scholarly journals Triggers for Atrial Fibrillation: The Role of Anxiety

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Paolo Severino ◽  
Marco Valerio Mariani ◽  
Annalisa Maraone ◽  
Agostino Piro ◽  
Andrea Ceccacci ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Anxiety Disorders ◽  
Heart Diseases ◽  
Poor Quality ◽  
Valvular Heart Diseases ◽  
Arrhythmogenic Substrate ◽  
Clinical Strategies

Atrial fibrillation (AF) is the most widely recognized arrhythmia. Systemic arterial hypertension, diabetes, obesity, heart failure, and valvular heart diseases are major risk factors for the onset and progression of AF. Various studies have emphasized the augmented anxiety rate among AF patients due to the poor quality of life; however, little information is known about the possibility of triggering atrial fibrillation by anxiety. The present review sought to underline the possible pathophysiological association between AF and anxiety disorders and suggests that anxiety can be an independent risk factor for AF, acting as a trigger, creating an arrhythmogenic substrate, and modulating the autonomic nervous system. The awareness of the role of anxiety disorders as a risk factor for AF may lead to the development of new clinical strategies for the management of AF.

scholarly journals Is Catheter Ablation Better Than Antiarrhythmic Drugs for the Treatment of Atrial Fibrillation?

2020 ◽  
Vol 29 (02) ◽  
pp. 131-140
Author(s):  
Balaji Natarajan ◽  
Srishti Nayak ◽  
Ramdas G. Pai
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Persistent Atrial Fibrillation ◽  
Poor Quality ◽  
Treatment Side Effects ◽  
Randomized Controlled Studies ◽  
Antiarrhythmic Medications ◽  
Better Than

AbstractLong-standing atrial fibrillation is associated with significant morbidity including stroke and development of heart failure. Patients also report poor quality of life as a result of debilitating symptoms or treatment side effects from antiarrhythmic medications. Radio frequency or cryothermal mediated catheter ablation has a central role in the management of symptomatic patients with paroxysmal or persistent atrial fibrillation. Circumferential pulmonary vein isolation is vital to the success of this therapy and other ancillary techniques have been described, especially for persistent atrial fibrillation. Several randomized controlled studies have been reported over the last two decades studying important clinical outcomes in patients with atrial fibrillation. In this article, we aim to provide a review of the major studies that have helped define the role of catheter ablation in the management of symptomatic atrial fibrillation in patients with both diseased and structurally normal hearts.

Use of SAMe-TT₂R₂ Score to Predict the Quality of Anticoagulation Control in Patients with Atrial Fibrillation Receiving Warfarin in Thailand

2020 ◽  
Vol 103 (6) ◽  
pp. 548-552
Keyword(s):  
Atrial Fibrillation ◽  
Therapeutic Range ◽  
Statistical Significance ◽  
Discrimination Performance ◽  
Poor Quality ◽  
Chi Square ◽  
Exact Test ◽  
Time In Therapeutic Range ◽  
Anticoagulation Control

