scholarly journals Rationale and design of the improving Care for Cardiovascular Disease in China (CCC) project: a national registry to improve management of atrial fibrillation

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e020968 ◽  
Author(s):  
Yongchen Hao ◽  
Jing Liu ◽  
Sidney C Smith ◽  
Yong Huo ◽  
Gregg C Fonarow ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiovascular Disease ◽  
Quality Improvement ◽  
Anticoagulation Therapy ◽  
Clinical Information ◽  
Heart Association ◽  
National Registry ◽  
Hospital Quality ◽  
Quality Improvement Initiative ◽  
Chinese Society

IntroductionInadequate management of patients with atrial fibrillation (AF) has been reported in China for anticoagulation therapy and treatment for concomitant diseases. An effective quality improvement programme has been lacking to promote the use of evidence-based treatments and improve outcome in patients with AF.Methods and analysisThe Improving Care for Cardiovascular Disease in China-AF programme is a collaboration of the American Heart Association and the Chinese Society of Cardiology. This programme is designed to promote adherence to AF guideline recommendations and outcomes for inpatients with AF. Launched in February 2015, 150 hospitals are recruited by geographic-economic regions across 30 provinces in China. Each month, 10–20 inpatients with AF are enrolled in each hospital. A web-based data collection platform is used to collect clinical information for patients with AF, including patients’ demographics, admission information, medical history, in-hospital care and outcomes, and discharge medications for managing AF. The quality improvement initiative includes monthly benchmarked reports on hospital quality, training sessions, regular webinars and recognitions of hospital quality achievement. Primary analyses will include adherence to performance measures and guidelines. To address intrahospital correlation, generalised estimating equation models will be applied. As of March 2017, 28 801 AF inpatients have been enrolled.Ethics and disseminationThis study protocol was approved by the Ethics Committee of Beijing Anzhen Hospital, Capital Medical University. Results will be published in peer-reviewed medical journals.Trial registration numberNCT02309398.

scholarly journals Prevention of stroke in chronic andrecurrent atrial fibrillation

2001 ◽  
Vol 24 (3) ◽  
pp. 61 ◽  
Author(s):  
Anne-Maree Kelly ◽  
Debra Kerr ◽  
Ruth Hew
Keyword(s):  
Atrial Fibrillation ◽  
High Risk ◽  
American Heart ◽  
Anticoagulation Therapy ◽  
Heart Association ◽  
Chronic Atrial Fibrillation ◽  
Prior History ◽  
Demographic Information ◽  
Thromboembolic Stroke ◽  
History Of

The objective was to determine the proportion of patients presenting to the Emergency Department (ED) in atrialfibrillation (AF) who are at high risk of thromboembolic stroke as defined by the American Heart Association andwho might benefit from anticoagulation therapy.We enrolled all patients identified as having AF between 28th June 1999 and 26th March 2000. Data collectedincluded demographic information, presenting complaint, discharge diagnosis, risk factors for thromboembolic stroke,contraindications to anticoagulation (as defined by the Stroke Prevention in AF Investigators), admission anddischarge medications, and cardiac rhythm on presentation and at discharge.193 patients were identified within the study period. Two patient histories were not available for review. 121 patientshad a prior history of AF. Of these, 65 patients were at high risk for thromboembolic stroke and had no contra-indicationto anticoagulation therapy. 43 (66%) were on Warfarin at presentation but 14 (22%) were on Aspirinand 8 (12%) were on neither.34% of patients with chronic atrial fibrillation presenting to the ED, at high risk of thromboembolic stroke andwithout contra-indication to anticoagulation, were not anticoagulated on presentation. ED attendance provides anopportunity for intervention for the prevention of stroke in this group.

Abstract 096: Association of Body Mass Index With Bleeding in Patients Taking Warfarin for Atrial Fibrillation or Venous Thromboembolism

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Kyle Stahlbaum ◽  
Eva Kline-Rogers ◽  
Xiaowen Kong ◽  
Geoffrey D Barnes ◽  
Brian Haymart ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Body Mass Index ◽  
Quality Improvement ◽  
Venous Thromboembolism ◽  
Body Mass ◽  
Normal Weight ◽  
Risk Scores ◽  
Quality Improvement Initiative ◽  
Minor Bleeding ◽  
Life Threatening

Background: Most patients taking warfarin for atrial fibrillation (AF) and venous thromboembolism (VTE) have a target International Normalized Ratio (INR) between 2-3 to reduce risk of bleeding and thromboembolic events. Body Mass Index (BMI) is not included in traditional bleed risk scores, but may be an indicator of bleeding risk in warfarin patients. Methods: Using data from the multi-site Michigan Anticoagulation Quality Improvement Initiative (MAQI 2 ) Registry, we identified all AF/VTE patients , separated them into three cohorts: BMI < 20 (underweight), BMI 20-25 (normal weight) and BMI >25 (overweight). Bleeding events in these cohorts were identified and stratified into severity according to International Society of Thrombosis and Hemostasis criteria. Results: Of 6,054 patients, 4,766 (78.7%) had a BMI of > 25. These patients were generally younger, with higher prevalence of hypertension. The HAS-BLED scores were slightly lower in overweight AF patients (2.6 vs 2.8; p=0.04); otherwise no difference between groups. The overall minor, major, and life threatening bleeding rates were 22.8/27.7; 4.3/3.7; and 1.2/0.7 (per 100 patient years) in AF and VTE patients, respectively. A higher proportion of females were underweight for both indications, and AF patients were older. More underweight and normal weight AF and VTE patients had a bleeding history compared to overweight patients. Bleeding outcomes are listed in Table. Comparisons were made with Poisson regression analysis. Conclusion: In a large, unselected cohort of warfarin treated patient from a multi-site registry, minor bleeding was more common in underweight and normal weight AF patients; major and life-threatening bleeding was more common in underweight and normal weight VTE patients. Since the majority of patients were overweight, further studies are needed to determine if reasons for bleeding differ between patients based on BMI in order to guide quality improvement efforts.

