Atrial fibrillation as a risk factor for stroke: a retrospective cohort study of hospitalized Medicare beneficiaries.

Yuan, Zuyi; Bowlin, Steven J.; Einstadter, Douglas; Cebul, Randall D.; Conners, A; Rimm, Alfred A.

doi:10.2105/ajph.88.3.395

Cited by 43 publications

(23 citation statements)

References 33 publications

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“…[13][14][15][16][17] The 1-year mortality rates in our model were 4.3% for no antithrombotic therapy, 4.2% for aspirin or dual antiplatelet therapy, 4.0% for warfarin, and 3.9% for dabigatran (either dose). Rates were calibrated with mortality in RE-LY.…”

Section: Probability Of Adverse Outcomes In the Decision Modelmentioning

confidence: 99%

Cost-Effectiveness of Dabigatran for Stroke Prophylaxis in Atrial Fibrillation

2011

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Background-Recent studies have investigated alternatives to warfarin for stroke prophylaxis in patients with atrial fibrillation (AF), but whether these alternatives are cost-effective is unknown. Methods and Results-On the basis of the results from Randomized Evaluation of Long Term Anticoagulation Therapy (RE-LY) and other trials, we developed a decision-analysis model to compare the cost and quality-adjusted survival of various antithrombotic therapies. We ran our Markov model in a hypothetical cohort of 70-year-old patients with AF using a cost-effectiveness threshold of $50 000/quality-adjusted life-year. We estimated the cost of dabigatran as US $9 a day. For a patient with an average risk of major hemorrhage (Ϸ3%/y), the most cost-effective therapy depended on stroke risk. For patients with the lowest stroke rate (CHADS 2 stroke score of 0), only aspirin was cost-effective. For patients with a moderate stroke rate (CHADS 2 score of 1 or 2), warfarin was cost-effective unless the risk of hemorrhage was high or quality of international normalized ratio control was poor (time in the therapeutic range Ͻ57.1%). For patients with a high stroke risk (CHADS 2 stroke score Ն3), dabigatran 150 mg (twice daily) was cost-effective unless international normalized ratio control was excellent (time in the therapeutic range Ͼ72.6%). Neither dabigatran 110 mg nor dual therapy (aspirin and clopidogrel) was cost-effective. Conclusions-Dabigatran 150 mg (twice daily) was cost-effective in AF populations at high risk of hemorrhage or high risk of stroke unless international normalized ratio control with warfarin was excellent. Warfarin was cost-effective in moderate-risk AF populations unless international normalized ratio control was poor. (Circulation. 2011;123:2562-2570.)

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Section: Probability Of Adverse Outcomes In the Decision Modelmentioning

confidence: 99%

Cost-Effectiveness of Dabigatran for Stroke Prophylaxis in Atrial Fibrillation

2011

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“…Indeed, atrial fibrillation by itself is an independent risk factor for stroke, angina pectoris, and congestive heart failure, and is associated with a twofold higher risk of death (43,44).…”

Section: Endogenous Causesmentioning

confidence: 99%

Subclinical hyperthyroidism: clinical features and treatment options

et al. 2005

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Subclinical hyperthyroidism appears to be a common disorder. It may be caused by exogenous or endogenous factors: excessive TSH suppressive therapy with L-thyroxine (L-T4) for benign thyroid nodular disease, differentiated thyroid cancer, or hormone over-replacement in patients with hypothyroidism are the most frequent causes. Consistent evidence indicates that 'subclinical' hyperthyroidism reduces the quality of life, affecting both the psycho and somatic components of well-being, and produces relevant signs and symptoms of excessive thyroid hormone action, often mimicking adrenergic overactivity. Subclinical hyperthyroidism exerts many significant effects on the cardiovascular system; it is usually associated with a higher heart rate and a higher risk of supraventricular arrhythmias, and with an increased left ventricular mass, often accompanied by an impaired diastolic function and sometimes by a reduced systolic performance on effort and decreased exercise tolerance. It is well known that these abnormalities usually precede the onset of a more severe cardiovascular disease, thus potentially contributing to the increased cardiovascular morbidity and mortality observed in these patients. In addition, it is becoming increasingly apparent that subclinical hyperthyroidism may accelerate the development of osteoporosis and hence increased bone vulnerability to trauma, particularly in postmenopausal women with a pre-existing predisposition. Subclinical hyperthyroidism and its related clinical manifestations are reversible and may be prevented by timely treatment.European Journal of Endocrinology 152 1-9

