Atrial fibrillation burden and atrial fibrillation type: Clinical significance and impact on the risk of stroke and decision making for long-term anticoagulation

2016 ◽  
Vol 83 ◽  
pp. 26-35 ◽  
Author(s):  
Giuseppe Boriani ◽  
Daniele Pettorelli
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Clinical Significance ◽  
Atrial Fibrillation Burden

scholarly journals Impact of atrial antitachycardia pacing and atrial pace prevention therapies on atrial fibrillation burden over long-term follow-up

EP Europace ◽  
2009 ◽  
Vol 11 (8) ◽  
pp. 1041-1047 ◽  
Author(s):  
A. M. Gillis ◽  
M. Morck ◽  
D. V. Exner ◽  
R. S. Sheldon ◽  
H. J. Duff ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Pace ◽  
Antitachycardia Pacing ◽  
Long Term Follow Up ◽  
Atrial Fibrillation Burden ◽  
Pace Prevention

scholarly journals Understanding the barriers to using oral anticoagulants among long-term aspirin users with atrial fibrillation – A qualitative study

2020 ◽  
Author(s):  
Vanessa WS Ng ◽  
Chung-Wah Siu ◽  
Patrick KC Chiu ◽  
Carolyn PL Kng ◽  
Elizabeth Jamieson ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Stroke Prevention ◽  
Treatment Guidelines ◽  
Oral Anticoagulants ◽  
Structured Interview ◽  
Bleeding Complications ◽  
Suitable Alternative ◽  
Prevention Therapy

Abstract Background: Despite international treatment guidelines currently advocating oral anticoagulants (OACs) as the only appropriate stroke prevention therapy for patients with atrial fibrillation (AF) and evidence that OACs can greatly reduce the risk of stroke with similar risk of bleeding compared with aspirin, the underuse of OACs in patients with AF is common globally, especially in Asia. This study aimed to identify the barriers to prescribing and using OACs among long-term aspirin users with AF.Method: Face-to-face interviews were conducted with fourteen eligible patients with AF using a semi-structured interview guide. The interview recordings were transcribed verbatim and data was analyzed according to the principles of thematic analysis.Results: Five themes were developed: awareness of AF symptoms and diagnosis; knowledge and understanding of AF and stroke prevention therapy; role of decision-making in prescribing; willingness to switch from aspirin to OACs; and impact of OAC regimen on daily living. The majority of the patients were not aware of the symptoms and diagnosis of AF and only had a vague understanding of the illness and stroke prevention therapy, leading to their minimal involvement in decisions relating to their treatment. Some patients and their caregivers were particularly concerned about the bleeding complications from OACs and perceived aspirin to be a suitable alternative as they find the adverse effects from aspirin manageable and so preferred to remain on aspirin if switching to OACs was not compulsory. Lastly, the lifestyle modifications required when using warfarin, e.g. alternative dosing regimen, diet restriction, were seen as barriers to some patients and caregivers.Conclusion: The findings revealed patients’ knowledge gap in AF management which may be targeted using educational interventions to improve patients’ understanding of AF and its management and hence encourage active participation in the decision-making of their treatment in the future.

scholarly journals Understanding the Barriers to Using Oral Anticoagulants Among Long-Term Aspirin Users With Atrial Fibrillation – A Qualitative Study

2020 ◽  
Author(s):  
Vanessa WS Ng ◽  
Chung-Wah Siu ◽  
Patrick KC Chiu ◽  
Carolyn PL Kng ◽  
Elizabeth Jamieson ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Stroke Prevention ◽  
Treatment Guidelines ◽  
Oral Anticoagulants ◽  
Structured Interview ◽  
Bleeding Complications ◽  
Suitable Alternative ◽  
Prevention Therapy

