scholarly journals Atrial Fibrillation in the Young: A Neurologist’s Nightmare

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Nikhil Aggarwal ◽  
Subothini Selvendran ◽  
Claire E. Raphael ◽  
Vassilios Vassiliou
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Cardiac Arrhythmia ◽  
The Elderly ◽  
Morbidity And Mortality ◽  
Significant Morbidity ◽  
Younger Patients ◽  
The Impact

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia seen in clinical practice with prevalence in excess of 33 million worldwide. Although often asymptomatic and until recently considered a “benign” arrhythmia, it is now appreciated that thromboembolism resulting from AF results in significant morbidity and mortality predominantly due to stroke. Although an arrhythmia more commonly affecting the elderly, AF can also occur in the young. This review focuses on the impact of AF in the younger population and discusses the dilemmas of managing younger patients with AF.

Uptake of adjuvant chemotherapy for colon cancer in older and younger patients in the Irish population.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 478-478
Author(s):  
Seamus Coyle ◽  
Zia Rehman ◽  
Chalen Lee ◽  
Sandra Deady ◽  
Harry Comber ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Clinical Practice ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Older Patients ◽  
The Elderly ◽  
Stage Ii ◽  
Stage Iii ◽  
Younger Patients ◽  
The Impact

478 Background: Colon cancer is predominantly a disease of the elderly, with recent evidence supporting the use of adjuvant chemotherapy in the older population. However, it remains unclear to what degree such patients are receiving adjuvant therapy in clinical practice. We examined uptake of adjuvantchemotherapy and it’s impact on survival in older patients with stage II and stage III colon cancer in a national cohort. Methods: Using the National cancer Registry of Ireland, we identified 3,486 patients with stage II and III colon cancer who were treated with curative resection from 2004-2009. Clinopathological features and chemotherapy use were compared between those ≥70 years and those < 70 years. Results: A total of 2,026 patients with stage II disease were identified, 56% male and 60% ≥ 70 years. T3 tumors accounted for 81%, T4 19% and 89% were grade 2/3. Adjuvant chemotherapy was utilized in 10% and 40% of ≥ 70 and <70 years, respectively (p<0.0001). A benefit for chemotherapy over observation alone was seen in both the older [HR 0.36; 95% CI 0.36 – 0.68; p <0.0001] and younger patient groups [HR 0.43; 95% CI 0.2701 - 0.6881; p<0.0004]. Of 1,460 patients with stage III disease, 51% were ≥ 70 years, 54% male. 34% of older and 83% of younger patients received adjuvant therapy (p<0.0001). A similar magnitude of benefit from chemotherapy compared to observation was seen in patients ≥ 70 years [HR 0.30; 95% CI 0.29 - 0.45 ; p <0.0001] and <70 years [HR 0.22 95%CI 0.1 – 0.2; p<0.0001] with stage III disease. Conclusions: Adoption of adjuvant chemotherapy appears to be associated with significant survival benefit in older patients (age ≥ 70 years), however, is still underutilized in clinical practice. The impact of sociodemographic and clinicopathological features as potential drivers of treatment decisions in a cohort of this population will be reported.

scholarly journals Amiodarone Toxicity Screening: What are the Clinicians Supposed to Tell Patients

2020 ◽  
pp. 1-5
Author(s):  
John D Rozich ◽  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Clinical Practice ◽  
Kidney Disease ◽  
Low Dose ◽  
The Elderly ◽  
Toxicity Screening ◽  
Nonvalvular Atrial Fibrillation ◽  
Routine Testing ◽  
Continued Use

The use of amiodarone in clinical practice continues to be widespread in the setting of nonvalvular atrial fibrillation (NVAF). Use of amiodarone continues especially in the elderly where the drug’s favorable characteristics and outcomes in the setting of chronic kidney disease coupled to its low inherent proarrhythmic profile has ensured its continued use. The present work focuses on the information that clinicians should tell their patients regarding requisite toxicity screening during daily treatment with amiodarone when it is maintained at a low dose of 200 mgs per day or less. Several questions need be answered in pursuit of the fundamental query as to whether routine testing for toxicity should still be advised. Most importantly, has ongoing screening shown to be of any proven value?

