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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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Effect of Catheter Ablation vs Antiarrhythmic Medication on Quality of Life in Patients With Atrial Fibrillation: The CAPTAF Randomized Clinical Trial. Importance: Quality of life is not a standard primary outcome in ablation trials, even though symptoms drive the indication. Objective: To assess quality of life with catheter ablation vs antiarrhythmic medication at 12 months in patients with atrial fibrillation. Design, Setting, and Participants: Randomized clinical trial at 4 university (...) hospitals in Sweden and 1 in Finland of 155 patients aged 30-70 years with more than 6 months of atrial fibrillation and treatment failure with 1 antiarrhythmic drug or β-blocker, with 4-year follow-up. Study dates were July 2008-September 2017. Major exclusions were ejection fraction <35%, left atrial diameter >60 mm, ventricular pacing dependency, and previous ablation. Interventions: Pulmonary vein isolation ablation (n = 79) or previously untested antiarrhythmic drugs (n = 76). Main Outcomes
Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation. BACKGROUND: Appropriate antithrombotic regimens for patients with atrial fibrillation who have an acute coronary syndrome or have undergone percutaneous coronary intervention (PCI) are unclear. METHODS: In an international trial with a two-by-two factorial design, we randomly assigned patients with atrial fibrillation who had an acute coronary syndrome or had undergone PCI and were planning to take a P2Y 12 (...) (23.5% vs. 27.4%; hazard ratio, 0.83; 95% CI, 0.74 to 0.93; P = 0.002) and a similar incidence of ischemic events. Patients in the aspirin group had an incidence of death or hospitalization and of ischemic events that was similar to that in the placebo group. CONCLUSIONS: In patients with atrial fibrillation and a recent acute coronary syndrome or PCI treated with a P2Y 12 inhibitor, an antithrombotic regimen that included apixaban, without aspirin, resulted in less bleeding and fewer
Performance of the ABC Scores for Assessing the Risk of Stroke or Systemic Embolism and Bleeding in Patients With Atrial Fibrillation in ENGAGE AF-TIMI 48 30586727 2019 02 07 1524-4539 139 6 2019 Feb 05 Circulation Circulation Performance of the ABC Scores for Assessing the Risk of Stroke or Systemic Embolism and Bleeding in Patients With Atrial Fibrillation in ENGAGE AF-TIMI 48. 760-771 10.1161/CIRCULATIONAHA.118.038312 The ABC (age, biomarker, clinical history)-stroke and ABC-bleeding risk (...) scores incorporate clinical variables and cardiovascular biomarkers to estimate risk of stroke or systemic embolic events and bleeding, respectively, in patients with atrial fibrillation. These scores have been proposed for routine clinical use, but their performance in external cohorts remains uncertain. ENGAGE AF-TIMI 48 (Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction 48) was a multinational randomized trial of the oral factor
CHA2DS2-VASc Score and Stroke Prediction in Atrial Fibrillation in Whites, Blacks, and Hispanics 30580712 2019 01 11 1524-4628 2018 Nov 29 Stroke Stroke CHA 2 DS 2 -VASc Score and Stroke Prediction in Atrial Fibrillation in Whites, Blacks, and Hispanics. STROKEAHA118021453 10.1161/STROKEAHA.118.021453 Background and Purpose- Despite modest predictive ability for ischemic stroke (IS), the CHA 2 DS 2 -VASc score is widely used for stroke prediction in atrial fibrillation. Among patients (...) with atrial fibrillation, we aimed to (1) compare the IS or transient ischemic attack (TIA) incidence by CHA 2 DS 2 -VASc in blacks and Hispanics versus whites; (2) compare predictive ability of CHA 2 DS 2 -VASc score for IS or TIA in blacks and Hispanics versus whites; and (3) determine improvement in predictive ability of CHA 2 DS 2 -VASc score from addition of race/ethnicity. Methods- Using data from Optum Clinformatics, a large administrative claims database, we analyzed patients with atrial fibrillation enrolled
Direct acting oral anticoagulants likely to be better than warfarin for people taking them for atrial fibrillation Signal - Direct acting oral anticoagulants likely to be better than warfarin for people taking them for atrial fibrillation Dissemination Centre Discover Portal NIHR DC Discover Direct acting oral anticoagulants likely to be better than warfarin for people taking them for atrial fibrillation Published on 6 February 2018 In people with atrial fibrillation 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 atrial fibrillation. Researchers used a technique called network
Rhythm control drugs after catheter ablation for atrial fibrillation give short-term but not long term benefits Signal - Rhythm control drugs after catheter ablation for atrial fibrillation give short-term but not long term benefits Dissemination Centre Discover Portal NIHR DC Discover Rhythm control drugs after catheter ablation for atrial fibrillation give short-term but not long term benefits Published on 27 September 2016 When treating atrial fibrillation, 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 atrial fibrillation in the longer term. Atrial fibrillation 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
