CHA 2 DS 2 -VASc Score and Heart Rate Predict Ischemic Stroke Outcomes in Patients with Atrial Fibrillation
|
|
- Percival Stephens
- 8 years ago
- Views:
Transcription
1 Mini Forum for EPS Acta Cardiol Sin 2014;30:16 21 CHA 2 DS 2 -VASc Score and Heart Rate Predict Ischemic Stroke Outcomes in Patients with Atrial Fibrillation Chih-Shan Huang, 1 Chin-I Chen, 1 Ya-Ting Liu, 1 Jen-Hung Huang 2 and Yi-Jen Chen 2,3 Purpose: To evaluate the factors determining the severity and outcome of ischemic stroke in patients with atrial fibrillation (AF). Methods: Our study examined 210 patients with AF and acute ischemic stroke to investigate the relative risks of age, gender, comorbidities, CHADS2 and CHA2DS2-VASc scores, warfarin use, heart rate, and blood pressure on stroke severity, hospitalization duration, and mortality rate. Results: Patients with poor outcomes [n = 109, National Institutes of Health Stroke Scale (NIHSS) scores of 8] had elevated CHA2DS2-VASc scores [5, interquartile range (IQR) 3-6 versus 4, IQR 2.5-5, p = 0.005] and were older with a female predominance, less prior warfarin use, and a higher heart rate (93 24 versus beats/min, p = 0.004) in the emergency department, with a longer duration of hospitalization (24 23 versus days, p < 0.001) and a higher mortality rate (11.0% versus 0.0%, p = 0.002) than those with better outcomes (n = 101, low NIHSS scores of 7). Patients who died (n = 12) were older and had a higher NIHSS, CHADS2 (3.5, IQR versus 2, IQR 1-4, p = 0.040), or CHA2DS2-VASc (5.5, IQR 4-6 versus 4, IQR 3-5, p = 0.046) scores than patients who survived. The multivariate analysis showed that female gender, no prior warfarin use, and heart rate were independent predictors of stroke severity. Conclusions: Our results showed that CHADS2 and CHA2DS2-VASc scores, and heart rate were useful parameters for predicting outcomes in AF patients with stroke. Key Words: Atrial fibrillation CHA 2 DS 2 -VASc score Heart rate Ischemic stroke INTRODUCTION Atrial fibrillation (AF) is the most common cardiac arrhythmia which can induce stroke with a higher mortality rate and more-disabling outcomes. 1,2 The CHADS 2 Received: October 11, 2013 Accepted: November 13, Department of Neurology; 2 Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University; 3 Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei, Taiwan. Address correspondence and reprint requests to: Dr. Yi-Jen Chen, Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, No. 111, Hsing-Lung Road, Sec. 3, Taipei 116, Taiwan. Tel: ; Fax: ; a @ms15.hinet.net (congestive heart failure, hypertension, age 75 years, diabetes mellitus, stroke) score, and the recently developed CHA 2 DS 2 -VASc (congestive heart failure, hypertension, age 75 years, diabetes mellitus, stroke, vascular disease, age years, sex category) score, were proposed to predict stroke risk, and thus are used to select high-risk AF patients who should take anticoagulant agents to reduce their risk of stroke. 3-5 However, prognostic factors for AF patients with stroke are not fully elucidated. AF in older stroke patients ( 75 years) is known to impact mortality and recurrence after an initial ischemic stroke. 6 Moreover, females are associated with an elevated frequency of AF more than males, 7 and AF is only an independent predictor of poor stroke out- Acta Cardiol Sin 2014;30:
2 Factors Affecting Stroke Outcome with Atrial Fibrillation comes for woman. 8 Therefore, aging and female gender might affect the prognosis of AF patients Recently, CHADS 2 and CHA 2 DS 2 -VASc scores were also proposed to be useful parameters for assessing outcomes after AF-induced stroke. 12 Adequate control of the international normalized ratio (INR) with an anticoagulant decreases the occurrence of ischemic stroke in AF patients, and also may reduce its severity and the risk of death from stroke. 17 AFwitharapidventricular rate can produce heart failure and increases the risk of stroke. However, RACEII showed that strict and lenient rates of control have similar stroke risks in AF patients. 18 Moreover, it is not clear whether the heart rate or other hemodynamic parameters can predict stroke outcomes. Therefore, the purpose of this study was to investigate factors affecting potential outcomes in AF patients with acute stroke. MATERIALS AND METHODS Study subjects This study was approved by the Taipei Medical University Joint Institutional Review Board. Informed consent was obtained from all participants. In total, 210 patients in a university hospital with acute ischemic stroke and AF from January 2006 to December 2011, who had been consecutively registered in the Taiwan Stroke Registry, were enrolled in this study. During admission, all patients received computed tomography (CT) and/or magnetic resonance imaging (MRI) to exclude hemorrhagic stroke and to evaluate the ischemic stroke area. All patients were managed according to stroke guidelines (from the American Stroke Association). We recorded the gender, age, systolic blood pressure (SBP), and heart rate upon arrival at the emergency department, anticoagulant treatment at the time of stroke onset, prothrombin time (reported as the INR) at presentation, and days of hospitalization. The CHADS 2 and CHA 2 DS 2 -VASc scores were calculated for each patient according to the clinical status. Neurological assessment The neurological condition of each patient was evaluated on arrival. The initial stroke severity was assessed by a trained neurologist using the National Institutes of Health Stroke Scale (NIHSS), 19 which includes 11 items: level of consciousness, horizontal eye movement, visual field test, facial palsy, motor arm, motor leg, limb ataxia, sensory loss, language, dysarthria, and extinction and inattention. Individual scores from each item are summedinordertocalculateapatient stotalnihssscore. Statistical analysis All continuous variables are expressed as the mean standard deviation (SD). Comparisons between groups were made using a t-test or the Mann-Whitney ranksum test depending on the outcome of the normality test. Nominal variables were compared by a chi-square test. A logistic regression analysis was used to analyze stroke severity, in terms of the initial NIHSS score. Variables that reached statistical significance (p < 0.05) in the univariate analysis were applied to the multivariate analysis to determine independent variables associated with the initial stroke severity, hospitalization period and mortality. Statistical significance was set at p < 0.05 from a two-tailed t-test. Statistical analyses were performed using the SigmaPlot 12.3 and SPSS 13.0 (SPSS, Chicago, IL, USA) software packages. RESULTS Patient characteristics Of the 210 patients with AF and ischemic stroke, 103 (49.0%) were female with an average age of (range, 40-97) years. Only 29 patients (13.8%) had received oral anticoagulant (i.e., warfarin) therapy, with an average INR of , and only 2 (6.9%) of them had INR levels that had reached therapeutic intensity (INR > 2) at the time of the stroke. Fifty-five patients (26.2%) with heart failure, 169 patients (80%) with hypertension, 51 patients (24.3%) with diabetes mellitus (DM), 70 (33.3%) with a history of stroke, and 53 (25.2%) with vascular disease (coronary artery disease, peripheral artery disease, etc) were found among these patients. CHADS 2 scoreswere0in10(4.8%)patients,1 in 44 (20.9%) patients, 2 in 50 (23.8%) patients, 3 in 47 (22.4%) patients, 4 in 35 (16.7%) patients, 5 in 17 (8.1%) patients, and 6 in seven (3.3%) patients. CHA 2 DS 2 -VASc scores were 0 in two (1%) patients, 1 in 10 (4.8%) patients, 2 in 28 (13.3%) patients, 3 in 30 (14.3%) patients, 17 Acta Cardiol Sin 2014;30:16 21
