Comparative Analysis of Risk Stratification Scores in Atrial Fibrillation

Background: Atrial Fibrillation (AF) has become a major global health concern and is associated with increased risk of poor outcomes. Identifying risk factors in patients with AF can be challenging, given the high burden of comorbidities in these patients. Risk stratification schemes appear to facilitate accurate prediction of outcomes and assist therapeutic management decisions. Objective: To summarize current evidence on risk stratification scores for patients with AF. Results: Traditional risk models rely heavily on demographics and comorbidities, while newer tools have been gradually focusing on novel biomarkers and diagnostic imaging to facilitate more personalized risk assessment. Several studies have been conducted to compare existing risk schemes and identify specific patient populations in which the prognostic ability of each scheme excels. However, current guidelines do not appear to encourage implementation of risk models in clinical practice, as they have not incorporated new ones in their recommendations for management of patients with AF since almost a decade. Conclusion: Further work is warranted to analyze new reliable risk stratification schemes and optimally implement them into routine clinical life.

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Atrial fibrillation ablation in heart failure: What do we know? What can we do?

EP Europace ◽

10.1093/europace/euaa217 ◽

2020 ◽

Author(s):

Andrea Chiocchini ◽

Maria Terricabras ◽

Atul Verma

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Catheter Ablation ◽

Ejection Fraction ◽

Potential Benefit ◽

Randomized Trials ◽

Specific Patient ◽

Reduced Ejection Fraction ◽

Increased Risk ◽

Maintain Sinus Rhythm

Abstract Atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF) are two conditions that frequently impact reciprocally on each other. Patients with HFrEF have an increased risk of stroke, hospitalization and mortality after they develop AF and vice versa, AF causing deterioration of the ejection fraction is also associated to increased mortality. Catheter ablation has emerged as an effective alternative to antiarrhythmic drug treatment to maintain sinus rhythm and some randomized trials have shown a potential benefit in terms of mortality and hospitalization. This review discusses the available evidence regarding catheter ablation treatment in this specific patient group.

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Prevalence of Valvular and Non-valvular Atrial Fibrillation and the Application of Antithrombotic Treatment in a Tertiary Care Hospital

Journal of Nepal Medical Association ◽

10.31729/jnma.5113 ◽

2020 ◽

Vol 58 (231) ◽

Author(s):

Sahadeb Prasad Dhungana ◽

Rinku Ghimire

Keyword(s):

Atrial Fibrillation ◽

Risk Stratification ◽

Tertiary Care Hospital ◽

Oral Anticoagulants ◽

Tertiary Care ◽

International Normalized Ratio ◽

Care Hospital ◽

Clinical Practices ◽

Antithrombotic Treatment ◽

Increased Risk

Introduction: Atrial fibrillation is a common atrial tachyarrhythmia with an increased risk of thromboembolism. This study aims to provide information about the application of antithrombotic treatment based on risk stratification schemes for stroke in real-life clinical practices. Methods: This was a descriptive cross-sectional study in 260 patients admitted at the tertiary care hospital with a diagnosis of atrial fibrillation from January 2019 to February 2020 after approval from the Institutional Review Committee (ref. no. 207/2018). Convenient sampling was used. Predisposing conditions for atrial fibrillation, risk factors for stroke, and the use of antithrombotics were obtained based on the pre-structured questionnaires. Data were analyzed by Statistical Package for the Social Sciences version 20. Results: The prevalence of valvular and non-valvular atrial fibrillation was 125 (48.0%), and 135 (51.9%) respectively. Among patients with a non-valvular variant, 102 (75.5%) had a CHA2DS2VASC score of ≥ 2 who were eligible for oral anticoagulants, 13 (9.6 %) patients received it with a majority having sub-therapeutic international normalized ratio. Among patients with valvular type, only 47 (37.6%) patients were receiving oral anticoagulants and 20 (42.5%) patients achieved therapeutic international normalized ratio. Two hundred forty three (93.4%) patients had dilated left atrium (≥40mm), 119 (45.9%) had hypertension and 27 (10.3%) had diabetes mellitus. Conclusions: Antithrombotics were markedly underused in patients with atrial fibrillation. There is a need for proper application of risk stratification schemes for stroke and appropriate use of antithrombotics to prevent thromboembolism.

