Predictive Value of the HAS-BLED and ATRIA Bleeding Scores for the Risk of Serious Bleeding in a “Real-World” Population With Atrial Fibrillation Receiving Anticoagulant Therapy

Abstract Background/Introduction The primary goal of monitoring for atrial fibrillation (AF) after cryptogenic stroke (CS) is secondary stroke prevention. Therefore, long-term monitoring of CS patients with insertable cardiac monitors (ICMs) is likely important to ensure appropriate secondary stroke prevention therapy, regardless of when AF is detected after the index event. However, long-term data on the incidence and duration of AF from real-world populations are sparse. Purpose To investigate the long-term incidence and duration of AF episodes in real-world clinical practice among a large population of patients with ICMs placed for AF detection following CS. Methods We included patients from a large device manufacturer's database who received an ICM for the purpose of AF detection following CS and were monitored for up to 3 years. All detected AF episodes (≥2 minutes) were adjudicated. We quantified the AF detection rate for various episode duration thresholds using Kaplan-Meier survival estimates, analyzed the maximum duration of AF episodes, and measured the time to initial AF detection. Results A total of 1247 patients (65.3±13.0 years, 53% male) were included and followed for 763±362 days. AF episodes (n=5456) were detected in 257 patients, resulting in a median frequency of 5 episodes [IQR 2–19] per patient. At 3 years, the AF detection rate for episodes ≥2 minutes was 24.2%. The AF detection rates at 3 years for episodes ≥6 minutes, ≥30 minutes, and ≥1 hour were 22.4%, 20.6%, and 19.1%, respectively. The median duration of the longest detected AF episode was 4.4 [IQR 1.2–13.9] hours and the median time to AF detection was 129 [IQR 45–354] days. Conclusion AF episodes were detected via ICMs in approximately one-quarter of CS patients within 3 years of follow-up. More than 75% of patients with AF detected had episodes lasting ≥1 hour and half had episodes lasting ≥4 hours. Detection of the first AF episode typically occurred beyond the range of conventional ambulatory monitors. Long-term surveillance of CS patients is likely important given the appreciable incidence, frequency, and duration of these AF episodes. Funding Acknowledgement Type of funding source: None

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Is anticoagulant therapy always indicated in “medium-risk” patients with first diagnosed atrial fibrillation? Insights from a real world, 10-year observational study

International Journal of Cardiology ◽

10.1016/j.ijcard.2019.04.057 ◽

2019 ◽

Vol 288 ◽

pp. 76-81

Author(s):

Laura Bonfanti ◽

Giuseppe Lippi ◽

Valentina Donelli ◽

Federica Pigna ◽

Carlotta Saccenti ◽

...

Keyword(s):

Atrial Fibrillation ◽

Observational Study ◽

Anticoagulant Therapy ◽

Real World ◽

Medium Risk ◽

Risk Patients

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Abstract TMP40: Impact of Age on Atrial Fibrillation Detection among a Large, Real-World Population of Cryptogenic Stroke Patients with Insertable Cardiac Monitors

Stroke ◽

10.1161/str.47.suppl_1.tmp40 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Mark Richards ◽

John D Rogers ◽

Scott W Ferreira ◽

Allan J Nichols ◽

Jodi L Koehler ◽

...

Keyword(s):

Atrial Fibrillation ◽

Median Time ◽

Real World ◽

Detection Rate ◽

Recurrent Stroke ◽

Anticoagulation Therapy ◽

Cryptogenic Stroke ◽

World Population ◽

Time To Detection ◽

The Impact

Introduction: Detection of atrial fibrillation (AF) in patients with a cryptogenic stroke (CS) is critical for reducing the risk of recurrent stroke by enabling oral anticoagulation therapy. However, the impact of age on AF detection and the optimum duration of AF monitoring in patients following a CS is not well characterized. We investigated the impact of age on AF detection among a large, real-world cohort of unselected patients with an implantable cardiac monitor (ICM) placed following CS. Methods: Patients in the de-identified Medtronic Discovery™ Link database who received an ICM (Reveal LINQ™) for AF detection following CS were included and monitored for up to 182 days. All AF episodes were adjudicated. We compared the mean age between patients with vs. without AF detected and compared the median time to detection of the first AF episode between younger (age ≤65) and older (age >65) patients. Results: Among 1247 patients (mean age 65.3±13.0, 53% male) followed for 182 [IQR 182-182] days, 1521 AF episodes were detected in 147 patients and resulted in an AF detection rate of 12.2%. Patients with AF detected were significantly older than patients without AF detected (71.3±10.9 vs. 64.5±13.1 years, respectively; p<0.001). The median time to detection of the first AF episode was shorter for older vs. younger patients (43 [10-91] vs. 89 [29-127] days, respectively; p=0.016; Figure). Conclusion: Continuous monitoring of CS patients with an ICM resulted in an AF detection rate of 12.2% within the initial 6 months. Patients with AF detected were older and patients >65 years of age had shorter times to initial AF detection. However even among older patients, the majority of AF occurred outside the range of external monitoring devices and thus highlights the importance of long-term monitoring with ICMs in the management of CS patients.