Objective: To predict the quality of anticoagulation control in patients with atrial fibrillation (AF) receiving warfarin in Thailand. Materials and Methods: The present study retrospectively recruited Thai AF patients receiving warfarin for three months or longer between June 2012 and December 2017 in Central Chest Institute of Thailand. The patients were classified into those with SAMe-TT₂R₂ of 2 or less, and 3 or more. The Chi-square test or Fisher’s exact test was used to compare the proportion of the patients with poor time in therapeutic range (TTR) between the two groups of SAMe-TT₂R₂ score. The discrimination performance of SAMe-TT₂R₂ score was demonstrated with c-statistics. Results: Ninety AF patients were enrolled. An average age was 69.89±10.04 years. Most patients were persistent AF. An average CHA₂DS₂-VASc, SAMe-TT₂R₂, and HAS-BLED score were 3.68±1.51, 3.26±0.88, and 1.98±0.85, respectively. The present study showed the increased proportion of AF patients with poor TTR with higher SAMe-TT₂R₂ score. The AF patients with SAMe-TT₂R₂ score of 3 or more had a larger proportion of patients with poor TTR than those with SAMe-TT₂R₂ score of 2 or less with statistical significance when TTR was below 70% (p=0.03) and 65% (p=0.04), respectively. The discrimination performance of SAMe-TT₂R₂ score was demonstrated with c-statistics of 0.60, 0.59, and 0.55 when TTR was below 70%, 65% and 60%, respectively. Conclusion: Thai AF patients receiving warfarin had a larger proportion of patients with poor TTR when the SAMe-TT₂R₂ score was higher. The score of 3 or more could predict poor quality of anticoagulation control in those patients. Keywords: Time in therapeutic range, Poor quality of anticoagulation control, Warfarin, SAMe-TT₂R₂, Labile INR

Die Reformen des Wahlrechts zum Deutschen Bundestag 2011 und 2013 im öffentlichen Diskurs

2020 ◽  
Vol 51 (4) ◽  
pp. 844-864
Author(s):  
Eric Linhart ◽  
Oke Bahnsen
Keyword(s):  
Political Institutions ◽  
Public Discourse ◽  
Social Groups ◽  
Poor Quality ◽  
Public Debate ◽  
The Public ◽  
Electoral Law ◽  
German Newspapers

The German electoral law to the federal parliament was reformed in 2011 and in 2013 . While political scientists have extensively evaluated consequences of these reforms, the role of the public discourse has been largely neglected . We analyze articles from three leading German newspapers (FAZ, SZ, Welt) on this topic and find the debate around the reforms to be dominated by parties and political institutions . Scientists, interest groups, and journalists have only played minor roles . Regarding content, the discourse largely focused on surplus seats, reform speed, and a proposal by the CDU/CSU‑FDP coalition government in 2011 . A broad public debate in which multiple social groups could participate has not taken place . From a normative perspective this is problematic since the lack of a public debate might have contributed to the poor quality of the reform’s result .

Abstract 147: Impact of Risk Factor Modification in Improving Quality of Life and Arrhythmia Symptoms in Patients With Atrial Fibrillation

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Amaryah Yaeger ◽  
Nancy R Cash ◽  
Tara Parham ◽  
Rajeev Pathak ◽  
David S Frankel ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Risk Factor ◽  
Improve Quality ◽  
Risk Factor Modification ◽  
Obstructive Sleep ◽  
Sf 36 ◽  
The Impact ◽  
Factor Modification

Objective: The desired goal of atrial fibrillation (AF) management is maintenance of sinus rhythm in order to improve quality of life (QoL) and arrhythmia symptoms (AS). Although obesity and obstructive sleep apnea (OSA) are known risk factors for development of AF, these remain inadequately treated. We report the impact of prospectively modifying these risk factors on QoL and AS in AF patients (pts). Methods: AF pts with obesity (body mass index (BMI) ≥30kg/m 2 ) and/or the need for OSA management (high-risk as per Berlin Questionnaire or untreated OSA) were voluntarily enrolled in a nurse-led risk factor modification (RFM) program at their arrhythmia clinic visit. RFM entailed patient education, lifestyle modification counseling, coordination of care with appropriate specialists, and longitudinal care management. Progress with weight loss (WL) and OSA treatment was monitored via monthly follow-up calls and/or downloads from continuous positive airway pressure (CPAP) units for up to 12 months. QoL and AS were determined with the SF-36 and AF Severity Scale (AFSS) respectively, and were assessed at baseline, 6 months, and 12 months. Student t-test and chi-square tests were used to compare continuous and dichotomous variables. Results: From 11/1/16 to 10/31/17, 252 pts (age 63±11 years; male=179; paroxysmal AF=126) were enrolled as follows: 189 for obesity and 93 for OSA. The mean WL was 2.7±3.8% from baseline and 78% (n=126 of 162 pts with available data) of enrolled obese patients achieved WL. Among 93 pts at risk for OSA, 70 completed sleep studies and 50 were identified with OSA. Majority of these patients (76%; n=38 of 50) started CPAP therapy and have remained full (57%; n=17 of 30 pts with available CPAP data) and partial (13%; n=4 of 30) users. Table shows that SF-36 and AFSS scores improved for most measures of QoL and AS from baseline to 6 months. Conclusion: Participation in a risk factor modification program targeting obesity and obstructive sleep apnea can improve quality of life and arrhythmia symptoms in patients with atrial fibrillation. The impact of this strategy on long-term maintenance of sinus rhythm remains to be determined.

