scholarly journals Anticoagulation Management in Patients with Pacemaker-Detected Atrial Fibrillation

2016 ◽  
Vol 4 (2) ◽  
pp. 243-247 ◽  
Author(s):  
Lidija Poposka ◽  
Vladimir Boskov ◽  
Dejan Risteski ◽  
Jane Taleski ◽  
Ljubica Georgievska-Ismail
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Anticoagulation Therapy ◽  
Anticoagulation Management ◽  
Oral Anticoagulation Therapy ◽  
The Past ◽  
Permanent Pacing ◽  
Increased Risk ◽  
Implanted Pacemaker

INTRODUCTION: In patients with an implanted pacemaker, asymptomatic atrial fibrillation (AF) is associated with an increased risk of thrombo-embolic complications. There is still no consensus which duration of episodes of atrial fibrillation should be taken as an indicator for inclusion of oral anticoagulation therapy (OAC). MATERIAL AND METHODS: A total of 104 patients who had no AF episodes in the past and have an indication for permanent pacing were included in the study.RESULTS: During an average follow-up of 18 months, 33 of the patients developed episodes of AF. Inclusion of OAC was performed in 17 patients, in whom AF was recorded, although in all patients CHA2DS2-VASc score was ≥ 1. The inclusion of OAC showed a statistically significant correlation with increasing duration of episodes of AF (r = 0.502, p = 0.003). During the follow-up period none of the patients developed thrombo-embolic complication. CONCLUSION: Considering that our group of patients had no thrombo-embolic events, we could conclude that dividing the AF episodes in less than 1% in 24 hours and longer than 1% within 24 hours could be an indicator for decision-making to include OAK if the CHA2DS2-VASc score is ≥ 1.

scholarly journals Association between personalized evidence-based anticoagulation therapy and outcomes at 1-year follow-up in patients with atrial fibrillation: an analysis from the Atrial Fibrillation registry

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
E Pokushalov ◽  
D Losik ◽  
S Kozlova ◽  
A Konradi ◽  
M Sekacheva ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
High Risk ◽  
Anticoagulation Therapy ◽  
Specific Treatment ◽  
Composite Endpoint ◽  
Cardiovascular Death ◽  
Evidence Based ◽  
Anticoagulation Management ◽  
Increased Risk

Abstract Background The guideline treatments based on a relatively broad set of enrollment criteria inhibits the personalized evidence-based approach. Personalized evidence-based medicine (EBM) involves the ability to classify individuals into subpopulations that differ in their susceptibility to a particular disease or their response to a specific treatment. Objective We report the 1-year follow-up data of the Atrial Fibrillation Registry, focusing on the relationship between personalized EBM and guideline-adherent anticoagulation therapy use and the occurrence of major clinical adverse events. Methods 2683 patients at high risk for stroke and 1-year follow-up were enrolled in study. The primary endpoint was the percentage of guideline-based and personalized EBM recommendations acted on by clinicians. Secondary endpoints include the following: outcomes for all-cause mortality, thromboembolism (TE), bleeding, and the composite endpoints. Results From 2683 patients, 1971 (73.5%) EMR were guideline adherent and only 824 (30.7%) of them were personalized EBM anticoagulation therapy adherent, whilst 712 (26.5%) were non-guideline adherent and 1147 (42.8%) were guideline adherent but non-personalized EBM adherent. The composite endpoint of cardiovascular death, any TE or bleeding was significantly lower in personalized EBM adherent patients during 1-year follow-up (P=0.02). The endpoint of all cause death and any TE is increased by >20% by guideline adherent but non-personalized EBM adherent treatment [hazard ratio (HR) 1.254 (95% CI 0.931; 1.689)] and >80% non-guideline adherent and non-personalized EBM adherent treatment [HR 1.892 (95% CI 1.359; 2.635)]. For the composite endpoint of cardiovascular death, any TE or bleeding, guideline adherent but non-personalized EBM adherent treatment increased risk by >40% [HR 1.454 (95% CI 1.037; 2.040)], and non-guideline adherent and non-personalized EBM adherent treatment by >110% [HR 2.113 (95% CI 1.453; 3.074)]. Conclusion Personalized EBM anticoagulation management is associated with significantly better outcomes, including those related to the composite endpoint of cardiovascular death, any TE or bleeding in high-risk patients. FUNDunding Acknowledgement Type of funding sources: None.