A STUDY ON CLINICAL PROFILE OF PATIENTS WITH ATRIAL FIBRILLATION

2021 ◽  
pp. 42-43
Author(s):  
Syed Yousuf Faisal ◽  
Manish Kumar ◽  
Krishna Kumar Jha ◽  
Debarshi Jana
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Cardiac Arrhythmia ◽  
Descriptive Study ◽  
Clinical Profile ◽  
Age Group ◽  
Medicine Department ◽  
Epidemiological Features

Background: Atrial brillation (AF) is the most common sustained cardiac arrhythmia encountered in clinical practice. This study is about the etiological and clinical prole of paroxysmal, persistent and permanent AF. T Aim: he aim of this article was to review the clinical epidemiological features of atrial brillation. A hospital-based descriptive study was conduct Materials and methods: ed among 50 patients, diagnosed as atrial brillation in Medicine Department of DMCH, from June 2019 to May 2020. Out of 50 pati Results: ents with atrial brillation, 32% were aged between 60 – 69 years and 42(84%) were females and 8 (16%) were males. Permanent AF was seen in 56% patients. Palpitation Conclusions: followed by dyspnoea was the major symptoms encountered with atrial brillation, and in females within the age group of 50 years and above are prone to develop AF.

scholarly journals Tapentadol Prolonged Release for Severe Chronic Osteoarthritis Pain in the Elderly—A Subgroup Analysis of Routine Clinical Practice Data

2020 ◽  
Vol 2020 ◽  
pp. 1-10 ◽  
Author(s):  
Andreas Schwittay ◽  
Melanie Sohns ◽  
Birgit Heckes ◽  
Christian Elling
Keyword(s):  
Quality Of Life ◽  
Clinical Practice ◽  
Elderly Patients ◽  
Subgroup Analysis ◽  
The Elderly ◽  
Routine Clinical Practice ◽  
Prolonged Release ◽  
Younger Patients ◽  
Quality Of Life Measures

Background. Tapentadol prolonged release (PR) has been shown effective and generally well tolerated in a broad range of chronic pain conditions. This subgroup analysis investigated its benefits for elderly patients with severe chronic osteoarthritis (OA) pain in routine clinical practice. Patients and Methods. Data of all patients with chronic OA pain were extracted from the database of a prospective, 3-month noninterventional tapentadol PR trial. The data of elderly OA patients (>65 years of age; n = 752) were compared with the data of younger OA patients (≤65 years; n = 282). Results. Almost all patients (elderly 98.7% and younger patients 99.3%) had received long-term analgesic medication prior to the start of tapentadol PR treatment but presented with severe pain accompanied by considerable impairments in sleep quality and quality of life measures. Tapentadol PR provided effective pain relief in both patient groups, with slightly better outcomes in younger patients. However, the mean baseline pain intensity of 7.1 (SD 1.5) was reduced by 3.8 points (p≤0.001), and sleep and quality of life measures had also markedly improved in the elderly: quality of sleep by 3 points, quality of life by 3.4 points, social activities by 3 points, and independence by 2.7 points (p≤0.001 for all measures; 11-point scale). At the end of observation, 68% of the elderly had clinically relevant pain reductions of at least 50% (vs baseline), and 87.9% attained either their intended pain reduction target and/or an additional individual treatment target (both predefined during baseline examination). Only 8.4% of the elderly experienced adverse drug reactions, most frequently nausea (2.7% of patients) and dizziness (1.5%). Conclusion. Tapentadol PR provided effective and well-tolerated treatment of severe chronic OA pain for elderly patients in routine clinical practice. The favorable tolerability profile in particular suggests tapentadol PR as a treatment option before classical strong opioids are considered.

scholarly journals Gastrointestinal and liver diseases and atrial fibrillation: a review of the literature

2019 ◽  
Vol 12 ◽  
pp. 175628481983223 ◽  
Author(s):  
Michelle T. Long ◽  
Darae Ko ◽  
Lindsay M. Arnold ◽  
Ludovic Trinquart ◽  
Jason A. Sherer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Current Literature ◽  
Liver Diseases ◽  
Morbidity And Mortality ◽  
Review Of The Literature ◽  
Significant Morbidity ◽  
Bidirectional Associations

Atrial fibrillation (AF) is the most common arrhythmia worldwide and is associated with significant morbidity and mortality. A number of risk factors have been associated with AF, though few studies have explored the association between gastrointestinal and liver diseases and AF. Additionally, AF and treatment for AF may predispose to gastrointestinal and liver diseases. We review the current literature on the bidirectional associations between gastrointestinal and liver diseases and AF. We highlight the gaps in knowledge and areas requiring future investigation.

scholarly journals A Systematic Review of Depression and Anxiety in Patients with Atrial Fibrillation: The Mind-Heart Link

