Latest & greatest articles for atrial fibrillation

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Top results for atrial fibrillation

41. Left atrial appendage occlusion (LAAO) in patients with atrial fibrillation who have contraindications to oral anticoagulation

Left atrial appendage occlusion (LAAO) in patients with atrial fibrillation who have contraindications to oral anticoagulation SHTG Advice | 1 SHTG Advice 06-19 August 2019 In response to an enquiry from the National Advisory Committee for Heart Disease Left atrial appendage occlusion (LAAO) in patients with atrial fibrillation who have contraindications to oral anticoagulation Advice for NHSScotland Left atrial appendage occlusion (LAAO) may be offered to patients with non-valvular atrial (...) procedure volume per centre should be maximised to support optimal patient outcomes and ensure clinical experience is achieved and retained. NHSScotland is required to consider the Scottish Health Technologies Group (SHTG) advice. SHTG Advice | 2 What were we asked to look at? The National Advisory Committee for Heart Disease asked us to look at a percutaneous intervention, left atrial appendage occlusion (LAAO), in patients with atrial fibrillation and contraindications to oral anticoagulation. Why

2019 SHTG Advice Statements

42. Oral anticoagulants in atrial fibrillation with valvular heart disease and bioprosthetic heart valves (Abstract)

Oral anticoagulants in atrial fibrillation with valvular heart disease and bioprosthetic heart valves Current guidelines endorse the use of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation (AF). However, little is known about their safety and efficacy in valvular heart disease (VHD). Similarly, there is a paucity of data regarding NOACs use in patients with a bioprosthetic heart valve (BPHV). We, therefore, performed a network meta-analysis

2019 EvidenceUpdates

43. Atrial fibrillation: apixaban (Eliquis) as an alternative to warfarin (Coumadin and other brands) in some situations

Atrial fibrillation: apixaban (Eliquis) as an alternative to warfarin (Coumadin and other brands) in some situations Prescrire IN ENGLISH - Spotlight ''Atrial fibrillation: apixaban (Eliquis°) as an alternative to warfarin (Coumadin° and other brands) in some situations'', 1 June 2019 {1} {1} {1} | | > > > Atrial fibrillation: apixaban (Eliquis°) as an alternative to warfarin (Coumadin° and other brands) in some situations Spotlight Every month, the subjects in Prescrire’s Spotlight. 100 most (...) recent :  |   |   |   |   |   |   |   |   |  Spotlight Atrial fibrillation: apixaban (Eliquis°) as an alternative to warfarin (Coumadin° and other brands) in some situations When atrial fibrillation warrants the use of an anticoagulant, the anti-vitamin K warfarin (Coumadin° and other brands) is still the best long-term evaluated oral anticoagulant. The anti-Xa apixaban (Eliquis°) is an alternative in some situations. In patients

2019 Prescrire

44. Atrial fibrillation type and renal dysfunction as important predictors of left atrial thrombus Full Text available with Trip Pro

Atrial fibrillation type and renal dysfunction as important predictors of left atrial thrombus We aimed to identify predictors of left atrial appendage (LAA) thrombus in patients with atrial fibrillation (AF) and to enhance the prognostic value of the CHA2DS2-VASc score.Derivation cohort included 1033 consecutive AF patients referred for catheter ablation or direct current cardioversion, in whom transoesophageal echocardiography (TOE) was performed prior to the procedure. Logistic regression

2019 EvidenceUpdates

45. Safety and Efficacy of Minimally Interrupted Dabigatran vs Uninterrupted Warfarin Therapy in Adults Undergoing Atrial Fibrillation Catheter Ablation: A Randomized Clinical Trial Full Text available with Trip Pro

Safety and Efficacy of Minimally Interrupted Dabigatran vs Uninterrupted Warfarin Therapy in Adults Undergoing Atrial Fibrillation Catheter Ablation: A Randomized Clinical Trial Uninterrupted dabigatran therapy reduces stroke risk in patients with nonvalvular atrial fibrillation (NVAF) undergoing ablation and is associated with a lower bleeding risk than uninterrupted warfarin therapy. Minimally interrupted direct oral anticoagulant therapy is widely used, but data from controlled studies (...) the incidence of embolism during the perioperative period and atrial thrombus just before the ablation. The main secondary end point was the incidence of major bleeding events until 3 months after ablation.Of the 442 patients who underwent ablation, 74.9% were men and the median age was 66 years (interquartile range, 59-71 years). Before ablation, 1 cerebral infarction and 1 thrombus in the left atrium occurred in the warfarin group, but no events occurred in the interrupted dabigatran group. After ablation