Poor adherence to guideline recommendations among patients with atrial fibrillation and acute myocardial infarction

2019 ◽  
Vol 26 (13) ◽  
pp. 1373-1382 ◽  
Author(s):  
Jarle Jortveit ◽  
Are H Pripp ◽  
Jørund Langørgen ◽  
Sigrun Halvorsen
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Anticoagulation Therapy ◽  
Long Term Outcomes ◽  
Recommended Treatment ◽  
Increased Risk ◽  
Norwegian Patient

Background The prevalence of atrial fibrillation in patients with acute myocardial infarction is largely unknown. The aims of the present study were to assess the prevalence of atrial fibrillation in a nationwide cohort of patients with acute myocardial infarction, to assess the prescription of anticoagulation therapy, and to study the long-term outcomes. Design A nationwide registry-based cohort study. Methods All patients registered in the Norwegian Myocardial Infarction Registry between 2013 and 2016 were included and followed up through 2017. Stroke rates during follow-up were obtained through linkage with the Norwegian Patient Registry. Results In total, 47,204 patients were registered in the Norwegian Myocardial Infarction Registry. Atrial fibrillation on admission was recorded in 5393 (11%) patients, and 2190 (5%) additional patients developed atrial fibrillation during their hospital stay. Only 45% of patients with atrial fibrillation on admission and CHA2DS2-VASc score ≥ 2 were treated with anticoagulation therapy prior to myocardial infarction, and 56% of patients with atrial fibrillation and CHA2DS2-VASc score ≥ 2 were prescribed anticoagulation therapy at discharge. Patients with myocardial infarction and atrial fibrillation had an increased risk of stroke or death during 822 (426, 1278) days of follow-up compared with patients without atrial fibrillation (multivariate adjusted hazard ratio 1.4, 95% confidence interval 1.3–1.4). Conclusions Almost half of patients with atrial fibrillation and myocardial infarction were not prescribed the guideline recommended treatment with anticoagulation therapy at discharge, and their long-term risk of stroke and death was increased compared with patients without atrial fibrillation. Increased efforts to improve the treatment of patients with myocardial infarction and atrial fibrillation are needed.

Abstract P009: Risk of Mortality According to Burden of Atrial Fibrillation: Results From a 60-year Cohort Study

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
William F McIntyre ◽  
Mahmoud Tourabi ◽  
Philip D St John ◽  
Robert B Tate
Keyword(s):  
Atrial Fibrillation ◽  
Adverse Events ◽  
Sinus Rhythm ◽  
Proportional Hazards ◽  
Anticoagulation Therapy ◽  
Cox Proportional Hazards ◽  
Risk Of Death ◽  
Increased Risk ◽  
All Cause Mortality

Introduction: Atrial Fibrillation (AF) is the most common serious cardiac arrhythmia and is associated with an increased risk of stroke and mortality. These risks can be modified with oral anticoagulation therapy. Clinically, the arrhythmia can be permanent or intermittent. Prior studies that have used time-constant, categorical covariates to examine the relationship between the pattern of AF and the occurrence of adverse events have produced conflicting results. We hypothesized that the amount of time that patients spend in AF, hereinafter termed arrhythmia “burden”, may be important in predicting adverse events. Objective: To examine the effects of the burden of AF on all-cause mortality. Methods: The Manitoba Follow-Up Study is a longitudinal, prospective study of 3983 originally healthy young men (mean age at entry 30 years) who have been followed with routine medical and electrocardiographic examinations since 1948. After 60 years of follow-up to July 1, 2008, AF had been documented on the electrocardiograms of 581 men (15% of the cohort) and 3182 (80%) of the original cohort had died. We created a Cox proportional hazards model with time-dependent covariates to estimate relative risks for mortality according to AF burden. AF status during each follow-up visit was classified as persistent when the patient was in AF on consecutive examinations, transient when the patient reverted to sinus rhythm after being in AF and incident when the patient developed AF after a period in sinus rhythm. Results: Results of the Cox proportional hazards regression model are displayed in the Table. Age, persistent AF and incident AF were all significant variables in the model. Holding all the other variables constant, persistent AF increased the risk of death by two times and incident AF increased the risk of death by 87%. Conclusions: Persistent AF and incident AF are associated with increased all-cause mortality. Estimating AF burden may have implications for risk stratification in patients with AF.

