scholarly journals Molecular Insights in Atrial Fibrillation Pathogenesis and Therapeutics: A Narrative Review

Diagnostics ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. 1584
Author(s):  
Konstantinos A. Papathanasiou ◽  
Sotiria G. Giotaki ◽  
Dimitrios A. Vrachatis ◽  
Gerasimos Siasos ◽  
Vaia Lambadiari ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Health Care Systems ◽  
Drug Repurposing ◽  
Calcium Handling ◽  
Treatment Modalities ◽  
Success Rates ◽  
Mortality And Morbidity ◽  
Therapeutic Modalities ◽  
Molecular Alterations ◽  
Care Systems

The prevalence of atrial fibrillation (AF) is bound to increase globally in the following years, affecting the quality of life of millions of people, increasing mortality and morbidity, and beleaguering health care systems. Increasingly effective therapeutic options against AF are the constantly evolving electroanatomic substrate mapping systems of the left atrium (LA) and ablation catheter technologies. Yet, a prerequisite for better long-term success rates is the understanding of AF pathogenesis and maintenance. LA electrical and anatomical remodeling remains in the epicenter of current research for novel diagnostic and treatment modalities. On a molecular level, electrical remodeling lies on impaired calcium handling, enhanced inwardly rectifying potassium currents, and gap junction perturbations. In addition, a wide array of profibrotic stimuli activates fibroblast to an increased extracellular matrix turnover via various intermediaries. Concomitant dysregulation of the autonomic nervous system and the humoral function of increased epicardial adipose tissue (EAT) are established mediators in the pathophysiology of AF. Local atrial lymphomononuclear cells infiltrate and increased inflammasome activity accelerate and perpetuate arrhythmia substrate. Finally, impaired intracellular protein metabolism, excessive oxidative stress, and mitochondrial dysfunction deplete atrial cardiomyocyte ATP and promote arrhythmogenesis. These overlapping cellular and molecular alterations hinder us from distinguishing the cause from the effect in AF pathogenesis. Yet, a plethora of therapeutic modalities target these molecular perturbations and hold promise in combating the AF burden. Namely, atrial selective ion channel inhibitors, AF gene therapy, anti-fibrotic agents, AF drug repurposing, immunomodulators, and indirect cardiac neuromodulation are discussed here.

scholarly journals Use of mHealth Devices to Screen for Atrial Fibrillation: Cost-Effectiveness Analysis (Preprint)

2020 ◽  
Author(s):  
Godwin D Giebel
Keyword(s):  
Atrial Fibrillation ◽  
Cost Effectiveness ◽  
Economic Burden ◽  
Health Care Systems ◽  
Anticoagulation Therapy ◽  
Risk Scores ◽  
Increased Risk ◽  
Care Systems ◽  
Additional Costs ◽  
The Cost