scholarly journals Quality indicators for the care and outcomes of adults with atrial fibrillation

EP Europace ◽  
2020 ◽  
Author(s):  
Elena Arbelo ◽  
Suleman Aktaa ◽  
Andreas Bollmann ◽  
André D’Avila ◽  
Inga Drossart ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Quality Indicators ◽  
Control Strategy ◽  
Rate Control ◽  
Rhythm Control ◽  
Patient Assessment ◽  
Risk Factor Management ◽  
Diagnosis And Management

Abstract Aims To develop quality indicators (QIs) that may be used to evaluate the quality of care and outcomes for adults with atrial fibrillation (AF). Methods and results We followed the ESC methodology for QI development. This methodology involved (i) the identification of the domains of AF care for the diagnosis and management of AF (by a group of experts including members of the ESC Clinical Practice Guidelines Task Force for AF); (ii) the construction of candidate QIs (including a systematic review of the literature); and (iii) the selection of the final set of QIs (using a modified Delphi method). Six domains of care for the diagnosis and management of AF were identified: (i) Patient assessment (baseline and follow-up), (ii) Anticoagulation therapy, (iii) Rate control strategy, (iv) Rhythm control strategy, (v) Risk factor management, and (vi) Outcomes measures, including patient-reported outcome measures (PROMs). In total, 17 main and 17 secondary QIs, which covered all six domains of care for the diagnosis and management of AF, were selected. The outcome domain included measures on the consequences and treatment of AF, as well as PROMs. Conclusion This document defines six domains of AF care (patient assessment, anticoagulation, rate control, rhythm control, risk factor management, and outcomes), and provides 17 main and 17 secondary QIs for the diagnosis and management of AF. It is anticipated that implementation of these QIs will improve the quality of AF care.

scholarly journals Murcia atrial fibrillation project II: protocol for a prospective observational study in patients with atrial fibrillation

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e033712
Author(s):  
José Miguel Rivera-Caravaca ◽  
Francisco Marín ◽  
María Asunción Esteve-Pastor ◽  
Josefa Gálvez ◽  
Gregory Y.H. Lip ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Observational Study ◽  
Heart Valves ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Real Life ◽  
Poor Quality ◽  
Prosthetic Heart Valves

IntroductionAtrial fibrillation (AF) is characterised by a high stroke risk. Vitamin K antagonists (VKAs) are the most commonly used oral anticoagulants (OACs) in Spain, but their efficacy and safety depend on the time in therapeutic range of International Normalized Ratio (INR) 2.0–3.0 over 65%–70%. Unfortunately, the difficulties of maintaining an optimal level of anticoagulation and the complications of VKAs (particularly haemorrhagic ones), frequently lead to cessation of this therapy, which has been associated with higher risk of adverse events (AEs), including ischaemic stroke. Our aims are as follows: (1) to evaluate the quality of oral anticoagulation with VKAs, the prevalence of poor quality of anticoagulation, and to identify factors predisposing to poor quality anticoagulation; and (2) to identify patients who will stop OAC and to investigate what factors influence the decision of OAC withdrawal.Methods and analysisProspective observational cohort study including outpatients newly diagnosed with AF and naïve for OACs from July 2016 to June 2018 in an anticoagulation clinic. Patients with prosthetic heart valves, rheumatic mitral valves or valvular AF will be excluded. Follow-up will extend for up to 3 years. During this period, the INR results and changes in the anticoagulant therapy will be recorded, as well as all AEs, or any other information that would be relevant to the proper conduct of research.Ethics and disseminationAll patients were informed about the nature and purpose of the study, and the protocol was approved by the Ethics Committee of Hospital General Universitario Morales Meseguer (reference: EST:20/16). This is an observational study focusing on ‘real life’ practice and therefore all treatments and follow-up will be performed in accordance to the routine clinical practice with no specific interventions or visits. The results of our study will be disseminated by presentations at national and international meetings, and publications in peer-reviewed journals.