3 Chih-Shan Huang et al. 4in49(23.3%)patients,5in37(17.6%)patients,6in34 (16.2%)patients,7in11(5.2%)patients,8inseven (3.3%) patients, and 9 in two (1%) patients. Ratios of patients with a CHADS 2 score of = 2 and a CHA 2 DS 2 -VASc score of 2 were 74.3% and 94.3%, respectively. The mean SBP in the emergency department was mmhg. The mean heart rate in the emergency department was 89 22BPM.Themedianvalueoftheinitial NIHSS was 8, with a 25% value of 3 and a 75% value of 18. The mean duration of hospitalization was days. Twelve (5.7%) patients died after the stroke. Stroke severity and outcomes We compared patients with high and low NIHSS values (Table 1) and found that patients with more-severe Table 1. Differences between atrial fibrillation (AF) patients with different stroke severities NIHSS 7 (n = 101) NIHSS 8 (n = 109) pvalue Mean age (years) < Gender, female (%) < Heart failure (%) Hypertension (%) Diabetes mellitus (%) History of stroke (%) Vascular disease (%) CHADS 2 score 2 (1-3.5) 3 (2-4) CHA 2 DS 2 -VASc score 4 (2.5-5) 5 (3-6) Prior warfarin use (%) Systolic blood pressure (mmhg) Heart rate (BPM) Hospitalization days < Mortality (%) stroke (NIHSS 8) were associated with an older age, a female gender, a higher CHA 2 DS 2 -VASc score, no prior warfarin use, a higher heart rate measured in the emergency department, a longer hospitalization period, and a higher mortality rate. High-NIHSS patients receiving warfarin (n =9)hadasimilarINR( vs , p > 0.05) to low-nihss patients receiving warfarin (n = 20). Figure 1 shows the relationship between NIHSS scores and heart rates. Most notably, we also found a good linear correlation between heart rates and NIHSS scores. Moreover, patients with a faster heart rate ( 90 BPM) had a higher NIHSS score than patients with a slower heart rate ( 90 BPM), as shown in Table 2. In addition, the NIHSS score was also well correlated with the CHADS 2 (Figure 2A) and CHA 2 DS 2 -VASc scores (Figure 2B). Figure 1. Correlations of the NIHSS score and heart rate in patients with atrial fibrillation and stroke. Table 2. Difference between faster or slower heart rates in atrial fibrillation stroke patients Heat rate of < 90 BPM (n = 120) Heart rate of 90 BPM (n =90) pvalue Initial NIHSS score Mean age (years) Gender, female (%) Heart failure (%) Hypertension (%) Diabetes mellitus (%) History of stroke (%) Vascular disease (%) CHADS 2 score 2 (2-4) 3 (1-4) CHA 2 DS 2 -VASc score 4 (3-5) 4 (3-6) Warfarin use (%) Systolic blood pressure (mmhg) Hospitalization days Mortality (%) Acta Cardiol Sin 2014;30:
4 Factors Affecting Stroke Outcome with Atrial Fibrillation Table 3. Differences between atrial fibrillation and stroke patients with different hospitalization periods A 17 days (n =140) 18 days (n = 70) pvalue Initial NIHSS score < Mean age (years) < Gender, female (%) Heart failure (%) Hypertension (%) Diabetes mellitus (%) History of stroke (%) Vascular disease (%) CHADS 2 score 3 (1-4) 2 (2-4) CHA 2 DS 2 -VASc score 4 (3-5.75) 4 (3-6) Warfarin use (%) Systolic blood pressure (mmhg) Heart rate (BPM) Mortality (%) B Figure 2. Correlations of NIHSS scores with CHADS 2 (A) and CHA 2 DS 2 - VASc scores (B) in patients with atrial fibrillation and stroke. Table 3 compares patients with longer ( 18 days) and shorter ( 17 days) hospitalization stays. The cut-off value was set at 18 days because it was the mean duration of hospitalization. We found that patients with a longer hospitalization were older and had more-severe stroke (higher NIHSS scores) and higher SBP. Moreover, NIHSS scores were also correlated with the duration of hospitalization (Figure 3). Table 4 compares patients who died with those who survived. We found that patients who died had higher NIHSS, CHADS 2,andCHA 2 DS 2 - VASc scores, and were older than surviving patients. We added gender, age, CHA 2 DS 2 -VASc score, prior warfarin use and heart rate into the multivariate analysis, which showed that female gender [OR = 3.35 (95% CI: ), p < 0.001], no prior warfarin use [OR = 2.58 (95% CI: ), p < 0.05], and heart rate [OR = 1.02 (95% CI: ), p < 0.005] were independent Figure 3. Correlations of NIHSS scores with hospitalization length of stay in patients with atrial fibrillation and stroke. risk factors for predicting a higher stroke severity (NIHSS 8) after a stroke in patients with AF. In addition, the NIHSS score was the independent risk factor for predicting a long hospitalization ( 17 days) [OR = 1.08 (95% CI: ), p < 0.001] and for predicting mortality [OR = 1.13 (95% CI: ), p = 0.001] from stroke in patients with AF. DISCUSSION AF is more frequently associated with severe or fatal stroke. 1,2 An anticoagulant agent is indicated to prevent 19 Acta Cardiol Sin 2014;30:16 21
5 Chih-Shan Huang et al. Table 4. Differences between surviving patients with atrial fibrillation and stroke and those who died Surviving (n = 198) Died (n = 12) pvalue Initial NIHSS score < Mean age (years) Gender, female (%) Heart failure (%) Hypertension (%) Diabetes mellitus (%) History of stroke (%) Vascular disease (%) CHADS 2 score 2 (1-4) 3.5 (2-4.75) CHA 2 DS 2 -VASc score 4 (3-5) 5.5 (4-6) Warfarin use (%) Systolic blood pressure (mmhg) Heart rate (BPM) thromboembolisms and a stroke A higher CHADS 2 or CHA 2 DS 2 -VASc score is related to an increased risk of stroke occurrence, 3-5 andapatientwithascoreof 2 on the CHADS 2 or CHA 2 DS 2 -VASc is recommended to receive an anticoagulant. In this study, we found that more than 90% of AF patients with stroke had a CHA 2 DS 2 - VASc score of 2, but only 74% of AF patients with a stroke had a CHADS 2 score of 2. In contrast, 95% of AF patientswithastrokehadachads 2 score of 1. Consistent with these recommendations, our findings also suggest that patients with a CHADS 2 score of 1 should receive a CHA 2 DS 2 -VASc evaluation to reduce the inadequate use of anticoagulants. In this study, for the first time, we found that a faster heart rate in the emergency room is an important predictive factor for assessing the severity of stroke. This simple parameter was also correlated with the NIHSS score. The multivariate analysis also indicated that the heart rate is an independent predictive factor for stroke severity. The heart rate in AF patients is regulated by the conduction properties of the atrioventricular node, which is controlled by the autonomic nervous system. A faster heart rate may imply an unstable autonomic nervous system or more stress during a severe stroke. Although unstable hemodynamics may also produce AF with rapid ventricular responses, the SBP was similar between high- and low-nihss patients. Consistent with previous studies, we found that older and female AF patients had poor stroke outcomes. 