BACKGROUND With an estimated prevalence of around 3% and an about 2.5-fold increased risk of stroke, atrial fibrillation (AF) is a serious threat for patients and a high economic burden for health care systems all over the world. Patients with AF could benefit from screening through mobile health (mHealth) devices. Thus, an early diagnosis is possible with mHealth devices, and the risk for stroke can be markedly reduced by using anticoagulation therapy. OBJECTIVE The aim of this work was to assess the cost-effectiveness of algorithm-based screening for AF with the aid of photoplethysmography wrist-worn mHealth devices. Even if prevented strokes and prevented deaths from stroke are the most relevant patient outcomes, direct costs were defined as the primary outcome. METHODS A Monte Carlo simulation was conducted based on a developed state-transition model; 30,000 patients for each CHA<sub>2</sub>DS<sub>2</sub>-VASc (Congestive heart failure, Hypertension, Age≥75 years, Diabetes mellitus, Stroke, Vascular disease, Age 65-74 years, Sex category [female]) score from 1 to 9 were simulated. The first simulation served to estimate the economic burden of AF without the use of mHealth devices. The second simulation served to simulate the economic burden of AF with the use of mHealth devices. Afterwards, the groups were compared in terms of costs, prevented strokes, and deaths from strokes. RESULTS The CHA<sub>2</sub>DS<sub>2</sub>-VASc score as well as the electrocardiography (ECG) confirmation rate had the biggest impact on costs as well as number of strokes. The higher the risk score, the lower were the costs per prevented stroke. Higher ECG confirmation rates intensified this effect. The effect was not seen in groups with lower risk scores. Over 10 years, the use of mHealth (assuming a 75% ECG confirmation rate) resulted in additional costs (€1=US $1.12) of €441, €567, €536, €520, €606, €625, €623, €692, and €847 per patient for a CHA<sub>2</sub>DS<sub>2</sub>-VASc score of 1 to 9, respectively. The number of prevented strokes tended to be higher in groups with high risk for stroke. Higher ECG confirmation rates led to higher numbers of prevented strokes. The use of mHealth (assuming a 75% ECG confirmation rate) resulted in 25 (7), –68 (–54), 98 (–5), 266 (182), 346 (271), 642 (440), 722 (599), 1111 (815), and 1116 (928) prevented strokes (fatal) for CHA<sub>2</sub>DS<sub>2</sub>-VASc score of 1 to 9, respectively. Higher device accuracy in terms of sensitivity led to even more prevented fatal strokes. CONCLUSIONS The use of mHealth devices to screen for AF leads to increased costs but also a reduction in the incidence of stroke. In particular, in patients with high CHA<sub>2</sub>DS<sub>2</sub>-VASc scores, the risk for stroke and death from stroke can be markedly reduced.

Atrial fibrillation after coronary surgery: comparison between different health care systems

2002 ◽  
Vol 82 (3) ◽  
pp. 209-218 ◽  
Author(s):  
Silja Majahalme ◽  
Michael H. Kim ◽  
David Bruckman ◽  
Matti Tarkka ◽  
Kim A. Eagle
Keyword(s):  
Atrial Fibrillation ◽  
Health Care ◽  
Health Care Systems ◽  
Coronary Surgery ◽  
Care Systems

scholarly journals Responsibilities of Pregnant Women for on Going Pregnancy - Medical Aspects

2016 ◽  
Vol 9 (2) ◽  
pp. 121-130
Author(s):  
Ratko Matijević ◽  
Katja Erjavec
Keyword(s):  
Health Care ◽  
Pregnant Women ◽  
Pregnancy Outcome ◽  
Health Care Systems ◽  
Unborn Child ◽  
Communication Education ◽  
Mortality And Morbidity ◽  
Good Communication ◽  
Care Systems ◽  
Potential Damage

There are numerous factors known to affect the course of pregnancy and adversely impact perinatal mortality and morbidity. Some of them are avoidable and some are not. Avoidable factors can be either under responsibility of medical staff, health care systems and communities; or under responsibility of pregnant women. By modifying and changing their lifestyle, pregnant women can influence some avoidable factors and improve their pregnancy outcome. However, by ignoring them, they can cause potential damage to themselves and to their unborn child. There is no well defined responsibility for women concerning ways they influence their pregnancy outcome; they have a full right to make decisions about themselves and their unborn children, whether right or wrong. Good communication, education and understanding are essential when dealing with these issues.

Hospitalization

2015 ◽  
Author(s):  
Michael A. Norko ◽  
Craig G. Burns ◽  
Charles Dike
Keyword(s):  
Due Process ◽  
Psychiatric Care ◽  
Health Care Systems ◽  
Clinical Care ◽  
Treatment Modalities ◽  
Legal Rights ◽  
Hospital Level ◽  
Advantages And Disadvantages ◽  
Care Systems ◽  
Acute Psychiatric Care