scholarly journals Percutaneous Left Atrial Appendage Occlusion: A View From the UK

2020 ◽  
Vol 9 (2) ◽  
pp. 83-87
Author(s):  
Wern Yew Ding ◽  
Dhiraj Gupta ◽  
◽  
Keyword(s):  
Left Atrial ◽  
Left Atrial Appendage ◽  
Anticoagulation Therapy ◽  
Population Data ◽  
Atrial Appendage ◽  
Oral Anticoagulation Therapy ◽  
The Past ◽  
Left Atrial Appendage Occlusion ◽  
Increased Risk ◽  
The Uk

AF is associated with an increased risk of thromboembolic events, which is usually managed with oral anticoagulation therapy. However, despite a broad range of anticoagulant options and improved uptake in anticoagulation over the past decade, there are some limitations to this approach. Percutaneous left atrial appendage occlusion has been shown to be an effective alternative in this setting, and population data suggest a clear demand for this procedure. Over the past decade, several important changes to the commissioning and delivery of this service have occurred in the UK. In this article, the authors describe the use of percutaneous left atrial appendage occlusion in the UK and discuss the challenges that lie ahead.

scholarly journals THE USE OF PACEMAKER DIAGNOSTICS FOR SUPPORTING THE ANTICOAGULATION TREATMENT MANAGEMENT

2020 ◽  
Vol 50 (4) ◽  
pp. 142-145
Author(s):  
David Korpas ◽  
Michaela Tanzerová
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulation ◽  
Anticoagulation Therapy ◽  
Dual Chamber ◽  
Diagnostic Features ◽  
Oral Anticoagulation Therapy ◽  
Treatment Management ◽  
Anticoagulation Treatment ◽  
Increased Risk ◽  
Simple Logic

In this work, the analysis of data on atrial fibrillation (AF) burden from dual chamber pacemakers is used for supporting the anticoagulation treatment management. The aim is to evaluate the benefit of basic diagnostic functions to support oral anticoagulation therapy in patients with atrial fibrillation. These patients have increased risk of thromboembolism. If patients have an implanted pacemaker, the device’s diagnostic features monitor the frequency and duration of atrial fibrillation episodes. This data can then be used for further decisions. Statistical data processing was performed on a group of 117 patients with an implanted dual chamber pacemaker. From these results, we evaluated the benefits of the algorithms. In the whole group, a trend was observed in increase of the AF burden between the two monitored periods. The increase of AF burden occurred in 17 patients, while the decrease occurred in 6 patients only. Using simple logic functions, the numbers of patients with different binary values of the presence of AF, the presence of oral anticoagulation therapy, the risk CHA2DS2-VASc score and the values of AF burden were determined. Thus, in the whole group of patients, the diagnostic functions of the implanted devices contributed to the change in oral anticoagulation therapy for 24% of patients.

Abstract P649: Extracranial Hemorrhage in the Setting of Gastrointestinal Or Genitourinary Cancer is Associated With Increased Risk of Ischemic Stroke in Patients With Atrial Fibrillation

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Eric Zhou ◽  
Aaron Lord ◽  
Amelia K Boehme ◽  
Nils Henninger ◽  
Adam H De Havenon ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Hospital Admissions ◽  
Cox Regression ◽  
Anticoagulation Therapy ◽  
Bleeding Complications ◽  
Outcome Variable ◽  
Increased Risk ◽  
Exposure Variable

