Background Atrial fibrillation (AF) is an irregular heart rhythm which is becoming more and more common in this new era. Obesity is a risk factor for cardiovascular events, and obese patients are more at risk for stroke. The Framingham Heart Study demonstrated an increase in the developmental risk of AF by 4% for every unit (kg/m2) increase in body mass index (BMI). An anticoagulant is often required for the management of such patients. In this analysis, we aimed to systematically compare the clinical outcomes which were associated with rivaroxaban versus warfarin for the treatment of obese patients with non-valvular AF. Methods PubMed, EMBASE, Web of Science, http://www.ClinicalTrials.gov, Google Scholar, and Cochrane Central were the searched databases. Clinical outcomes including stroke, systemic embolism, and major bleeding were the endpoints. In this study, dichotomous data were analyzed by the RevMan software version 5.4. Risk ratio (RR) with 95% confidence interval (CI) was used for result interpretation. Results Ten studies consisting of a total number of 168,081 obese participants were included whereby 81,332 participants were treated with rivaroxaban and 86,749 participants were treated with warfarin. The risks of ischemic (RR: 0.79, 95% CI: 0.74–0.84; P = 0.00001) and hemorrhagic stroke (RR: 0.61, 95% CI: 0.48–0.76; P = 0.0001) as well as systemic embolism (RR: 0.73, 95% CI: 0.62–0.87; P = 0.0004) were significantly lower with rivaroxaban compared to warfarin for the management of these obese patients with non-valvular AF. Rivaroxaban was also associated with a significantly lower risk of major bleeding (RR: 0.75, 95% CI: 0.65–0.87; P = 0.0001). Conclusion Based on this analysis, rivaroxaban seemed to be a better option in comparison to warfarin, due to its association with significantly lower risks of stroke and bleeding outcomes in obese patients with non-valvular AF. However, this hypothesis should further be confirmed in larger clinical trials.

Background Chronic kidney disease is a common clinical problem that endangers human physical and mental health and life safety. It eventually evolves into end-stage renal disease, and the incidence has increased year by year. It has been reported that the incidence of chronic kidney disease in China is about 10 %, and most patients need to carry out dialysis to maintain life. Objective To observe the influence of an individualized management model based on shared decision-making (SDM) between doctors, nurses and patients on the health outcomes and quality of life of maintenance hemodialysis patients. Methods A total of 100 end-stage renal disease patients treated with maintenance hemodialysis intervention in the Department of Nephrology, Changyisha City Fourth Hospital from May 2020 to May2021 were selected. According to the order of admission, they were randomly divided into control groups (n=50)) And the observation group (n=50). The control group received conventional management mode intervention, and the observation group received SDM-based individualized management mode intervention. The blood pressure and fluid control of the two groups were recorded, and the self-management behavior scale for hemodialysis patients (SMSH), the satisfaction survey questionnaire for patient participation in medical decision-making, and the kidney disease-related quality of life scale (KDTA) were used to evaluate the self-management ability of the two groups. Satisfaction and quality of life. Results After the intervention, fluid intake, weight gain between dialysis intervals, and the number of dialysis-related complications in the observation group decreased significantly (P<0.05), while the number of dialysis-related complications in the control group decreased (P<0.05), but fluid The intake and weight gain between dialysis intervals were similar to those before the intervention (P>0.05), and the fluid control in the observation group improved more significantly than the control group after the intervention (P<0.05). After the intervention, the systolic and diastolic blood pressure of the observation group decreased significantly (P<0.05), and the systolic and diastolic blood pressure of the control group were similar to those before the intervention (P>0.05). The blood pressure of the observation group improved more significantly than the control group after the intervention (P<0.05). After the intervention, the two groups of SMSH scale scores (problem solving, self-care, partnership, emotional processing, etc.), satisfaction scores (information, communication and negotiation, decision-making, total satisfaction and confidence, etc.), quality of life scores (symptoms, kidney disease, etc.) The impact of kidney disease, the burden of kidney disease, work status, cognitive function, social quality, sleep, social support, etc.) have been greatly improved (P<0.05), and the SMSH scale score, satisfaction score, quality of life of the observation group after intervention The score improved more significantly than the control group (P<0.05). Conclusion Intervention of maintenance hemodialysis patients based on an individualized management model of SDM can improve the self-management ability and satisfaction of patients, improve the quality of life, and reduce the occurrence of adverse events and complications.