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Latest & greatest articles for atrial fibrillation
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on atrial fibrillation or other clinical topics then use Trip today.
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Incident Risk Factors and Major Bleeding in Patients with AtrialFibrillation Treated with Oral Anticoagulants: A Comparison of Baseline, Follow-up and Delta HAS-BLED Scores with an Approach Focused on Modifiable Bleeding Risk Factors When assessing bleeding risk in patients with atrialfibrillation (AF), risk stratification is often based on the baseline risks. We aimed to investigate changes in bleeding risk factors and alterations in the HAS-BLED score in AF patients. We hypothesized
Atrialfibrillation and venous thromboembolism: evidence of bidirectionality in the Atherosclerosis Risk in Communities Study Essentials Atrialfibrillation (AF) may increase risk of venous thromboembolism (VTE), and vice versa. Bidirectionality was assessed prospectively via data from 15 129 black and white individuals. AF was associated with greater risk of developing VTE, and VTE with greater risk of AF. Associations were strongest among blacks and in the first 6 months after initial (...) diagnosis.Background Atrialfibrillation (AF) and venous thromboembolism (VTE) frequently co-occur. These conditions have shared risk factors and are accompanied by coagulation abnormalities. Furthermore, mechanistic pathways may directly link the disorders. Objectives To test the hypothesis that individuals with incident AF are at greater risk of developing VTE, and those with VTE are at elevated risk of AF. We also tested whether associations were stronger in the first 6 months after the initial diagnosis
Selective screening for atrialfibrillation using multivariable risk models Atrialfibrillation can lead to stroke if untreated, and identifying those at higher risk is necessary for cost-effective screening for asymptomatic, paroxysmal atrialfibrillation. Age has been proposed to identify those at risk, but risk models may provide better discrimination. This study compares atrialfibrillation risk models with age for screening for atrial fibrillation.Nine atrialfibrillation risk models were (...) compared using the Atherosclerosis Risk in Communities study (11 373 subjects, 60.0±5.7 years old). A new risk model (Screening for Asymptomatic AtrialFibrillation Events-SAAFE) was created using data collected in the Monitoring Disparities in Chronic Conditions study (3790 subjects, 58.9±15.3 years old). The primary measure was the fraction of incident atrialfibrillation subjects who should receive treatment due to a high CHA2DS2-VASc score identified when screening a fixed number equivalent
Lifetime risk of atrialfibrillation according to optimal, borderline, or elevated levels of risk factors: cohort study based on longitudinal data from the Framingham Heart Study. To examine the association between risk factor burdens-categorized as optimal, borderline, or elevated-and the lifetime risk of atrial fibrillation.Community based cohort study.Longitudinal data from the Framingham Heart Study.Individuals free of atrialfibrillation at index ages 55, 65, and 75 years were assessed (...) . Smoking, alcohol consumption, body mass index, blood pressure, diabetes, and history of heart failure or myocardial infarction were assessed as being optimal (that is, all risk factors were optimal), borderline (presence of borderline risk factors and absence of any elevated risk factor), or elevated (presence of at least one elevated risk factor) at index age.Lifetime risk of atrialfibrillation at index age up to 95 years, accounting for the competing risk of death.At index age 55 years, the study
Association between incidence of atrialfibrillation and duration of cardiopulmonary bypass in coronary artery bypass graft surgery (CABG): a cohort study Open heart surgery is one of the most common and valuable treatment methods for cardiovascular diseases, a common side effect of which is atrialfibrillation that occurs due to various reasons.To determine the relationship between incidence of atrialfibrillation (AF) and duration of cardiopulmonary bypass (CPB) in patients after open heart (...) of the patients was 61.76±9.2, the majority of the patients (70.1%) were male. The association between Incidence of AtrialFibrillation and cardiopulmonary pump time (minute) was not meaningful. Incidence of atrialfibrillation had statistically significant relationship with variables of mean age, BMI, PAC, PVC, creatinine and duration of hospitalization (p<0.05); on the other hand, variables of gender, cross clamp time (minute), intubation time (hour), and clinical history had no effect on atrial
Screen reminders for GPs did not improve anticoagulant prescribing in atrialfibrillation Screen reminders for GPs did not improve anticoagulant prescribing in atrialfibrillation Discover Portal Discover Portal Screen reminders for GPs did not improve anticoagulant prescribing in atrialfibrillation Published on 18 July 2017 doi: General practice software that generated screen reminders for patients with atrialfibrillation did not increase the proportion taking oral anticoagulants (...) appropriately by six months. This NIHR-funded trial included GPs in 47 surgeries in England and found that at the start only 63% of eligible patients with atrialfibrillation were being prescribed anticoagulants. Six months later the rate had increased to 66% in intervention practices and 64% in those following usual practice, a non-significant difference between the groups. Use of the software was associated with increased diagnosis of transient ischemic attack, which could be due to improved detection
