Guidelines for the management of patients with atrial fibrillation. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to develop guidelines for the management of patients with atrial fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology

Fuster, Valentín; Rydén, Lars; Asinger, Richard W.; Cannom, D.S.; Crijns, Harry J.G.M.; Frye, Robert L.; Halperin, Jonathan L.; Kay, G. Neal; Klein, W.; Lévy, Samuel; McNamara, Robert L.; Prystowsky, Eric N.; Wann, L. Samüel; Wyse, D. George; Alonso-García, Ángeles; Blomström‐Lundqvist, Carina; Backer, Guy De; Flather, Markus; Hradec, J; Oto, Ali̇; Parkhomenko, Alexander; Silber, Sigmund; Torbicki, Adam; Gibbons, Raymond J.; Antman, Elliott M.; Alpert, Joseph S.; Faxon, David P.; Gregoratos, Gabriel; Hiratzka, Loren F.; Jacobs, Alice K.; Russell, Richard O.; Smith, Jr Jc

doi:10.1053/euhj.2001.2983

Cited by 386 publications

(25 citation statements)

References 512 publications

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“…Our thromboembolic prophylaxis protocol has been described in earlier publications [8] and was established by consensus among investigators, after reviewing the guidelines of the Spanish Society of Cardiology for antithrombotic treatment in cardiology [9], published before the design of the study, and the scientific evidence available at that time. In the course of the study, the ACC/AHA/ESC guidelines for atrial fibrillation [10] and the guidelines of the Spanish Society of Cardiology on cardiac arrhythmias [11] became available. After reviewing both documents, the protocol was not changed because it was consistent with the basic principles of the 3 guidelines.…”

Section: Methodsmentioning

confidence: 99%

Oral Anticoagulation in Nonvalvular Atrial Fibrillation in Clinical Practice: Impact of CHADS<sub>2</sub> Score on Outcome

et al. 2010

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Objectives: CHADS₂ score predicts embolic risk in patients with nonvalvular atrial fibrillation (NVAF), but also bleeding risk in patients receiving oral anticoagulation (OAC). Our objective is to analyze the effectiveness and safety of OAC in patients with NVAF in daily clinical practice, according to embolic risk evaluated by means of CHADS₂ score. Methods: All consecutive outpatients with permanent NVAF seen at 2 cardiology clinics were prospectively followed for embolic events (transient ischemic attack, ischemic stroke, peripheral embolism) and severe bleedings. OAC was prescribed according to the recommendations of scientific associations. CHADS₂ score was obtained for each patient. Results: From February 1, 2000 to July 31, 2003, 796 outpatients fulfilled the inclusion criteria. OAC was prescribed to 564 (71%) patients. After 2.4 ± 1.9 years of follow-up, the embolic event rates (per 100 patient-years) for each stratum of the CHADS₂score for patients with/without OAC were: 1/4.1, p = 0.23 (CHADS₂ = 0); 0.6/7.1, p = 0.0018 (CHADS₂ = 1); 0.5/5.1, p = 0.0014 (CHADS₂ = 2); 2.4/12.5, p = 0.0017 (CHADS₂ = 3) and 2.9/20, p = 0.013 (CHADS₂ ≧4). The severe bleeding rates for the same CHADS₂ score strata were 3/0.8, 0.8/0.7, 1.3/0.7, 0.4/0, and 2.9/5 in patients with/without OAC (n.s.). Conclusion: OAC is effective and safe in daily clinical practice in patients with NVAF and CHADS₂ score ≧1.

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Section: Methodsmentioning

confidence: 99%

Oral Anticoagulation in Nonvalvular Atrial Fibrillation in Clinical Practice: Impact of CHADS<sub>2</sub> Score on Outcome

et al. 2010

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“…Warfarin loading doses may paradoxically result in a hypercoagulable state and potential clot formation because of significant reductions in protein C and protein S 3,4. A precipitous reduction in the concentration of protein C and protein S (with an approximate half-life of 8 hours) occurs during the first 36 hours of warfarin therapy, which is when warfarin has a very limited effect on prothrombin (which has an approximate half-life of 50 hours) 5.…”

Section: Discussionmentioning

confidence: 99%

Warfarin-induced deep vein thrombosis

Binymin¹,

Patel²

2014

IMCRJ

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We are presenting a 72-year-old female who was admitted to hospital with deep vein thrombosis (DVT). She was known to have atrial fibrillation and was initiated on warfarin for stroke prophylaxis 3 days earlier. She was given warfarin therapy without low molecular weight heparin cover as per “slow-start regimen” protocol. The warfarin dose was increased after 3 days to achieve rapid anticoagulation, resulting in DVT in the left leg. We propose that the higher unopposed warfarin dose utilized in this case resulted in DVT. Warfarin loading doses may paradoxically result in a hypercoagulable state and potential clot formation because of significant reductions in protein C and protein S levels.

