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Diemberger I, Imberti JF, Spagni S, Rapacciuolo A, Curcio A, Attena E, Amadori M, De Ponti R, D’Onofrio A, Boriani G. Drug management of atrial fibrillation in light of guidelines and current evidence: an Italian Survey on behalf of Italian Association of Arrhythmology and Cardiac Pacing. J Cardiovasc Med (Hagerstown) 2023; 24:430-440. [PMID: 37222631 PMCID: PMC10319250 DOI: 10.2459/jcm.0000000000001501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/10/2023] [Accepted: 04/30/2023] [Indexed: 05/25/2023]
Abstract
AIM Atrial fibrillation is a multifaceted disease requiring personalized treatment, in accordance with current ESC guidelines. Despite a wide range of literature, we still have various aspects dividing the opinion of the experts in rate control, rhythm control and thromboembolic prophylaxis. The aim of this survey was to provide a country-wide picture of current practice regarding atrial fibrillation pharmacological management according to a patient's characteristics. METHODS Data were collected using an in-person survey that was administered to members of the Italian Association of Arrhythmology and Cardiac Pacing. RESULTS We collected data from 106 physicians, working in 72 Italian hospitals from 15 of 21 regions. Our work evidenced a high inhomogeneity in atrial fibrillation management regarding rhythm control, rate control and thromboembolic prophylaxis in both acute and chronic patients. This element was more pronounced in settings in which literature shows a lack of evidence and, consequently, the indications provided by the guidelines are weak or absent. CONCLUSION This National survey evidenced a high inhomogeneity in current approaches adopted for atrial fibrillation management by a sample of Italian cardiologist experts in arrhythmia management. Further studies are needed to explore if these divergences are associated with different long-term outcomes.
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Affiliation(s)
- Igor Diemberger
- Institute of Cardiology, Department of Medical and Surgical Sciences, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna
- IRCCS Policlinico di S.Orsola, U.O.C. di Cardiologia
- Pharmacologic Area of AIAC (Associazione Italiana Aritmologia e Cardiostimolazione), Rome
| | - Jacopo Francesco Imberti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia
- Pharmacologic Area of AIAC (Associazione Italiana Aritmologia e Cardiostimolazione), Rome
| | - Stefano Spagni
- Institute of Cardiology, Department of Medical and Surgical Sciences, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna
| | - Antonio Rapacciuolo
- Department of Advanced Biomedical Science, University of Naples Federico II, Corso Umberto I 40, Naples
- Pharmacologic Area of AIAC (Associazione Italiana Aritmologia e Cardiostimolazione), Rome
| | - Antonio Curcio
- Pharmacologic Area of AIAC (Associazione Italiana Aritmologia e Cardiostimolazione), Rome
- Department of Medical and Surgical Sciences, University ‘Magna Graecia’ of Catanzaro, Catanzaro
| | - Emilio Attena
- Pharmacologic Area of AIAC (Associazione Italiana Aritmologia e Cardiostimolazione), Rome
- Cardiology Unit, Roccadaspide Hospital, ASL Salerno
| | - Martina Amadori
- Institute of Cardiology, Department of Medical and Surgical Sciences, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna
| | - Roberto De Ponti
- Cardiovascular Department, Circolo Hospital, Università degli Studi dell’Insubria
| | - Antonio D’Onofrio
- Departmental Unit of Electrophysiology, Evaluation and Treatment of Arrhythmias, Monaldi Hospital, Naples, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena
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Nuñez-Garcia JC, Sánchez-Puente A, Sampedro-Gómez J, Vicente-Palacios V, Jiménez-Navarro M, Oterino-Manzanas A, Jiménez-Candil J, Dorado-Diaz PI, Sánchez PL. Outcome Analysis in Elective Electrical Cardioversion of Atrial Fibrillation Patients: Development and Validation of a Machine Learning Prognostic Model. J Clin Med 2022; 11:jcm11092636. [PMID: 35566761 PMCID: PMC9101912 DOI: 10.3390/jcm11092636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The integrated approach to electrical cardioversion (EC) in atrial fibrillation (AF) is complex; candidates can resolve spontaneously while waiting for EC, and post-cardioversion recurrence is high. Thus, it is especially interesting to avoid the programming of EC in patients who would restore sinus rhythm (SR) spontaneously or present early recurrence. We have analyzed the whole elective EC of the AF process using machine-learning (ML) in order to enable a more realistic and detailed simulation of the patient flow for decision making purposes. Methods: The dataset consisted of electronic health records (EHRs) from 429 consecutive AF patients referred for EC. For analysis of the patient outcome, we considered five pathways according to restoring and maintaining SR: (i) spontaneous SR restoration, (ii) pharmacologic-cardioversion, (iii) direct-current cardioversion, (iv) 6-month AF recurrence, and (v) 6-month rhythm control. We applied ML classifiers for predicting outcomes at each pathway and compared them with the CHA2DS2-VASc and HATCH scores. Results: With the exception of pathway (iii), all ML models achieved improvements in comparison with CHA2DS2-VASc or HATCH scores (p < 0.01). Compared to the most competitive score, the area under the ROC curve (AUC-ROC) was: 0.80 vs. 0.66 for predicting (i); 0.71 vs. 0.55 for (ii); 0.64 vs. 0.52 for (iv); and 0.66 vs. 0.51 for (v). For a threshold considered optimal, the empirical net reclassification index was: +7.8%, +47.2%, +28.2%, and +34.3% in favor of our ML models for predicting outcomes for pathways (i), (ii), (iv), and (v), respectively. As an example tool of generalizability of ML models, we deployed our algorithms in an open-source calculator, where the model would personalize predictions. Conclusions: An ML model improves the accuracy of restoring and maintaining SR predictions over current discriminators. The proposed approach enables a detailed simulation of the patient flow through personalized predictions.
