scholarly journals Atrial fibrillation: a new facet of diabetes mellitus in the XXI century

2011 ◽  
Vol 14 (1) ◽  
pp. 53-60 ◽  
Author(s):  
Andrey Alexeevich Aleksandrov ◽  
M N Yadrikhinskaya ◽  
Svetlana Semenovna Kukharenko
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Congestive Heart Failure ◽  
Risk Factor ◽  
Life Expectancy ◽  
Cardiac Rhythm ◽  
Cardiovascular Complications ◽  
Cardiac Insufficiency

Congestive heart failure, diabetes mellitus, and ciliary arrhythmia are three epidemic cardiovascular conditions threatening the mankind in the XXIcentury. Ciliary arrhythmia is the commonest disturbance of cardiac rhythm characterized by inability of the atrium to maintain coordinated contractions.The importance of ciliary rrhythmia as a problem facing public heath services is underlain by its role as a risk factor of disturbed cerebralcirculation and severe cardiac insufficiency, the two most serious and costly cardiovascular complications influencing life expectancy of the affectedsubjects.

scholarly journals Diagnostic Accuracy of the HAS-BLED Bleeding Score in VKA- or DOAC-Treated Patients With Atrial Fibrillation: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Xinxing Gao ◽  
Xingming Cai ◽  
Yunyao Yang ◽  
Yue Zhou ◽  
Wengen Zhu
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Congestive Heart Failure ◽  
Oral Anticoagulants ◽  
Bleeding Risk ◽  
Risk Scores ◽  
C Statistic ◽  
Ischemic Attack ◽  
Anticoagulated Patients

Background: Several bleeding risk assessment models have been developed in atrial fibrillation (AF) patients with oral anticoagulants, but the most appropriate tool for predicting bleeding remains uncertain. Therefore, we aimed to assess the diagnostic accuracy of the Hypertension, Abnormal liver/renal function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly, Drugs/alcohol concomitantly (HAS-BLED) score compared with other risk scores in anticoagulated patients with AF.Methods: We comprehensively searched the PubMed and Embase databases until July 2021 to identify relevant pieces of literature. The predictive abilities of risk scores were fully assessed by the C-statistic, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) values, calibration data, and decision curve analyses.Results: A total of 39 studies met the inclusion criteria. The C-statistic of the HAS-BLED score for predicting major bleeding was 0.63 (0.61–0.65) in anticoagulated patients regardless of vitamin k antagonists [0.63 (0.61–0.65)] and direct oral anticoagulants [0.63 (0.59–0.67)]. The HAS-BLED had the similar C-statistic to the Hepatic or renal disease, Ethanol abuse, Malignancy, Older, Reduced platelet count or function, Re-bleeding risk, Hypertension (uncontrolled), Anemia, Genetic factors, Excessive fall risk, Stroke (HEMORR2HAGES), the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA), the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT), the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF), or the Age, Biomarkers, Clinical History (ABC) scores, but significantly higher C-statistic than the Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, Stroke/transient ischemic attack history (CHADS2) or the Congestive heart failure/left ventricular ejection fraction ≤ 40%, Hypertension, Age ≥75 years, Diabetes mellitus, Stroke/transient ischemic attack/thromboembolism history, Vascular disease, Age 65–74 years, Sex (female) (CHA2DS2-VASc) scores. NRI and IDI values suggested that the HAS-BLED score performed better than the CHADS2 or the CHA2DS2-VASc scores and had similar or superior predictive ability compared with the HEMORR2HAGES, the ATRIA, the ORBIT, or the GARFIELD-AF scores. Calibration and decision curve analyses of the HAS-BLED score compared with other scores required further assessment due to the limited evidence.Conclusion: The HAS-BLED score has moderate predictive abilities for bleeding risks in patients with AF regardless of type of oral anticoagulants. Current evidence support that the HAS-BLED score is at least non-inferior to the HEMORR2HAGES, the ATRIA, the ORBIT, the GARFIELD-AF, the CHADS2, the CHA2DS2-VASc, or the ABC scores.

scholarly journals How do family medicine residents choose an anticoagulation regimen for patients with nonvalvular atrial fibrillation?

2017 ◽  
Vol 18 (05) ◽  
pp. 472-481 ◽  
Author(s):  
Payam Yazdan-Ashoori ◽  
Zardasht Oqab ◽  
William F. McIntyre ◽  
Kieran L. Quinn ◽  
Erik van Oosten ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Congestive Heart Failure ◽  
Family Medicine ◽  
Adverse Events ◽  
Risk Stratification ◽  
Nonvalvular Atrial Fibrillation ◽  
Clinical Scenarios ◽  
Family Medicine Residents

