Paroxysmal atrial fibrillation and the hazards of under-treatment

Aronis, Konstantinos N.; Thigpen, Jonathan; Tripodis, Yorghos; Dillon, Chrisly; Forster, Kristen; Henault, Lori; Quinn, Emily; Berger, Peter B.; Limdi, Nita A.

doi:10.1016/j.ijcard.2015.09.006

Cited by 14 publications

(24 citation statements)

References 45 publications

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“…The guideline on AF management recommended OAC for stroke prevention, irrespective of the type of AF [8]. Aronis et al in 2016 [34] and Rizos et al [35] in 2011 reported that a significant proportion of episodes of stroke in patients with AF occur in patients with a history of paroxysmal AF, varying from 31 to 53%. In view of this, physicians should pay more attention to patients with paroxysmal or persistent AF.…”

Section: Duration and Type Of Afmentioning

confidence: 99%

Current status and factors influencing oral anticoagulant therapy among patients with non-valvular atrial fibrillation in Jiangsu province, China: a multi-center, cross-sectional study

Liu

Yang

et al. 2020

BMC Cardiovasc Disord

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Background: It has been reported that oral anticoagulation (OAC) is underused among Chinese patients with nonvalvular atrial fibrillation (NVAF). Non-vitamin K antagonist oral anticoagulants (NOAC) have been recommended by recent guidelines and have been covered since 2017 by the Chinese medical insurance; thus, the overall situation of anticoagulant therapy may change. The aim of this study was to explore the current status of anticoagulant therapy among Chinese patients with NVAF in Jiangsu province. Methods: This was a multi-center, cross-sectional study that was conducted in seven hospitals from January to September in 2017. The demographic characteristics and medical history of the patients were collected by questionnaire and from the medical records. Multivariate logistic regression was used to identify factors associated with anticoagulant therapy. Results: A total of 593 patients were included in the analysis. A total of 35.6% of the participants received OAC (11.1% NOAC and 24.5% warfarin). Of those patients with a high risk of stroke, 11.1% were on NOAC, 24.8% on warfarin, 30.6% on aspirin, and 33.6% were not on medication. Self-paying, duration of AF ≥5 years were negatively associated with anticoagulant therapy in all patients (OR 1.724, 95% CI 1.086~2.794; OR 1.471, 95% CI 1.006~2.149, respectively), whereas, permanent AF was positively associated with anticoagulant therapy (OR 0.424, 95% CI 0.215~0.839). Among patients with high risk of stroke, self-paying and increasing age were negatively associated with anticoagulant therapy (OR 2.305, 95% CI 1.186~4.478; OR 1.087, 95% CI 1.041~1.135, respectively). Conclusions: Anticoagulant therapy is positively associated with permanent AF and negatively associated with selfpaying, duration of AF > 5 years. Furthermore, the current status of anticoagulant therapy among Chinese patients with NVAF in Jiangsu province does not appear optimistic. Therefore, further studies should focus on how to improve the rate of OAC use among NVAF patients. In addition, policy makers should pay attention to the economic situation of the patients with NVAF using NOAC. Trial registration: 2,017,029. Registered 20 March 2017 (retrospectively registered).

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Section: Duration and Type Of Afmentioning

confidence: 99%

Current status and factors influencing oral anticoagulant therapy among patients with non-valvular atrial fibrillation in Jiangsu province, China: a multi-center, cross-sectional study

Liu

Yang

et al. 2020

BMC Cardiovasc Disord

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“…Yet, most studies defined PAF as events lasting more than 30 seconds, derived from the AHA 2006 guidelines [ 10 ]. PAF is a self-promoting process that can progress to persistent AF if left undetected and untreated with rhythm control and anticoagulation [ 27 ]. In AF, diminished blood flow within the complex trabeculated anatomy of the left atrial appendage (LAA) promotes thrombus formation with associated inflammation, leading to stroke by embolization [ 28 ].…”

Section: Paroxysmal Atrial Fibrillation and Strokementioning

confidence: 99%

Optimal Duration of Monitoring for Atrial Fibrillation in Cryptogenic Stroke: A Nonsystematic Review

