Rationale and design of a randomized study comparing Motivational Interviewing to Support Oral Anticoagulation adherence versus usual care in patients with nonvalvular atrial fibrillation: The MISOAC-AF trial

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

doi:10.1016/j.hjc.2020.02.007

Cited by 26 publications

(21 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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

View full text Add to dashboard Cite

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.

show abstract

Section: Methodsmentioning

confidence: 99%

Prognostic significance of diabetes mellitus in patients with atrial fibrillation

Papazoglou

Κάρτας

Samaras

et al. 2021

Cardiovasc Diabetol

View full text Add to dashboard Cite

show abstract

“…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

View full text Add to dashboard Cite

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

show abstract

“…This is a post-hoc analysis of the MISOAC-AF trial [ 22 , 23 ]. This study population comprised consecutive adult patients who were hospitalized in the Cardiology ward from December 2015 to June 2018 with any diagnosis and comorbid AF.…”

Section: Methodsmentioning

confidence: 99%

Prognostic implications of valvular heart disease in patients with non-valvular atrial fibrillation

Samaras

Vrana

Κάρτας

et al. 2021

BMC Cardiovasc Disord

View full text Add to dashboard Cite

Background Valvular heart disease (VHD) in non-valvular atrial fibrillation (AF) is a puzzling clinical entity. The aim of this study was to evaluate the prognostic effect of significant VHD (sVHD) among patients with non-valvular AF. Methods This is a post-hoc analysis of the MISOAC-AF trial (NCT02941978). Consecutive inpatients with non-valvular AF who underwent echocardiography were included. sVHD was defined as the presence of at least moderate aortic stenosis (AS) or aortic/mitral/tricuspid regurgitation (AR/MR/TR). Cox regression analyses with covariate adjustments were used for outcome prediction. Results In total, 983 patients with non-valvular AF (median age 76 [14] years) were analyzed over a median follow-up period of 32 [20] months. sVHD was diagnosed in 575 (58.5%) AF patients. sVHD was associated with all-cause mortality (21.6%/yr vs. 6.5%/yr; adjusted HR [aHR] 1.55, 95% confidence interval [CI] 1.17–2.06; p = 0.02), cardiovascular mortality (16%/yr vs. 4%/yr; aHR 1.70, 95% CI 1.09–2.66; p = 0.02) and heart failure-hospitalization (5.8%/yr vs. 1.8%/yr; aHR 2.53, 95% CI 1.35–4.63; p = 0.02). The prognostic effect of sVHD was particularly evident in patients aged < 80 years and in those without history of heart failure (p for interaction < 0.05, in both subgroups). After multivariable adjustment, moderate/severe AS and TR were associated with mortality, while AS and MR with heart failure-hospitalization. Conclusion Among patients with non-valvular AF, sVHD was highly prevalent and beared high prognostic value across a wide spectrum of clinical outcomes, especially in patients aged < 80 years or in the absence of heart failure. Predominantly AS, as well as MR and TR, were associated with worse prognosis.

show abstract

Rationale and design of a randomized study comparing Motivational Interviewing to Support Oral Anticoagulation adherence versus usual care in patients with nonvalvular atrial fibrillation: The MISOAC-AF trial

Cited by 26 publications

References 10 publications

Prognostic significance of diabetes mellitus in patients with atrial fibrillation

Prognostic significance of diabetes mellitus in patients with atrial fibrillation

Prognostic significance of diabetes mellitus in patients with atrial fibrillation

Prognostic implications of valvular heart disease in patients with non-valvular atrial fibrillation

Contact Info

Product

Resources

About