20 However, the incidences of comorbidities of hypertension, heart failure, diabetes mellitus, and a history of stroke or vascular diseases were similar between AF patients with different stroke severities. Therefore, female and aging might be the main factors contributing tothepredictiveroleofthecha 2 DS 2 -VASc score in stroke severity in AF patients. To date, it is not yet known why female AF patients have poor stroke outcomes. It may be attributable to physiology, genetic factors or hormonal factors that differ between men and women. Further studies may be needed to further investigate and more comprehensively explain sex differences in stroke severity. Through a multivariate analysis, we found that female gender, no prior warfarin use, and heart rate were independent factors for stroke severity. High-NIHSS patients also had high mortality and longer hospitalization. No patient with an NIHSS score of 7diedinthisstudy.Strokeseverity(NIHSS score) was the independent risk factor for longer hospitalization and for mortality. Therefore, different parameters were related to the severity, hospitalization length, and mortality in stroke patients with AF. Use of an anticoagulant can reduce the occurrence of stroke in AF patients. In this study, we found a larger proportion of patients had been taking warfarin in the low-severity group. Therefore, anticoagulant therapy might reduce the stroke incidence in patients with AF, and also lower stroke severity. 17 However, in patients with AF and a stroke receiving warfarin, there were similar INR values between the high- and low-severity groups. This may have resulted from the fact that most of our stroke patients had not reached therapeutic intensity at presentation. 15 Since new anticoagulation therapies (thrombin or Xa inhibitors) have similar or even better effects than warfarin, the underuse or poor control of INR in our study suggests that these patients should be considered to receive these new agents. However, it is not clear whether the new anticoagulation therapies would change the outcome prediction of stroke patients with AF, and additional studies are required. There are some limitations to our study. First, this study only evaluated the acute outcome of stroke in AF patients. It is not clear whether these predictive parameters can be applied to long-term outcomes. Second, this is a single center, retrospective, non-randomized study. In addition, ethnicity plays an important role in the Acta Cardiol Sin 2014;30:
6 Factors Affecting Stroke Outcome with Atrial Fibrillation occurrence of stroke in AF patients. Applying our data to the general population should be done with caution. CONCLUSIONS We confirmed in our study that AF patients with severe stroke had distinctive clinical characteristics. Namely, AF patients who were older and female, and had a faster heart rate, higher CHA 2 DS 2 -VASc score, and no use of warfarin carried a high risk of poor stroke outcomes and require additional attention. ACKNOWLEDGEMENT The present work was supported by grants from Taipei Medical University-Wan Fang Hospital (102-wf-eva- 15), and grants from the National Science Council, Taiwan (NSC B , NSC B ). Competing interests and funding None declared. REFERENCES 1. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 1991;22: Lin HJ, Wolf PA, Kelly-Hayes M, et al. Stroke severity in atrial fibrillation. The Framingham Study. Stroke 1996;27: Gage BF, Waterman AD, Shannon W, et al. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 2001;285: Lip GY, Nieuwlaat R, Pisters R, et al. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest 2010;137: Olesen JB, Lip GY, Hansen ML, et al. Validation of risk stratification schemes for predicting stroke and thromboembolism in patients with atrial fibrillation: nationwide cohort study. BMJ 2011;342:d Kaarisalo MM, Immonen-Räihä P, Marttila RJ, et al. Atrial fibrillation in older stroke patients: association with recurrence and mortality after first ischemic stroke. J Am Geriatr Soc 1997;45: Friberg J, Scharling H, Gadsboll N, et al. Comparison of the impact of atrial fibrillation on the risk of stroke and cardiovascular death in women versus men (the Copenhagen City Heart Study). Am J Cardiol 2004;94: Roquer J, Rodríguez-Campello A, Gomis M, et al. Comparison of the impact of atrial fibrillation on the risk of early death after stroke in women versus men. J Neurol 2006;253: Di Carlo A, Lamassa M, Baldereschi M, et al. Sex differences in the clinical presentation, resource use, and 3-month outcome of acute stroke in Europe: data from a multicenter multinational hospital-based registry. Stroke 2003;34: Kelly-Hayes M, Beiser A, Kase CS, et al. The influence of gender and age on disability following ischemic stroke: The Framingham Study. J Stroke Cerebrovasc Dis 2003;12: Santalucia P, Pezzella FR, Sessa M, et al. Sex differences in clinical presentation, severity and outcome of stroke: results from a hospital-based registry. Eur J Intern Med 2013;24: Hong HJ, Kim YD, Cha MJ, et al. Early neurological outcomes according to CHADS 2 score in stroke patients with non-valvular atrial fibrillation. Eur J Neurol 2012;19: Hert RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have non-valvular atrial fibrillation. Ann Intern Med 2007;146: Fuster V, Rydén LE, Cannom DS, et al ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/ American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. J Am Coll Cardiol 2011;57:e Ogilvie IM, Newton N, Welner SA, et al. Underuse of oral anticoagulants in atrial fibrillation: a systemic review. Am J Med 2010;123:638.e4-645.e O Dell KM, Igawa D, Hsin J. New oral anticoagulants for atrial fibrillation: a review of clinical trials. Clin Ther 2012;34: Hylek EM, Go AS, Chang Y, et al. Effect of intensity of oral anticoagulation on stroke severity and mortality in atrial fibrillation. N Engl J Med 2003;349: Van Gelder IC, Groenveld HF, Crijns HJ, et al. Lenient versus strict rate control in patients with atrial fibrillation. N Engl J Med 2010;362: Brott T, Adams HP Jr, Olinger CP, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke 1989; 20: Avgil Tsadok M, Jackevicius CA, Rahme E, et al. Sex differences in stroke risk among older patients with recently diagnosed atrial fibrillation. JAMA 2012;307: Acta Cardiol Sin 2014;30:16 21
STROKE PREVENTION IN ATRIAL FIBRILLATION. TARGET AUDIENCE: All Canadian health care professionals. OBJECTIVE: ABBREVIATIONS: BACKGROUND:
STROKE PREVENTION IN ATRIAL FIBRILLATION TARGET AUDIENCE: All Canadian health care professionals. OBJECTIVE: To guide clinicians in the selection of antithrombotic therapy for the secondary prevention
More informationStroke Risk Scores. CHA 2 DS 2 -VASc. CHA 2 DS 2 -VASc Scoring Table 2
Bleeding/Clotting Risk Evaluation Tools for Atrial Fibrillation Patients Before prescribing anticoagulants, providers should weigh the risk of thrombosis against the risk of bleeding. The tools below can
More informationSTROKE PREVENTION IN ATRIAL FIBRILLATION
STROKE PREVENTION IN ATRIAL FIBRILLATION OBJECTIVE: To guide clinicians in the selection of antithrombotic therapy for the secondary prevention of ischemic stroke and arterial thromboembolism in patients
More informationPHARMACOLOGICAL Stroke Prevention in Atrial Fibrillation STROKE RISK ASSESSMENT SCORES Vs. BLEEDING RISK ASSESSMENT SCORES.