A significant number of people with serious mentally illness are found in correctional settings and must be provided with clinical care commensurate with their needs. Many of those needs may be met within the mental health care systems established in jails and prisons. When clinical conditions are more complex and require more intensive management, the availability of hospital level of care becomes important. The relationship for care for an incarcerated patient between acute psychiatric care in jails and prisons on the one hand and forensic or community hospitals on the other varies by jurisdiction. While the decision to pursue hospitalization for an acutely ill inmate is driven chiefly by clinical considerations, it is also influenced by security and safety concerns. These factors need to be considered on an individual basis, weighing the advantages and disadvantages of treatment in an outside hospital versus management in the prison or jail with available resources. Involuntary medication and involuntary hospital transfer implicate important legal rights, the protection of which requires due process established by federal and state laws and case precedents. Clinicians working in corrections and in hospital settings that admit inmates and detainees need to be aware of the relevant procedures required for these involuntary treatment modalities. In all jurisdictions, hospital level care is necessary for a subset of sentenced inmates and jail detainees and must therefore be made available when appropriate. This chapter discusses a variety of models linking psychiatric care across institutional boundaries.

scholarly journals Management of Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Grafting

2018 ◽  
Vol 13 (6) ◽  
pp. 383-390 ◽  
Author(s):  
Ali J. Khiabani ◽  
Taylan Adademir ◽  
Richard B. Schuessler ◽  
Spencer J. Melby ◽  
Marc R. Moon ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Maze Procedure ◽  
Success Rates ◽  
Surgical Ablation ◽  
Mortality And Morbidity ◽  
Randomized Controlled Studies ◽  
Increased Risk

Untreated atrial fibrillation is associated with an increased risk of all-cause mortality and morbidity. Despite the current guidelines recommending surgical ablation of atrial fibrillation at the time of coronary artery bypass surgery, most patients with concomitant atrial fibrillation and coronary artery disease do not receive surgical ablation for their atrial fibrillation. This review reports the efficacy of different surgical ablation techniques used for the treatment of atrial fibrillation during coronary artery bypass. PubMed was systematically searched for studies reporting outcomes of concomitant surgical ablation in coronary artery bypass patients between January 2002 and March 2018. Data were independently extracted and analyzed by two investigators. Twenty-four studies were included. Twelve studies exclusively reported outcomes of surgical ablation in patients undergoing coronary artery bypass, whereas the remaining 12 reported outcomes of concomitant cardiac surgery with subgroup analysis. Only four studies performed the concomitant Cox-Maze procedure. Freedom from atrial tachyarrhythmia was reported as high as 98% at 1 year and 76% at 5 years with Cox-Maze procedure, whereas lesser lesion sets had more variable outcomes, ranging from 35% to 93%. In most studies, the addition of surgical ablation was not associated with increased morbidity and mortality. Although the Cox-Maze procedure had the greatest short- and long-term success rates, most studies comprising the evidence documenting the safety and efficacy of adding surgical ablation were of low or moderate quality. There was a great deal of heterogeneity among study populations, follow-up times, methods, and definition of failure. To establish a consensus regarding a surgical ablation technique for atrial fibrillation in coronary artery bypass population, larger multicenter randomized controlled studies need to be designed.

Appropriateness of Direct Oral Anticoagulant Dosing in Patients With Atrial Fibrillation: Insights From the Veterans Health Administration

2019 ◽  
Vol 33 (5) ◽  
pp. 647-653 ◽  
Author(s):  
George C. Leef ◽  
Alexander C. Perino ◽  
Mariam Askari ◽  
Jun Fan ◽  
P. Michael Ho ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Health Care ◽  
Health Care Systems ◽  
Oral Anticoagulants ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Anticoagulation Management ◽  
Management Interventions ◽  
Care Systems

Background: Direct oral anticoagulants (DOACs) have strict dosing guidelines, but recent studies indicate that inappropriate dosing is common, particularly in chronic kidney disease (CKD), for which it has been reported to be as high as 43%. Since 2011, the Veterans Health Administration (VA) has implemented anticoagulation management programs for DOACs, generally led by pharmacists, which has previously been shown to improve medication adherence. Objective: We investigated the prevalence of overdosing and underdosing of DOACs in the VA. Methods: Using data from the TREAT-AF cohort study (The Retrospective Evaluation and Assessment of Therapies in AF), we identified VA patients with newly diagnosed atrial fibrillation (AF) and receipt of a DOAC between 2003 and 2015. We classified dosing as correct, overdosed, or underdosed based on the Food and Drug Administration–approved dosing criteria. Results: Of 230 762 patients, 5060 received dabigatran (77.3%) or rivaroxaban (22.7%) within 90 days of AF diagnosis (age 69 [10[ years; CHA2DS2-VASc 1.6 [1.4]), of which 1312 (25.9%) had CKD based on estimated glomerular filtration rate <60. Overall, 93.6% of patients, 83.2% with CKD, received appropriate DOAC dosing. Incorrect dosing increased with worsening renal function. Conclusion: Compared to recent studies of commercial payers and health-care systems, incorrect dosing of DOACs is less common across the VA. Pharmacist-led DOAC management or similar anticoagulation management interventions may reduce the risk of incorrect dosing across health-care systems.