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EPC Dysfunction and Immune Networks: Translating Opportunities for Clinical Setting in Personalized Medicine

Current Medicinal Chemistry ◽

10.2174/0929867324666170606101823 ◽

2018 ◽

Vol 25 (35) ◽

pp. 4497-4506 ◽

Cited By ~ 5

Author(s):

Javier Rodríguez-Carrio ◽

Patricia López ◽

Ana Suárez

Keyword(s):

Risk Factors ◽

Personalized Medicine ◽

Risk Stratification ◽

Current Evidence ◽

Novel Biomarkers ◽

Endothelial Homeostasis ◽

And Oxidative Stress ◽

Insight Into ◽

Similar Risk ◽

Gaining Insight

Background: Cardiovascular (CV) risk stratification is suboptimal if solely based on traditional CV risk factors, since individuals with similar risk profiles could exhibit diverging CV outcomes. Thus, there is a need for new risk factors to be identified. Recent studies emphasize the relevance of the endothelial homeostasis in the control of CV risk, but the clinical relevance of these findings is starting to be appreciated. Gaining insight into the actual players involved in this phenomenon would lead to the identification of novel biomarkers. Due to their central role in vascular repair, Endothelial Progenitor Cells (EPC) are promising candidates for this issue. <P> Objective: Since excessive inflammation or imbalanced immune responses are known to underlie numerical or functional alterations of EPC, it can be speculated that these mediators may be considered as biomarkers for risk stratification. In the present narrative review, we aimed to compile and critically appraise all the current evidence linking inflammation and immune pathways with a compromised EPC functionality. <P> Results: A mounting body of evidence points to an inflammation-driven traditional CV risk factorsrelated EPC dysfunction. The effect of aging on EPC was associated with the CXCR4 pathway, whereas that of hypertension was related to TNFα. Activation of Akt/eNOS was observed in response to diabetes- and dyslipidemia-related traits. Inflammation and oxidative stress underlie the EPC dysfunction during smoking. <P> Conclusion: Inflammatory and immune networks can be proposed as feasible biomarkers for risk stratification in personalized medicine schemes.

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How Much Atrial Fibrillation is Enough to Warrant Oral Anticoagulation: Management of Subclinical Atrial Fibrillation?

Canadian Journal of General Internal Medicine ◽

10.22374/cjgim.v13isp1.314 ◽

2018 ◽

Vol 13 (SP1) ◽

Author(s):

Jeff Healey

Keyword(s):

Atrial Fibrillation ◽

Oral Anticoagulation ◽

Continuous Monitoring ◽

Absolute Risk ◽

Oral Anticoagulants ◽

Heart Rhythm ◽

Anticoagulation Management ◽

Specific Patient ◽

Increased Risk ◽

Patient Groups

Stroke due to atrial fibrillation (AF) is common, the cause of significant morbidity and mortality, but is highly preventable with the appropriate use of oral anticoagulants. Recent advances in implantable and wearable electrocardiographic (ECG) technologies now allow continuous monitoring of a patient’s heart rhythm for months or years at a time. Cohort studies have shown that using such methods, it is very common to find asymptomatic, short-lasting episodes of subclinical AF. Subclinical AF is also associated with an increased risk of stroke; however, the risk is lower than with traditional, ECG-detected AF and the absolute risk appears to depend on the overall burden of AF. There is currently great uncertainty as to what duration of AF should trigger the use of oral anticoagulation in specific patient groups. Large randomized trials are underway to help clarify this issue; however, in the meantime, researchers and guideline committees have proposed some guidance to assist clinicians.

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Biomarkers Associated with Bleeding Risk in the Setting of Atrial Fibrillation

Current Medicinal Chemistry ◽

10.2174/0929867324666170718124742 ◽

2019 ◽

Vol 26 (5) ◽

pp. 824-836 ◽

Cited By ~ 1

Author(s):

Skevos Sideris ◽

Stefanos Archontakis ◽

George Latsios ◽

George Lazaros ◽

Konstantinos Toutouzas ◽

...

