Sex-related differences in self-reported treatment burden in patients with atrial fibrillation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
M Mihajlovic ◽  
J Simic ◽  
M Marinkovic ◽  
V Kovacevic ◽  
A Kocijancic ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Vitamin K ◽  
Well Being ◽  
Coronary Intervention ◽  
Vitamin K Antagonist ◽  
Adverse Outcomes ◽  
Treatment Burden ◽  
Patient Functioning ◽  
Funding Sources ◽  
Multivariable Regression

Abstract Funding Acknowledgements Type of funding sources: None. Background  Treatment burden (TB) is defined as the patient’s workload of health care and its impact on patient functioning and well-being. High TB can lead to nonadherence, higher risk of adverse outcomes and lower quality of life. We have previously reported a higher TB in patients with atrial fibrillation (AF) vs. those with other chronic conditions. In this analysis, we explored sex-related differences in self-reported TB in AF patients. Methods  A single-centre, prospective study included consecutive patients with AF under drug treatment for at least six months before enrolment from April to June 2019. Patients were asked to voluntarily and anonymously answer Treatment Burden Questionnaire (TBQ). All patients signed the written consent for participation. Results  Of 331 patients (mean age 65.4 ±10.3 years, mean total AF history 6.41 ±6.62 years), 127 (38.4%) were females. The mean TB was significantly higher in females compared to males (53.7 vs. 42.6 out of 170 points, p < 0.001), also females more frequently reported TB ≥59 points than males (37.8% vs 20.6%, p = 0.001). Item-specific sex-related differences in self-reported TB questionnaire are showed in Figure. Sex-related differences in TB on multivariable regression analyses of the highest TB quartile (≥59 points) are showed in Table. Conclusion  Our study was first to explore the sex-specific determinants of TB in AF patients. Females had significantly higher TB compared with males. Approximately 2 in 5 females and 1 in 5 males reported TB ≥59 points, previously shown to be an unacceptable burden of treatment for patients. Using a NOAC rather than VKA in females and a rhythm control strategy in males could decrease TB to acceptable values. Table.Multivariable Logistic Regression analysis of the highest TB quartile (TB ≥59)VariableOR95% CIP valueFemalePPI therapy5.3541.97-14.560.001NOAC0.3190.12-0.830.019Diuretic therapy0.3180.13-0.760.010CHA2DS2-VASc score0.7000.49-0.990.045MaleAblation and/or ECV0.3830.18-0.810.012Supraventricular arrhythmias0.2220.05-0.980.047VKA Vitamin K antagonist; ECV: electrical cardioversion; AF: Atrial fibrillation; PPI: Proton pump inhibitor; PCI: Percutaneous coronary intervention; NOAC: Non-vitamin k antagonist oral anticoagulant.Abstract Figure.

scholarly journals Antithrombotic Therapy in Patients With Atrial Fibrillation Treated With Oral Anticoagulation Undergoing Percutaneous Coronary Intervention

Circulation ◽  
2018 ◽  
Vol 138 (5) ◽  
pp. 527-536 ◽  
Author(s):  
Dominick J. Angiolillo ◽  
Shaun G. Goodman ◽  
Deepak L. Bhatt ◽  
John W. Eikelboom ◽  
Matthew J. Price ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Percutaneous Coronary Intervention ◽  
Vitamin K ◽  
Oral Anticoagulation ◽  
Antithrombotic Therapy ◽  
Oral Anticoagulant ◽  
Coronary Intervention ◽  
Vitamin K Antagonist ◽  
Percutaneous Coronary ◽  
Antithrombotic Management

The optimal antithrombotic treatment regimen for patients with atrial fibrillation undergoing percutaneous coronary intervention with stent implantation represents a challenge in clinical practice. In 2016, an updated opinion of selected experts from the United States and Canada on the treatment of patients with atrial fibrillation undergoing percutaneous coronary intervention was reported. After the 2016 North American consensus statement on the management of antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention, results of pivotal clinical trials assessing the type of oral anticoagulant agent and the duration of antiplatelet treatment have been published. On the basis of these results, this focused update on the antithrombotic management of patients with atrial fibrillation undergoing percutaneous coronary intervention recommends that a non–vitamin K antagonist oral anticoagulant be preferred over a vitamin K antagonist as the oral anticoagulant of choice. Moreover, a double-therapy regimen (oral anticoagulant plus single antiplatelet therapy with a P2Y 12 inhibitor) by the time of hospital discharge should be considered for most patients, whereas extending the use of aspirin beyond hospital discharge (ie, triple therapy) should be considered only for selected patients at high ischemic/thrombotic and low bleeding risks and for a limited period of time. The present document provides a focused updated on the rationale for the new expert consensus–derived recommendations on the antithrombotic management of patients with atrial fibrillation treated with oral anticoagulation undergoing percutaneous coronary intervention.