Abstract Background: Despite international treatment guidelines currently advocating oral anticoagulants (OACs) as the only appropriate stroke prevention therapy for patients with atrial fibrillation (AF) and evidence that OACs can greatly reduce the risk of stroke with similar risk of bleeding compared with aspirin, the underuse of OACs in patients with AF is common globally, especially in Asia. This study aimed to identify the barriers to prescribing and using OACs among long-term aspirin users with AF.Method: Face-to-face interviews were conducted with fourteen eligible patients with AF using a semi-structured interview guide. The interview recordings were transcribed verbatim and data was analyzed according to the principles of thematic analysis.Results: Five themes were developed: awareness of AF symptoms and diagnosis; knowledge and understanding of AF and stroke prevention therapy; role of decision-making in prescribing; willingness to switch from aspirin to OACs; and impact of OAC regimen on daily living. The majority of the patients were not aware of the symptoms and diagnosis of AF and only had a vague understanding of the illness and stroke prevention therapy, leading to their minimal involvement in decisions relating to their treatment. Some patients and their caregivers were particularly concerned about the bleeding complications from OACs and perceived aspirin to be a suitable alternative as they find the adverse effects from aspirin manageable and so preferred to remain on aspirin if switching to OACs was not compulsory. Lastly, the lifestyle modifications required when using warfarin, e.g. alternative dosing regimen, diet restriction, were seen as barriers to some patients and caregivers. Conclusion: The findings revealed patients’ knowledge gap in AF management which may be targeted using educational interventions to improve patients’ understanding of AF and its management and hence encourage active participation in the decision-making of their treatment in the future.

P1014The natural history of atrial fibrillation after the first clinical episode: a prospective observational study via implantable loop recorders

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
P Papakonstantinou ◽  
E Simantirakis ◽  
E Kanoupakis ◽  
F Parthenakis ◽  
P Vardas
Keyword(s):  
Atrial Fibrillation ◽  
Natural History ◽  
Clinical Significance ◽  
Loop Recorder ◽  
Clinical Episode ◽  
History Of ◽  
Second Year ◽  
Af Recurrence

Abstract Funding Acknowledgements The study was supported by Medtronic Inc Background The natural history of paroxysmal atrial fibrillation (AF) after the first clinical AF episode is not well known. AF burden is of clinical significance as it may have clinical implications concerning the long-term management of the arrhythmia and the decision-making on AF patients.  Purpose To observe the natural history of AF in patients after their first clinical paroxysmal AF episode.  Methods Thirty consecutive patients (age 66.9 ± 10 years; 14 men) received an implantable loop recorder (ILR) after their first symptomatic paroxysmal AF episode. We recorded the AF recurrences and burden (clinical and subclinical AF) during a follow-up period of three years. We excluded patients with persistent or permanent AF and patients with an episode of AF attributed to reversible or transient causes.  Results Eight patients (26.6%) did not present any AF recurrence during the first year of the follow-up period. Five patients (16.6%) did not also suffer any AF episode during the second year, while in three patients (10%) no AF episode was recorded during the three-year follow-up period. In 16 patients (53.3%) the AF burden was increased during the second year of follow-up period while in 9 patients (30%) the AF burden was decreased. During the third year of follow-up period the AF burden was increased in 19 patients (63.3%), decreased in 7 patients (23.3%) and remained almost the same in 4 patients (13.3%). Five patients (16.6%) presented at least one episode of persistent AF during the follow-up period. Seven patients (23.3%) suffered only from symptomatic AF episodes, while in nine patients (30%) only asymptomatic AF episodes were recorded. Eleven patients (36.7%) had both types of AF episodes (symptomatic and asymptomatic).  Conclusions The AF recurrence and burden increased in most AF patients during the three-year follow-up period. However, some patients did not suffer any AF recurrence or they presented a decrease in AF burden. Paroxysmal AF clinical profile differs among the AF patients significantly and this indicates that an individualized approach via long-term rhythm monitoring may be of clinical significance, at least in some newly diagnosed AF patients.

Long-term monitoring to detect atrial fibrillation with the indwelling implantable cardiac monitors

2018 ◽  
Vol 13 (9) ◽  
pp. 893-904 ◽  
Author(s):  
Tommaso Sanna
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
High Sensitivity ◽  
Implantable Cardioverter Defibrillators ◽  
Cardiac Implantable Electronic Devices ◽  
Use Of Resources ◽  
Atrial Fibrillation Burden ◽  
Detection Strategies ◽  
Atrial Fibrillation Detection