Direct acting oral anticoagulants likely to be better than warfarin for people taking them for atrialfibrillation Direct acting oral anticoagulants likely to be better than warfarin for people taking them for atrialfibrillation Discover Portal Discover Portal Direct acting oral anticoagulants likely to be better than warfarin for people taking them for atrialfibrillation Published on 6 February 2018 doi: In people with atrialfibrillation needing anticoagulant treatment, deaths were fewer (...) in those who had direct acting oral anticoagulants compared with warfarin. The picture is less clear for the risk of stroke and complications such as bleeding in the brain or gut. Apixaban had the best efficacy and safety profile and was cost-effective compared with warfarin. This study pooled the data in all trials reporting efficacy, safety and cost of anticoagulant prevention of stroke events in people with atrialfibrillation. Researchers used a technique called network meta-analysis to compare
Alternative drug may prevent atrialfibrillation following heart surgery Alternative drug may prevent atrialfibrillation following heart surgery Discover Portal Discover Portal Alternative drug may prevent atrialfibrillation following heart surgery Published on 12 December 2017 doi: After heart surgery around a third of people have atrialfibrillation, an abnormal heart rhythm, which impedes their recovery and lengthens hospital stay. Colchicine treatment could reduce this complication (...) by about a third. About 11 people would need this treatment to prevent one of them developing atrialfibrillation. Using amiodarone, an alternative drug commonly used in this situation, other research shows that about seven people would be treated to prevent one person suffering fibrillation. Colchicine is a drug licensed for the treatment of gout that combines both anti-inflammatory and heart rate control properties. As an older drug, it might be a cheaper alternative and could be safer. Further study
Rhythm control drugs after catheter ablation for atrialfibrillation give short-term but not long term benefits Rhythm control drugs after catheter ablation for atrialfibrillation give short-term but not long term benefits Discover Portal Discover Portal Rhythm control drugs after catheter ablation for atrialfibrillation give short-term but not long term benefits Published on 27 September 2016 doi: When treating atrialfibrillation, short-term use of rhythm control drugs after catheter (...) ablation reduced the risk of abnormal heart rhythms in the three months after the procedure. They were of no benefit in preventing recurrence of atrialfibrillation in the longer term. Atrialfibrillation is a common abnormal heart rhythm that carries a high risk of stroke. Catheter ablation can be used to destroy the electrical pathways in the heart muscle that cause the abnormal rhythm, but recurrence is common. Several factors could influence the likelihood of abnormal rhythms returning after
Preventing Postoperative AtrialFibrillation After Noncardiac Surgery: A Meta-analysis Although postoperative atrialfibrillation is common after noncardiac surgery, there is a paucity of data regarding prophylaxis. We sought to determine whether pharmacologic prophylaxis reduces the incidence of postoperative atrialfibrillation after noncardiac surgery.We performed an electronic search of Ovid MEDLINE, the Cochrane central register of controlled trials database, and SCOPUS from inception (...) to September 7, 2016 and included prospective randomized studies in which patients in sinus rhythm underwent noncardiac surgery and examined the incidence of postoperative atrialfibrillation as well as secondary safety outcomes.Twenty-one studies including 11,608 patients were included. Types of surgery included vascular surgery (3465 patients), thoracic surgery (2757 patients), general surgery (2292 patients), orthopedic surgery (1756 patients), and other surgery (1338 patients). Beta-blockers (relative
Apixaban in patients at risk of stroke undergoing atrialfibrillation ablation It is recommended to perform atrialfibrillation ablation with continuous anticoagulation. Continuous apixaban has not been tested.We compared continuous apixaban (5 mg b.i.d.) to vitamin K antagonists (VKA, international normalized ratio 2-3) in atrialfibrillation patients at risk of stroke a prospective, open, multi-centre study with blinded outcome assessment. Primary outcome was a composite of death, stroke (...) , or bleeding (Bleeding Academic Research Consortium 2-5). A high-resolution brain magnetic resonance imaging (MRI) sub-study quantified acute brain lesions. Cognitive function was assessed by Montreal Cognitive Assessment (MoCA) at baseline and at end of follow-up. Overall, 674 patients (median age 64 years, 33% female, 42% non-paroxysmal atrialfibrillation, 49 sites) were randomized; 633 received study drug and underwent ablation; 335 undertook MRI (25 sites, 323 analysable scans). The primary outcome
Meta-Analysis of Antithrombotic Therapy in AtrialFibrillation After Percutaneous Coronary Intervention Current clinical practice prefers oral anticoagulation (OAC) plus dual antiplatelet therapy (DAPT) in atrialfibrillation (AF) after percutaneous coronary intervention (PCI). We conducted a meta-analysis to test the hypothesis that the superiority of OAC plus DAPT is mainly endorsed by observational studies (OSs); conversely, randomized clinical trials (RCTs) have suggested that OAC plus