Screen reminders for GPs did not improve anticoagulant prescribing in atrial fibrillation Signal - Screen reminders for GPs did not improve anticoagulant prescribing in atrial fibrillation Dissemination Centre Discover Portal NIHR DC Discover Screen reminders for GPs did not improve anticoagulant prescribing in atrial fibrillation Published on 18 July 2017 General practice software that generated screen reminders for patients with atrial fibrillation 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 atrial fibrillation 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
Alternative drug may prevent atrial fibrillation following heart surgery Signal - Alternative drug may prevent atrial fibrillation following heart surgery Dissemination Centre Discover Portal NIHR DC Discover Alternative drug may prevent atrial fibrillation following heart surgery Published on 12 December 2017 After heart surgery around a third of people have atrial fibrillation, 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 atrial fibrillation. 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
Antithrombotic therapy use and clinical outcomes following thrombo-embolic events in patients with atrial fibrillation: insights from ARISTOTLE. 29385429 2019 01 25 2019 01 25 2055-6845 4 2 2018 04 01 European heart journal. Cardiovascular pharmacotherapy Eur Heart J Cardiovasc Pharmacother Antithrombotic therapy use and clinical outcomes following thrombo-embolic events in patients with atrial fibrillation: insights from ARISTOTLE. 75-81 10.1093/ehjcvp/pvy002 We investigated baseline (...) characteristics, antithrombotic use, and clinical outcomes of patients with atrial fibrillation (AF) and a thrombo-embolic event in the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) study to better inform the care of these high-risk patients. Thrombo-embolic events were defined as stroke (ischaemic or unknown cause) or systemic embolism (SE). Clinical outcomes were estimated using the Kaplan-Meier method. All-cause mortality and International Society
Development and validation of a score to detect paroxysmal atrial fibrillation after stroke 30530796 2019 01 08 1526-632X 92 2 2019 Jan 08 Neurology Neurology Development and validation of a score to detect paroxysmal atrial fibrillation after stroke. e115-e124 10.1212/WNL.0000000000006727 Prolonged monitoring times (72 hours) are recommended to detect paroxysmal atrial fibrillation (pAF) after ischemic stroke but this is not yet clinical practice; therefore, an individual patient selection (...) to be predictive for the detection of pAF within 72 hours of Holter monitoring and included in the final score (Age: 0.76 points/year, Stroke Severity NIHSS ≤5 = 9 points, NIHSS >5 = 21 points; to Find AF [AS5F]). The high-risk group defined by AS5F is characterized by a predicted risk between 5.2% and 40.8% for detection of pAF with a number needed to screen of 3 for the highest observed AS5F points within the study population. Regarding the low number of outcomes before generalization of AS5F, the results
Efficacy and safety of reduced-dose non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: a meta-analysis of randomized controlled trials 30590440 2018 12 27 1522-9645 2018 Dec 22 European heart journal Eur. Heart J. Efficacy and safety of reduced-dose non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: a meta-analysis of randomized controlled trials. 10.1093/eurheartj/ehy802 Non-vitamin K antagonist oral anticoagulants (NOACs) require (...) dose reductions according to patient or clinical factors for patients with atrial fibrillation (AF). In this meta-analysis, we aimed to assess outcomes with reduced-dose NOACs when given as pre-specified in pivotal trials. Aggregated data abstracted from Phase III trials comparing NOACs with warfarin in patients with AFwere assessed by treatment using risk ratios (RRs) and 95% confidence intervals (CIs) stratified by patient eligibility for NOAC dose reduction. Irrespective of treatments
Relation of the CHA2DS2-VASc Score to Risk of Thrombotic and Embolic Stroke in Community-Dwelling Individuals Without Atrial Fibrillation (From The Atherosclerosis Risk in Communities [ARIC] Study) 30527796 2019 01 14 1879-1913 123 3 2019 Feb 01 The American journal of cardiology Am. J. Cardiol. Relation of the CHA 2 DS 2 -VASc Score to Risk of Thrombotic and Embolic Stroke in Community-Dwelling Individuals Without Atrial Fibrillation (From The Atherosclerosis Risk in Communities [ARIC] Study (...) ). 402-408 S0002-9149(18)32052-6 10.1016/j.amjcard.2018.10.037 Recent hospital-based cohort studies found the CHA 2 DS 2 -VASc score to be associated with ischemic stroke in individuals without atrial fibrillation (AF). Our aim was to determine the distribution of embolic and thrombotic strokes and association with the CHA 2 DS 2 -VASc score, among community-dwelling individuals without AF. We included participants from the Atherosclerosis Risk in Communities (ARIC) Study who attended visit 4 (1996