Psychiatry’s ethical involvement in gender-affirming care

2018 ◽  
Vol 26 (5) ◽  
pp. 460-463 ◽  
Author(s):  
Roberto D’Angelo
Keyword(s):  
Gender Dysphoria ◽  
Poor Quality ◽  
Medline Search ◽  
Gender Reassignment ◽  
The Subject ◽  
Poor Outcomes ◽  
Physical Treatments

Objective: To reflect on the role of psychiatry in authorising physical treatments for Gender Dysphoria and to examine the quality of evidence for gender-reassignment. Method: A Medline search was performed with the subject term “transsexualism” or “gender dysphoria” and “outcome” or “follow-up” in the title. Studies published from 2005 onwards reporting psychosocial outcomes were selected for review. Results: Most available evidence indicating positive outcomes for gender reassignment is of poor quality. The few studies with robust methodology suggest that some patients have poor outcomes and may be at risk of suicide. Conclusion: The author raises questions about the implications for ethical treatment of transgender individuals.

Symptoms, Hope, Self-Management Behaviors, and Quality of Life Among Chinese Preoperative Patient With Symptomatic Valvular Heart Diseases

2019 ◽  
Vol 31 (3) ◽  
pp. 284-293 ◽  
Author(s):  
Yongfeng Chen ◽  
Guifen Fu ◽  
Fang Liang ◽  
Jing Wei ◽  
Jing He ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Rural Areas ◽  
Heart Diseases ◽  
Adult Population ◽  
Food Culture ◽  
Self Management ◽  
Valvular Heart Diseases ◽  
Loss Of Appetite ◽  
Management Behaviors

Introduction: More than 42 million people are estimated to suffer from valvular heart disease (VHD) worldwide with a prevalence of 5.3% to 7.7% in the Chinese adult population. The purpose of this study was to examine the associations between symptoms, hope, self-management behaviors, and quality of life (QOL) for preoperative patients with symptomatic VHD in a rural area of China. Method: This was a descriptive comparative study that took place in Nanning, China, between January 2015 and March 2016. The sample was 128 preoperative patients with symptomatic VHD. Data were collected using the Symptom Distress Questionnaire, Herth Hope Index, Self-Management Scale, and Minnesota Living with Heart Failure Questionnaire. Results: Data from 122 patients were included in the final analysis. Mean scores of hope, self-management, and QOL were 36.71, 55.27, and 55.56. Worse total scores of symptom severity ( r = 0.57 to 0.69, p < .001) and self-management behaviors ( r = −0.22 to −0.25, p < .05) were associated with poorer QOL. Fatigue, loss of appetite, and self-management behaviors explained 49.90% variance of QOL ( p < .001). Discussion: Fatigue, loss of appetite, and self-management influenced QOL of patients with symptomatic VHD. Interventions aimed at strengthening self-management and relieving symptoms should be tailored for patients with symptomatic VHD base on their traditional animist belief and food culture in rural areas of China such as the Zhuang Autonomous Region.

Sign in / Sign up

Export Citation Format

Share Document