An increasing number of detection tools are available and several detection strategies have been described to pursue the diagnosis of atrial fibrillation to prevent ischemic stroke. Monitoring tools include standard electrocardiography, snapshot single-lead recordings with professional or personal devices (e.g. smartphone-based), Holter monitor, external devices with long-term recording capabilities, and cardiac implantable electronic devices, including pacemakers, implantable cardioverter defibrillators and insertable cardiac monitors. Insertable cardiac monitors have shown high sensitivity and specificity for the detection of atrial fibrillation, allow up to three years of continuous monitoring, do not require cooperation of the patient, are well tolerated, have a short device-related time delay between detection of atrial fibrillation and notification to the physician, provide information on atrial fibrillation burden and are minimally invasive. On the other hand, insertable cardiac monitors require a considerable use of resources to process the recordings and have a significant initial cost. Studies conducted with insertable cardiac monitors on patients with prior stroke and on patients with risk factors for stroke but no prior cerebrovascular events or atrial fibrillation have consistently shown a measurable incidence of atrial fibrillation at follow-up. However, the effectiveness of oral anticoagulations in reducing the incidence of ischemic stroke in patients with atrial fibrillation lasting less than 24 h, though reasonable, is currently unproven. The future of atrial fibrillation detection tools and atrial fibrillation detection strategies will be influenced by ongoing studies exploring whether oral anticoagulations reduce the incidence of stroke in patients with atrial fibrillation burden lower than 24 h.

Decision-making interventions to stop the global atrial fibrillation-related stroke tsunami

2017 ◽  
Vol 12 (3) ◽  
pp. 222-228 ◽  
Author(s):  
Joshua O Cerasuolo ◽  
Manuel Montero-Odasso ◽  
Agustin Ibañez ◽  
Shannon Doocy ◽  
Gregory YH Lip ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Ischemic Stroke ◽  
Oral Anticoagulation ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Catastrophic Event ◽  
Income Levels ◽  
Atrial Fibrillation Burden

Atrial fibrillation affects 33.5 million people worldwide and its prevalence is expected to double by 2050 because of the aging population. Atrial fibrillation confers a 5-fold higher risk of ischemic stroke compared to sinus rhythm. We present our view of the role of shared medical decision-making to combat global underutilization of oral anticoagulation for stroke prevention in atrial fibrillation patients. Oral anticoagulation underuse is widespread as it is present within atrial fibrillation patients of all risk strata and in countries across all income levels. Reasons for oral anticoagulation underuse include but are probably not limited to poor risk stratification, over-interpretation of contraindications, and discordance between physician prescription preferences and actual administration. By comparing a catastrophic event to the consequences of atrial fibrillation related strokes, it may help physicians and patients understand the negative outcomes associated with oral anticoagulation under-utilization and the magnitude to which oral anticoagulations neutralize atrial fibrillation burden.

scholarly journals Understanding the barriers to using oral anticoagulants among long-term aspirin users with atrial fibrillation – A qualitative study 

2020 ◽  
Author(s):  
Vanessa WS Ng ◽  
Chung-Wah Siu ◽  
Patrick KC Chiu ◽  
Carolyn PL Kng ◽  
Elizabeth Jamieson ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Stroke Prevention ◽  
Treatment Guidelines ◽  
Oral Anticoagulants ◽  
Structured Interview ◽  
Bleeding Complications ◽  
Suitable Alternative ◽  
Prevention Therapy

Abstract Background: Despite international treatment guidelines currently advocating oral anticoagulants (OACs) as the only appropriate stroke prevention therapy for patients with atrial fibrillation (AF) and evidence that OACs can greatly reduce the risk of stroke with similar risk of bleeding compared with aspirin, the underuse of OACs in patients with AF is common globally, especially in Asia. This study aimed to identify the barriers to prescribing and using OACs among long-term aspirin users with AF.Method: Face-to-face interviews were conducted with fourteen eligible patients with AF using a semi-structured interview guide. The interview recordings were transcribed verbatim and data was analyzed according to the principles of thematic analysis.Results: Five themes were developed: awareness of AF symptoms and diagnosis; knowledge and understanding of AF and stroke prevention therapy; role of decision-making in prescribing; willingness to switch from aspirin to OACs; and impact of OAC regimen on daily living. The majority of the patients were not aware of the symptoms and diagnosis of AF and only had a vague understanding of the illness and stroke prevention therapy, leading to their minimal involvement in decisions relating to their treatment. Some patients and their caregivers were particularly concerned about the bleeding complications from OACs and perceived aspirin to be a suitable alternative as they find the adverse effects from aspirin manageable and so preferred to remain on aspirin if switching to OACs was not compulsory. Lastly, the lifestyle modifications required when using warfarin, e.g. alternative dosing regimen, diet restriction, were seen as barriers to some patients and caregivers. Conclusion: The findings revealed patients’ knowledge gap in AF management which may be targeted using educational interventions to improve patients’ understanding of AF and its management and hence encourage active participation in the decision-making of their treatment in the future.

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