Abstract 16088: Mortality Trend Among Patients With Atrial Fibrillation on Long Term Anticoagulation Who Developed Intracranial Hemorrhage: Insights From the National Inpatient Database From 2006 to 2014

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Karol Quelal ◽  
Andrea Torres ◽  
Christian Torres ◽  
Alfonso Tafur
Keyword(s):  
Atrial Fibrillation ◽  
Hospital Mortality ◽  
Intracranial Hemorrhage ◽  
Vitamin K Antagonists ◽  
Hospital Death ◽  
Chi Square ◽  
Fda Approval ◽  
The Us ◽  
Inpatient Database

Introduction: Intracranial hemorrhage (ICH), is a potential complication of anticoagulation use in atrial fibrillation (AF). During the last decade, guidelines have evolved from recommending vitamin K antagonists to a preference for DOACs in the case of non-valvular AF after FDA approval in 2010. Data have reported that DOACs have a lower rate of ICH and an overall better clinical profile when compared to VKA. Aim: We sought to describe the rate of ICH and its associated mortality h with the increment in the use of DOACs over the period of 2006 to 2014 in the US population with AF. Methods: We queried the NIS database 2006-2014. AF patients, patients using long term anticoagulation, and intracranial hemorrhage admissions were selected using the appropriate ICD-9 codes. Time trend was analyzed using Chi-square. In-hospital mortality was evaluated by binomial logistic regression. Results: We found a 30740346 weighted population with AF between 2006 and 2014. 16.8 % were long term users of anticoagulants. Of them, 1.1% (n: 56400) were admitted due to ICH. Long term anticoagulation use in AF went from 13.3% in 2006 to 17.3% in 2010 (p<0.001). Among AF patients, 30.7% of patients had in-hospital death when admitted for ICH using long term anticoagulation. Long term anticoagulation was associated with increased in-hospital death in ICH patients aOR 1.31 (95% CI 1.24 - 1.39) when compared to those not using long term anticoagulation. Patients with AF and long term use of anticoagulants showed an increased frequency of in-hospital mortality from 32.7% in 2006 to 34.2% in 2007 and a decrease to 30.9% up to 2010. The decrease in mortality rate was more notorious from 2010 to 2014 going to 25.8% (p< 0.001). Conclusions: The rate of ICH diagnosis among anticoagulated atrial fibrillation patients has remained stable after the introduction of DOACs. Rates of inpatient death have decreased from 2006 to 2014 having the most notorious inflection point in 2010 after the progressive introduction of DOACs .

scholarly journals Long-term antithrombotic treatment in intracranial hemorrhage survivors with atrial fibrillation

Neurology ◽  
2017 ◽  
Vol 89 (7) ◽  
pp. 687-696 ◽  
Author(s):  
Eleni Korompoki ◽  
Filippos T. Filippidis ◽  
Peter B. Nielsen ◽  
Angela Del Giudice ◽  
Gregory Y. H. Lip ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Intracranial Hemorrhage ◽  
Observational Studies ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Vitamin K Antagonists ◽  
Cochrane Library ◽  
Meta Analyses

Objective:To perform a systematic review and meta-analysis of studies reporting recurrent intracranial hemorrhage (ICH) and ischemic stroke (IS) in ICH survivors with atrial fibrillation (AF) during long-term follow-up.Methods:A comprehensive literature search including MEDLINE, EMBASE, Cochrane library, clinical trials registry was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We considered studies capturing outcome events (ICH recurrence and IS) for ≥3 months and treatment exposure to vitamin K antagonists (VKAs), antiplatelet agents (APAs), or no antithrombotic medication (no-ATM). Corresponding authors provided aggregate data for IS and ICH recurrence rate between 6 weeks after the event and 1 year of follow-up for each treatment exposure. Meta-analyses of pooled rate ratios (RRs) were conducted with the inverse variance method.Results:Seventeen articles met inclusion criteria. Seven observational studies enrolling 2,452 patients were included in the meta-analysis. Pooled RR estimates for IS were lower for VKAs compared to APAs (RR = 0.45, 95% confidence interval [CI] 0.27–0.74, p = 0.002) and no-ATM (RR = 0.47, 95% CI 0.29–0.77, p = 0.002). Pooled RR estimates for ICH recurrence were not significantly increased across treatment groups (VKA vs APA: RR = 1.34, 95% CI 0.79–2.30, p = 0.28; VKA vs no-ATM: RR = 0.93, 95% CI 0.45–1.90, p = 0.84).Conclusions:In observational studies, anticoagulation with VKA is associated with a lower rate of IS than APA or no-ATM without increasing ICH recurrence significantly. A randomized controlled trial is needed to determine the net clinical benefit of anticoagulation in ICH survivors with AF.

