Clinical Outcomes and History of Fall in Patients with Atrial Fibrillation Treated with Oral Anticoagulation: Insights From the ARISTOTLE Trial

2018 ◽  
Vol 131 (3) ◽  
pp. 269-275.e2 ◽  
Author(s):  
Meena P. Rao ◽  
Dragos Vinereanu ◽  
Daniel M. Wojdyla ◽  
John H. Alexander ◽  
Dan Atar ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Outcomes ◽  
Oral Anticoagulation ◽  
History Of

Atrial fibrillation detected at screening is not a benign condition - a comparison of clinical outcomes in screen-detected vs. hospital-detected atrial fibrillation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
VW Zwartkruis ◽  
B Geelhoed ◽  
N Suthahar ◽  
RT Gansevoort ◽  
SJL Bakker ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Outcomes ◽  
Cox Regression ◽  
Population Based ◽  
Adverse Outcomes ◽  
Albumin Concentration ◽  
Benign Condition ◽  
National Budget ◽  
History Of ◽  
Time Varying Covariates

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Dutch Heart Foundation Background Screening for atrial fibrillation (AF) improves detection of AF. However, it is unknown whether AF detected at screening carries risks similar to clinically detected AF, and if it should be treated similarly. Purpose We aimed to compare clinical outcomes in individuals with screen-detected vs. hospital-detected incident AF. Methods We studied 8265 individuals (mean age 49 ± 13 years, 50% women) without prevalent AF from the population-based PREVEND (Prevention of Renal and Vascular End-Stage Disease) cohort study. By design, 70% of PREVEND participants had urinary albumin concentration ≥10 mg/l. AF was considered screen-detected when first detected on a 12-lead electrocardiogram (ECG) during one of the PREVEND study visits, and hospital-detected when first detected on a hospital ECG. Using Cox regression models with screen-detected and hospital-detected AF as time-varying covariates, we studied the association of screen-detected vs. hospital-detected AF with mortality, incident heart failure (HF), and incident cardiovascular (CV) events. Results During a mean follow-up of 9.7 years, 265 participants (3.2%) developed incident AF (mean age 62 ± 9 years, 30% women, 65% hypertension, 23% obesity, 9% diabetes, 15% history of myocardial infarction, 3% history of stroke, 2% prevalent HF). Of all incident AF cases, 60 (23%) were screen-detected and 205 (77%) hospital-detected. Baseline characteristics were generally comparable between participants with screen-detected and hospital-detected AF. A larger proportion of incident AF was screen-detected in men (26%) compared to women (15%). In univariabe analysis, both screen-detected and hospital-detected AF were strongly associated with death, incident HF, and incident CV events. After multivariable adjustment, hospital-detected AF was significantly associated with death (HR 2.95, 95% CI 2.18-4.00), incident HF (HR 3.98, 95% CI 2.49-6.34), and incident CV events (HR 1.92, 95% CI 1.21-3.06). Screen-detected AF was significantly associated with death (HR 2.21, 95% CI 1.09-4.47) and incident HF (HR 4.90, 95% CI 2.28-10.57), but not with incident CV events (HR 1.12, 95% CI 0.46-2.71). Conclusions In a population-based cohort enriched for microalbuminuria, almost a quarter of incident AF cases was first detected through ECG screening. Compared to hospital-detected AF, screen-detected AF was similarly associated with adverse outcomes. Although randomised trials are needed, this study highlights that AF screening may help decrease the general burden of CV disease.

