Reggio Emilia, Policlinico di Modena; Modena Italy
| | - Cécile Laroche
- EURObservational Research Programme Department; European Society of Cardiology; Sophia Antipolis France
| | - Igor Diemberger
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine; University of Bologna, S. Orsola-Malpighi University Hospital; Bologna Italy
| | - Elisa Fantecchi
- Cardiology Department; University of Modena and Reggio Emilia, Policlinico di Modena; Modena Italy
| | - Joan Meeder
- Department of Cardiology; VieCuri Medical Center; Venlo the Netherlands
| | | | - Monica Mariana Baluta
- Cardiology Department; Carol Davila University of Medicine and Pharmacy, St. Pantelimon Emergency Hospital; Bucharest Romania
| | - Marco Proietti
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital; Birmingham United Kingdom
| | - Luigi Tavazzi
- Maria Cecilia Hospital; GVM Care&Research. E.S. Health Science Foundation; Cotignola Italy
| | - Aldo P. Maggioni
- EURObservational Research Programme Department; European Society of Cardiology; Sophia Antipolis France
- ANMCO Research Center; Firenze Italy
| | - Gregory Y. H. Lip
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital; Birmingham United Kingdom
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine; Aalborg University; Aalborg Denmark
| | | |
Collapse
|
385
|
Katritsis GD, Katritsis DG. Management of Complications in Anticoagulated Patients with Atrial Fibrillation. Arrhythm Electrophysiol Rev 2018; 6:167-178. [PMID: 29326831 DOI: 10.15420/aer.2017.23.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Oral anticoagulation is mandatory for patients at high risk of thromboembolism, but the risk of bleeding should also be taken into account. Direct oral anticoagulants are now recommended for non-valvular AF as a potential alternative to warfarin. In this article we discuss methods to assess the anticoagulant effect of these agents, specific and general antidotes, and management of complications such as embolic and haemorrhagic stroke, and significant bleeding.
Collapse
|
386
|
Boriani G, Biagini E, Ziacchi M, Malavasi VL, Vitolo M, Talarico M, Mauro E, Gorlato G, Lattanzi G. Cardiolaminopathies from bench to bedside: challenges in clinical decision-making with focus on arrhythmia-related outcomes. Nucleus 2018; 9:442-459. [PMID: 30130999 PMCID: PMC6244733 DOI: 10.1080/19491034.2018.1506680] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/16/2018] [Accepted: 07/25/2018] [Indexed: 02/07/2023] Open
Abstract
Lamin A/C gene mutations can be associated with cardiac diseases, usually referred to as 'cardiolaminopathies' characterized by arrhythmic disorders and/or left ventricular or biventricular dysfunction up to an overt picture of heart failure. The phenotypic cardiac manifestations of laminopathies are frequently mixed in complex clinical patterns and specifically may include bradyarrhythmias (sinus node disease or atrioventricular blocks), atrial arrhythmias (atrial fibrillation, atrial flutter, atrial standstill), ventricular tachyarrhythmias and heart failure of variable degrees of severity. Family history, physical examination, laboratory findings (specifically serum creatine phosphokinase values) and ECG findings are often important 'red flags' in diagnosing a 'cardiolaminopathy'. Sudden arrhythmic death, thromboembolic events or stroke and severe heart failure requiring heart transplantation are the most dramatic complications of the evolution of cardiolaminopathies and appropriate risk stratification is clinically needed combined with clinical follow-up. Treatment with cardiac electrical implantable devices is indicated in case of bradyarrhythmias (implant of a device with pacemaker functions), risk of life-threatening ventricular tachyarrhythmias (implant of an ICD) or in case of heart failure with wide QRS interval (implant of a device for cardiac resynchronization). New technologies introduced in the last 5 years can help physicians to reduce device-related complications, thanks to the extension of device longevity and availability of leadless pacemakers or defibrillators, to be implanted in appropriately selected patients. An improved knowledge of the complex pathophysiological pathways involved in cardiolaminopathies and in the determinants of their progression to more severe forms will help to improve clinical management and to better target pharmacological and non-pharmacological treatments.