PHARMACOLOGICAL Stroke Prevention in Atrial Fibrillation STROKE RISK ASSESSMENT SCORES Vs. BLEEDING RISK ASSESSMENT SCORES. Hossam Bahy, MD (1992 2012), 19 tools have been identified 11 stroke scores 1
More informationAtrial Fibrillation 2014 How to Treat How to Anticoagulate. Allan Anderson, MD, FACC, FAHA Division of Cardiology
Atrial Fibrillation 2014 How to Treat How to Anticoagulate Allan Anderson, MD, FACC, FAHA Division of Cardiology Projection for Prevalence of Atrial Fibrillation: 5.6 Million by 2050 Projected number of
More informationPerioperative Bridging in Atrial Fibrillation: Is it necessary?
Perioperative Bridging in Atrial Fibrillation: Is it necessary? Jason B. Thompson M.D., Ph.D. August 29, 2015 2015 NCVH Birmingham Hypothesis: When bridging, risk of bleeding < risk systemic embolism (SE).
More informationFOR THE PREVENTION OF ATRIAL FIBRILLATION RELATED STROKE
www.bpac.org.nz keyword: warfarinaspirin FOR THE PREVENTION OF ATRIAL FIBRILLATION RELATED STROKE Key Concepts In atrial fibrillation (AF) warfarin is more effective than aspirin for stroke prevention.
More informationKevin Saunders MD CCFP Rivergrove Medical Clinic Wellness Institute @ SOGH April 17 2013
Kevin Saunders MD CCFP Rivergrove Medical Clinic Wellness Institute @ SOGH April 17 2013 Family physician with Rivergrove Medical Clinic Practice in the north end since 1985 Medical Director of the Wellness
More informationLong term anticoagulant therapy in patients with atrial fibrillation at high risk of stroke: a new scenario after RE-LY trial
Long term anticoagulant therapy in patients with atrial fibrillation at high risk of stroke: a new scenario after RE-LY trial Camillo Autore Università di Roma Sapienza II Facoltà di Medicina e Chirurgia
More informationAnticoagulants in Atrial Fibrillation
Anticoagulants in Atrial Fibrillation Starting and Stopping Them Safely Carmine D Amico, D.O. Overview Learning objectives Introduction Basic concepts Treatment strategy & options Summary 1 Learning objectives
More informationNew Treatments for Stroke Prevention in Atrial Fibrillation. John C. Andrefsky, MD, FAHA NEOMED Internal Medicine Review course May 5 th, 2013
New Treatments for Stroke Prevention in Atrial Fibrillation John C. Andrefsky, MD, FAHA NEOMED Internal Medicine Review course May 5 th, 2013 Classification Paroxysmal atrial fibrillation (AF) Last < 7
More informationAtrial Fibrillation: Stroke and Thromboprophylaxis. Derek Waller
Atrial Fibrillation: Stroke and Thromboprophylaxis Derek Waller Atrial Fibrillation in the Elderly: Risk of Stroke Framingham study AGE 50-59 60-69 70-79 80-89 Prevalence of AF % Attributable Risk of AF
More informationPrevention of stroke in patients with atrial fibrillation
www.sign.ac.uk Prevention of stroke in patients with atrial fibrillation A guide for primary care January 2014 Evidence Contents 1 Introduction... 1 2 Detection...2 3 Risk stratification... 3 4 Treatment
More informationSTROKE PREVENTION AND TREATMENT MARK FISHER, MD PROFESSOR OF NEUROLOGY UC IRVINE
STROKE PREVENTION AND TREATMENT MARK FISHER, MD PROFESSOR OF NEUROLOGY UC IRVINE CASE REPORT: ACUTE STROKE MANAGEMENT 90 YEAR OLD WOMAN, PREVIOUSLY ACTIVE AND INDEPENDENT, CHRONIC ATRIAL FIBRILLATION,
More informationThe Unmet Need of Stroke Prevention in Atrial Fibrillation in the Far East and South East Asia
Editorial The Unmet Need of Stroke Prevention in Atrial Fibrillation in the Far East and South East Asia Yutao Guo 1, Gregory Y. H. Lip 2, Stavros Apostolakis 2 Submitted: 20 Mac 2012 Accepted: 27 Mac
More informationAnticoagulation before and after cardioversion; which and for how long
Anticoagulation before and after cardioversion; which and for how long Sameh Samir, MD Cardiovascular medicine dept. Tanta faculty of medicine Atrial fibrillation goals of management Identify and treat
More informationTHE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT
THE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT Stroke Prevention in Atrial Fibrillation Gregory Albers, M.D. Director Stanford Stroke Center Professor of Neurology and Neurological
More informationIntroduction. Methods. Study population
New Technologies, Diagnostic Tools and Drugs Schattauer 2012 1 Net clinical benefit of new oral anticoagulants (dabigatran, rivaroxaban, apixaban) versus no treatment in a real world atrial fibrillation
More informationPEER REVIEW HISTORY ARTICLE DETAILS TITLE (PROVISIONAL)
PEER REVIEW HISTORY BMJ Open publishes all reviews undertaken for accepted manuscripts. Reviewers are asked to complete a checklist review form (http://bmjopen.bmj.com/site/about/resources/checklist.pdf)
More informationThe Evaluation of Risk Assessment Tools in Patients with Atrial Fibrillation to Prevent Stroke
The Evaluation of Risk Assessment Tools in Patients with Atrial Fibrillation to Prevent Stroke Laurens FM Verscheijden (1), Jasper MJ Coolen (1), Jelle Evers (1) and Corne GF Hendriks (1) (1) Student RadboudUMC
More informationTreating AF: The Newest Recommendations. CardioCase presentation. Ethel s Case. Wayne Warnica, MD, FACC, FACP, FRCPC
Treating AF: The Newest Recommendations Wayne Warnica, MD, FACC, FACP, FRCPC CardioCase presentation Ethel s Case Ethel, 73, presents with rapid heart beating and mild chest discomfort. In the ED, ECG
More informationThe warfarin dilemma Oral anticoagulation with warfarin in older people with atrial fibrillation
The warfarin dilemma Oral anticoagulation with warfarin in older people with atrial fibrillation 22 BPJ Issue 31 www.bpac.org.nz keyword: warfarin Atrial fibrillation and increasing age are both risk factors