Qualität des Antikoagulationsmanagements bei ambulanten Patienten mit Vorhofflimmern

Praxis ◽  
2003 ◽  
Vol 92 (21) ◽  
pp. 991-995 ◽  
Author(s):  
Gubler ◽  
Martina ◽  
Arpagaus ◽  
Dieterle
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Oral Anticoagulation ◽  
Medical Emergency ◽  
Psychiatric Disease ◽  
Recurrent Falls ◽  
History Of ◽  
Acute Condition

Many patients with atrial fibrillation do not receive anticoagulation due to accepted contraindications but also due to considerable underuse. We screened 2215 consecutive patients when they entered the Medical Emergency Department for any acute condition. The decision on correct use or underuse of oral anticoagulation was made from the charts by consensus of two experienced physicians. The prevalence of atrial fibrillation was 3.7%. 43 of 83 patients with atrial fibrillation had oral anticoagulation (52%, mean age 76 years). 32 patients were treated with Aspirin only (38%, mean age 79 years). 29 patients (35%) did not receive anticoagulation because of accepted contraindications, i.e., dementia and risk for recurrent falls (n = 16), history of bleeding (n = 6), drug malcompliance due to forgetfulness (n = 4) and psychiatric disease (n = 1). Underuse of anticoagulation occurred only in three patients (4%, unclear reasons in two patients, patient's unwillingness in one patient). Conclusion: We did not observe substantial underuse of anticoagulation in patients with atrial fibrillation.

scholarly journals Atrial fibrillation and clinical outcomes 1 to 3 years after myocardial infarction

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001726
Author(s):  
Anthony P Carnicelli ◽  
Ruth Owen ◽  
Stuart J Pocock ◽  
David B Brieger ◽  
Satoshi Yasuda ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Clinical Outcomes ◽  
Oral Anticoagulants ◽  
Adverse Outcomes ◽  
Increased Risk ◽  
History Of ◽  
The Impact

ObjectiveAtrial fibrillation (AF) and myocardial infarction (MI) are commonly comorbid and associated with adverse outcomes. Little is known about the impact of AF on quality of life and outcomes post-MI. We compared characteristics, quality of life and clinical outcomes in stable patients post-MI with/without AF.Methods/resultsThe prospective, international, observational TIGRIS (long Term rIsk, clinical manaGement and healthcare Resource utilization of stable coronary artery dISease) registry included 8406 patients aged ≥50 years with ≥1 atherothrombotic risk factor who were 1–3 years post-MI. Patient characteristics were summarised by history of AF. Quality of life was assessed at baseline using EQ-5D. Clinical outcomes over 2 years of follow-up were compared. History of AF was present in 702/8277 (8.5%) registry patients and incident AF was diagnosed in 244/7575 (3.2%) over 2 years. Those with AF were older and had more comorbidities than those without AF. After multivariable adjustment, patients with AF had lower self-reported quality-of-life scores (EQ-5D UK-weighted index, visual analogue scale, usual activities and pain/discomfort) than those without AF. CHA2DS2-VASc score ≥2 was present in 686/702 (97.7%) patients with AF, although only 348/702 (49.6%) were on oral anticoagulants at enrolment. Patients with AF had higher rates of all-cause hospitalisation (adjusted rate ratio 1.25 [1.06–1.46], p=0.008) over 2 years than those without AF, but similar rates of mortality.ConclusionsIn stable patients post-MI, those with AF were commonly undertreated with oral anticoagulants, had poorer quality of life and had increased risk of clinical outcomes than those without AF.Trial registration numberClinicalTrials: NCT01866904.

Abstract 14599: Association of Fibrillation Cycle Length on the Surface Electrocardiogram With Clinical Outcomes in Atrial Fibrillation Patients: The Fushimi AF Registry

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Hisashi Ogawa ◽  
Yoshimori An ◽  
Masahiro Esato ◽  
Kenjiro Ishigami ◽  
Syuhei Ikeda ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rate ◽  
Body Weight ◽  
Clinical Outcomes ◽  
Cycle Length ◽  
Hazard Ratios ◽  
History Of ◽  
Artery Disease ◽  
Incidence Of Hospitalization ◽  
Surface Electrocardiogram

