Atrial fibrillation in the elderly

Franken, Roberto Alexandre; Rosa, Ronaldo F.; Santos, Silvio Cm

doi:10.3724/sp.j.1263.2011.12293

Cited by 14 publications

(7 citation statements)

References 62 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Sex steroid hormone-dependent mechanisms are evidenced by the effects of menopause on cardiovascular risk, 19 especially the increased risk of AF after menopause. 20 We sought to find the mechanical link between these factors.…”

Section: Discussionmentioning

confidence: 99%

Effect of Sex Differences on the Association Between Stroke Risk and Left Atrial Anatomy or Mechanics in Patients With Atrial Fibrillation

Yoshida

Obokata

Kurosawa

et al. 2016

Circ: Cardiovascular Imaging

View full text Add to dashboard Cite

Background-Embolic stroke in atrial fibrillation is more prevalent in women than in men, yet the basis for this difference remains unclear. This study seeks to elucidate whether there are any sex differences in the relationships between stroke risk (CHADS 2 score, CHA 2 DS 2 -VASc score without a sex category, and estimated stroke rate) and left atrial (LA) anatomy or mechanics in patients with atrial fibrillation. Methods and Results-LA emptying fraction and global peak atrial longitudinal strain were assessed in 414 subjects with paroxysmal or persistent atrial fibrillation (156 women and 258 men). Linear regression models with an interaction term were performed to test the effect of sex difference on associations between the embolic risk and LA function or anatomy. Sensitivity analyses were performed in 228 age, heart rate, and rhythm-matched subjects (114 women and men). Women were older and had larger LA volumes and lower LA mechanics than men. Significant negative association between the CHADS 2 score and LA emptying fraction was only demonstrated in women with a significant interaction between sexes. Similar significant interactions were found in global peak atrial longitudinal strain but not in LA volume. These findings were corroborated in the comparisons against CHA 2 DS 2 -VASc score without a sex category and the estimated stroke rate. Sensitivity analyses in the matched subgroup also confirmed the robustness of these sex differences in LA emptying fraction, but less so in global peak atrial longitudinal strain. Conclusions-Significant sex interactions on the association between global LA function and risk stratification schemes exist, which may be a reason for the higher prevalence of embolic stroke in women. (Circ Cardiovasc Imaging. 2016;9:e004999.

show abstract

Section: Discussionmentioning

confidence: 99%

Effect of Sex Differences on the Association Between Stroke Risk and Left Atrial Anatomy or Mechanics in Patients With Atrial Fibrillation

Yoshida

Obokata

Kurosawa

et al. 2016

Circ: Cardiovascular Imaging

View full text Add to dashboard Cite

show abstract

“…Atrial fibrillation (AF) is the most common sustained arrhythmia reported in adult patients [1] and is associated with an at least a five-fold increase in the risk of stroke [2]. Vitamin K antagonists (VKAs) formed the cornerstone of thromboembolic prophylaxis in patients with AF for many years.…”

Section: Introductionmentioning

confidence: 99%

International longitudinal registry of patients with atrial fibrillation and treated with rivaroxaban: RIVaroxaban Evaluation in Real life setting (RIVER)