2019 EvidenceUpdates

46. Incident Atrial Fibrillation, Dementia and the Role of Anticoagulation: A Population-Based Cohort Study (Abstract)

Incident Atrial Fibrillation, Dementia and the Role of Anticoagulation: A Population-Based Cohort Study  Atrial fibrillation (AF) is associated with dementia. Anticoagulation may modify this relationship, but it is unclear if this is due to stroke reduction alone. Age- and sex-matched individuals from the U.K. Clinical Practice Research Datalink (2008-2016) with and without an incident diagnosis of AF were followed for a new dementia diagnosis. We estimated adjusted hazard ratios (aHRs

2019 EvidenceUpdates

47. Uninterrupted edoxaban vs. vitamin K antagonists for ablation of atrial fibrillation: the ELIMINATE-AF trial Full Text available with Trip Pro

Uninterrupted edoxaban vs. vitamin K antagonists for ablation of atrial fibrillation: the ELIMINATE-AF trial Edoxaban is a direct factor Xa inhibitor approved for stroke prevention in atrial fibrillation (AF). Uninterrupted edoxaban therapy in patients undergoing AF ablation has not been tested.The ELIMINATE-AF trial, a multinational, multicentre, randomized, open-label, parallel-group study, was conducted to assess the safety and efficacy of once-daily edoxaban 60 mg (30 mg in patients

2019 EvidenceUpdates

48. Lead-I ECG devices for detecting symptomatic atrial fibrillation using single time point testing in primary care

Lead-I ECG devices for detecting symptomatic atrial fibrillation using single time point testing in primary care L Lead-I ECG de ead-I ECG devices for detecting vices for detecting symptomatic atrial fibrillation using symptomatic atrial fibrillation using single time point testing in primary care single time point testing in primary care Diagnostics guidance Published: 8 May 2019 www.nice.org.uk/guidance/dg35 © NICE 2019. All rights reserved. Subject to Notice of rights (https (...) health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Lead-I ECG devices for detecting symptomatic atrial fibrillation using single time point testing in primary care (DG35) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 2 of 40Contents Contents 1 Recommendations 4 2 Clinical need and practice 5 The problem addressed 5 The condition 5

2019 National Institute for Health and Clinical Excellence - Diagnostics Guidance

49. A Simple Clinical Risk Score (C2HEST) for Predicting Incident Atrial Fibrillation in Asian Subjects: Derivation in 471,446 Chinese Subjects, With Internal Validation and External Application in 451,199 Korean Subjects Full Text available with Trip Pro

A Simple Clinical Risk Score (C2HEST) for Predicting Incident Atrial Fibrillation in Asian Subjects: Derivation in 471,446 Chinese Subjects, With Internal Validation and External Application in 451,199 Korean Subjects The incidence of atrial fibrillation (AF) is increasing, conferring a major health-care issue in Asia. No risk score for predicting incident AF has been specifically developed in Asian subjects. Our aim was to investigate risk factors for incident AF in Asian subjects

2019 EvidenceUpdates

50. Effect of Catheter Ablation vs Antiarrhythmic Medication on Quality of Life in Patients With Atrial Fibrillation: The CAPTAF Randomized Clinical Trial. Full Text available with Trip Pro

Effect of Catheter Ablation vs Antiarrhythmic Medication on Quality of Life in Patients With Atrial Fibrillation: The CAPTAF Randomized Clinical Trial. Quality of life is not a standard primary outcome in ablation trials, even though symptoms drive the indication.To assess quality of life with catheter ablation vs antiarrhythmic medication at 12 months in patients with atrial fibrillation.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.Pulmonary vein isolation ablation (n = 79) or previously untested antiarrhythmic drugs (n = 76).Primary outcome was the General Health subscale score (Medical Outcomes Study 36-Item Short-Form