More informationNOAC S For Stroke Prevention in. Atrial Fibrillation. Peter Cohn M.D FACC Associate Physician in Chief Cardiovascular Care Center Southcoast Health
NOAC S For Stroke Prevention in Atrial Fibrillation Peter Cohn M.D FACC Associate Physician in Chief Cardiovascular Care Center Southcoast Health New Oral Anti Coagulant Formal Definition: Atrial Fibrillation
More informationManaging the Patient with Atrial Fibrillation
Pocket Guide Managing the Patient with Atrial Fibrillation Updated April 2012 Editor Stephen R. Shorofsky, MD, Ph.D. Assistant Editors Anastasios Saliaris, MD Shawn Robinson, MD www.hrsonline.org DEFINITION
More informationNew in Atrial Fibrillation
New in Atrial Fibrillation September 2011 Stroke prevention more options Rhythm Control -drugs - alternatives to drugs; ablation Rate Control - pace + ablate A-FIB Dell Stroke Risk AFib Two Principles
More informationRefining Clinical Risk Stratification for Predicting Stroke and Thromboembolism in Atrial Fibrillation Using a Novel Risk Factor-Based Approach
CHEST Original Research Refining Clinical Risk Stratification for Predicting Stroke and Thromboembolism in Atrial Fibrillation Using a Novel Risk Factor-Based Approach The Euro Heart Survey on Atrial Fibrillation
More informationCardiology Update 2014
Cardiology Update 2014 Update on the Novel Oral Anticoagulants (NOACS) Raymond Kawasaki, MD AMG Cardiology December 6, 2014 Disclosures I have no disclosures relevant to this presentation Contents I. The
More informationThe author has no disclosures
Mary Bradbury, PharmD, BCPS Clinical Pharmacy Specialist, Cardiac Surgery September 18, 2012 Mary.bradbury@inova.org This presentation will discuss unlabeled and investigational use of products The author
More informationGoals 6/6/2014. Stroke Prevention in Atrial Fibrillation: New Oral Anti-Coagulants No More INRs. Ashkan Babaie, MD
Stroke Prevention in Atrial Fibrillation: New Oral Anti-Coagulants No More INRs Ashkan Babaie, MD Arrhythmia Service Providence Heart Clinic June 8 th, 2014 Goals Discuss the data behind approval of NOACs
More informationNone. Dual Antiplatelet Therapy Plus Systemic Anticoagulation: Bleeding Risk and Management. 76 year old male LINGO 1/5/2015
Financial Disclosure Information Dual Antiplatelet Therapy Plus Systemic Anticoagulation: Bleeding Risk and Management Robert D. McBane, M.D. Division of Cardiology Mayo Clinic Rochester Dual Antiplatelet
More informationAntiplatelet and Antithrombotics From clinical trials to guidelines
Antiplatelet and Antithrombotics From clinical trials to guidelines Ashraf Reda, MD, FESC Prof and head of Cardiology Dep. Menofiya University Preisedent of EGYBAC Chairman of WGLVR One of the big stories
More information4/9/2015. Risk Stratify Our Patients. Stroke Risk in AF: CHADS2 Scoring system JAMA 2001; 285: 2864-71
Anticoagulation in the 21 st Century Adam Karpman, D.O. Saint Francis Medical Center/Oklahoma State University Medical Center Disclosures: None Atrial Fibrillation Most common arrhythmia in clinical practice.
More informationACCIDENT AND EMERGENCY DEPARTMENT/CARDIOLOGY
Care Pathway Triage category ATRIAL FIBRILLATION PATHWAY ACCIDENT AND EMERGENCY DEPARTMENT/CARDIOLOGY AF/ FLUTTER IS PRIMARY REASON FOR PRESENTATION YES NO ONSET SYMPTOMS OF AF./../ TIME DURATION OF AF
More informationMaking the Health Check work for you
Making the Health Check work for you Atrial Fibrillation and the GRASP toolkit (Guidance on Risk Assessment and Stroke Prevention ) Dr. Indira Natarajan Consultant Stroke Physician University Hospital
More informationDERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) MANAGEMENT of Atrial Fibrillation (AF)
DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) MANAGEMENT of Atrial Fibrillation (AF) Key priorities Identification and diagnosis Treatment for persistent AF Treatment for permanent AF Antithrombotic
More informationA focus on atrial fibrillation
A focus on atrial fibrillation Is being female really a risk factor for stroke? Dr Justin Mariani MBBS BMedSci PhD FRACP FCSANZ Consultant Cardiologist and Interventional Heart Failure Specialist Alfred
More informationLimitations of VKA Therapy
Fibrillazione Atriale Non Valvolare Ischemia o Emorragia le Due Utopie Rivali nella Scelta dei NAO Gianluca Botto, MD, FESC, UO Elettrofisiologia, Dip Medicina Limitations of VKA Therapy Unpredictable
More informationAtrial Fibrillation: A Different Perspective. Michael Heffernan MD PhD FRCPC FACC Staff Cardiologist Oakville Hospital
Atrial Fibrillation: A Different Perspective Michael Heffernan MD PhD FRCPC FACC Staff Cardiologist Oakville Hospital Faculty/Presenter Disclosure Faculty: Dr. Michael Heffernan Relationships with commercial
More informationAnalyzing Clinical Trial Findings of the Efficacy and Safety Profiles of Novel Anticoagulants for Stroke Prevention in Atrial Fibrillation
Analyzing Clinical Trial Findings of the Efficacy and Safety Profiles of Novel Anticoagulants for Stroke Prevention in Atrial Fibrillation Drew Baldwin, MD Virginia Mason Seattle, Washington NCVH May 29,
More informationXarelto (Rivaroxaban)
Xarelto (Rivaroxaban) Hightly selective, reversible, direct oral FXa inhibitor Maxium concentratiion after 2 to 4 hrs High bioavailability(66%),increase with food ( suggest with food) 1/3 from renal excretion,
More informationStroke risk in atrial fibrillation: Do we anticoagulate CHADS 2 or CHA 2 DS 2 -VASc 1, or higher?