Opportunistic screening for heart failure with natriuretic peptides in patients with atrialfibrillation: a meta-analysis of individual participant data of four screening studies Heart failure (HF) often coexists in atrialfibrillation (AF) but is frequently unrecognised due to overlapping symptomatology. Furthermore, AF can cause elevated natriuretic peptide levels, impairing its diagnostic value for HF detection. We aimed to assess the prevalence of previously unknown HF in community-dwelling
Digoxin and Mortality in Patients With AtrialFibrillation Digoxin is widely used in patients with atrialfibrillation (AF).The goal of this paper was to explore whether digoxin use was independently associated with increased mortality in patients with AF and if the association was modified by heart failure and/or serum digoxin concentration.The association between digoxin use and mortality was assessed in 17,897 patients by using a propensity score-adjusted analysis and in new digoxin users
Factor Xa inhibitors versus vitamin K antagonists for preventing cerebral or systemic embolism in patients with atrialfibrillation. Factor Xa inhibitors and vitamin K antagonists (VKAs) are now recommended in treatment guidelines for preventing stroke and systemic embolic events in people with atrialfibrillation (AF). This is an update of a Cochrane review previously published in 2013.To assess the effectiveness and safety of treatment with factor Xa inhibitors versus VKAs for preventing
New-Onset AtrialFibrillation After PCI or CABG for Left Main Disease: The EXCEL Trial There is limited information on the incidence and prognostic impact of new-onset atrialfibrillation (NOAF) following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for left main coronary artery disease (LMCAD).This study sought to determine the incidence of NOAF following PCI and CABG for LMCAD and its effect on 3-year cardiovascular outcomes.In the EXCEL (Evaluation (...) of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial, 1,905 patients with LMCAD and low or intermediate SYNTAX scores were randomized to PCI with everolimus-eluting stents versus CABG. Outcomes were analyzed according to the development of NOAF during the initial hospitalization following revascularization.Among 1,812 patients without atrialfibrillation on presentation, NOAF developed at a mean of 2.7 ± 2.5 days after revascularization in 162 patients
Stroke Risk in Patients With Reduced Ejection Fraction After Myocardial Infarction Without AtrialFibrillation Stroke can occur after myocardial infarction (MI) in the absence of atrialfibrillation (AF).This study sought to identify risk factors (excluding AF) for the occurrence of stroke and to develop a calibrated and validated stroke risk score in patients with MI and heart failure (HF) and/or systolic dysfunction.The datasets included in this pooling initiative were derived from 4 trials
Meta-Analysis Comparing the Safety and Efficacy of Dual Versus Triple Antithrombotic Therapy in Patients With AtrialFibrillation Undergoing Percutaneous Coronary Intervention In patients with atrialfibrillation undergoing percutaneous coronary intervention (PCI), the effectiveness and safety of dual compared with triple antithrombotic therapy are a matter of debate, especially when considering the prevention of end points at low incidence, such as myocardial infarction (MI), stent thrombosis (...) , or mortality. This study-level meta-analysis included 4 controlled randomized trials and 6,036 patients with a clinical indication to chronic oral anticoagulation (OAC) after PCI, mainly for atrialfibrillation. Patients receiving dual therapy with a single antiplatelet agent, essentially a P2Y12 inhibitor, plus OAC were compared with those treated with triple therapy (aspirin, a P2Y12 inhibitor, and OAC). The incidence of the following outcomes was evaluated: Thrombolysis In Myocardial Infarction major
Lifetime Risks, Projected Numbers, and Adverse Outcomes in Asian Patients With AtrialFibrillation: A Report From the Taiwan Nationwide AF Cohort Study Most data on the clinical epidemiology of atrialfibrillation (AF) come from Western populations, and data for Asians are limited. We investigated the lifetime risk and projected number of AF among Asians. The annual risks of adverse events among patients with AF, time trends, and the risks compared with patients without AF were analyzed.Between
Female Sex Is a Risk Modifier Rather Than a Risk Factor for Stroke in AtrialFibrillation: Should We Use a CHA2DS2-VA Score Rather Than CHA2DS2-VASc? Stroke risk in atrialfibrillation is assessed by using the CHA2DS2-VASc score. Sex category (Sc, ie, female sex) confers 1 point on CHA2DS2-VASc. We hypothesized that female sex is a stroke risk modifier, rather than an overall risk factor, when added to a CHA2DS2-VA (sex-independent thromboembolism risk) score scale.Using 3 nationwide registries (...) , we identified patients with incident nonvalvular atrialfibrillation from January 1, 1997, through December 31, 2015. Patients receiving oral anticoagulant treatment at baseline were excluded, and person-time was censored at the time of treatment initiation (if any). CHA2DS2-VA scores were calculated for men and women, and were followed for up to 1 year in the Danish National Patient Registry. The primary outcome was a primary hospital code for ischemic stroke or systemic embolism