Dialysis Modality and Incident Atrial Fibrillation in Older Patients With ESRD 30449517 2018 12 23 1523-6838 2018 Nov 15 American journal of kidney diseases : the official journal of the National Kidney Foundation Am. J. Kidney Dis. Dialysis Modality and Incident Atrial Fibrillation in Older Patients With ESRD. S0272-6386(18)31017-5 10.1053/j.ajkd.2018.09.011 Atrial fibrillation (AF) is common in patients with kidney failure treated by maintenance dialysis. Whether the incidence of AFdiffers (...) between patients receiving hemodialysis and peritoneal dialysis is uncertain. Retrospective cohort study. Using the US Renal Data System, we identified older patients (≥67 years) with Medicare Parts A and B who initiated dialysis therapy (1996-2011) without a diagnosis of AFduring the prior 2 years. Dialysis modality at incident end-stage renal disease (ESRD) and maintained for at least 90 days. Patients were followed up for 36 months or less for a new diagnosis of AF. Time-to-event analysis using
A randomized, double-blind, placebo-controlled trial assessing the efficacy of S66913 in patients with paroxysmal atrial fibrillation. 30052825 2019 01 08 2055-6845 5 1 2019 01 01 European heart journal. Cardiovascular pharmacotherapy Eur Heart J Cardiovasc Pharmacother A randomized, double-blind, placebo-controlled trial assessing the efficacy of S66913 in patients with paroxysmal atrial fibrillation. 21-28 10.1093/ehjcvp/pvy022 Antiarrhythmic drugs (AADs) for the treatment (...) of atrial fibrillation (AF) are associated with limited efficacy and adverse effects. Inhibition of the atrial current IKur, absent from the ventricle, is expected to be antiarrhythmic, without adverse cardiac effects, particularly ventricular pro-arrhythmic effects. A randomized clinical trial in symptomatic paroxysmal AFpatients being considered for ablation. The primary endpoint was AFburden (AFB) as measured by insertable continuous monitoring (ICM) devices. Screened patients had an ICM implanted and were
Catheter Ablation of Atrial Fibrillation in Patients With Heart Failure: A Meta-analysis of Randomized Controlled Trials. Background: Atrial fibrillation (AF) and heart failure (HF) frequently coexist and are associated with increased morbidity and mortality risk. Purpose: To compare benefits and harms between catheter ablation and drug therapy in adult patients with AFand HF. Data Sources: ClinicalTrials.gov, PubMed, Web of Science (Clarivate Analytics), EBSCO Information Services, Cochrane (...) Central Register of Controlled Trials, Google Scholar, and various scientific conference sessions from 1 January 2005 to 1 October 2018. Study Selection: Randomized controlled trials (RCTs) published in English that had at least 6 months of follow-up and compared clinical outcomes of catheter ablation versus drug therapy in adults with AFand HF. Data Extraction: 2 investigators independently extracted data and assessed study quality. Data Synthesis: 6 RCTs involving 775 patients met inclusion
Association Between Titin Loss-of-Function Variants and Early-Onset Atrial Fibrillation. Importance: Atrial fibrillation (AF) is the most common arrhythmia affecting 1% of the population. Young individuals with AFhave a strong genetic association with the disease, but the mechanisms remain incompletely understood. Objective: To perform large-scale whole-genome sequencing to identify genetic variants related to AF. Design, Setting, and Participants: The National Heart, Lung, and Blood (...) Institute's Trans-Omics for Precision Medicine Program includes longitudinal and cohort studies that underwent high-depth whole-genome sequencing between 2014 and 2017 in 18 526 individuals from the United States, Mexico, Puerto Rico, Costa Rica, Barbados, and Samoa. This case-control study included 2781 patients with early-onset AFfrom 9 studies and identified 4959 controls of European ancestry from the remaining participants. Results were replicated in the UK Biobank (346 546 participants
Predicting Thromboembolic and Bleeding Event Risk in Patients with Non-Valvular Atrial Fibrillation: A Systematic Review 30376678 2018 12 03 2567-689X 118 12 2018 Dec Thrombosis and haemostasis Thromb. Haemost. Predicting Thromboembolic and Bleeding Event Risk in Patients with Non-Valvular Atrial Fibrillation: A Systematic Review. 2171-2187 10.1055/s-0038-1675400 Atrial fibrillation (AF) is a common cardiac arrhythmia that increases the risk of stroke. Medical therapy for decreasing stroke risk (...) involves anticoagulation, which may increase bleeding risk for certain patients. In determining the optimal therapy for stroke prevention for patients with AF, clinicians use tools with various clinical, imaging and patient characteristics to weigh stroke risk against therapy-associated bleeding risk. This article reviews published literature and summarizes available risk stratification tools for stroke and bleeding prediction in patients with AF. We searched for English-language studies in PubMed
Comment on model-based meta-analysis to evaluate optimal doses of direct oral factor Xa inhibitors in atrial fibrillation patients 30482761 2018 11 28 2473-9537 2 22 2018 Nov 27 Blood advances Blood Adv Comment on model-based meta-analysis to evaluate optimal doses of direct oral factor Xa inhibitors in atrial fibrillation patients. 3193-3195 10.1182/bloodadvances.2018027078 Willmann Stefan S Clinical Pharmacometrics, Bayer AG, Wuppertal, Germany. Zhang Liping L Global Clinical Pharmacology