Current Controversies 1165 Stroke risk in atrial fibrillation: Do we anticoagulate CHADS 2 or CHA 2 DS 2 -VASc 1, or higher? Jonas Bjerring Olesen 1 ; Christian Torp-Pedersen 2 1 Department of Cardiology,
More informationGRASP-AF Coming to a PCT near you.
GRASP-AF Coming to a PCT near you. ADAS Anticoagulation dosing advisory service Blackpool Teaching Hospitals Trust Sean O'Brien; Anticoagulation Specialist BMS Grasp-AF and the implications on our Anticoagulation
More informationAnticoagulation For Atrial Fibrillation
Anticoagulation For Atrial Fibrillation New Agents In A New Era Arjun V Gururaj, MD Arrhythmia and Electrophysiology Nevada Heart and Vascular Center Disclosures Biotronik Speaker Clinical investigator
More informationAnticoagulation Therapy Update
Anticoagulation Therapy Update JUDY R. WALLING, FNP-BC ARRHYTHMIA MANAGEMENT MUSC CARDIOLOGY Outline Who do we anticoagulate? Review classes of Anticoagulants Review examples of Anticoagulants Review CHADS2
More informationThere are an estimated 3 million adults in the United
POPULATION HEALTH MANAGEMENT Volume 17, Number 3, 2014 ª Mary Ann Liebert, Inc. DOI: 10.1089/pop.2013.0056 The Economic Burden to Medicare of Stroke Events in Atrial Fibrillation Populations With and Without
More informationAnticoagulation at the end of life. Rhona Maclean Rhona.maclean@sth.nhs.uk
Anticoagulation at the end of life Rhona Maclean Rhona.maclean@sth.nhs.uk Content Anticoagulant Therapies Indications for anticoagulation Venous thromboembolism (VTE) Atrial Fibrillation Mechnical Heart
More informationStroke mechanism in patients with non-valvular atrial fibrillation according to the CHADS 2 and CHA 2 DS 2 -VASc scores
European Journal of Neurology 2012, 19: 473 479 doi:10.1111/j.1468-1331.2011.03547.x Stroke mechanism in patients with non-valvular atrial fibrillation according to the CHADS 2 and CHA 2 DS 2 -VASc scores
More informationAtrial Fibrillation and Heart Failure: A Cause or a Consequence
Atrial Fibrillation and Heart Failure: A Cause or a Consequence Rajat Deo, MD, MTR Assistant Professor of Medicine Division of Cardiology, Electrophysiology Section University of Pennsylvania November
More informationNHS DORSET CLINICAL COMMISSIONING GROUP POSITION STATEMENT ON ORAL ANTICOAGULANTS IN ATRIAL FIBRILLATION
Version 3 August 2014 NHS DORSET CLINICAL COMMISSIONING GROUP POSITION STATEMENT ON ORAL ANTICOAGULANTS IN ATRIAL FIBRILLATION Dorset CCG commissions the use of newer oral anti-coagulants in accordance
More informationAtrial Fibrillation An update on diagnosis and management
Dr Arvind Vasudeva Consultant Cardiologist Atrial Fibrillation An update on diagnosis and management Atrial fibrillation (AF) remains the commonest disturbance of cardiac rhythm seen in clinical practice.
More informationNational Medicines Information Centre
National Medicines Information Centre ST. JAMES S HOSPITAL DUBLIN 8 TEL 01-4730589 or 1850-727-727 FAX 01-4730596 www.nmic.ie THE CONTEMPORARY MANAGEMENT OF ATRIAL FIBRILLATION VOLUME 12 NUMBER 3 2006
More informationSporadic or short episodes of paroxysmal atrial fibrillation - still a need for antithrombotic therapy?
Sporadic or short episodes of paroxysmal atrial fibrillation - still a need for antithrombotic therapy? Carina Blomström Lundqvist Dept Cardiology, Uppsala University, Sweden Patterns of AF Terminates
More informationRATE VERSUS RHYTHM CONTROL OF ATRIAL FIBRILLATION: SPECIAL CONSIDERATION IN ELDERLY. Charles Jazra
RATE VERSUS RHYTHM CONTROL OF ATRIAL FIBRILLATION: SPECIAL CONSIDERATION IN ELDERLY Charles Jazra NO CONFLICT OF INTEREST TO DECLARE Relationship Between Atrial Fibrillation and Age Prevalence, percent
More informationHow to control atrial fibrillation in 2013 The ideal patient for a rate control strategy
How to control atrial fibrillation in 2013 The ideal patient for a rate control strategy L. Pison, MD Advances in Cardiac Arrhythmias and Great Innovations in Cardiology - Torino, September 28 th 2013
More informationDorset Cardiac Centre
P a g e 1 Dorset Cardiac Centre Patients with Atrial Fibrillation/Flutter undergoing DC Cardioversion or Ablation procedures- Guidelines for Novel Oral Anti-coagulants (NOACS) licensed for this use February
More informationAtrial Fibrillation, Chronic - Antithrombotic Treatment - OBSOLETE
Atrial Fibrillation, Chronic - Antithrombotic Treatment - OBSOLETE Clinical practice guidelines serve as an educational reference, and do not supersede the clinical judgment of the treating physician with
More informationMain Effect of Screening for Coronary Artery Disease Using CT
Main Effect of Screening for Coronary Artery Disease Using CT Angiography on Mortality and Cardiac Events in High risk Patients with Diabetes: The FACTOR-64 Randomized Clinical Trial Joseph B. Muhlestein,
More informationAtrial fibrillation: medicines to help reduce your risk of a stroke what are the options?