Collapse
Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Elena Biagini
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Matteo Ziacchi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Vincenzo Livio Malavasi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Marisa Talarico
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Erminio Mauro
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Giulia Gorlato
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Giovanna Lattanzi
- CNR Institute of Molecular Genetics, Unit of Bologna, Bologna, Italy
- Laboratory of Musculoskeletal Cell Biology, Rizzoli Orthopedic Institute, Bologna, Italy
| |
Collapse
|
387
|
Soni A, Karna S, Patel H, Fahey N, Raithatha S, Handorf A, Bostrom J, Bashar S, Talati K, Shah R, Goldberg RJ, Thanvi S, Phatak AG, Allison JJ, Chon K, Nimbalkar SM, McManus DD. Study protocol for Smartphone Monitoring for Atrial fibrillation in Real- Time in India (SMART-India): a community-based screening and referral programme. BMJ Open 2017; 7:e017668. [PMID: 29247089 PMCID: PMC5736031 DOI: 10.1136/bmjopen-2017-017668] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Atrial fibrillation (AF), the world's most common arrhythmia, often goes undetected and untreated in low-resource communities, including India, where AF epidemiology is undefined. AF is an important risk factor for stroke, which plagues an estimated 1.6 million Indians annually. As such, early detection of AF and management of high-risk patients is critically important to decrease stroke burden in individuals with AF. This study aims to describe the epidemiology of AF in Anand District, Gujarat, India, characterise the clinical profile of individuals who are diagnosed with AF and determine the performance of two mobile technologies for community-based AF screening. METHODS This observational study builds on findings from a previous feasibility study and leverages two novel technologies as well as an existing community health programme to perform door-to-door AF screening for 2000 people from 60 villages of Anand District, Gujarat, India using local health workers. A single-lead ECG and a pulse-based application is used to screen each individual for AF three times over a period of 5 days. Participants with suspected arrhythmias are followed up by study cardiologist who makes final diagnoses. Participants diagnosed with AF are initiated on treatment based on current anticoagulation guidelines and clinical reasoning. ANALYTICAL PLAN Age-stratified and sex-stratified prevalence of AF in the Anand District will be calculated for sample and estimated for Anand distribution using survey design weights. Sociodemographic and clinical factors associated with AF will be evaluated using multivariable regression methods. Performance of each mobile technology in detecting AF will be evaluated using a 12-lead ECG interpretation as the gold standard. ETHICS AND DISSEMINATION This protocol was approved separately by the Institutional Review Board of University of Massachusetts Medical School and the Human Research Ethics Committee at Charutar Arogya Mandal. The findings of this study will be disseminated through peer-reviewed journals and scientific conferences.
Collapse
Affiliation(s)
- Apurv Soni
- Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- School of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Sunil Karna
- Cardiovascular Medicine, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Harshil Patel
- Central Research Services, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Nisha Fahey
- Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Shyamsundar Raithatha
- Community Extension, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Anna Handorf
- School of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - John Bostrom
- School of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Syed Bashar
- Biomedical Engineering, University of Connecticut, Storrs, Connecticut, USA
| | - Kandarp Talati
- Central Research Services, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Ravi Shah
- Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Robert J Goldberg
- Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Sunil Thanvi
- Cardiovascular Medicine, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Ajay Gajanan Phatak
- Central Research Services, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Jeroan J Allison
- Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Ki Chon
- Biomedical Engineering, University of Connecticut, Storrs, Connecticut, USA
| | | | - David D McManus
- Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| |
Collapse
|
388
|
Boriani G, Proietti M. Atrial fibrillation prevention: an appraisal of current evidence. Heart 2017; 104:882-887. [PMID: 29191806 DOI: 10.1136/heartjnl-2017-311546] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 11/04/2017] [Accepted: 11/06/2017] [Indexed: 01/08/2023] Open
Abstract
Atrial fibrillation (AF), which is the most diagnosed arrhythmia, is becoming a significant issue for health policy-makers. In particular, more and more attention is being devoted to AF prevention. Indeed, several studies recently published point out how targeted interventions could be useful in reducing the risk of AF occurrence (or recurrence). In this review, we briefly summarised the role of the major risk factors associated with the incidence of AF, as well as the effectiveness of interventions aimed at controlling these risk factors. Several general risk factors, such as alcohol consumption, physical activity, smoking habit, as well as specific cardiovascular risk factors as diabetes mellitus, hypertension and obesity have a relevant impact in determining the occurrence of AF, along with a strong clinical evidence of a dose-effect response mechanism for most of the factors examined. Specific interventions aimed at controlling risk factors have been showed to clearly reduce the risk of AF in several cohorts. Even more importantly, integrated programmes aimed at controlling for multiple risk factors would be more efficient in terms of reducing risk of AF, in particular whena stricter control is observed. AF prevention requires a series of initiatives focused on the many risk factors that we reviewed, as well as a more integrated approach, which should involve many stakeholders at different levels. In this light and also considering the constantly changing epidemiology, AF prevention may constitute a future 'win-win' strategy for all the stakeholders.