Keyword(s):

Atrial Fibrillation ◽

Large Scale ◽

Oral Anticoagulants ◽

Significant Risk ◽

Bleeding Risk ◽

Hepatic Function ◽

Risk Scores ◽

Current Evidence ◽

Prognostic Impact ◽

Increased Risk

Background: Prevention of thromboembolic disease, mainly stroke, with oral anticoagulants remains a major therapeutic goal in patients with atrial fibrillation. Unfortunately, despite the high efficacy, anticoagulant therapy is associated with a significant risk of, frequently catastrophic, and hemorrhagic complications. Among different clinical and laboratory parameters related to an increased risk of bleeding, several biological markers have been recognized and various risk scores for bleeding have been developed. Objectives/Methods: The aim of the present study is to review current evidence regarding the different biomarkers associated with raised bleeding risk in atrial fibrillation. Results: Data originating from large cohorts or the recent large-scale trials of atrial fibrillation have linked numerous individual biomarkers to an increased bleeding risk. Such a relation was revealed for markers of cardiac physiology, such as troponin, BNP and NT-proBNP, markers of renal function, such as GFR and Cystatin or hepatic function, markers involving the system of coagulation, such as D-dimer and Von Willebrand factor, hematologic markers, such as low haemoglobin or low platelets, inflammatory markers, such as interleukin-6, other factors such as GDF-15 and vitamin-E and finally genetic polymorphisms. Many such biomarkers are incorporated in the bleeding risk schemata developed for the prediction of the hemorrhagic risk. Conclusions: Biomarkers were introduced in clinical practice in order to better estimate the potential risk of haemorrhage in these patients and increase the prognostic impact of clinical risk scores. In the last years this concept is gaining significant importance.

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Are patients with cognitive impairment fit to fly? Current evidence and practical recommendations

Journal of Travel Medicine ◽

10.1093/jtm/taaa123 ◽

2020 ◽

Author(s):

Angélique Sadlon ◽

Angela Ensslin ◽

Gregor Freystätter ◽

Michael Gagesch ◽

Heike A Bischoff-Ferrari

Keyword(s):

Cognitive Impairment ◽

Environmental Changes ◽

Air Travel ◽

Vulnerable Population ◽

Health Concern ◽

Current Evidence ◽

Older Individuals ◽

Pharmacological Interventions ◽

Increased Risk ◽

The Impact

Abstract Background The worldwide prevalence of dementia is increasing and represents a major public health concern. In the last decades, air travel services have undergone an impressive expansion and one of ten passengers is aged 65 years and older. While air travel can be stressful at all ages and health conditions, older individuals with cognitive impairment carry a greater risk for air-travel-related complications. Consequently, demands to general practitioners for assessing their older patient’s fitness to fly are increasing. Methods We conducted a search of the literature in PubMed on the impact of in-flight environmental changes on passengers with cognitive impairment and possible resulting complications. This set the base for a discussion on pharmacological and non-pharmacological interventions aimed at preventing in-flight complications in this vulnerable population. Results While our research strategy identified a total of 11 articles related to older age and air travel, only three focused on passengers with cognitive impairment. Our literature review showed that the airplane environment may lead to a large spectrum of symptoms in passengers of all age groups. However, passengers with cognitive impairment due to neurodegenerative diseases are at increased risk for experiencing the most extreme symptoms such as acute confusional state. Non-pharmacological and pharmacological interventions at different stages of the travel process (before, during and after) can help prevent complications in this vulnerable population. Conclusion The decision to let a patient with cognitive impairment fly requires a solid understanding of the in-flight environmental changes and their impact on older patients with cognitive impairment. Moreover, a sound weighing of the risks and benefits while considering different aspects of the patient’s history is demanded. In this regard, the role of the treating physicians and caregivers is essential along with the support of the medical department of the airline.