scholarly journals Systematic review of cost-effectiveness analyses of dabigatran versus warfarin for atrial fibrillation across different health care systems

2013 ◽  
Vol 16 (3) ◽  
pp. A288
Author(s):  
J. Jegathisawaran ◽  
J.M. Bowen ◽  
F. Khondoker ◽  
K. Campbell ◽  
N. Burke ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Health Care ◽  
Cost Effectiveness ◽  
Health Care Systems ◽  
Care Systems

scholarly journals Role of mhealth in the management of Tuberculosis: A new approach to improve adherence

2020 ◽  
Vol 11 (4) ◽  
pp. 5560-5568
Author(s):  
Rajavardhana T ◽  
Rajanandh M G ◽  
Geethavani M ◽  
Sreedhar V
Keyword(s):  
Health Care Systems ◽  
Treatment Compliance ◽  
World Health ◽  
Single Individual ◽  
Success Rates ◽  
Tb Treatment ◽  
Care Systems ◽  
New Ideas ◽  
Health Accounts ◽  
Health Organization

Compliance with Tuberculosis (TB) treatment is essential in enhancing singly and public health as well. may come out with suffering, disease worsening, and mortality and also leads to increased economic burden to the patients. Through this article, we want to explore new ideas to strengthen medication adherence with the assistance of approaches to monitor and enhance TB patient's medication-taking behavior. have more success rates in particular parts, whereas its limitations in improving the adherence can be understood in the world health organization End Tuberculosis plan of action. To provide disease and treatment-related education to the patients, apps should be of educational worth to patients by delivering classified information, which is easily accessible to the patients and caregivers. Hurdles to TB treatment compliance are noteworthy and multiple. Mobile health accounts for an arising field with significant promises to locate barriers, thus enhancing every single individual and community health and health care systems planning.

Overcoming global challenges in stroke prophylaxis in atrial fibrillation: The role of non-vitamin K antagonist oral anticoagulants

2016 ◽  
Vol 11 (9) ◽  
pp. 950-967 ◽  
Author(s):  
Ayrton Massaro ◽  
Robert P Giugliano ◽  
Bo Norrving ◽  
Ali Oto ◽  
Roland Veltkamp
Keyword(s):  
Atrial Fibrillation ◽  
Vitamin K ◽  
Health Care Systems ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
Ageing Population ◽  
Maximum Benefit ◽  
Increased Risk ◽  
Care Systems

Atrial fibrillation is the world's most common sustained cardiac arrhythmia and is associated with a significantly increased risk of stroke. The global burden of atrial fibrillation is rising, commensurate with the ageing population. Well-controlled vitamin K antagonist-based anticoagulation has been shown to reduce the risk of stroke secondary to atrial fibrillation by two-thirds. However, patients with atrial fibrillation have frequently been denied anticoagulation because of a variety of perceived risks related to bleeding, falls, chronological age, and poor compliance. Even when vitamin K antagonists are used, maximum benefit and safety are only delivered when high quality control of therapy (TTR > 70%) is achieved, which has proven remarkably difficult in many health-care systems and amongst many patient groups. The non-vitamin K antagonist oral anticoagulants (NOACs) offer solutions to many of the challenges of achieving widespread, safe, and effective anticoagulation for stroke prophylaxis in atrial fibrillation, yet their uptake into routine clinical practice remains variable. The evidence supporting their more widespread use to overcome the challenges of stroke prophylaxis for atrial fibrillation is reviewed in this article.

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