Collapse
Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Marco Proietti
- Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
389
|
Reiffel JA. When Silence Isn't Golden: The Case of "Silent" Atrial Fibrillation. J Innov Card Rhythm Manag 2017; 8:2886-2893. [PMID: 32477759 PMCID: PMC7252797 DOI: 10.19102/icrm.2017.081102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 09/06/2017] [Indexed: 11/08/2022] Open
Abstract
Silent atrial fibrillation (AF) is common. In some patients, it is the only manifestation of AF, while in others, the AF may be symptomatic or both symptomatic and asymptomatic. Regardless, however, to date, the significance, detection, and management considerations for silent AF have been incompletely elucidated. This current study aimed to review, for both the current clinician and investigator, considerations and attitudes and the ongoing studies, respectively, with respect to silent AF. The methods used were a literature review and personal trial and clinical experience; the frequency of silent AF, concerns regarding silent AF, methods to detect silent AF, and prospective trials focused on the detection and management of silent AF were considered. The results of the literature search indicated that recently conducted relevant trials, such as PREDATE AF, ASSERT-II, and REVEAL AF, have shown that silent AF is frequent in patients with risk markers for AF and stroke in whom no prior AF history is present, and in whom no pacemaker or implantable cardioverter-defibrillator implantations have been previously performed. Furthermore, the GLORIA-AF Registry has reported the observance of more permanent AF and more prior strokes in asymptomatic patients. Ongoing trials such as ARTESiA and NOAH-AFNET 6 are expected to clarify the benefits and risks of oral anticoagulation in patients with silent AF. At present, when silent AF is detected in patients with stroke risk markers, most practitioners initiate an anticoagulation regimen.
Collapse
Affiliation(s)
- James A Reiffel
- Department of Medicine, Division of Cardiology, Electrophysiology Section, Columbia University, New York, NY, USA
| |
Collapse
|
390
|
Hald J, Poulsen PB, Qvist I, Holm L, Wedell-Wedellsborg D, Dybro L, Frost L. Opportunistic screening for atrial fibrillation in a real-life setting in general practice in Denmark-The Atrial Fibrillation Found On Routine Detection (AFFORD) non-interventional study. PLoS One 2017; 12:e0188086. [PMID: 29131836 PMCID: PMC5683635 DOI: 10.1371/journal.pone.0188086] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 10/31/2017] [Indexed: 11/19/2022] Open
Abstract
Atrial fibrillation (AF) is a chronic disease with an incidence increasing steeply by age and affecting more than 11 million patients in Europe and the United States. Diagnosing AF is essential for the prevention of stroke by oral anticoagulation. Opportunistic screening for AF in patients ≥65 years of age is recommended by the European and Danish Societies of Cardiology. The study aim was to examine the detection rate of AF in consecutively screened patients in the primary care setting in Denmark. In an open, non-interventional, cluster, multicenter, cross-sectional, observational study patients ≥65 years of age entering consecutively into general practice clinics were invited to nurse-assisted opportunistic screening for AF. The General Practice (GP) clinics participating were randomized to patient inclusion in three age groups: 65-74, 75-84, and ≥85 years respectively. All patients underwent pulse palpation followed by 12-led electrocardiogram in case of irregular pulse. Two cardiologists validated all electrocardiogram examinations. Forty-nine general practice clinics recruited in total 970 patients split into three age groups; 480 patients (65-74 years), 372 (75-84 years), and 118 patients ≥85 years of age. Co-morbidities increased by age with hypertension being most frequent. Eighty-seven patients (9%) were detected with an irregular pulse, representing 4.4%, 10.5% and 22.9%, respectively in the three age groups. Assessment of electrocardiograms by the GP showed suspicion of AF in 13 patients with final verification of electrocardiograms by cardiologists revealing 10 AF-patients. The highest detection rate of AF was found in the ≥85 age group (3.39%) followed by the 65-74 age group (0.83%) and the 75-84 age group (0.54%). Opportunistic screening of AF in primary care is feasible and do result in the detection of new AF-patients. Close collaboration with cardiologists is advisable to avoid false positive screening results.