scholarly journals LA3CK Score for Predicting in-Hospital Mortality after Minor Bleeding in Patients with Atrial Fibrillation

2021 ◽  
Author(s):  
Ying Bai ◽  
Xin-Yao Liu ◽  
Yi-Xi Zou ◽  
Shi-Dong Guo ◽  
Zhen-Zhou Wang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Hospital Mortality ◽  
Major Bleeding ◽  
Chronic Kidney Disease Stage ◽  
Disease Stage ◽  
Hospital Death ◽  
Minor Bleeding ◽  
Good Efficiency ◽  
Chronic Lung Diseases ◽  
Risk Of Mortality

Abstract Backgrounds and Purposes Minor bleeding was found to be closely related with death in in-hospital patients with atrial fibrillation (AF）and the factors affecting mortality after minor bleedings were then explored.Methods This study was divided into two parts. First, 15219 AF patients without major bleeding were included at their first hospitalizations from our centers since 2008 to 2018 to explore the association of minor bleeding with in-hospital mortality. Then factors related with in-hospital death were further explored in 789 AF patients with minor bleeding but without major bleeding and joined into one score predicting mortality after the minor bleedings during hospital stay.Results Patients with minor bleedings were at high risk of mortality (Adjusted OR:4.61, 95% CI: 3.77-5.65, p<0.001), especially if they were older (Adjusted OR:1.05, 95% CI: 1.03-1.06, p<0.001), or complicated with chronic lung diseases, chronic kidney disease stage III-V, anemia, malignant tumor, acute myocardial infarction. The c-index was 0.681 using ROC curve when these risk factors were joined into the score LA3CK. The c-index was 0.81 when this score was extended to the whole in-hospital AF population.Conclusions In the in-hospital AF patients, risk of mortality increased in patients with minor bleeding. The score LA3CK score had a good efficiency in predicting in-hospital mortality after minor bleedings.

scholarly journals The international normalized ratio (INR) as seen in a population of patients with atrial fibrillation and cerebral infarction undergoing long-term treatment with vitamin K antagonists

2015 ◽  
Vol 28 (4) ◽  
pp. 269-272
Author(s):  
Anna Szczepańska-Szerej ◽  
Magdalena Wojtan ◽  
Beata Szajnoga
Keyword(s):  
Atrial Fibrillation ◽  
Cerebral Infarction ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
International Normalized Ratio ◽  
Blood Parameters ◽  
Term Treatment ◽  
Adequate Treatment ◽  
Long Term Treatment

Abstract It is estimated that nearly 20% of all cerebral infarctions in the total population are the result of a complication of atrial fibrillation (AF). While oral anticoagulation with vitamin K antagonists (AVKs) substantially reduces this risk, this requires regular monitoring of the international normalized ratio (INR) in order to achieve therapeutic levels (2,0-3,0). The aim of this study was to evaluate a group at high risk of cerebral infarction, among patients with AF undergoing long-term treatment with VKAs, taking into account the significance of therapeutic INR values. The analysed group consisted of 90 acute ischaemic stroke patients with paroxysmal or chronic “non-valvular” AF, receiving treatment with VKAs. As a result of the study, therapeutic INR values (≥ 2) were seen in thirty-five of these individuals (38,8%), while 55 (61,2%) showed non-therapeutic INR values. Moreover, there were no differences in demographics, vascular risk factors, biochemical and morphological blood parameters, mean CHA2DS2-VASc score and TOAST classification between either of the two groups. Furthermore, no additional factor that would increase their risk of cerebral infarction during the adequate treatment with VKAs was found. However, patients with non-therapeutic INR values had a statistically significantly higher frequency of concomitant moderate pathology of the bicuspid valve, p<0.05. Hence, a lack of proper control of INR can proved to be particularly dangerous for this subgroup of patients. Hence, this is a group with an elevated risk of cerebral infarction and therefore requires special oversight of VKA treatment or NOA treatment.

