scholarly journals Electronic Record Linkage cohort study of evidence-based management and outcomes in patients with ischaemic heart disease and atrial fibrillation

2021 ◽  
Author(s):  
◽  
Edward Daniel Harris
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Ischaemic Heart Disease ◽  
Evidence Based Medicine ◽  
Lipid Lowering ◽  
Evidence Based ◽  
Lipid Lowering Therapy ◽  
Lipid Levels ◽  
Increased Risk ◽  
Based Medicine

BACKGROUND Implementation of evidence-based medicine is often suboptimal. The objectives of this thesis are to explore the delivery of evidence-based medicine and outcomes in patients with ischaemic heart disease (IHD) and atrial fibrillation (AF). METHODS Retrospective observational cohort studies were conducted using linked anonymised data from the secure anonymised information linkage (SAIL) databank. Patients included (i) those undergoing percutaneous coronary intervention, (ii) patients prescribed vitamin K antagonist (VKA) for AF, and (iii) patients with AF who had undergone successful PCI. RESULTS Amongst patients directed to take clopidogrel for one-year post-PCI, discontinuation was far lower (~6%) than in previous studies where the treatment duration was not known. Despite this, early discontinuation and/or bleeding was associated with an increased risk of adverse events. In a national cohort of PCI patients, we observed a low rate of achievement of international guideline target lipid levels (<25%) and low prescribing of intensive lipid lowering therapy amongst those not at target. Females and patients who had undergone elective PCI were least likely to have their lipid levels documented and be at target. In patients prescribed VKA for AF guideline defined poor anticoagulation control was common and associated with significantly higher bleeding event rates, independent of common comorbidities that are recognised as risk factors for stroke and bleeding. In patients with AF who had undergone PCI outcomes were poor: approximately 1 in 5 had either a stroke, acute coronary syndrome (ACS) or died in the year follow-up. Bleeding events were also common and associated with a five, three and four-fold increased risk of stroke, ACS, and death. CONCLUSION This thesis has characterised the nature of multiple therapeutic gaps and associated adverse outcomes with common clinical conditions. Thus, identifying opportunities to improve outcomes in individual patients and at population level.

scholarly journals Incidence of atrial fibrillation, ischaemic heart disease and heart failure in patients with diabetes

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Amy Groenewegen ◽  
Victor W. Zwartkruis ◽  
Betül Cekic ◽  
Rudolf. A. de Boer ◽  
Michiel Rienstra ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Heart Disease ◽  
Ischaemic Heart Disease ◽  
Incidence Rate ◽  
Diabetes Status ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
Rate Ratios ◽  
Age And Sex

Abstract Background Diabetes has strongly been linked to atrial fibrillation, ischaemic heart disease and heart failure. The epidemiology of these cardiovascular diseases is changing, however, due to changes in prevalence of obesity-related conditions and preventive measures. Recent population studies on incidence of atrial fibrillation, ischaemic heart disease and heart failure in patients with diabetes are needed. Methods A dynamic longitudinal cohort study was performed using primary care databases of the Julius General Practitioners’ Network. Diabetes status was determined at baseline (1 January 2014 or upon entering the cohort) and participants were followed-up for atrial fibrillation, ischaemic heart disease and heart failure until 1 February 2019. Age and sex-specific incidence and incidence rate ratios were calculated. Results Mean follow-up was 4.2 years, 12,168 patients were included in the diabetes group, and 130,143 individuals in the background group. Incidence rate ratios, adjusted for age and sex, were 1.17 (95% confidence interval 1.06–1.30) for atrial fibrillation, 1.66 (1.55–1.83) for ischaemic heart disease, and 2.36 (2.10–2.64) for heart failure. Overall, incidence rate ratios were highest in the younger age categories, converging thereafter. Conclusion There is a clear association between diabetes and incidence of the major chronic progressive heart diseases, notably with heart failure with a more than twice increased risk.