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“…Its prevalence rapidly increases after the sixth decade of life and is about 10% in people more than 80 years of age [1][2][3]. AFF is associated with a 4-5 fold increase in the risk of ischemic stroke at all ages, and the percentage of ischemic strokes attributable to AFF rises with advancing age up to nearly 25% in the class from 80 to 89 years [4][5][6]. In patients with AFF oral anticoagulant therapy with vitamin K antagonists (VKAs) prevents cardio-embolism, with a relative risk reduction of ischemic stroke of more than 60% [7,8].…”

Section: Introductionmentioning

confidence: 99%

Factors affecting adherence to guidelines for antithrombotic therapy in elderly patients with atrial fibrillation admitted to internal medicine wards

Marcucci

Iorio

Nobili

et al. 2010

European Journal of Internal Medicine

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Introduction: Current guidelines for ischemic stroke prevention in atrial fibrillation or flutter (AFF) recommend Vitamin K antagonists (VKAs) for patients at high-intermediate risk and aspirin for those at intermediate-low risk. The cost-effectiveness of these treatments was demonstrated also in elderly patients. However, there are several reports that emphasize the underuse of pharmacological prophylaxis of cardio-embolism in patients with AFF in different health care settings. Aims: To evaluate the adherence to current guidelines on cardio-embolic prophylaxis in elderly (N 65 years old) patients admitted with an established diagnosis of AFF to the Italian internal medicine wards participating in REPOSI registry, a project on polypathologies/polytherapies stemming from the collaboration between the Italian Society of Internal Medicine and the Mario Negri Institute of Pharmacological Research; to investigate whether or not hospitalization had an impact on guidelines adherence; to test the role of possible modifiers of VKAs prescription. Methods: We retrospectively analyzed registry data collected from January to December 2008 and assessed the prevalence of patients with AFF at admission and the prevalence of risk factors for cardio-embolism. After stratifying the patients according to their CHADS 2 score the percentage of appropriateness of antithrombotic therapy prescription was evaluated both at admission and at discharge. Univariable and multivariable logistic regression models were employed to verify whether or not socio-demographic (age N 80 years, living alone) and clinical features (previous or recent bleeding, cranio-facial trauma, cancer, dementia) modified the frequency and modalities of antithrombotic drugs prescription at admission and discharge. Results: Among the 1332 REPOSI patients, 247 were admitted with AFF. At admission, CHADS 2 score was ≥ 2 in 68.4% of patients, at discharge in 75.9%. Among patients with AFF 26.5% at admission and 32.8% at discharge were not on any antithrombotic therapy, and 43.7% at admission and 40.9% at discharge were not taking an appropriate therapy according to the CHADS 2 score. The higher the level of cardio-embolic risk the higher was the percentage of antiplatelet-but not of VKAs-treated patients. At admission or at discharge, both at univariable and at multivariable logistic regression, only an age N 80 years and a diagnosis of cancer, previous or active, had a statistically significant negative effect on VKAs prescription. Moreover, only a positive history of bleeding events (past or present) was independently associated to no VKA prescription at discharge in patients who were on VKA therapy at admission. If heparin was considered as an appropriate therapy for patients with indication for VKAs, the percentage of patients admitted or discharged on appropriate therapy became respectively 43.7% and 53.4%. Conclusion: Among elderly patients admitted with a diagnosis of AFF to internal medicine wards, an appropriate antithrombotic prophylaxis was taken by less than ...

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Atrial fibrillation as a risk factor for stroke: a retrospective cohort study of hospitalized Medicare beneficiaries.

Cited by 43 publications

References 33 publications

Cost-Effectiveness of Dabigatran for Stroke Prophylaxis in Atrial Fibrillation

Cost-Effectiveness of Dabigatran for Stroke Prophylaxis in Atrial Fibrillation

Subclinical hyperthyroidism: clinical features and treatment options

Factors affecting adherence to guidelines for antithrombotic therapy in elderly patients with atrial fibrillation admitted to internal medicine wards

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