Motivational Interviewing to Support Oral AntiCoagulation adherence in patients with non-valvular Atrial Fibrillation (MISOAC-AF): a randomized clinical trial

Tzikas, Apostolos; Samaras, Athanasios; Κάρτας, Αναστάσιος; Vasdeki, Dimitra; Fotos, G; Dividis, G; Paschou, Eleni; Forozidou, Evropi; Tsoukra, Paraskevi; Kotsi, E; Goulas, Ioannis; Karvounis, Haralambos; Giannakoulas, George

doi:10.1093/ehjcvp/pvaa039

Cited by 31 publications

(30 citation statements)

References 35 publications

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“…This is an ancillary study to MISOAC-AF trial (Motivational Interviewing to Support Oral AntiCoagulation Adherence in patients with non-valvular Atrial Fibrillation, ClinicalTrials.gov identifier: NCT02941978) focusing on patients with AF and DM. The design and main results of the MISOAC-AF registry have been previously published [8,9]. In brief, MISOAC-AF demonstrated the impact of a patient-centered interview on improving patients' adherence to oral anticoagulation (OAC) treatment.…”

Section: Methodsmentioning

confidence: 99%

Prognostic significance of diabetes mellitus in patients with atrial fibrillation

Papazoglou

Κάρτας

Samaras

et al. 2021

Cardiovasc Diabetol

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Background There are limited data on the association of diabetes mellitus (DM) and levels of glycated hemoglobin (HbA1c) with outcomes in patients with atrial fibrillation (AF). Methods This retrospective cohort study included patients who were recently hospitalized with a primary or secondary diagnosis of AF from December 2015 through June 2018. Kaplan–Meier curves and Cox-regression adjusted hazard ratios (aHR) were calculated for the primary outcome of all-cause mortality and for the secondary outcomes of cardiovascular (CV) mortality and the composite outcome of CV death or hospitalization. Competing-risk regression analyses were performed to calculate the cumulative risk of stroke, major bleeding, AF- or HF-hospitalizations adjusted for the competing risk of all-cause death. Spline curve models were fitted to investigate associations of HbA1c values and mortality among patients with AF and DM. Results In total 1109 AF patients were included, of whom 373 (33.6%) had DM. During a median follow-up of 2.6 years, 414 (37.3%) patients died. The presence of DM was associated with a higher risk of all-cause mortality (aHR = 1.40 95% confidence intervals [CI] 1.11–1.75), CV mortality (aHR = 1.39, 95% CI 1.07–1.81), sudden cardiac death (aHR = 1.73, 95% CI 1.19–2.52), stroke (aHR = 1.87, 95% CI 1.01–3.45) and the composite outcome of hospitalization or CV death (aHR = 1.27, 95% CI 1.06–1.53). In AF patients with comorbid DM, the spline curves showed a positive linear association between HbA1c levels and outcomes, with values 7.6–8.2% being independent predictors of increased all-cause mortality, and values < 6.2% predicting significantly decreased all-cause and CV mortality. Conclusions The presence of DM on top of AF was associated with substantially increased risk for all-cause or CV mortality, sudden cardiac death and excess morbidity. HbA1c levels lower than 6.2% were independently related to better survival rates suggesting that optimal DM control could be associated with better clinical outcomes in AF patients with DM.

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Section: Methodsmentioning

confidence: 99%

Prognostic significance of diabetes mellitus in patients with atrial fibrillation

Papazoglou

Κάρτας

Samaras

et al. 2021

Cardiovasc Diabetol

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“…A recent cross-sectional study demonstrated high non-adherence rates or discontinuation of warfarin (26% and 17% respectively) in 127 young patients (mean age 31.2 years) after valve replacement surgery for rheumatic heart disease with a mean time since surgery of 3.7 years [ 39 ]. In general, adherence to NOACs is superior to VKAs [ 40 ], with one out of three patients who start warfarin for atrial fibrillation discontinuing treatment after one year of therapy [ 41 , 42 , 43 , 44 ]. Adherence to NOACs was also good (≥ 80%) during the two years of follow-up in the NOTE registry.…”

Section: Discussionmentioning

confidence: 99%

Non-Vitamin K Oral Anticoagulants in Adults with Congenital Heart Disease: A Systematic Review

Stalikas

Doundoulakis

Karagiannidis

et al. 2020

JCM

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Adults with congenital heart disease (ACHD) experience more thromboembolic complications than the general population. We systematically searched and critically appraised all studies on the safety and efficacy of non-vitamin-K oral anticoagulants (NOACs) in adult patients with various forms of congenital heart disease. PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL) were used, with duplicate extraction of data and risk of bias assessment. The Newcastle-Ottawa quality assessment scale was used to assess study quality. Three studies fulfilled the inclusion criteria and were analyzed. The total number of participants was 766, with a total follow-up of 923 patient-years. The majority of patients (77%) received a NOAC for atrial arrhythmias, while the remainder were prescribed NOACs for secondary (19%) or primary (4%) thromboprophylaxis. The annual rate of thromboembolic and major bleeding events was low: 0.98% (95% CI: 0.51–1.86) and 1.74% (95% CI: 0.86–3.49) respectively. In Fontan patients, the annual rate of thromboembolic and major bleeding events was 3.13% (95% CI: 1.18–8.03) and 3.17% (95% CI: 0.15–41.39) respectively. NOACs appear safe and effective in ACHD without mechanical prostheses. Additional studies are, however, needed to confirm their efficacy in complex ACHD, especially those with a Fontan-type circulation.