Abstract WP379: Sex-specific Effects of Comorbid Diabetes and Depression on Post-stroke Mortality in Individuals With Atrial Fibrillation

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Jodi Edwards ◽  
Jessica Colby-Milley ◽  
Jiming Fang ◽  
Limei Zhou ◽  
Baiju R Shah ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Hospital Mortality ◽  
Recurrent Stroke ◽  
Stroke Patients ◽  
Comorbid Depression ◽  
Term Care ◽  
Post Stroke ◽  
Specific Effects ◽  
Long Term Mortality

Background: Comorbid diabetes and depression are highly prevalent in atrial fibrillation (AF) and increase the risk of stroke. Women with AF show higher mortality rates and have worse functional outcomes post-stroke. However, the sex-specific effects of comorbid diabetes and depression on mortality and other adverse outcomes in stroke patients with a history of AF is unclear. Methods: Prospectively collected consecutive patients with ischemic stroke and known AF presenting to designated stroke centres in Ontario (2003-2013). Multinomial regression was used to determine sex-specific associations between diabetes and depression and in-hospital mortality post-stroke in individuals with AF. Cox proportional hazards regression was used to estimate the adjusted hazard of long-term mortality post-stroke and competing risks models to estimate hazards of recurrent stroke/TIA, admission to long-term care, and incident dementia post-discharge. Results: Among 5082 stroke patients with known AF (median age=80, IQR:73-85), female patients were more likely to have comorbid depression than males (63.5% vs. 36.5%) and those with comorbid diabetes and depression were younger (77 yrs) and had more vascular history (HTN, CAD, hyperlipidemia) than those with AF only. For males, comorbid diabetes increased the likelihood of in-hospital mortality post-stroke by 53% (OR=1.53, 95% CI=1.16-2.02), after adjustment for stroke severity, demographic and clinical factors, while comorbid depression did not significantly impact in-hospital mortality and neither diabetes or depression affected in-hospital mortality post-stroke for females. However, diabetes was independently associated with increased hazard of long-term mortality for both female (HR=1.15, 95%CI=1.02-1.29) and male AF stroke patients (HR=1.35, 95%CI=1.19-1.53). No associations with recurrent stroke/TIA, institutionalization or dementia post-stroke were observed for either females or males. Conclusion: In stroke patients with known AF, comorbid diabetes but not depression was independently associated with increased in-hospital mortality for males and increased long-term mortality post-stroke for both females and males.

scholarly journals Using Data Analytics to Predict Hospital Mortality in Sepsis Patients

2019 ◽  
Vol 14 (3) ◽  
pp. 40-57
Author(s):  
Yazan Alnsour ◽  
Rassule Hadidi ◽  
Neetu Singh
Keyword(s):  
Hospital Mortality ◽  
Predictive Model ◽  
Health Care Providers ◽  
Prediction Models ◽  
Predictive Analytics ◽  
Area Under The Curve ◽  
The United States ◽  
Hospital Death ◽  
Care Providers ◽  
Chi Square

Predictive analytics can be used to anticipate the risks associated with some patients, and prediction models can be employed to alert physicians and allow timely proactive interventions. Recently, health care providers have been using different types of tools with prediction capabilities. Sepsis is one of the leading causes of in-hospital death in the United States and worldwide. In this study, the authors used a large medical dataset to develop and present a model that predicts in-hospital mortality among Sepsis patients. The predictive model was developed using a dataset of more than one million records of hospitalized patients. The independent predictors of in-hospital mortality were identified using the chi-square automatic interaction detector. The authors found that adding hospital attributes to the predictive model increased the accuracy from 82.08% to 85.3% and the area under the curve from 0.69 to 0.84, which is favorable compared to using only patients' attributes. The authors discuss the practical and research contributions of using a predictive model that incorporates both patient and hospital attributes in identifying high-risk patients.