Collapse
Affiliation(s)
- Jonas Hald
- Lægerne Odingården (GP-clinic), Viborg, Denmark
| | | | - Ina Qvist
- Department of Cardiology, University Research Clinic for Innovative Patient Pathways, Regional Hospital of Silkeborg, Silkeborg, Denmark
| | | | | | - Lars Dybro
- Pfizer Denmark, Internal Medicine, Ballerup, Denmark
| | - Lars Frost
- Department of Cardiology, University Research Clinic for Innovative Patient Pathways, Regional Hospital of Silkeborg, Silkeborg, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
391
|
Weng LC, Preis SR, Hulme OL, Larson MG, Choi SH, Wang B, Trinquart L, McManus DD, Staerk L, Lin H, Lunetta KL, Ellinor PT, Benjamin EJ, Lubitz SA. Genetic Predisposition, Clinical Risk Factor Burden, and Lifetime Risk of Atrial Fibrillation. Circulation 2017; 137:1027-1038. [PMID: 29129827 DOI: 10.1161/circulationaha.117.031431] [Citation(s) in RCA: 176] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/02/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND The long-term probability of developing atrial fibrillation (AF) considering genetic predisposition and clinical risk factor burden is unknown. METHODS We estimated the lifetime risk of AF in individuals from the community-based Framingham Heart Study. Polygenic risk for AF was derived using a score of ≈1000 AF-associated single-nucleotide polymorphisms. Clinical risk factor burden was calculated for each individual using a validated risk score for incident AF comprised of height, weight, systolic and diastolic blood pressure, current smoking status, antihypertensive medication use, diabetes mellitus, history of myocardial infarction, and history of heart failure. We estimated the lifetime risk of AF within tertiles of polygenic and clinical risk. RESULTS Among 4606 participants without AF at 55 years of age, 580 developed incident AF (median follow-up, 9.4 years; 25th-75th percentile, 4.4-14.3 years). The lifetime risk of AF >55 years of age was 37.1% and was substantially influenced by both polygenic and clinical risk factor burden. Among individuals free of AF at 55 years of age, those in low-polygenic and clinical risk tertiles had a lifetime risk of AF of 22.3% (95% confidence interval, 15.4-9.1), whereas those in high-risk tertiles had a risk of 48.2% (95% confidence interval, 41.3-55.1). A lower clinical risk factor burden was associated with later AF onset after adjusting for genetic predisposition (P<0.001). CONCLUSIONS In our community-based cohort, the lifetime risk of AF was 37%. Estimation of polygenic AF risk is feasible and together with clinical risk factor burden explains a substantial gradient in long-term AF risk.
Collapse
Affiliation(s)
- Lu-Chen Weng
- Cardiovascular Research Center (L.-C.W., O.L.H., P.T.E., S.A.L.).,Massachusetts General Hospital, Boston. Program in Medical and Population Genetics, The Broad Institute of Harvard and MIT, Cambridge, MA (L.-C.W., O.L.H., S.H.C., P.T.E., S.A.L.)
| | - Sarah R Preis
- Department of Biostatistics, Boston University School of Public Health, MA (S.R.P., M.G.L., B.W., L.T., K.L.L.).,Boston University and National Heart, Lung and Blood Institute's Framingham Heart Study, MA (S.R.P., M.G.L., L.T., L.S., H.L., K.L.L., E.J.B.)