scholarly journals Atrial fibrillation patients undergoing percutaneous coronary intervention: dual or triple antithrombotic therapy with non-vitamin K antagonist oral anticoagulants

2020 ◽  
Vol 22 (Supplement_I) ◽  
pp. I22-I31
Author(s):  
Andreas Goette ◽  
Pascal Vranckx
Keyword(s):  
Atrial Fibrillation ◽  
Percutaneous Coronary Intervention ◽  
Triple Therapy ◽  
Vitamin K ◽  
Antithrombotic Therapy ◽  
Oral Anticoagulants ◽  
Coronary Intervention ◽  
Vitamin K Antagonist ◽  
Percutaneous Coronary ◽  
The Impact

Abstract About 20% of all atrial fibrillation (AF) patients develop coronary artery disease, which requires coronary stenting [percutaneous coronary intervention (PCI)]. Thus, this subcohort of AF patients may require aggressive antithrombotic therapy encompassing vitamin K antagonist (VKA) or non-vitamin K antagonist oral anticoagulants (NOAC) plus aspirin and a P2Y12 inhibitor. At present, four clinical Phase IIIb trials using dabigatran, rivaroxaban, apixaban, or edoxaban, were published. These studies assessed the impact of NOACs as a part of DAT therapy vs. triple therapy. Compared with triple therapy, NOAC-based DAT has been shown to be associated with reduced major bleeding as well as intracranial haemorrhages. The benefit, however, is somewhat counterbalanced by a higher risk of stent-related ischaemia during the early phase of dual therapy. Thus, triple therapy after stenting is appropriate for at least 14 days with a maximum of 30 days. Thereafter, DAT including a NOAC is the therapy of choice in AF PCI patients to reduce the risk of bleeding during a 1 year of follow-up compared to VKA-based regimes. The present review summarizes the published study results and demonstrates differences in trial design and reported outcomes.

Antithrombotic treatment in patients with atrial fibrillation and acute coronary syndromes: results of the European Heart Rhythm Association survey

EP Europace ◽  
2019 ◽  
Vol 21 (7) ◽  
pp. 1116-1125 ◽  
Author(s):  
Deirdre A Lane ◽  
Nikolaos Dagres ◽  
Gheorghe-Andrei Dan ◽  
Javier García Seara ◽  
Konstantinos Iliodromitis ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Vitamin K ◽  
Heart Rhythm ◽  
Dual Therapy ◽  
Coronary Intervention ◽  
Vitamin K Antagonist ◽  
Cardiac Events ◽  
University Hospitals ◽  
Antithrombotic Treatment ◽  
Coronary Syndrome

Abstract The management of an acute coronary syndrome (ACS) in a patient with existing atrial fibrillation (AF) often presents a management dilemma both in the acute phase and post-ACS, since the majority of AF patients will already be receiving oral anticoagulation (OAC) for stroke prevention and will require further antithrombotic treatment to reduce the risk of in-stent thrombosis or recurrent cardiac events. Current practice recommendations are based largely on consensus option as there is limited evidence from randomized controlled trials. Prior to the launch of the new European Heart Rhythm Association (EHRA) consensus document, a survey was undertaken to examine current clinical management of these patients across centres in Europe. Forty-seven centres submitted valid responses, with the majority (70.2%) being university hospitals. This EHRA survey demonstrated overall the management of ACS in AF patients is consistent with the available guidance. Most centres would use triple therapy for a short duration (4 weeks) and predominantly utilize a strategy of OAC (vitamin K antagonist, VKA or non-vitamin K antagonist oral anticoagulant, NOAC) plus aspirin and clopidogrel, followed by dual therapy [(N)OAC plus clopidogrel] until 12 months post-percutaneous coronary intervention, followed by (N)OAC monotherapy indefinitely. Where NOAC was used in combination with antiplatelet(s), the lower dose of the respective NOAC was preferred, in accordance with current recommendations.

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