Patient decision aid Atrial fibrillation: medicines to help reduce your risk of a stroke what are the options? http://guidance.nice.org.uk/cg180/patientdecisionaid/pdf/english Published: June 2014 About
More informationAnticoagulation: Stroke Prevention in Patients with Atrial Fibrillation
Anticoagulation: Stroke Prevention in Patients with Atrial Fibrillation Albert L.Waldo, MD KEYWORDS Atrial fibrillation Oral anticoagulation Stroke risk EPIDEMIOLOGY OF STROKE RISK It is well recognized
More informationOn route to 65......by optimising warfarin monitoring
On route to 65......by optimising warfarin monitoring Warfarin tried, trusted, underused Stroke significant costs to patients and the NHS In the UK, there are 12,500 strokes per year attributable to AF
More informationAHA/ASA Scientific Statement Oral Antithrombotic Agents for the Prevention of Stroke in Atrial Fibrillation
AHA/ASA Scientific Statement Oral Antithrombotic Agents for the Prevention of Stroke in Atrial Fibrillation A Statement for Healthcare Professionals from the American Heart Association/American Stroke
More information9/5/14. Objectives. Atrial Fibrillation (AF)
Novel Anticoagulation for Prevention of Stroke in Patients with Atrial Fibrillation Objectives 1. Review current evidence on use of warfarin in individuals with atrial fibrillation 2. Compare the three
More informationNew Anticoagulation Options for Stroke Prevention in Atrial Fibrillation. Joy Wahawisan, Pharm.D., BCPS April 25, 2012
New Anticoagulation Options for Stroke Prevention in Atrial Fibrillation Joy Wahawisan, Pharm.D., BCPS April 25, 2012 Stroke in Atrial Fibrillation % Stroke 1991;22:983. Age Range (years) CHADS 2 Risk
More informationA Patient s Guide to Antithrombotic Therapy in Atrial Fibrillation
Patient s Guide to Antithrombotic Therapy in Atrial Fibrillation A Patient s Guide to Antithrombotic Therapy in Atrial Fibrillation PATIENT EDUCATION GUIDE What is atrial fibrillation? Atrial fibrillation
More informationDISCLOSURES RISK ASSESSMENT. Stroke and Heart Disease -Is there a Link Beyond Risk Factors? Daniel Lackland, MD
STROKE AND HEART DISEASE IS THERE A LINK BEYOND RISK FACTORS? D AN IE L T. L AC K L AN D DISCLOSURES Member of NHLBI Risk Assessment Workgroup RISK ASSESSMENT Count major risk factors For patients with
More information3/25/14. To Clot or Not What s New In Anticoagulation? Clotting Cascade. Anticoagulant drug targets. Anita Ralstin, MS CNS CNP. Heparin.
To Clot or Not What s New In Anticoagulation? Anita Ralstin, MS CNS CNP 1 Clotting Cascade 2 Anticoagulant drug targets Heparin XI VIII IX V X VII LMWH II Warfarin Fibrin clot 1 Who Needs Anticoagulation
More informationDISCLOSURE. Atrial Fibrillation Management An Evidence-based Approach OBJECTIVES BACKGROUND AFFIRM 9/16/2015
Death (%) Mortality (%) 9/16/2015 DISCLOSURE Atrial Fibrillation Management An Evidence-based Approach Jonathon Adams, MD, FHRS Relevant Financial Relationship(s) None Off Label Usage None OBJECTIVES What
More informationAF, Stroke Risk and New Anticoagulants
Carmarthen Cardiac Update Course AF, Stroke Risk and New Anticoagulants Dr Hamsaraj Shetty, B.Sc, FRCP (London & Edinburgh) Consultant Physician & Honorary Senior Lecturer University Hospital of Wales,Cardiff
More informationAtrial fibrillation, anticoagulation, fall risk, and outcomes in elderly patients
Curriculum in Cardiology Atrial fibrillation, anticoagulation, fall risk, and outcomes in elderly patients Matthew B. Sellers, MD, a and L. Kristin Newby, MD, MHS a,b,c Durham, NC Atrial fibrillation (AF)
More information2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS, REGISTRY
Measure #326 (NQF 1525): Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy National Quality Strategy Domain: Effective Clinical Care 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS,
More informationEvidence-Based Secondary Stroke Prevention and Adherence to Guidelines
Evidence-Based Secondary Stroke Prevention and Adherence to Guidelines Mitchell S.V. Elkind, MD, MS Associate Professor of Neurology Columbia University New York, NY Presenter Disclosure Information Mitchell
More informationSurvey of Canadian Physicians Use of anti-thrombotic therapy for Atrial Fibrillation
Survey of Canadian Physicians Use of anti-thrombotic therapy for Atrial Fibrillation On the following pages are a number of questions asking about the conditions under which you would prescribe anticoagulation
More informationWhat s New in Stroke?
5 th McMaster University Review Course in INTERNAL MEDICINE What s New in Stroke? Robert Hart, M.D. HHS / McMaster Stroke Program Department of Medicine (Neurology) McMaster University Hamilton, Ontario
More informationManagement of Antithrombotics with Procedures. Jordan Weinstein, MD
Management of Antithrombotics with Procedures Jordan Weinstein, MD Presenter Disclosure Information Cardiology Update 2013 I have no relevant financial interest and/or arrangement with industry. Novel
More informationAtherosclerosis of the aorta. Artur Evangelista
Atherosclerosis of the aorta Artur Evangelista Atherosclerosis of the aorta Diagnosis Classification Prevalence Risk factors Marker of generalized atherosclerosis Risk of embolism Therapy Diagnosis Atherosclerosis
More informationElisabetta Toso, MD Dipartment of Medical Sciences University of Turin
Security and efficacy of Rivaroxaban in real life in the prevention of the stroke in non valvular AF patients: presentation of the results of the international study Xantus Elisabetta Toso, MD Dipartment
More informationRisk of stroke and oral anticoagulant use in atrial fibrillation:
Research Tim A Holt, Tina D Hunter, Candace Gunnarsson, Nada Khan, Paul Cload and Gregory YH Lip Risk of stroke and oral anticoagulant use in atrial fibrillation: a cross-sectional survey Abstract Background
More informationKDIGO THE GEORGE INSTITUTE FOR GLOBAL HEALTH. Antiocoagulation in diabetes and CKD Vlado Perkovic
THE GEORGE INSTITUTE FOR GLOBAL HEALTH Antiocoagulation in diabetes and CKD Vlado Perkovic Executive Director, George Institute Australia Professor of Medicine, University of Sydney Affiliated with the
More informationΠΟΙΟ ΑΝΤΙΠΗΚΤΙΚΟ ΓΙΑ ΤΟΝ ΑΣΘΕΝΗ ΜΟΥ? ΚΛΙΝΙΚΑ ΠΑΡΑΔΕΙΓΜΑΤΑ. Σωκράτης Παστρωμάς Καρδιολόγος Νοσοκομείο Ερρίκος Ντυνάν
ΠΟΙΟ ΑΝΤΙΠΗΚΤΙΚΟ ΓΙΑ ΤΟΝ ΑΣΘΕΝΗ ΜΟΥ? ΚΛΙΝΙΚΑ ΠΑΡΑΔΕΙΓΜΑΤΑ Σωκράτης Παστρωμάς Καρδιολόγος Νοσοκομείο Ερρίκος Ντυνάν The AF epidemic Mayo Clinic data (assuming a continued increase in the AF incidence) Mayo
More informationAntiplatelet and Antithrombotic Therapy. Dr Curry Grant Stroke Prevention Clinic Quinte Health Care
Antiplatelet and Antithrombotic Therapy Dr Curry Grant Stroke Prevention Clinic Quinte Health Care Disclosure of Potential for Conflict of Interest Dr. F.C. Grant Atrial Fibrillation FINANCIAL DISCLOSURE:
More informationNon- Valvular Atrial Fibrillation and Stroke Prevention: Which OAC Do I Choose. Warfarin vs the NOACs
Non- Valvular Atrial Fibrillation and Stroke Prevention: Which OAC Do I Choose Warfarin vs the NOACs Dr. Lori McIntosh D.O. Board Certified Neurologist Objectives Be able to list the current options of
More informationCosts and Benefits of Antithrombotic Therapy in Atrial Fibrillation in England: An Economic Analysis based on GRASP-AF
Costs and Benefits of Antithrombotic Therapy in Atrial Fibrillation in England: An Economic Analysis based on GRASP-AF Marion Kerr Insight Health Economics for NHS We would like to acknowledge PRIMIS who
More informationRecurrent AF: Choosing the Right Medication.