| | - Olivia L Hulme
- Cardiovascular Research Center (L.-C.W., O.L.H., P.T.E., S.A.L.).,Massachusetts General Hospital, Boston. Program in Medical and Population Genetics, The Broad Institute of Harvard and MIT, Cambridge, MA (L.-C.W., O.L.H., S.H.C., P.T.E., S.A.L.)
| | - Martin G Larson
- Department of Biostatistics, Boston University School of Public Health, MA (S.R.P., M.G.L., B.W., L.T., K.L.L.).,Boston University and National Heart, Lung and Blood Institute's Framingham Heart Study, MA (S.R.P., M.G.L., L.T., L.S., H.L., K.L.L., E.J.B.)
| | - Seung Hoan Choi
- Massachusetts General Hospital, Boston. Program in Medical and Population Genetics, The Broad Institute of Harvard and MIT, Cambridge, MA (L.-C.W., O.L.H., S.H.C., P.T.E., S.A.L.)
| | - Biqi Wang
- Department of Biostatistics, Boston University School of Public Health, MA (S.R.P., M.G.L., B.W., L.T., K.L.L.)
| | - Ludovic Trinquart
- Department of Biostatistics, Boston University School of Public Health, MA (S.R.P., M.G.L., B.W., L.T., K.L.L.).,Boston University and National Heart, Lung and Blood Institute's Framingham Heart Study, MA (S.R.P., M.G.L., L.T., L.S., H.L., K.L.L., E.J.B.)
| | - David D McManus
- Department of Medicine, Cardiology Division, University of Massachusetts Medical School, Worcester (D.D.M.)
| | - Laila Staerk
- Boston University and National Heart, Lung and Blood Institute's Framingham Heart Study, MA (S.R.P., M.G.L., L.T., L.S., H.L., K.L.L., E.J.B.).,Cardiovascular Research Center, Herlev and Gentofte University Hospital, Hellerup, Denmark (L.S.)
| | - Honghuang Lin
- Boston University and National Heart, Lung and Blood Institute's Framingham Heart Study, MA (S.R.P., M.G.L., L.T., L.S., H.L., K.L.L., E.J.B.).,Department of Medicine, Sections of Computational Biomedicine (H.L.)
| | - Kathryn L Lunetta
- Department of Biostatistics, Boston University School of Public Health, MA (S.R.P., M.G.L., B.W., L.T., K.L.L.).,Boston University and National Heart, Lung and Blood Institute's Framingham Heart Study, MA (S.R.P., M.G.L., L.T., L.S., H.L., K.L.L., E.J.B.)
| | - Patrick T Ellinor
- Cardiovascular Research Center (L.-C.W., O.L.H., P.T.E., S.A.L.).,Cardiac Arrhythmia Service (P.T.E., S.A.L.).,Massachusetts General Hospital, Boston. Program in Medical and Population Genetics, The Broad Institute of Harvard and MIT, Cambridge, MA (L.-C.W., O.L.H., S.H.C., P.T.E., S.A.L.)
| | - Emelia J Benjamin
- Boston University and National Heart, Lung and Blood Institute's Framingham Heart Study, MA (S.R.P., M.G.L., L.T., L.S., H.L., K.L.L., E.J.B.).,Preventive Medicine and Cardiovascular Medicine (E.J.B.), Boston University School of Medicine, MA
| | - Steven A Lubitz
- Cardiovascular Research Center (L.-C.W., O.L.H., P.T.E., S.A.L.) .,Cardiac Arrhythmia Service (P.T.E., S.A.L.).,Massachusetts General Hospital, Boston. Program in Medical and Population Genetics, The Broad Institute of Harvard and MIT, Cambridge, MA (L.-C.W., O.L.H., S.H.C., P.T.E., S.A.L.)