Hariri

Hachem

Sarkis

et al. 2016

BioMed Research International

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Atrial fibrillation (AF) is the most common form of cardiac arrhythmias and an independent risk factor for stroke. Despite major advances in monitoring strategies, clinicians tend to miss the diagnoses of AF and especially paroxysmal AF due mainly to its asymptomatic presentation and the rather limited duration dedicated for monitoring for AF after a stroke, which is 24 hours as per the current recommended guidelines. Hence, determining the optimal duration of monitoring for paroxysmal atrial fibrillation after acute ischemic stroke remains a matter of debate. Multiple trials were published in regard to this matter using both invasive and noninvasive monitoring strategies for different monitoring periods. The data provided by these trials showcase strong evidence suggesting a longer monitoring strategy beyond 24 hours is associated with higher detection rates of AF, with the higher percentage of patients detected consequently receiving proper secondary stroke prevention with anticoagulation and thus justifying the cost-effectiveness of such measures. Overall, we thus conclude that increasing the monitoring duration for AF after a cryptogenic stroke to at least 72 hours will indeed enhance the detection rates, but the cost-effectiveness of this monitoring strategy compared to longer monitoring durations is yet to be established.

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“…Underutilisation of anticoagulation, particularly in the older population, has been reported in several studies. 7 - 9 Appropriate anticoagulation is particularly important among older persons since this patient group is at greater risk of stroke attributable to AF. 22 Recurrent falls or a high risk for falls was a common reason for withholding anticoagulation therapy in the study population as has been reported in other studies.…”

Section: Discussionmentioning

confidence: 99%

“… 1 , 3 , 4 , 5 Although recent data shows good progress in the management of patients with AF, there is still substantial evidence of suboptimal therapy. 6 , 7 , 8 9 …”

Section: Introductionmentioning

confidence: 99%

Assessing appropriateness of drug therapy in older persons: Development and application of a medication assessment tool for long-term management of atrial fibrillation

Gauci¹,

Wirth²,

Camilleri³

et al. 2017

Pharm Pract (Granada)

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Background:Atrial fibrillation (AF) is highly prevalent in older persons and is associated with considerable morbidity and mortality. Assessing appropriateness of drug therapy in AF may be facilitated by application of medication assessment tools (MATs).Objective:To develop, psychometrically evaluate and apply an innovative MAT for the long-term management of AF with particular relevance to older persons.Methods:Key recommendations from clinical practice guidelines for the long-term management of AF were selected and review criteria defining appropriate drug therapy were constructed as a ‘qualifying statement’ followed by a ‘standard’. The developed MAT was given the designation MAT-AF. An application guide was compiled where justifications for non-adherence were specified. Content validity was tested by an expert group using a three-round Delphi process. Inter- and intra-observer reliability testing was conducted with agreement expressed by Cohen’s kappa and application time measured to assess feasibility. MAT-AF was applied to 150 patients with a diagnosis of AF admitted to a rehabilitation hospital.Results:MAT-AF consists of 15 criteria sectioned into antithrombotic, rate control and rhythm control therapy. Content validity was demonstrated for all criteria. Reliability was confirmed with kappa values of 0.84 and 0.91 for inter- and intra-observer agreements. Mean application time for the two observers was 3.9 and 2.4 minutes, which decreased significantly in the second application conducted after a four-week interval (p<0.001). Overall adherence to applicable criteria was 59.8%. Non-adherence was evident for prescription of anticoagulation in patients with a CHA2DS2VASc score ≥1 (29.5%). Monitoring of laboratory parameters for digoxin was suboptimal. Ophthalmic and pulmonary monitoring and patient counselling regarding amiodarone therapy could not be assessed since relevant records were not readily available.Conclusion:MAT-AF application highlighted key aspects which need to be addressed to improve patient care.

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Paroxysmal atrial fibrillation and the hazards of under-treatment

Cited by 14 publications

References 45 publications

Current status and factors influencing oral anticoagulant therapy among patients with non-valvular atrial fibrillation in Jiangsu province, China: a multi-center, cross-sectional study

Current status and factors influencing oral anticoagulant therapy among patients with non-valvular atrial fibrillation in Jiangsu province, China: a multi-center, cross-sectional study

Optimal Duration of Monitoring for Atrial Fibrillation in Cryptogenic Stroke: A Nonsystematic Review

Assessing appropriateness of drug therapy in older persons: Development and application of a medication assessment tool for long-term management of atrial fibrillation

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