Aim To examine the choices Canadian family medicine residents make for oral anticoagulation (OAC) for patients with nonvalvular atrial fibrillation (AF). Background AF increases the risk of strokes. An important consideration in AF management is risk stratification for stroke and prescription of appropriate OAC. Family physicians provide the vast majority of OAC prescriptions. Methods We administered a survey to residents in multiple Canadian family medicine training programmes. Questions explored the experiences and attitudes towards risk stratification and choices of OAC when presented with standardized clinical scenarios. In each scenario, a novel oral anticoagulant (NOAC) would be the preferred treatment according to the contemporary Canadian and European guidelines. Findings A total of 247 residents participated in the survey. Most used the congestive heart failure, hypertension, age ≥ 75, diabetes mellitus, stroke or TIA (2 points) (81%) and congestive heart failure, hypertension, age ≥ 75 (2 points) or age 65-74 (1 point), diabetes mellitus, stroke or TIA, vascular disease including peripheral arterial disease, myocardial infarction, or aortic plaque, sex (female) (67%) risk stratification schemes while the preferred bleeding risk stratification scheme was hypertension, abnormal liver or renal function, stroke, bleeding, labile international normalized ratio, elderly (age ≥ 65), drugs or alcohol (84%). In the clinical scenarios, residents generally preferred warfarin in favour of NOACs, independent of training level. Residents ranked the risk of adverse events and the cost to the patient as their most and least important consideration when prescribing OAC, respectively. Therefore in patients with nonvalvular AF, Canadian family medicine residents prefer warfarin in comparison with NOACs despite the latest Canadian and European guideline recommendations. This knowledge gap may be enhanced by multiple factors, including a sometimes magnified fear of adverse events and a rapidly changing landscape in stroke prophylaxis.

scholarly journals Predictors of progression of atrial fibrillation in patients with congestive heart failure

2017 ◽  
Vol 95 (7) ◽  
pp. 613-617
Author(s):  
V. I. Podzolkov ◽  
A. I. Tarzimanova ◽  
L. Mohammadi
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Congestive Heart Failure ◽  
Cardiovascular Complications ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Multifactorial Analysis ◽  
Telephone Interviews ◽  
Observation Period

An appreciable progress has recently been achieved in the study of the nature of atrial fibrillation (AF), from its early asymptomatic stages to irreversible arrhythmia. There are data on the risk factors of AF in the literature, but predictors of progressive arrhythmia remain to be elucidated. This study was aimed to identify predictors of AF progression in patients with congestive heart failure (CHF). Material and methods. The study involved 64 patients aged 59-82 (mean 69,4±3,9) followed up prospectively from September 2010 till June 2016 (observations of mean duration 60±3 mo included regular telephone interviews (each 3 mo) and annual general clinical examination with laboratory and instrumental studies. Continuous or persisting AF served as the criterion for progressive arrhythmia. Results. Cardiovascular complications and progressive arrhythmia were documented in 23 (36%) and 38 (59%) patients respectively during the 60±3 mo observation period. The multifactorial analysis revealed the significant influence of a decrease of left ventricular ejection function (EF) to below 40% and a rise in the plasma level of brain natriuretic peptide (Nt-proBNP) to more than 903 pg/ml on the risk of development of arrhythmia. Conclusion. Independent predictors of arrhythmia in patients with CHF and persistent AF are a decrease in left ventricular ejection function (EF) to below 40% (1,2, 95% CI 0,9-1,5) and a rise in the plasma Nt-proBNP level to more than 903 pg/ml (OR 1,3, 95% , CI+1,1-2,9). Such a rise predicts transition of arrhythmia into continuous form with sensitivity 92,1% and specificity 84,6%.

Abstract P256: Increased Risk of Ischemic Stroke in Adolescents and Adults with Congenital Heart Disease

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Lindsey M Duca ◽  
David Kao ◽  
Amber Khanna ◽  
Tessa Crume
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Congestive Heart Failure ◽  
Ischemic Stroke ◽  
Congenital Heart ◽  
Insurance Status ◽  
Cardiovascular Comorbidities ◽  
Increased Risk ◽  
Adolescents And Adults

Introduction: Improvements in the treatment of congenital heart defects (CHD) have resulted in the majority of infants born with CHD surviving into adulthood. This new population of adolescents and adults living with CHD have unique challenges for lifelong care, such as suffering prematurely from ischemic strokes. Hypothesis: The aim of this analysis was to examine specific cardiovascular abnormalities that increase the risk of the early development of an ischemic stroke in individuals with CHD. Methods: This study included all patients diagnosed with CHD age 18-65 that sought medical care from 2011 to 2013 at the University of Colorado Hospital, the only adult CHD clinic in Colorado. There were 3,255 individuals mean±SD age of 47±13 years diagnosed with a CHD. Marelli groups were created to categorize the severity of CHD and cardiovascular comorbidities (atrial fibrillation, hypertension, congestive heart failure, and diabetes mellitus) were extracted from the medical records. Logistic regression models were performed to evaluate the association between cardiovascular comorbidities and risk for stroke, adjusting for age, sex, race, insurance status and CHD severity. Results: Of the 3,255 adolescents and young adults with CHD (52.3% male, 47.7% female), 146 (4.49%) were diagnosed with an ischemic stroke. The greatest proportion of ischemic strokes occurred in the shunt CHD severity group (Table). In the multivariable analysis of CHD patients, atrial fibrillation (OR=2.13, 95% CI 1.45-3.12, p=0.0001) and congestive heart failure (OR=2.60, 95% CI 1.52-4.44, p=0.0005) were associated with greater than a 2-fold increase in the odds of ischemic stroke after adjusting for age, sex, race, insurance status and CHD severity. Hypertension and diabetes mellitus were not associated with the risk of stroke. Conclusion: Cardiovascular comorbidities were strongly associated with the development of an ischemic stroke in adolescents and adults with CHD independent of CHD severity.

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