| |
Collapse
|
392
|
Halcox JP, Wareham K, Cardew A, Gilmore M, Barry JP, Phillips C, Gravenor MB. Assessment of Remote Heart Rhythm Sampling Using the AliveCor Heart Monitor to Screen for Atrial Fibrillation. Circulation 2017; 136:1784-1794. [PMID: 28851729 DOI: 10.1161/circulationaha.117.030583] [Citation(s) in RCA: 348] [Impact Index Per Article: 49.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 08/16/2017] [Indexed: 01/16/2023]
Affiliation(s)
- Julian P.J. Halcox
- From Swansea University Medical School, UK (J.P.J.H., K.W., M.B.G.); Swansea University College of Health and Human Sciences, UK (C.P., A.C.); Princess of Wales Hospital, Cardiology, Bridgend, UK (M.G.); and Regional Cardiac Centre, Morriston Hospital, Swansea, UK (J.P.B.)
| | - Kathie Wareham
- From Swansea University Medical School, UK (J.P.J.H., K.W., M.B.G.); Swansea University College of Health and Human Sciences, UK (C.P., A.C.); Princess of Wales Hospital, Cardiology, Bridgend, UK (M.G.); and Regional Cardiac Centre, Morriston Hospital, Swansea, UK (J.P.B.)
| | - Antonia Cardew
- From Swansea University Medical School, UK (J.P.J.H., K.W., M.B.G.); Swansea University College of Health and Human Sciences, UK (C.P., A.C.); Princess of Wales Hospital, Cardiology, Bridgend, UK (M.G.); and Regional Cardiac Centre, Morriston Hospital, Swansea, UK (J.P.B.)
| | - Mark Gilmore
- From Swansea University Medical School, UK (J.P.J.H., K.W., M.B.G.); Swansea University College of Health and Human Sciences, UK (C.P., A.C.); Princess of Wales Hospital, Cardiology, Bridgend, UK (M.G.); and Regional Cardiac Centre, Morriston Hospital, Swansea, UK (J.P.B.)
| | - James P. Barry
- From Swansea University Medical School, UK (J.P.J.H., K.W., M.B.G.); Swansea University College of Health and Human Sciences, UK (C.P., A.C.); Princess of Wales Hospital, Cardiology, Bridgend, UK (M.G.); and Regional Cardiac Centre, Morriston Hospital, Swansea, UK (J.P.B.)
| | - Ceri Phillips
- From Swansea University Medical School, UK (J.P.J.H., K.W., M.B.G.); Swansea University College of Health and Human Sciences, UK (C.P., A.C.); Princess of Wales Hospital, Cardiology, Bridgend, UK (M.G.); and Regional Cardiac Centre, Morriston Hospital, Swansea, UK (J.P.B.)
| | - Michael B. Gravenor
- From Swansea University Medical School, UK (J.P.J.H., K.W., M.B.G.); Swansea University College of Health and Human Sciences, UK (C.P., A.C.); Princess of Wales Hospital, Cardiology, Bridgend, UK (M.G.); and Regional Cardiac Centre, Morriston Hospital, Swansea, UK (J.P.B.)
| |
Collapse
|
393
|
Freedman B, Wachter R. The role of atrial fibrillation in patients with an embolic stroke of unknown source (ESUS). Thromb Haemost 2017; 117:1833-1835. [DOI: 10.1160/th17-08-0592] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 12/24/2022]
|
394
|
Affiliation(s)
- Mikhail S. Dzeshka
- From the Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom (M.S.D., A.S., E.S., G.Y.H.L.); Grodno State Medical University, Belarus (M.S.D.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.)
| | - Alena Shantsila
- From the Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom (M.S.D., A.S., E.S., G.Y.H.L.); Grodno State Medical University, Belarus (M.S.D.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.)
| | - Eduard Shantsila
- From the Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom (M.S.D., A.S., E.S., G.Y.H.L.); Grodno State Medical University, Belarus (M.S.D.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.)
| | - Gregory Y.H. Lip
- From the Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom (M.S.D., A.S., E.S., G.Y.H.L.); Grodno State Medical University, Belarus (M.S.D.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.)