2019 JAMA Controlled trial quality: predicted high

51. Early or Delayed Cardioversion in Recent-Onset Atrial Fibrillation. Full Text available with Trip Pro

Early or Delayed Cardioversion in Recent-Onset Atrial Fibrillation. Patients with recent-onset atrial fibrillation commonly undergo immediate restoration of sinus rhythm by pharmacologic or electrical cardioversion. However, whether immediate restoration of sinus rhythm is necessary is not known, since atrial fibrillation often terminates spontaneously.In a multicenter, randomized, open-label, noninferiority trial, we randomly assigned patients with hemodynamically stable, recent-onset (<36 (...) hours), symptomatic atrial fibrillation in the emergency department to be treated with a wait-and-see approach (delayed-cardioversion group) or early cardioversion. The wait-and-see approach involved initial treatment with rate-control medication only and delayed cardioversion if the atrial fibrillation did not resolve within 48 hours. The primary end point was the presence of sinus rhythm at 4 weeks. Noninferiority would be shown if the lower limit of the 95% confidence interval for the between

2019 NEJM Controlled trial quality: predicted high

52. Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation. Full Text available with Trip Pro

Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation. Appropriate antithrombotic regimens for patients with atrial fibrillation who have an acute coronary syndrome or have undergone percutaneous coronary intervention (PCI) are unclear.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 P2Y12 inhibitor to receive (...) , 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.In patients with atrial fibrillation and a recent acute coronary syndrome or PCI treated with a P2Y12 inhibitor, an antithrombotic regimen that included apixaban, without aspirin, resulted in less bleeding and fewer hospitalizations without significant differences

2019 NEJM Controlled trial quality: predicted high

53. Effect of Catheter Ablation vs Medical Therapy on Quality of Life Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial. Full Text available with Trip Pro

Effect of Catheter Ablation vs Medical Therapy on Quality of Life Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial. Catheter ablation is more effective than drug therapy in restoring sinus rhythm in patients with atrial fibrillation (AF), but its incremental effect on long-term quality of life (QOL) is uncertain.To determine whether catheter ablation is more beneficial than conventional drug therapy for improving QOL in patients with AF.An open-label randomized (...) by investigators for the drug therapy group (n = 1096).Prespecified co-primary QOL end points at 12 months, including the Atrial Fibrillation Effect on Quality of Life (AFEQT) summary score (range, 0-100; 0 indicates complete disability and 100 indicates no disability; patient-level clinically important difference, ≥5 points) and the Mayo AF-Specific Symptom Inventory (MAFSI) frequency score (range, 0-40; 0 indicates no symptoms and 40 indicates the most severe symptoms; patient-level clinically important

2019 JAMA Controlled trial quality: predicted high

54. Effect of Catheter Ablation vs Antiarrhythmic Drug Therapy on Mortality, Stroke, Bleeding, and Cardiac Arrest Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial. Full Text available with Trip Pro

Effect of Catheter Ablation vs Antiarrhythmic Drug Therapy on Mortality, Stroke, Bleeding, and Cardiac Arrest Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial. Catheter ablation is effective in restoring sinus rhythm in atrial fibrillation (AF), but its effects on long-term mortality and stroke risk are uncertain.To determine whether catheter ablation is more effective than conventional medical therapy for improving outcomes in AF.The Catheter Ablation vs (...) Antiarrhythmic Drug Therapy for Atrial Fibrillation trial is an investigator-initiated, open-label, multicenter, randomized trial involving 126 centers in 10 countries. A total of 2204 symptomatic patients with AF aged 65 years and older or younger than 65 years with 1 or more risk factors for stroke were enrolled from November 2009 to April 2016, with follow-up through December 31, 2017.The catheter ablation group (n = 1108) underwent pulmonary vein isolation, with additional ablative procedures

2019 JAMA Controlled trial quality: predicted high

55. Blood & Clots Series: What is the optimal antithrombotic strategy for atrial fibrillation post-PCI? Full Text available with Trip Pro

Blood & Clots Series: What is the optimal antithrombotic strategy for atrial fibrillation post-PCI? Blood & Clots Series: What is the optimal antithrombotic strategy for atrial fibrillation post-PCI? - CanadiEM Blood & Clots Series: What is the optimal antithrombotic strategy for atrial fibrillation post-PCI? In , by Vinai Bhagirath March 5, 2019 All the content from the Blood & Clots series can be found . CanMEDS Roles addressed: Medical Expert Main Messages P2Y12 inhibition is important (...) for the first 1-6 months after PCI insertion, and may have ongoing benefits up to 12 months or longer. Addition of anticoagulant to antiplatelet therapy increases the risk of bleeding, but reduces the risk of stroke. Use of an anticoagulant plus P2Y12 inhibitor is preferable to anticoagulant plus dual antiplatelet therapy, because of reduced bleeding risk. Case Description You are seeing a 72-year-old woman with a history of atrial fibrillation (AF), and additional stroke risk factors of hypertension