Pharmacogenetics of apolipoprotein E gene during lipid-lowering therapy: lipid levels and prevention of coronary heart disease

2008 ◽  
Vol 9 (10) ◽  
pp. 1475-1486 ◽  
Author(s):  
Tuomo Nieminen ◽  
Mika Kähönen ◽  
Leena E Viiri ◽  
Paula Grönroos ◽  
Terho Lehtimäki
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Apolipoprotein E ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Lipid Levels ◽  
E Gene ◽  
Lowering Therapy ◽  
Apolipoprotein E Gene

POSSIBILITIES OF USING EDOXABAN IN STROKE PREVENTION IN PATIENTS WITH ATRIAL FIBRILLATION

Vestnik ◽  
2021 ◽  
pp. 62-67
Author(s):  
Н.Е. Айдаргалиева ◽  
А.О. Доскулова ◽  
Ж.C. Шерияздан ◽  
М.Е. Рамазанов
Keyword(s):  
Atrial Fibrillation ◽  
Evidence Based Medicine ◽  
Stroke Prevention ◽  
Factor Xa ◽  
Evidence Based ◽  
Factor Xa Inhibitor ◽  
Percutaneous Coronary Interventions ◽  
Efficacy And Safety ◽  
Percutaneous Coronary ◽  
Based Medicine

Применение антикоагулянтов у пациентов с фибрилляцией предсердий (ФП) - краеугольный камень профилактики инсульта. Обзор включает современные данные доказательной медицины по эффективности и безопасности применения Эдоксабана - ингибитора Xa фактора - для предупреждения инсульта при ФП, включая больных с чрескожными коронарными вмешательствами. The use of anticoagulants in patients with atrial fibrillation (AF) is the cornerstone of stroke prevention. The review includes modern evidence-based medicine data on the efficacy and safety of the use of Edoxaban, a factor Xa inhibitor, for the prevention of stroke in AF, including in patients with percutaneous coronary interventions.

scholarly journals Association between the TIMD4-HAVCR1 variants and serum lipid levels, coronary heart disease and ischemic stroke risk and atorvastatin lipid-lowering efficacy

2018 ◽  
Vol 38 (1) ◽  
Author(s):  
Qing-Hui Zhang ◽  
Rui-Xing Yin ◽  
Wu-Xian Chen ◽  
Xiao-Li Cao ◽  
Yu-Ming Chen
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
Serum Lipid ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Lipid Lowering ◽  
Lipid Levels ◽  
Serum Lipid Levels ◽  
Increased Risk

Little is known about the association of the TIMD4 (T-cell immunoglobulin and mucin domain 4 gene)-HAVCR1 (hepatitis A virus cellular receptor 1) variants and lipid metabolism, the risk of coronary heart disease (CHD) and ischemic stroke (IS). The present study aimed to determine the TIMD4-HAVCR1 variants, their haplotypes and gene–environment interactions on serum lipid levels, the risk of CHD and IS, and the lipid-lowering efficacy of atorvastatin in a southern Chinese Han population. Genotypes of three variants in 622 controls, 579 CHD, and 546 IS patients were determined by the Snapshot technology. Atorvastatin calcium tablet (20 mg/day) was given in 724 hyperlipidemic patients for 8 weeks after genotyping. The rs12522248 genotypic and allelic frequencies were different between controls and patients, and were associated with the risk of CHD and IS. The rs1501908G-rs12522248T-rs2036402T haplotype was associated with an increased risk of CHD; the G-C-T haplotype was associated with lower risk of CHD; and the C-C-C haplotype was associated with an increased risk of IS. Variants and their haplotypes in controls were associated with triglyceride (rs1501908), low-density lipoprotein cholesterol (LDL-C, rs1501908, G-T-T), high-density lipoprotein cholesterol (HDL-C, rs12522248, C-C-C) and the ratio of total cholesterol (TC) to HDL-C (C-C-C). Interactions of rs1501908- and rs2036402-alcohol (HDL-C); rs1501908- and rs12522248-high body mass index (hBMI, ≥24 kg/m2; TC); and TIMD4-HAVCR1 variants-atorvastatin on several lipid parameters were detected. Interactions of rs12522248TC/CC-hBMI, G-T-T-, and C-C-C-smoking on the risk of CHD; and C-C-C-smoking, C-C-C-, and G-C-T-hBMI on the risk of IS were also observed. These findings suggest that the TIMD4-HAVCR1 variants may be the genetic risk factors for CHD and IS.

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