In the name of God Shiraz E-Medical Journal Vol. 11, No. 3, July 2010 http://semj.sums.ac.ir/vol11/jul2010/89015.htm Recurrent AF: Choosing the Right Medication. Basamad Z. * Assistant Professor, Department
More informationManagement of atrial fibrillation. Satchana Pumprueg, MD Sirin Apiyasawat, MD Thoranis Chantrarat, MD
Management of atrial fibrillation Satchana Pumprueg, MD Sirin Apiyasawat, MD Thoranis Chantrarat, MD Antithrombotic therapy in atrial fibrillation Satchana Pumprueg, MD AF has serious consequences Independent
More informationOAC and NOAC with or without platelet inhibition
Zürich 11.06.2015 Preoperative antithrombotic management OAC and NOAC with or without platelet inhibition Miodrag Filipovic miodrag.filipovic@kssg.ch Anästhesiologie & Intensivmedizin Case 1 76 yr old
More informationCurrent Management of Atrial Fibrillation DISCLOSURES. Heart Beat Anatomy. I have no financial conflicts to disclose
Current Management of Atrial Fibrillation Mary Macklin, MSN, APRN Concord Hospital Cardiac Associates DISCLOSURES I have no financial conflicts to disclose Book Women: Fit at Fifty. A Guide to Living Long.
More informationHow do you decide on rate versus rhythm control?
Heart Rhythm Congress 2014 How do you decide on rate versus rhythm control? Dr Ed Duncan Consultant Cardiologist & Electrophysiologist Define Rhythm Control DC Cardioversion Pharmacological AFFIRM study
More information1/7/2012. Objectives. Epidemiology of Atrial Fibrillation(AF) Stroke in AF. Stroke Risk Stratification in AF
Objectives Atrial Fibrillation and Prevention of Thrombotic Complications: Therapeutic Update Andrea C. Flores Pharm.D Pharmacy Resident at the Miami VA Healthcare System Review the epidemiology, pathophysiology
More informationEXPANDING THE EVIDENCE BASE IN OUTCOMES RESEARCH: USING LINKED ELECTRONIC MEDICAL RECORDS (EMR) AND CLAIMS DATA
EXPANDING THE EVIDENCE BASE IN OUTCOMES RESEARCH: USING LINKED ELECTRONIC MEDICAL RECORDS (EMR) AND CLAIMS DATA A CASE STUDY EXAMINING RISK FACTORS AND COSTS OF UNCONTROLLED HYPERTENSION ISPOR 2013 WORKSHOP
More informationMEETING THE CHALLENGES IN ATRIAL FIBRILLATION MANAGEMENT: THE ROLE OF NEW ANTICOAGULANTS
MEETING THE CHALLENGES IN ATRIAL FIBRILLATION MANAGEMENT: THE ROLE OF NEW ANTICOAGULANTS Summary of Presentations from the Daiichi Sankyo Satellite Symposium, held at the Annual ESC Congress, Barcelona,
More informationThe 50-year Quest to Replace Warfarin: Novel Anticoagulants Define a New Era. CCRN State of the Heart 2012 June 2, 2012
The 50-year Quest to Replace Warfarin: Novel Anticoagulants Define a New Era CCRN State of the Heart 2012 June 2, 2012 Disclosures I have I have been involved in trials of new anticoagulants and have received
More informationManagement of ATRIAL FIBRILLATION. in general practice. 22 BPJ Issue 39
Management of ATRIAL FIBRILLATION in general practice 22 BPJ Issue 39 What is atrial fibrillation? Atrial fibrillation (AF) is the most common cardiac arrhythmia encountered in primary care. It is often
More informationHERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC) RIVAROXABAN RECOMMENDED see specific recommendations for licensed indications below
Name: generic (trade) Rivaroxaban (Xarelto ) HERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC) RIVAROXABAN RECOMMENDED see specific recommendations for licensed indications below What it is Indications
More informationAtrial Fibrillation: New Approaches to an Old Friend PETER JESSEL, MD ASSISTANT PROFESSOR
Atrial Fibrillation: New Approaches to an Old Friend PETER JESSEL, MD ASSISTANT PROFESSOR Disclosures None relevant to this presentation Outline Introduction Natural History and Stroke Risk Stroke/Bleeding
More informationApixaban Plus Mono vs. Dual Antiplatelet Therapy in Acute Coronary Syndromes: Insights from the APPRAISE-2 Trial
Apixaban Plus Mono vs. Dual Antiplatelet Therapy in Acute Coronary Syndromes: Insights from the APPRAISE-2 Trial Connie N. Hess, MD, MHS, Stefan James, MD, PhD, Renato D. Lopes, MD, PhD, Daniel M. Wojdyla,
More informationFinancial Disclosures
Financial Disclosures Consulting: AstraZeneca, Bayer, Boehringer Ingleheim, Bristol-Myers Squibb, Daiichi Sankyo, Eli Lilly, Glaxo Smith Kline, Johnson & Johnson, Merck, Novartis, Ortho/McNeill, Pfizer,
More informationAnticoagulation in Atrial Fibrillation
Anticoagulation in Atrial Fibrillation Parag P. Patel, MD FACC Disclosures Eliquis Speakers Bureau 1 Clinical Scenario Ms. L is a 76F admitted to the stroke service with a dense right sided hemiparesis
More informationAll Wales Risk/Benefit Assessment Tool for Oral Anticoagulant Treatment in People with Atrial Fibrillation
All Wales Risk/Benefit Assessment Tool for Oral Anticoagulant Treatment in People with Atrial Fibrillation October 2013 This report has been prepared by a multiprofessional collaborative group, with support
More informationATRIAL FIBRILLATION: Scope of the Problem. October 2015
ATRIAL FIBRILLATION: Scope of the Problem October 2015 Purpose of the Presentation Review the worldwide incidence and prognosis associated with atrial fibrillation (AF) Identify the types of AF, clinical
More informationAnticoagulation: How Do I Pick From All the Choices? Jeffrey H. Neuhauser, DO, FACC BHHI Primary Care Symposium February 28, 2014
Anticoagulation: How Do I Pick From All the Choices? Jeffrey H. Neuhauser, DO, FACC BHHI Primary Care Symposium February 28, 2014 Atrial Fibrillation 2 Atrial Fibrillation The most common arrhythmia encountered
More information