| |
Collapse
|
395
|
Chen Y, Lei L, Wang JG. Atrial fibrillation screening during automated blood pressure measurement-Comment on "Diagnostic accuracy of new algorithm to detect atrial fibrillation in a home blood pressure monitor". J Clin Hypertens (Greenwich) 2017; 19:1148-1151. [PMID: 28942614 DOI: 10.1111/jch.13081] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yi Chen
- Department of Hypertension, Shanghai Key Laboratory of Hypertension, Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Lei
- Department of Hypertension, Shanghai Key Laboratory of Hypertension, Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ji-Guang Wang
- Department of Hypertension, Shanghai Key Laboratory of Hypertension, Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
396
|
Thijs V. Atrial Fibrillation Detection: Fishing for An Irregular Heartbeat Before and After Stroke. Stroke 2017; 48:2671-2677. [PMID: 28916671 DOI: 10.1161/strokeaha.117.017083] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/14/2017] [Accepted: 07/18/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Vincent Thijs
- From the Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, and Department of Neurology, Austin Health, Heidelberg, Victoria, Australia.
| |
Collapse
|
397
|
Tavernier R, Wolf M, Kataria V, Phlips T, Huys R, Taghji P, Louw R, Hoeyweghen RV, Vandekerckhove Y, Knecht S, Duytschaever M. Screening for atrial fibrillation in hospitalised geriatric patients. Heart 2017; 104:588-593. [PMID: 28883032 DOI: 10.1136/heartjnl-2017-311981] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 07/25/2017] [Accepted: 08/14/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To assess whether daily short-term rhythm strip recordings on top of routine clinical care could increase the atrial fibrillation (AF) detection rate in the hospitalised elderly. METHODS A hand-held device storing a bipolar ECG during 1 min was used for daily rhythm recording in hospitalised elderly patients. RESULTS During 2 months, all patients admitted to the Department of Geriatric Medicine were screened (n=327). Five patients refused to participate in the study and 70 patients were unable to hold the device due to severe mental (n=46) or motor impairment (n=24). In the remaining 252 patients, 1582 recordings were successfully obtained after 1624 attempts with a median acquisition time of 1 min (min 1, max 9, IQR 1-2 min). The rhythm strips were not reliable interpretable due to artefacts in three patients or an implantable cardiac pulse generator in another 28 patients. Detailed clinical information was available in 214/221 patients. Mean age was 84±6 years. On top of 71 (33%) patients with AF identified by routine clinical care (history, n=64 or de novo detected during current hospitalisation, n=7), review of all rhythm strips identified another 28 patients (13%) with AF. All these patients had a CHA2DS2VASc score ≥2. A contraindication for anticoagulation was present in only 8/28 (25%) of identified patients. CONCLUSIONS On top of routine clinical care, daily short-term rhythm strip recordings identified another 13% of elderly hospitalised patients with AF, leading to an overall prevalence of 46% in hospitalised patients. This can have significant therapeutic implications with respect to initiation of anticoagulation.
Collapse
Affiliation(s)
- Rene Tavernier
- Department of Cardiology, AZ Sint Jan Bruges, Brugge, Belgium
| | - Michael Wolf
- Department of Cardiology, AZ Sint Jan Bruges, Brugge, Belgium
| | - Vikas Kataria
- Department of Cardiology, AZ Sint Jan Bruges, Brugge, Belgium
| | - Tom Phlips
- Department of Cardiology, AZ Sint Jan Bruges, Brugge, Belgium
| | - Ruben Huys
- Department of Cardiology, AZ Sint Jan Bruges, Brugge, Belgium
| | - Philippe Taghji
- Department of Cardiology, AZ Sint Jan Bruges, Brugge, Belgium
| | - Ruan Louw
- Department of Cardiology, AZ Sint Jan Bruges, Brugge, Belgium
| | | | | | | | - Mattias Duytschaever
- Department of Cardiology, AZ Sint Jan Bruges, Brugge, Belgium.,Department of Cardiology, University Hospital Ghent, Ghent, Belgium
| |
Collapse
|
398
|
Neubeck L, Orchard J, Lowres N, Freedman SB. To Screen or Not to Screen? Examining the Arguments Against Screening for Atrial Fibrillation. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.05.118] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
399
|
Freedman B, Boriani G, Glotzer TV, Healey JS, Kirchhof P, Potpara TS. Management of atrial high-rate episodes detected by cardiac implanted electronic devices. Nat Rev Cardiol 2017; 14:701-714. [DOI: 10.1038/nrcardio.2017.94] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|