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“…To be consistent with past research, 17 we excluded “focused updates” that are occasionally released between ACC/AHA guideline revisions to highlight interval changes to a limited number of recommendations. Our sample included 11 guidelines addressing a trial fibrillation 18,19 ; perioperative cardiovascular evaluation 20,21 ; cardiac pacemakers and antiar-rhythmia devices 22,23 ; secondary prevention of coronary artery disease 24,25 ; coronary artery bypass graft surgery 16,26 ; cardiovascular disease prevention in women 27,28 ; heart failure 29,30 ; percutaneous coronary intervention 31,32 ; chronic stable angina 33,34 ; unstable angina and non–ST-segment elevation myocardial infarction 35,36 ; and valvular heart disease. 37,38 A 12th guideline, on ST-segment elevation myocardial infarction, 39,40 was excluded because of differences in the topics addressed between versions.…”

Section: Methodsmentioning

confidence: 99%

Durability of Class I American College of Cardiology/American Heart Association Clinical Practice Guideline Recommendations

Neuman

Goldstein

Cirullo

et al. 2014

JAMA

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IMPORTANCE Little is known regarding the durability of clinical practice guideline recommendations over time. OBJECTIVE To characterize variations in the durability of class I (“procedure/treatment should be performed/administered”) American College of Cardiology/American Heart Association (ACC/AHA) guideline recommendations. DESIGN, SETTING, AND PARTICIPANTS Textual analysis by 4 independent reviewers of 11 guidelines published between 1998 and 2007 and revised between 2006 and 2013. MAIN OUTCOMES AND MEASURES We abstracted all class I recommendations from the first of the 2 most recent versions of each guideline and identified corresponding recommendations in the subsequent version. We classified recommendations replaced by less determinate or contrary recommendations as having been downgraded or reversed; we classified recommendations for which no corresponding item could be identified as having been omitted. We tested for differences in the durability of recommendations according to guideline topic and underlying level of evidence using bivariable hypothesis tests and conditional logistic regression. RESULTS Of 619 index recommendations, 495 (80.0%; 95%CI, 76.6%–83.1%) were retained in the subsequent guideline version, 57 (9.2%; 95%CI, 7.0%–11.8%) were downgraded or reversed, and 67 (10.8%; 95%CI, 8.4%–13.3%) were omitted. The percentage of recommendations retained varied across guidelines from 15.4%(95%CI, 1.9%–45.4%) to 94.1%(95%CI, 80.3%–99.3%; P < .001). Among recommendations with available information on level of evidence, 90.5%(95%CI, 83.2%–95.3%) of recommendations supported by multiple randomized studies were retained, vs 81.0% (95%CI, 74.8%–86.3%) of recommendations supported by 1 randomized trial or observational data and 73.7%(95% CI, 65.8%–80.5%) of recommendations supported by opinion (P = .001). After accounting for guideline-level factors, the probability of being downgraded, reversed, or omitted was greater for recommendations based on opinion (odds ratio, 3.14; 95%CI, 1.69–5.85; P < .001) or on 1 trial or observational data (odds ratio, 3.49; 95%CI, 1.45–8.41; P = .005) vs recommendations based on multiple trials. CONCLUSIONS AND RELEVANCE The durability of class I cardiology guideline recommendations for procedures and treatments promulgated by the ACC/AHA varied across individual guidelines and levels of evidence. Downgrades, reversals, and omissions were most common among recommendations not supported by multiple randomized studies.

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Cited by 386 publications

References 512 publications

Oral Anticoagulation in Nonvalvular Atrial Fibrillation in Clinical Practice: Impact of CHADS<sub>2</sub> Score on Outcome

Oral Anticoagulation in Nonvalvular Atrial Fibrillation in Clinical Practice: Impact of CHADS<sub>2</sub> Score on Outcome

Warfarin-induced deep vein thrombosis

Durability of Class I American College of Cardiology/American Heart Association Clinical Practice Guideline Recommendations

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