2013 ◽  
Vol 2013 ◽  
pp. 1-11 ◽  
Author(s):  
Dimpi Patel ◽  
Nathaniel D. Mc Conkey ◽  
Ryann Sohaney ◽  
Ashley Mc Neil ◽  
Andy Jedrzejczyk ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Clinical Practice ◽  
Relevant Literature ◽  
Illness Perception ◽  
Depression And Anxiety ◽  
Prevalence Of Depression ◽  
The Mind ◽  
The Impact

Atrial fibrillation (AF) is the most commonly seen arrhythmia in clinical practice. At present, few studies have been conducted centering on depression and anxiety in AF patients. Our aim in this systematic review is to use the relevant literature to (1) describe the prevalence of depression and anxiety in AF patients, (2) assess the impact that depression and anxiety have on illness perception in patients with AF, (3) provide evidence to support a hypothetical connection between the pathophysiology of AF and depression and anxiety, (4) evaluate the benefit of treatment of AF on depression and anxiety, and (5) give insight on medically managing a patient with AF and concomitant depression and anxiety.

scholarly journals Neurointensive care of traumatic brain injury in the elderly—age-specific secondary insult levels and optimal physiological levels to target need to be defined

2021 ◽  
Author(s):  
Samuel Lenell ◽  
Anders Lewén ◽  
Timothy Howells ◽  
Per Enblad
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
The Elderly ◽  
Favorable Outcome ◽  
Neurointensive Care ◽  
Younger Patients ◽  
Secondary Insults ◽  
Secondary Insult ◽  
Monitoring Time ◽  
The Impact

Abstract Background Elderly patients with traumatic brain injury increase. Current targets and secondary insult definitions during neurointensive care (NIC) are mostly based on younger patients. The aim was therefore to study the occurrence of predefined secondary insults and the impact on outcome in different ages with particular focus on elderly. Methods Patients admitted to Uppsala 2008–2014 were included. Patient characteristics, NIC management, monitoring data, and outcome were analyzed. The percentage of monitoring time for ICP, CPP, MAP, and SBP above-/below-predefined thresholds was calculated. Results Five hundred seventy patients were included, 151 elderly ≥ 65 years and 419 younger 16–64 years. Age ≥ 65 had significantly higher percentage of CPP > 100, MAP > 120, and SBP > 180 and age 16–64 had higher percentage of ICP ≥ 20, CPP ≤ 60, and MAP ≤ 80. Age ≥ 65 contributed independently to the different secondary insult patterens. When patients in all ages were analyzed, low percentage of CPP > 100 and SBP > 180, respectively, was significant predictors of favorable outcome and high percentage of ICP ≥ 20, CPP > 100, SBP ≤ 100, and SBP > 180, respectively, was predictors of death. Analysis of age interaction showed that patients ≥ 65 differed and had a higher odds for favorable outcome with large proportion of good monitoring time with SBP > 180. Conclusions Elderly ≥ 65 have different patterns of secondary insults/physiological variables, which is independently associated to age. The finding that SBP > 180 increased the odds of favorable outcome in the elderly but decreased the odds in younger patients may indicate that blood pressure should be treated differently depending on age.

scholarly journals Detección automática de la Fibrilación Auricular a través de un Smartwatch

2019 ◽  
Vol 11 (4) ◽  
pp. 3
Author(s):  
Anna Abad Torrent ◽  
Helena Benito Naverac
Keyword(s):  
Artificial Intelligence ◽  
Atrial Fibrillation ◽  
Clinical Practice ◽  
General Population ◽  
Cardiac Arrhythmia ◽  
Automatic Detection ◽  
Insuficiencia Cardiaca ◽  
Intelligence Models ◽  
Artificial Intelligence Models ◽  
Electrocardiogram Ecg

La fibrilación auricular es la arritmia cardiaca más frecuente en la práctica clínica. La prevalencia se sitúa en torno al 0,4 - 1 % de la población general. Aumenta con la edad, llegando hasta el 8% a partir de los 80 años. Esta arritmia es la principal causa a nivel mundial de accidente cerebrovascular (20-30% de los casos son debidos a la fibrilación auricular), insuficiencia cardíaca o muerte súbita. Muchas veces , es clínicamente silente o se manifiesta con síntomas vagos como las palpitaciones, que pueden atribuirse erróneamente a ansiedad y retrasar el diagnóstico. La instauración temprana de anticoagulación (en determinados casos) reduce, de forma significativa la incidencia de fenómenos tromboembólicos. ABSTRACT Automatic detection of atrial fibrillation using a Smartwatch Atrial fibrillation is the most common cardiac arrhythmia in clinical practice. The prevalence is around 0.4 — 1% of the general population. It increases with age, reaching up to 8% from 80 years. In cardiology, the standard for the diagnosis of a cardiac arrhythmia is based on the performance of an electrocardiogram (ECG). From the monitoring of KardiaBand ™ and SmartRhythm ™, AliveCor launches the first platform for Apple Watch series 4, which combines an electrocardiography device approved by the FDA and certain analysis algorithms with artificial intelligence models, which help to detect the atrial fibrillation.  