Background: It is unknown whether fibrillation cycle length (FCL) on the surface electrocardiogram is associated with clinical outcomes in patients with atrial fibrillation (AF). Methods: The Fushimi AF Registry, a community-based prospective survey, was designed to enroll all of the AF patients in Fushimi-ku, Kyoto. The FCL was calculated using spectral analysis of the fibrillation waves on the surface electrocardiogram in 966 patients (mean age; 73.2 years, female; 40.9%, mean CHA 2 DS 2 -VASc score; 3.21) with AF at baseline. We assessed the association of FCL with the demographics and clinical outcomes. Results: Median FCL was 163.8 ms (interquartile range; 148.0, 195.0 ms). We divided the patients into 2 groups: 524 patients with FCL ≥163 ms and 442 patients with FCL<163 ms. Patients with longer FCL were older (74.6 vs. 71.7 years of age; p<0.01), more often female (49.6% vs. 30.5%; p<0.01), more often paroxysmal type of AF (55.2% vs. 33.3%; p<0.01), had lower body weight (58.6 vs. 61.8 kg; p<0.01), higher heart rate (93.1 vs. 86.3 /min; p<0.01), higher CHA 2 DS 2 -VASc score (3.41 vs. 2.98; p<0.01). They were more likely to have history of heart failure (HF) (25.8% vs. 19.5%; p=0.02), valvular heart disease (24.1% vs. 15.6%; p<0.01), coronary artery disease (18.9% vs. 12.7%; p<0.01), and chronic kidney disease (38.6% vs. 26.2%; p<0.01). During the median follow-up of 2,194 days, all-cause mortality occurred in 99 patients (3.5 /100 person-years) with longer FCL and 55 patients (2.2 /100 person-years) with shorter FCL, with an adjusted hazard ratio of 1.46 (95% confidence interval [CI], 1.01-2.13; p=0.043), adjusted by age, sex, body weight, heart rate, type of AF and comorbidities. Adjusted hazard ratios of stroke or systemic embolism and hospitalization for HF for longer FCL were 1.23 (95%CI, 0.73-2.11; p=0.44) and 2.29 (95%CI, 1.52-3.50; p<0.01), respectively. Conclusion: The FCL on surface electrocardiogram was associated with higher mortality and incidence of hospitalization for HF in Japanese AF patients enrolled in the Fushimi AF Registry.

Abstract 20326: Impact of Gender on Clinical Outcomes in Non-Valvular Atrial Fibrillation: Contemporary Perspective From the GARFIELD Registry

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
John Camm ◽  
Samuel Z Goldhaber ◽  
Giuseppe Ambrosio ◽  
Petr Jansky ◽  
Wael Al Mahmeed ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Vascular Disease ◽  
Clinical Outcomes ◽  
Factor Xa ◽  
Thrombin Inhibitor ◽  
History Of ◽  
Ischaemic Attack ◽  
Contemporary Perspective ◽  
Baseline Characteristics

Purpose: To evaluate the influence of gender on baseline characteristics and 1-year clinical outcomes in patients with non-valvular atrial fibrillation (AF). Methods: In the ongoing, international registry GARFIELD, a total of 12,458 prospective patients were enrolled at 739 randomly selected sites in 30 countries between March 2010 and January 2013. Results: Compared with men, women with AF were more likely to be older and have a history of hypertension or venous thromboembolism, but less likely to have a history of vascular disease. Use of antithrombotic therapy was similar in the two groups. At 1-year follow-up, the hazard ratio for women versus men, adjusted for age group, use of vitamin K antagonist, Factor Xa inhibitor, direct thrombin inhibitor, and antiplatelet, congestive cardiac failure, hypertension, diabetes, stroke/transient ischaemic attack, and vascular disease, was 0.815 (95% confidence interval, 0.695-0.957) for the incidence of all-cause mortality, 1.414 (1.053-1.899) for the incidence of stroke/systemic embolism (SE), and 1.024 (0.714-1.470) for the incidence of major bleeding. Conclusion: These findings suggest that women with non-valvular AF have a lower mortality rate despite a higher stroke/SE rate compared with men.

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