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Major bleeding risk and healthcare economic outcomes of non-valvular atrial fibrillation patients newly-initiated with oral anticoagulant therapy in the real-world setting

Journal of Medical Economics ◽

10.1080/13696998.2017.1341902 ◽

2017 ◽

Vol 20 (9) ◽

pp. 952-961 ◽

Cited By ~ 16

Author(s):

Jay Lin ◽

Jeffrey Trocio ◽

Kiran Gupta ◽

Jack Mardekian ◽

Melissa Lingohr-Smith ◽

...

Keyword(s):

Atrial Fibrillation ◽

Anticoagulant Therapy ◽

Major Bleeding ◽

Real World ◽

Oral Anticoagulant ◽

Oral Anticoagulant Therapy ◽

Bleeding Risk ◽

Economic Outcomes ◽

The Real ◽

Real World Setting

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172 Effectiveness of warfarin therapy for atrial fibrillation in a real world population

Canadian Journal of Cardiology ◽

10.1016/j.cjca.2011.07.120 ◽

2011 ◽

Vol 27 (5) ◽

pp. S122

Author(s):

M. Pichette ◽

L.M. Stevens ◽

N. Noiseux ◽

F. Gobeil ◽

S. Mansour

Keyword(s):

Atrial Fibrillation ◽

Real World ◽

Warfarin Therapy ◽

World Population

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Multi-Detector Coronary CT Imaging for the Identification of Coronary Artery Stenoses in a “Real-World” Population

Clinical Medicine Insights Cardiology ◽

10.4137/cmc.s18223 ◽

2014 ◽

Vol 8s4 ◽

pp. CMC.S18223

Author(s):

Amgad N. Makaryus ◽

Sonia Henry ◽

Lee Loewinger ◽

John N. Makaryus ◽

Lawrence Boxt

Keyword(s):

Coronary Artery ◽

Real World ◽

Predictive Value ◽

Daily Practice ◽

Clinical Population ◽

Conventional Coronary Angiography ◽

World Population ◽

Non Invasive ◽

Coronary Ct ◽

Coronary Stenoses

Background Multi-detector computed tomography (CT) has emerged as a modality for the non-invasive assessment of coronary artery disease (CAD). Prior studies have selected patients for evaluation and have excluded many of the “real-world” patients commonly encountered in daily practice. We compared 64-detector-CT (64-CT) to conventional coronary angiography (CA) to investigate the accuracy of 64-CT in determining significant coronary stenoses in a “real-world” clinical population. Methods A total of 1,818 consecutive patients referred for 64-CT were evaluated. CT angiography was performed using the GE LightSpeed VCT (GE® Healthcare). Forty-one patients in whom 64-CT results prompted CA investigation were further evaluated, and results of the two diagnostic modalities were compared. Results A total of 164 coronary arteries and 410 coronary segments were evaluated in 41 patients (30 men, 11 women, age 39-85 years) who were identified by 64-CT to have significant coronary stenoses and who thereafter underwent CA. The overall per-vessel sensitivity, specificity, positive predictive value, negative predictive value, and accuracy at the 50% stenosis level were 86%, 84%, 65%, 95%, and 85%, respectively, and 77%, 93%, 61%, 97%, and 91%, respectively, in the per-segment analysis at the 50% stenosis level. Conclusion 64-CT is an accurate imaging tool that allows a non-invasive assessment of significant CAD with a high diagnostic accuracy in a “real-world” population of patients. The sensitivity and specificity that we noted are not as high as those in prior reports, but we evaluated a population of patients that is typically encountered in clinical practice and therefore see more “real-world” results.

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