scholarly journals Stroke Risk Factors, Subtypes and Outcome in Elderly Thai Patients

2021 ◽  
Author(s):  
Chatpol Samuthpongtorn ◽  
Tul Jereerat ◽  
Nijasri Suwanwela
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
The Elderly ◽  
P Value ◽  
Younger Patients ◽  
Factors Associated ◽  
Stroke Risk Factors ◽  
History Of ◽  
Ischemic Attack

Abstract Background: Nowadays, the number of elderly has steadily increased annually. Elderly patients with ischemic stroke often have worse outcomes than younger patients. However, there has not been a study of ischemic stroke in the elderly in Thailand. A better knowledge of the risk factors, subtypes, and outcomes of strokes in the elderly may have significant practical implications for the aged society in the future. The objective of the study was to assess the risk factor, stroke subtypes, and outcome of stroke in the elderly compared to the younger patients.Method: All patients presented with acute ischemic stroke and transient ischemic attack (TIA) aged over 45 years who were admitted in the Stroke unit between November 1st, 2016 and December 31st, 2017 were retrospectively studied.Result: 542 patients were included. The average age was 68.78±12.03, 44.8% of them were male. 186 (34.3%) patients were 75 or older. Cardioembolism was found to be the most common cause of ischemic stroke in 156 patients (28.8%). Patients who were 75 or older had significantly worse outcomes in all categories including NIHSS at discharge, modified Rankin scale, length of stay and the number of deaths) compared to the younger group. Atrial fibrillation was the risk factors associated with older age with OR 3.861 (p value<0.001). Aged 75 years or older, atrial fibrillation, more NIHSS score on admission and history of the previous stroke were the risk factors associated with a patient's death.Conclusion: The elderly who are 75 years or older accounts for more than one-third of ischemic stroke in our study. Stroke in the elderly correlates with higher mortality and poorer outcome. Cardioembolism related to atrial fibrillation is the major cause of stroke in this population.

scholarly journals Risk of Recurrent Bleeding Events in Nonvalvular Atrial Fibrillation Treated with Vitamin K Antagonists: A Clinical Practice Research Datalink Study

TH Open ◽  
2019 ◽  
Vol 03 (04) ◽  
pp. e316-e324 ◽  
Author(s):  
Raza Alikhan ◽  
Cinira Lefevre ◽  
Ian Menown ◽  
Steven Lister ◽  
Alex Bird ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Recurrent Bleeding ◽  
Bleeding Events ◽  
Nonvalvular Atrial Fibrillation ◽  
The Impact

Abstract Background There is little evidence on how the occurrence of a bleed in individuals on vitamin K antagonists (VKAs) impacts the risk of subsequent bleeds, and thromboembolic and ischemic events. Such information would help to inform treatment decisions following bleeds. Objective To estimate the impact of bleeding events on the risk of subsequent bleeds, venous thromboembolism (VTE), stroke, and myocardial infarction (MI) among patients initiating VKA treatment for new-onset nonvalvular atrial fibrillation (NVAF). Methods We conducted an observational cohort study using a linked Clinical Practice Research Datalink—Hospital Episode Statistics dataset. Among a cohort of individuals with NVAF, the risk of clinically relevant bleeding, VTE, stroke, and MI was compared between the period prior to the first bleed and the periods following each subsequent bleed. The rate and cost of general practitioner (GP) consultations, prescriptions, and hospitalizations were also compared across these periods. Results The risk of clinically relevant bleeding events was observed to be elevated at least twofold in all periods following the first bleeding event. The risk of VTE, stroke, and MI was not found to differ according to the number of clinically relevant bleeding events. The rate and cost of GP consultations, GP prescriptions, and hospitalizations were increased in all periods relative to the period prior to the first bleed. Conclusions The doubling in the risk of bleeding following the first bleed, taken alongside the stable risk of MI, VTE, and stroke, suggests that the risk–benefit balance for VKA treatment should be reconsidered following the first clinically relevant bleed.

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