et al. 2019

View full text Add to dashboard Cite

Background Real-world data on non-vitamin K oral anticoagulants (NOACs) are essential in determining whether evidence from randomised controlled clinical trials translate into meaningful clinical benefits for patients in everyday practice. RIVER (RIVaroxaban Evaluation in Real life setting) is an ongoing international, prospective registry of patients with newly diagnosed non-valvular atrial fibrillation (NVAF) and at least one investigator-determined risk factor for stroke who received rivaroxaban as an initial treatment for the prevention of thromboembolic stroke. The aim of this paper is to describe the design of the RIVER registry and baseline characteristics of patients with newly diagnosed NVAF who received rivaroxaban as an initial treatment. Methods and results Between January 2014 and June 2017, RIVER investigators recruited 5072 patients at 309 centres in 17 countries. The aim was to enroll consecutive patients at sites where rivaroxaban was already routinely prescribed for stroke prevention. Each patient is being followed up prospectively for a minimum of 2-years. The registry will capture data on the rate and nature of all thromboembolic events (stroke / systemic embolism), bleeding complications, all-cause mortality and other major cardiovascular events as they occur. Data quality is assured through a combination of remote electronic monitoring and onsite monitoring (including source data verification in 10% of cases). Patients were mostly enrolled by cardiologists ( n = 3776, 74.6%), by internal medicine specialists 14.2% ( n = 718) and by primary care/general practice physicians 8.2% ( n = 417). The mean (SD) age of the population was 69.5 (11.0) years, 44.3% were women. Mean (SD) CHADS 2 score was 1.9 (1.2) and CHA 2 DS 2 -VASc scores was 3.2 (1.6). Almost all patients (98.5%) were prescribed with once daily dose of rivaroxaban, most commonly 20 mg (76.5%) and 15 mg (20.0%) as their initial treatment; 17.9% of patients received concomitant antiplatelet therapy. Most patients enrolled in RIVER met the recommended threshold for AC therapy (86.6% for 2012 ESC Guidelines, and 79.8% of patients according to 2016 ESC Guidelines). Conclusions The RIVER prospective registry will expand our knowledge of how rivaroxaban is prescribed in everyday practice and whether evidence from clinical trials can be translated to the broader cross-section of patients in the real world. Trial registration Unique identifier: NCT02444221 . Registerd 14 May 2015; Retrospectively Registered. Electronic supplementary material The online version of this article (10.1186/s12959-019-0195-7) contains supplementary material, which is available to authorized users.

show abstract

“…Atrial fibrillation (AF) is also a disease of the ageing population. In fact, it is the most prevalent chronic arrhythmia in patients aged 65 years (5.9% of the population), and its prevalence from 50 years old on, doubles every 10 years 2 . Approximately 40% of patients with cardiac amyloidosis have coexistent AF 3 .…”

Section: Introductionmentioning

confidence: 99%

Best anticoagulation strategy with and without appendage occlusion for stroke‐prophylaxis in postablation atrial fibrillation patients with cardiac amyloidosis

Mohanty,

Torlapati,

La Fazia

et al. 2024

Cardiovasc electrophysiol

View full text Add to dashboard Cite

IntroductionBoth atrial fibrillation (AF) and amyloidosis increase stroke risk. We evaluated the best anticoagulation strategy in AF patients with coexistent amyloidosis.MethodsConsecutive AF patients with concomitant amyloidosis were divided into two groups based on the postablation stroke‐prophylaxis approach; group 1: left atrial appendage occlusion (LAAO) in eligible patients and group 2: oral anticoagulation (OAC). Group 1 patients were further divided into Gr. 1A: LAAO + half‐does NOAC (HD‐NOAC) for 6 months followed by aspirin 81 mg/day and Gr. 1B: LAAO + HD‐NOAC. In group 1 patients, with complete occlusion at the 45‐day transesophageal echocardiogram, patients were switched to aspirin, 81 mg/day at 6 months. In case of leak, or dense “smoke” in the left atrium (LA) or enlarged LA, they were placed on long‐term half‐dose (HD) NOAC. Group 2 patients remained on full‐dose NOAC during the whole study period.ResultsA total of 92 patients were included in the analysis; group 1: 56 and group 2: 36. After the 45‐day TEE, 31 patients from group 1 remained on baby‐aspirin and 25 on HD NOAC. At 1‐year follow‐up, four stroke, one TIA and six device‐thrombus were reported in group 1A, compared to none in patients in group 1B (5/31 vs. 0/25, p = .03). No bleeding events were reported in group 1, whereas group 2 had five bleeding events (one subdural hematoma, one retinal hemorrhage, and four GI bleedings). Additionally, one stroke was reported in group 2 that happened during brief discontinuation of OAC.ConclusionIn patients with coexistent AF and amyloidosis, half‐dose NOAC following LAAO was observed to be the safest stroke‐prophylaxis strategy.

show abstract

Atrial fibrillation in the elderly

Cited by 14 publications

References 62 publications

Effect of Sex Differences on the Association Between Stroke Risk and Left Atrial Anatomy or Mechanics in Patients With Atrial Fibrillation

Effect of Sex Differences on the Association Between Stroke Risk and Left Atrial Anatomy or Mechanics in Patients With Atrial Fibrillation

International longitudinal registry of patients with atrial fibrillation and treated with rivaroxaban: RIVaroxaban Evaluation in Real life setting (RIVER)

Best anticoagulation strategy with and without appendage occlusion for stroke‐prophylaxis in postablation atrial fibrillation patients with cardiac amyloidosis

Contact Info

Product

Resources

About