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Affiliation(s)
- Jean C. Nuñez-Garcia
- Department of Cardiology, Hospital Universitario de Salamanca—IBSAL, 37007 Salamanca, Spain; (J.C.N.-G.); (J.S.-G.); (V.V.-P.); (A.O.-M.); (J.J.-C.); (P.I.D.-D.)
| | - Antonio Sánchez-Puente
- Department of Cardiology, Hospital Universitario de Salamanca—IBSAL, 37007 Salamanca, Spain; (J.C.N.-G.); (J.S.-G.); (V.V.-P.); (A.O.-M.); (J.J.-C.); (P.I.D.-D.)
- CIBERCV (Centro de Investigacion Biomedica en Red Enfermedades Cardiovasculares), Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
- Correspondence: (A.S.-P.); (P.L.S.); Tel.: +34-92-329-1100 (ext. 55738) (P.L.S.)
| | - Jesús Sampedro-Gómez
- Department of Cardiology, Hospital Universitario de Salamanca—IBSAL, 37007 Salamanca, Spain; (J.C.N.-G.); (J.S.-G.); (V.V.-P.); (A.O.-M.); (J.J.-C.); (P.I.D.-D.)
- CIBERCV (Centro de Investigacion Biomedica en Red Enfermedades Cardiovasculares), Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - Victor Vicente-Palacios
- Department of Cardiology, Hospital Universitario de Salamanca—IBSAL, 37007 Salamanca, Spain; (J.C.N.-G.); (J.S.-G.); (V.V.-P.); (A.O.-M.); (J.J.-C.); (P.I.D.-D.)
- Philips Healthcare, 28050 Madrid, Spain
| | - Manuel Jiménez-Navarro
- Department of Cardiology, Hospital Virgen de la Victoria—IBIMA, 29010 Malaga, Spain;
- Facultad de Medicina, Universidad de Málaga, 29071 Malaga, Spain
| | - Armando Oterino-Manzanas
- Department of Cardiology, Hospital Universitario de Salamanca—IBSAL, 37007 Salamanca, Spain; (J.C.N.-G.); (J.S.-G.); (V.V.-P.); (A.O.-M.); (J.J.-C.); (P.I.D.-D.)
| | - Javier Jiménez-Candil
- Department of Cardiology, Hospital Universitario de Salamanca—IBSAL, 37007 Salamanca, Spain; (J.C.N.-G.); (J.S.-G.); (V.V.-P.); (A.O.-M.); (J.J.-C.); (P.I.D.-D.)
- CIBERCV (Centro de Investigacion Biomedica en Red Enfermedades Cardiovasculares), Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
- Departamento de Medicina, Universidad de Salamanca, 37007 Salamanca, Spain
| | - P. Ignacio Dorado-Diaz
- Department of Cardiology, Hospital Universitario de Salamanca—IBSAL, 37007 Salamanca, Spain; (J.C.N.-G.); (J.S.-G.); (V.V.-P.); (A.O.-M.); (J.J.-C.); (P.I.D.-D.)
- CIBERCV (Centro de Investigacion Biomedica en Red Enfermedades Cardiovasculares), Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - Pedro L. Sánchez
- Department of Cardiology, Hospital Universitario de Salamanca—IBSAL, 37007 Salamanca, Spain; (J.C.N.-G.); (J.S.-G.); (V.V.-P.); (A.O.-M.); (J.J.-C.); (P.I.D.-D.)
- CIBERCV (Centro de Investigacion Biomedica en Red Enfermedades Cardiovasculares), Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
- Departamento de Medicina, Universidad de Salamanca, 37007 Salamanca, Spain
- Correspondence: (A.S.-P.); (P.L.S.); Tel.: +34-92-329-1100 (ext. 55738) (P.L.S.)
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