Long-term quality of VKA treatment and clinical outcome after extreme overanticoagulation in 14,777 AF and VTE patients

2015 ◽  
Vol 113 (04) ◽  
pp. 881-890 ◽  
Author(s):  
Nic J. G. M. Veeger ◽  
Nakisa Khorsand ◽  
Hanneke C. Kluin-Nelemans ◽  
Hilde A. M. Kooistra ◽  
Karina Meijer ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Venous Thromboembolism ◽  
Clinical Outcome ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
P Value ◽  
Risk Of Bleeding ◽  
Increased Risk

SummaryVitamin K antagonists (VKA) are widely used in atrial fibrillation and venous thromboembolism (VTE). Their efficacy and safety depend on individual time in the therapeutic range (iTTR). Due to the variable dose-response relationship within patients, also patients with initially stable VKA treatment may develop extreme overanticoagulation (EO). EO is associated with an immediate bleeding risk, but it is unknown whether VKA treatment will subsequently restabilise. We evaluated long-term quality of VKA treatment and clinical outcome after EO. EO was defined as international normalized ratio (INR) ≥ 8.0 and/or unscheduled vitamin K supplementation. We included a consecutive cohort of initially stable atrial fibrillation and venous thromboembolism patients. In EO patients, the 90 days pre- and post-period were compared. In addition, patients with EO were compared with patients without EO using a matched 1:2 cohort. Of 14,777 initially stable patients, 800 patients developed EO. The pre-period was characterised by frequent overanticoagulation, and half of EO patients had an inadequate iTTR (< 65 %). After EO, underanticoagulation became more prevalent. Although the mean time between INR-measurements decreased from 18.6 to 13.2 days, after EO inadequate iTTR became more frequent (62 %), p-value < 0.001. A 2.3 times (95 % confidence interval [CI] 2.0–2.5) higher risk for iTTR< 65 % after EO, was accompanied by increased risk of bleeding (hazard ratio [HR] 2.1;CI 1.4–3.2), VKA-related death 17.0 (HR 17.0;CI 2.1–138) and thrombosis (HR 5.7;CI 1.5–22.2), compared to the 1600 controls. In conclusion, patients continuing VKA after EO have long-lasting inferior quality of VKA treatment despite intensified INR-monitoring, and an increased risk of bleeding, thrombosis and VKA-related death.Note: There have been no previous presentations, reports or publications of the complete data that appear in the article. Parts of the data in this article have been presented as a poster at the American Society of Hematology (ASH) congress 2013, New Orleans, United States.

scholarly journals 454 Mitral regurgitation and in-hospital mortality in patients with heart failure and low flow low gradient aortic stenosis

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Germano Junior Ferruzzi ◽  
Angela Pamela Peluso ◽  
Tiziana Attisano ◽  
Serena Migliarino ◽  
Francesco Vigorito ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Aortic Stenosis ◽  
Hospital Mortality ◽  
Low Flow ◽  
Volume Index ◽  
Hospital Death ◽  
The Mean