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Oral Anticoagulant Treatment in Patients with Atrial Fibrillation and Chronic Kidney Disease

Medicina ◽

10.3390/medicina57050422 ◽

2021 ◽

Vol 57 (5) ◽

pp. 422

Author(s):

Mihai Ciprian Stoica ◽

Zsolt Gáll ◽

Mirela Liana Gliga ◽

Carmen Denise Căldăraru ◽

Orsolya Székely

Keyword(s):

Atrial Fibrillation ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Vitamin K Antagonists ◽

Oral Anticoagulants ◽

Anticoagulation Therapy ◽

Safety Data ◽

Specific Patient ◽

Increased Risk ◽

Ckd Stage

Over the past few decades, a series of innovative medicines have been developed in order to optimize anticoagulation therapy for atrial fibrillation (AF). As a result, a number of nonvitamin K antagonist oral anticoagulants (NOAC) that directly target the enzymatic activity of factor II and factor Xa have been successfully licensed providing a more predictable effect and better safety profile compared to conventional anticoagulants (heparins and vitamin K antagonists (VKAs)). However, comparative efficacy and safety data is limited in patients with advanced chronic kidney disease (i.e., CKD stage 4/5 and end stage renal disease) because patients with estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2 were actively excluded from landmark trials, thus representing a major clinical limitation for the currently available agents. However, the renal function of AF patients can be altered over time. On the other hand, patients with CKD have an increased risk of developing AF. This review article will provide an overview of current concepts and recent evidence guiding the clinical use of NOACs in patients with CKD requiring chronic anticoagulation, and the associated risks and benefits of treatment in this specific patient population.

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Metabolomic and Proteomic Analyses of Persistent Valvular Atrial Fibrillation and Non-Valvular Atrial Fibrillation

Frontiers in Genetics ◽

10.3389/fgene.2021.789485 ◽

2021 ◽

Vol 12 ◽

Author(s):

Bo Hu ◽

Wen Ge ◽

Yuliang Wang ◽

Xiaobin Zhang ◽

Tao Li ◽

...

Keyword(s):

Atrial Fibrillation ◽

Enrichment Analysis ◽

Heart Rhythm ◽

Tca Cycle ◽

Inorganic Pyrophosphatase ◽

Pathway Enrichment Analysis ◽

Increased Risk ◽

Novel Biomarkers ◽

Glycerol 3 Phosphate Dehydrogenase ◽

Altered Proteins

Atrial fibrillation (AF) is an abnormal heart rhythm related to an increased risk of heart failure, dementia, and stroke. The distinction between valvular and non-valvular AF remains a debate. In this study, proteomics and metabolomics were integrated to describe the dysregulated metabolites and proteins of AF patients relative to sinus rhythm (SR) patients. Totally 47 up-regulated and 41 down-regulated proteins in valvular AF, and 59 up-regulated and 149 down-regulated proteins in non-valvular AF were recognized in comparison to SR patients. Moreover, 58 up-regulated and 49 significantly down-regulated metabolites in valvular AF, and 47 up-regulated and 122 down-regulated metabolites in persistent non-valvular AF patients were identified in comparison to SR patients. Based on analysis of differential levels of metabolites and proteins, 15 up-regulated and 22 down-regulated proteins, and 13 up-regulated and 122 down-regulated metabolites in persistent non-valvular AF were identified relative to valvular AF. KEGG pathway enrichment analysis showed the altered proteins and metabolites were significantly related to multiple metabolic pathways, such as Glycolysis/Gluconeogenesis. Interestingly, the enrichment pathways related to non-valvular AF were obviously different from those in valvular AF. For example, valvular AF was significantly related to Glycolysis/Gluconeogenesis, but non-valvular AF was more related to Citrate cycle (TCA cycle). Correlation analysis between the differentially expressed proteins and metabolites was also performed. Several hub proteins with metabolites were identified in valvular AF and non-valvular AF. For example, Taurine, D-Threitol, L-Rhamnose, and DL-lactate played crucial roles in valvular AF, while Glycerol-3-phosphate dehydrogenase, Inorganic pyrophosphatase 2, Hydroxymethylglutaryl-CoAlyase, and Deoxyuridine 5-triphosphate nucleotidohydrolase were crucial in non-valvular AF. Then two hub networks were recognized as potential biomarkers, which can effectively distinguish valvular AF and non-valvular persistent AF from SR samples, with areas under curve of 0.75 and 0.707, respectively. Hence, these metabolites and proteins can be used as potential clinical molecular markers to discriminate two types of AF from SR samples. In summary, this study provides novel insights to understanding the mechanisms of AF progression and identifying novel biomarkers for prognosis of non-valvular AF and valvular AF by using metabolomics and proteomics analyses.