Warfarin use in atrial fibrillation patients at low risk for stroke: analysis of the Michigan Anticoagulation Quality Improvement Initiative (MAQI2)

2013 ◽  
Vol 37 (2) ◽  
pp. 171-176 ◽  
Author(s):  
Geoffrey D. Barnes ◽  
Scott Kaatz ◽  
Julia Winfield ◽  
Xiaokui Gu ◽  
Brian Haymart ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Quality Improvement ◽  
Low Risk ◽  
Quality Improvement Initiative

Improving the Quality of Language Services Delivery: Findings from a Hospital Quality Improvement Initiative

2012 ◽  
Vol 34 (2) ◽  
pp. 53-63 ◽  
Author(s):  
Marsha Regenstein ◽  
Jenny Huang ◽  
Cathy West ◽  
Jennifer Trott ◽  
Holly Mead ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Hospital Quality ◽  
Quality Improvement Initiative ◽  
Language Services ◽  
Services Delivery

scholarly journals Mild renal insufficiency and attributable risk of adverse In-hospital outcomes in patients with Acute Coronary Syndrome from the improving care for Cardiovascular Disease in China (CCC) project

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Fengbo Xu ◽  
Guoqin Wang ◽  
Nan Ye ◽  
Weijing Bian ◽  
Lijiao Yang ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Acute Coronary Syndrome ◽  
Renal Insufficiency ◽  
Collaborative Study ◽  
Heart Association ◽  
Attributable Risk ◽  
Major Adverse Cardiovascular Events ◽  
Chinese Society ◽  
Hospital Outcomes ◽  
Coronary Syndrome

Abstract Background Renal insufficiency (RI) is a frequent comorbidity among patients with acute coronary syndrome (ACS). We aimed to evaluate the attributable risk associated with mild RI for the in-hospital outcomes in patients with ACS. Methods The Improving Care for Cardiovascular Disease in China-ACS (CCC-ACS) Project was a collaborative study of the American Heart Association and the Chinese Society of Cardiology. A total of 92,509 inpatients with a discharge diagnosis of ACS were included. The attributable risk was calculated to investigate the effect of mild RI (eGFR 60-89 ml / min · 1.73 m2) on major adverse cardiovascular events (MACEs) during hospitalization. Results The average age of these ACS patients was 63 years, and 73.9% were men. The proportion of patients with mild RI was 36.17%. After adjusting for other possible risk factors, mild RI was still an independent risk factor for MACEs in ACS patients. In the ACS patients, the attributable risk of eGFR 60-89ml/min·1.73m2 to MACEs was 7.78%, 4.69% of eGFR 45-59 ml/min·1.73m2, 4.46% of eGFR 30-44 ml/min·1.73m2, and 3.36% of eGFR<30 ml/min·1.73m2. Conclusion Compared with moderate to severe RI, mild RI has higher attributable risk to MACEs during hospitalization in Chinese ACS population.

Atrial Fibrillation

2016 ◽  
Author(s):  
Tareq Al-Salamah ◽  
Laura J. Bontempo
Keyword(s):  
Atrial Fibrillation ◽  
Rate Control ◽  
Oral Anticoagulation ◽  
Scoring System ◽  
Treatment Guidelines ◽  
Anticoagulation Therapy ◽  
Heart Association ◽  
Heart Rhythm ◽  
Heart Beat ◽  
Nonvalvular Atrial Fibrillation

Atrial fibrillation (AF) is a supraventricular tachyarrhythmia characterized by chaotic atrial electrical activity.  It is associated with heart failure, stroke, and reduced quality of life. AF is frequently recurrent and refractory to treatment. These facts underscore the importance of recognizing this arrhythmia even in its asymptomatic form. This review covers the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes of AF. Figures show AF, atrial flutter, and AF with preexcitation on a 12-lead electrocardiogram, rate control agent selection recommendations, and a decision-making algorithm for oral anticoagulation therapy. Tables list etiologies and risk factors for AF, American Heart Association/American College of Cardiology/Heart Rhythm Society classification of AF, some of the clinical consequences of AF, diagnostic evaluation for AF, antiarrhythmic drugs for conversion of AF, drugs used for acute rate control of AF, CHA2DS2-VASc score calculation, CHA2DS2-VASc  adjusted stroke rate and treatment guidelines, scoring system to assess the risk of bleeding with oral anticoagulation: HAS-BLED (hypertension, abnormal renal/liver function, history of stroke, bleeding history or predisposition, labile international normalized ratio, elderly [65 years], drugs/alcohol concomitant), and HAS-BLED scores with proportion of patients from the Euro Heart Survey in each category and associated major bleeding risk.   This review contains 5 highly rendered figures, 10 tables, and 69 references Key words: Atrial fibrillation; Supraventricular tachycardia; Irregular heart beat; Cardioversion; Nonvalvular atrial fibrillation; Paroxysmal atrial fibrillation; Rate control; CHA2DS2-VASc scoring system; Rhythm control

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