Abstract Aims This study sought to determine the prevalence, clinical impact, and in-hospital outcome of moderate to severe mitral regurgitation (MR) in patients with low-flow, low-gradient aortic stenosis (LFLG-AS) hospitalized for heart failure (HF). Methods and results Patients with aortic valve thickness and aortic velocities &gt;2.5 m/s hospitalized for heart failure in a single referral centre were prospectively enrolled from 2013 to 2021. LFLG-AS was defined as indexed aortic valve area (iAVA) ≤0.6 cm2/m2, mean transaortic gradient &lt;40 mmHg, and stroke volume index &lt;36 ml/m2. Complete demographic, clinical characteristics, and echocardiographic data were collected. Mitral regurgitation severity was graded according to current guidelines. Patients were divided into two subgroups according to MR severity: no/mild MR vs. moderate/severe MR. In hospital all cause death has been considered as the primary outcome. A total of 136 patients [78 ± 9 yy; 68 (50%) male] hospitalized for HF with a new diagnosis of LFLG-AS were included in the study. The most frequent comorbidities were hypertension (121, 89%), dyslipidemia (106, 78%), chronic kidney disease (85, 63%), diabetes (56, 41%), and obesity (44, 32%). Atrial fibrillation/flutter was detected in 61 (45%) patients. Moderate to severe MR was detected in 33%. Mean functional NYHA class was 2.8 ± 0.8. Concerning echocardiographic evaluation, the mean gradient of the aortic valve was 26 ± 7 mmHg and the mean iAVA was 0.42 ± 0.10 cm2/m2. The mean left ventricular ejection fraction (LV EF) was 46 ± 13%. Paradoxical LFLG-AS with a preserved LV EF was detected in 73 patients (54%) and the LFLG-AS with a low LV EF was detected in 63 (46%). In this population, 26 patients (19%) underwent surgical valvular replacement, 15 patients (11%) had aortic percutaneous valvuloplasty, and 33 patients (24%) underwent TAVI. The remaining patients (45%, n = 62) were maintained under optimized medical therapy. In-hospital death occurred in 17 (12.5%) patients (just 1 for non-cardiovascular causes). Moderate/severe MR was detected in 44 (33%) patients. When comparing the two subgroups statistically significant differences between age (P = 0.035), male sex (P = 0.028), atrial fibrillation/flutter (P = 0.003), obesity (P = 0.040), and in-hospital mortality (P = 0.013) were detected. In the overall population the multivariate regression analysis showed that only the presence of moderate/severe MR was a significant independent predictor of all-cause in-hospital death (P = 0.017; OR: 3.571; CI: 1.257–10.151). Conclusions Moderate to severe MR is frequently detected in patients with LFLG AS and HF. In this peculiar cohort significant MR has a negative impact on outcome and is independently associated with in-hospital mortality.

scholarly journals Intracranial hemorrhage in patients taking oral anticoagulants. Current possibilities for therapy

2019 ◽  
Vol 11 (3S) ◽  
pp. 82-88
Author(s):  
S. N. Yanishevsky
Keyword(s):  
Atrial Fibrillation ◽  
Intracranial Hemorrhage ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Severe Disabilities ◽  
Progression Rate ◽  
Reversal Agents ◽  
Traumatic Intracranial Hemorrhage ◽  
Hypertension Therapy ◽  
Specific Antagonist

The paper reviews an update on the possibilities of providing care for patients with spontaneous non-traumatic intracranial hemorrhage (ICH) developing in patients with atrial fibrillation who use oral anticoagulants. The incidence of ICH is shown to be considerably lower when nonvitamin K-dependent anticoagulants (NOACs) are used, but the hematoma evolution scenarios do not differ between the groups of patients receiving vitamin K antagonists or NOACs. The results of studies assessing hypertension therapy in patients with ICH are compared. The possibilities of using various reversal agents for various oral anticoagulants are also discussed. Since one of the main problems associated with increased mortality and severe disabilities is the progression rate of ICH, the possibility of using a specific antagonist can determine the choice of an anticoagulant for the primary prevention of ischemic stroke in a patient with atrial fibrillation.

Porcine Left Atrial Wall Stress After Ventricular Tachypacing Mimicking the Effects of Early Atrial Fibrillation

2010 ◽  
Author(s):  
Elena S. Di Martino ◽  
Chiara Bellini ◽  
Dale J. Ward ◽  
Nicolas Brown ◽  
David Schwartzman
Keyword(s):  
Atrial Fibrillation ◽  
Wall Stress ◽  
High Impact ◽  
Atrial Wall ◽  
Left Atrial Wall ◽  
The Us ◽  
Human Costs ◽  
Care Costs ◽  
Annual Mortality

Atrial Fibrillation (AF) is the cardiac arrhythmia most commonly encountered in clinical practice. Current statistics referring to the US population indicate a prevalence of AF up to 2.2 million people, projected to increase to 2.66 million by the end of 2010. AF has a high impact on society in terms of human costs, with an annual mortality rate of 11,438 patients. AF also increases the risk of ischemic stroke at least by a factor of 4 and it is responsible for at least 15% of all ischemic strokes, which represent the main cause of long-term disability and one of the main contributors to health care costs [1]. AF results from the synergic action of electrophysiological, biochemical and structural remodeling. Ventricular tachypacing (VTP) has been successfully used in animal models to reproduce relevant features observed in patients suffering from AF, such as ion-channel alterations, fibrosis development and atrial dilatation [2] [3].

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