Background and Purpose: Anticoagulation therapy reduces the risk for ischemic stroke in atrial fibrillation (AF) but also predisposes patients to hemorrhagic complications. Patients with GI or GU cancer and AF are at higher risk of bleeding complications with anticoagulation therapy. There is limited knowledge on the risk of first-ever ischemic stroke in AF patients after extracranial hemorrhage (ECH) in patients with gastrointestinal or genitourinary (GI/GU) cancer. Methods: We conducted a retrospective study using the California State Inpatient Database (SID) including all non-federal hospital admissions in California from 2005-2011. The exposure variable was hospitalization with a diagnosis of ECH with a previous diagnosis of AF. The outcome variable was a subsequent hospitalization with acute ischemic stroke. We excluded patients with stroke prior to or at the time of ECH diagnosis. We calculated adjusted hazard ratios (HRs) for ischemic stroke during follow up and at 6-month intervals using Cox regression models adjusted for pertinent demographics and co-morbidities and stratifying patients with ECH based on the presence/absence of a GI/GU cancer. Results: We identified 764,257 AF patients (mean age 75 years, 49% women) without a documented history of stroke. Of these, 98,647 (13%) had an ECH-associated hospitalization, and 22,748 patients (3%) developed an ischemic stroke during a mean follow up. Compared to non-ECH patients, patients with ECH in the setting of a GI/GU cancer had a significantly higher risk of incident ischemic stroke (adjusted HR 1.40, 95% CI 1.20-1.64).Whereas there was only a modest increase in ischemic stroke risk in those without GI/GU cancer (adjusted HR 1.09 95% CI 1.05-1.13). Conclusion: AF patients hospitalized with ECH in the setting of GI/GU cancer have a particularly high risk of incident ischemic stroke. Particular consideration should be given to the optimal balance between the benefits and risks of anticoagulation therapy and the use of non-anticoagulant alternatives such as left atrial appendage closure in this vulnerable population.

Depression and Uptake of Oral Anticoagulation Therapy in Patients With Atrial Fibrillation

Medical Care ◽  
2020 ◽  
Vol 58 (3) ◽  
pp. 216-224 ◽  
Author(s):  
Morten Fenger-Grøn ◽  
Claus H. Vestergaard ◽  
Lars Frost ◽  
Dimitry S. Davydow ◽  
Erik T. Parner ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulation ◽  
Anticoagulation Therapy ◽  
Oral Anticoagulation Therapy

scholarly journals Acute Dental Periapical Abscess and New-Onset Atrial Fibrillation: A Nationwide, Population-Based Cohort Study

2021 ◽  
Vol 10 (13) ◽  
pp. 2927
Author(s):  
Amaar Obaid Hassan ◽  
Gregory Y. H. Lip ◽  
Arnaud Bisson ◽  
Julien Herbert ◽  
Alexandre Bodin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Multivariable Analysis ◽  
National Database ◽  
Increased Risk ◽  
Periapical Abscess ◽  
The Relationship ◽  
Onset Atrial Fibrillation ◽  
New Onset

There are limited data on the relationship of acute dental infections with hospitalisation and new-onset atrial fibrillation (AF). This study aimed to assess the relationship between acute periapical abscess and incident AF. This was a retrospective cohort study from a French national database of patients hospitalized in 2013 (3.4 million patients) with at least five years of follow up. In total, 3,056,291 adults (55.1% female) required hospital admission in French hospitals in 2013 while not having a history of AF. Of 4693 patients classified as having dental periapical abscess, 435 (9.27%) developed AF, compared to 326,241 (10.69%) without dental periapical abscess that developed AF over a mean follow-up of 4.8 ± 1.7 years. Multivariable analysis indicated that dental periapical abscess acted as an independent predictor for new onset AF (p < 0.01). The CHA2DS2VASc score in patients with acute dental periapical abscess had moderate predictive value for development of AF, with Area Under the Curve (AUC) 0.73 (95% CI, 0.71–0.76). An increased risk of new onset AF was identified for individuals hospitalized with dental periapical abscess. Careful follow up of patients with severe, acute dental periapical infections is needed for incident AF, as well as investigations of possible mechanisms linking these conditions.

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