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Management of patients with arterial hypertension and atrial fibrillation

Systemic Hypertension ◽

10.26442/2075082x.2021.3.201077 ◽

2021 ◽

Vol 18 (3) ◽

pp. 105-128

Author(s):

Irina E. Chazova ◽

Sergei P. Golitsyn ◽

Juliya V. Zhernakova ◽

Ekaterina A. Zheleznova ◽

Ekaterina S. Kropacheva ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiovascular Disease ◽

Risk Factor ◽

Risk Stratification ◽

Arterial Hypertension ◽

Cardiovascular Events ◽

Electrophysiological Properties ◽

Increased Risk ◽

Key Features ◽

Selection Of

Arterial hypertension (AH) is a leading risk factor for cardiovascular disease as well as it is the most common, independent and potentially reversible risk factor for atrial fibrillation (AF). AH contributes to the occurrence and maintenance of AF due to hemodynamic disorders, alterations in cardiomyocyte electrophysiological properties and structural remodeling in the atria. AF, which is also associated with an increased risk of cardiovascular events, is the most common arrhythmia. AH and AF often coexist, and their prevalence increases with age. This consensus provides the key features of the management of patients with these nosological units. The pathogenesis, risk stratification, and features of the selection of antihypertensive, antiarrhythmic and antithrombotic therapy are described in detail.

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Biomarkers Associated with Stroke Risk in Atrial Fibrillation

Current Medicinal Chemistry ◽

10.2174/0929867324666170718120651 ◽

2019 ◽

Vol 26 (5) ◽

pp. 803-823 ◽

Cited By ~ 3

Author(s):

Adam Ioannou ◽

Nikolaos Papageorgiou ◽

Debbie Falconer ◽

Onkar Rehal ◽

Emma Sewart ◽

...

Keyword(s):

Atrial Fibrillation ◽

High Risk ◽

Scoring System ◽

Oral Anticoagulants ◽

Cardioembolic Stroke ◽

Number Of Patients ◽

Increased Risk ◽

Micro Rnas ◽

Risk Patients ◽

Novel Biomarkers

Background:Atrial fibrillation (AF) is associated with an increased risk of cardioembolic stroke. The risk of cardioembolism is not adequately reduced with the administration of oral anticoagulants, since a number of patients continue to experience thromboembolic events despite receiving treatment. Therefore, identification of a circulating biomarker to identify these high-risk patients would be clinically beneficial.Objective:In the present article, we aim to review the available data regarding use of biomarkers to predict cardioembolic stroke in patients with AF.Methods:We performed a thorough search of the literature in order to analyze the biomarkers identified thus far and critically evaluate their clinical significance.Results:A number of biomarkers have been proposed to predict cardioembolic stroke in patients with AF. Some of them are already used in the clinical practice, such as d-dimers, troponins and brain natriuretic peptide. Novel biomarkers, such as the inflammatory growth differentiation factor-15, appear to be promising, while the role of micro-RNAs and genetics appear to be useful as well. Even though these biomarkers are associated with an increased risk for thromboembolism, they cannot accurately predict future events. In light of this, the use of a scoring system, that would incorporate both circulating biomarkers and clinical factors, might be more useful.Conclusions:Recent research has disclosed several biomarkers as potential predictors of cardioembolic stroke in patients with AF. However, further research is required to establish a multifactorial scoring system that will identify patients at high-risk of thromboembolism, who would benefit from more intensive treatment and monitoring.

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