2019 CandiEM

56. Dabigatran dual therapy with ticagrelor or clopidogrel after percutaneous coronary intervention in atrial fibrillation patients with or without acute coronary syndrome: a subgroup analysis from the RE-DUAL PCI trial Full Text available with Trip Pro

Dabigatran dual therapy with ticagrelor or clopidogrel after percutaneous coronary intervention in atrial fibrillation patients with or without acute coronary syndrome: a subgroup analysis from the RE-DUAL PCI trial After percutaneous coronary intervention (PCI) in patients with atrial fibrillation, safety and efficacy with dabigatran dual therapy were evaluated in pre-specified subgroups of patients undergoing PCI due to acute coronary syndrome (ACS) or elective PCI, and those receiving

2019 EvidenceUpdates

57. Concomitant Use of Direct Oral Anticoagulants with Antiplatelet Agents and the Risk of Major Bleeding in Patients with Nonvalvular Atrial Fibrillation Full Text available with Trip Pro

Concomitant Use of Direct Oral Anticoagulants with Antiplatelet Agents and the Risk of Major Bleeding in Patients with Nonvalvular Atrial Fibrillation Patients with nonvalvular atrial fibrillation commonly have comorbidities requiring concurrent use of oral anticoagulants and antiplatelets. There are no real-world data on the comparative safety of concomitant antithrombotic treatments in the era of direct oral anticoagulant (DOACs). Thus, we compared the incidence of intracranial hemorrhage (...) , gastrointestinal bleeding, and other major bleeding between concomitant DOAC-antiplatelet use and concomitant vitamin K antagonist (VKA)-antiplatelet use in patients with nonvalvular atrial fibrillation.Using computerized health care databases from Québec, we conducted a cohort study among patients newly diagnosed with nonvalvular atrial fibrillation between January 2011 and March 2014. Cox proportional hazards models yielded hazard ratios (HRs) and 95% confidence intervals (CIs), adjusted for disease risk

2019 EvidenceUpdates

58. Major Bleeding Rates in Atrial Fibrillation Patients on Single, Dual, or Triple Antithrombotic Therapy Full Text available with Trip Pro

Major Bleeding Rates in Atrial Fibrillation Patients on Single, Dual, or Triple Antithrombotic Therapy Patients with atrial fibrillation generally require anticoagulant therapy and, at times, therapy with additional platelet aggregation inhibitors. Data are scarce on bleeding rates in high-risk groups receiving combination therapy, such as the elderly or patients with a high CHA2DS2-VASc score.We conducted a nationwide cohort study of Danish patients with atrial fibrillation ≥50 years of age (...) patients with atrial fibrillation. Median age was 75 years (interquartile range, 67-83) and 47% were women. Over a total follow-up period of 1 373 131 patient-years (PYs), 31 459 major bleeds occurred (IR 2.3/100 PYs; 95% CI, 2.3-2.3/100 PYs). In comparison with vitamin K antagonist monotherapy, adjusted hazard ratios of major bleeding were 1.13 (95% CI, 1.06-1.19) for dual antiplatelet therapy, 1.82 (95% CI, 1.76-1.89) for therapy with a vitamin K antagonist and an antiplatelet drug, 1.28 (95% CI

2019 EvidenceUpdates

59. 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 Full Text available with Trip Pro

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 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 Xa inhibitor edoxaban in patients with atrial fibrillation and a CHADS2 score ≥2. We performed a nested prospective biomarker study in 8705 patients, analyzing baseline high-sensitivity troponin T (hsTnT), NT-proBNP (N-terminal B-type natriuretic peptide), and growth

2019 EvidenceUpdates

60. CHA2DS2-VASc Score and Stroke Prediction in Atrial Fibrillation in Whites, Blacks, and Hispanics Full Text available with Trip Pro

CHA2DS2-VASc Score and Stroke Prediction in Atrial Fibrillation in Whites, Blacks, and Hispanics Background and Purpose- Despite modest predictive ability for ischemic stroke (IS), the CHA2DS2-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 CHA2DS2-VASc in blacks and Hispanics versus whites; (2) compare predictive ability of CHA2DS2-VASc score (...) for IS or TIA in blacks and Hispanics versus whites; and (3) determine improvement in predictive ability of CHA2DS2-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 in commercial and Medicare Advantage health plans from 2009 to 2015. We computed IS or TIA incidence rates, improvement in C statistic, continuous and categorical net reclassification improvement, and relative

2019 EvidenceUpdates