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“…This is an ancillary study to MISOAC-AF trial (Motivational Interviewing to Support Oral AntiCoagulation Adherence in patients with non-valvular Atrial Fibrillation, ClinicalTrials.gov identi er: NCT02941978) focusing on patients with AF and DM. The design and main results of the MISOAC-AF registry have been previously published 8,9 . In brief, MISOAC-AF demonstrated the impact of a patient-centered interview on improving patients' adherence to oral anticoagulation (OAC) treatment.…”

Section: Methodsmentioning

confidence: 99%

Prognostic significance of diabetes mellitus in patients with atrial fibrillation

et al. 2021

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Funding Acknowledgements Type of funding sources: None. Background Despite the plethora of studies on atrial fibrillation (AF) and diabetes mellitus (DM), there is still no sufficient data on the blood glucose regulation as a prognostic modifier in DM patients with AF. Purpose The purpose of this study was to investigate the association of DM and levels of glycated hemoglobin (HbA1c) with outcomes in patients with AF. Methods This retrospective cohort study included patients who were recently hospitalized with a primary or secondary diagnosis of AF from December 2015 through June 2018. Kaplan-Meier curves and Cox-regression adjusted hazard ratios (aHR) were calculated for the primary outcome of all-cause mortality and for the secondary outcomes of cardiovascular (CV) mortality, stroke and the composite outcome of CV death or hospitalization. Spline curve models were fitted to investigate associations of HbA1c values and mortality among patients with AF and DM. Results In total 1140 AF patients were included, of whom 373 (32.7%) had DM. During a median follow-up of 2.6 years, 414 (37.3%) patients died. The presence of DM was associated with a higher risk of all-cause mortality (aHR = 1.44, 95% confidence intervals [CI]: 1.12-1.85), CV mortality (aHR = 1.44, 95% CI: 1.08-1.93), stroke (aHR = 2.62, 95% CI: 1.24-5.53) and the composite outcome of hospitalization or CV death (aHR = 1.28, 95% CI: 1.06-1.54). In AF patients with comorbid DM, the spline curves showed a positive linear association between HbA1c levels and outcomes, with values <6.2% predicting significantly decreased all-cause and CV mortality. Conclusions The presence of DM on top of AF was associated with a 1.5-fold increased risk for all-cause or CV mortality and excess morbidity. HbA1c levels lower than 6.2% were independently related to better survival rates. Follow-up outcomes by presence of DMOutcomeDMNon-DMAdjusted HR(95% CI)p-valueAll-cause death171/373 (45.8%)243/736 (33%)1.44 (1.12-1.85)<0.001CV-death130/373 (34.9%)173/736 (23.5%)1.44 (1.08-1.93)<0.001Major bleeding18/340 (5.3%)29/644 (4.5%)1.53 (0.71-3.28)0.291Stroke24/340 (7.1%)28/645 (4.3%)2.62 (1.24-5.53)0.013AF-related hospitalization59/340 (17.4%)115/645 (17.8%)1.20 (0.78-1.85)0.281HF-related hospitalization35/333 (10.5%)46/640 (7.2%)1.34 (0.83-2.19)0.235Hospitalization or CV-death243/373 (65.1%)399/736(54.2%)1.28 (1.06-1.54)<0.001*Adjusted for: age, gender, smoking, BMI, history of hypertension, eGFR (CKD-EPI) and use of statin, ACEI-ARB, OAC and rate control medication after discharge.DM, diabetes mellitus; HR, hazard ratio; AF, atrial fibrillation; CV, cardiovascular; HF, heart failure.Abstract Figure. Visual overview of the study

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Motivational Interviewing to Support Oral AntiCoagulation adherence in patients with non-valvular Atrial Fibrillation (MISOAC-AF): a randomized clinical trial

Cited by 31 publications

References 35 publications

Prognostic significance of diabetes mellitus in patients with atrial fibrillation

Prognostic significance of diabetes mellitus in patients with atrial fibrillation

Non-Vitamin K Oral Anticoagulants in Adults with Congenital Heart Disease: A Systematic Review

Prognostic significance of diabetes mellitus in patients with atrial fibrillation

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