Real-world management of atrial fibrillation in Internal Medicine units

Campanini, Mauro; Frediani, Roberto; Artom, Alberto; Pinna, Giuliano; Valerio, Antonella; Regina, Micaela La; Marengo, Stefania; Pinto, Giuliano Lo; Signore, Erica Del; Bonizzoni, Erminio; Mathieu, Giovanni; Mazzone, Antonino; Vescovo, Giorgio

doi:10.2459/jcm.0b013e328348e5ce

Cited by 10 publications

(10 citation statements)

References 47 publications

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“…In the EORP-AF ancillary analysis on guidelines adherence, the South European region (which included Italy) was associated with undertreatment, confirming several previous reports of a significantly lower rate of patients treated with OAC among Italian AF patients [20][21][22][23][24]. This seems to occur despite several reports on effectiveness and safety, showing that elderly patients treated with a VKA had a significant benefit in reducing both thromboembolic events and mortality, irrespective of age [12].…”

Section: Discussionsupporting

confidence: 72%

Adherence to antithrombotic therapy guidelines improves mortality among elderly patients with atrial fibrillation: insights from the REPOSI study

et al. 2016

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Section: Discussionsupporting

confidence: 72%

Adherence to antithrombotic therapy guidelines improves mortality among elderly patients with atrial fibrillation: insights from the REPOSI study

et al. 2016

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“…1 Its natural history is associated with an increased risk of mortality and morbidity for cardioembolic disorder. Particularly, it is related to a five-fold increased risk of stroke occurrence.…”

Section: Introductionmentioning

confidence: 99%

CHA2DS2-VASc in the prediction of early atrial fibrillation relapses after electrical or pharmacological cardioversion

Falsetti

Viticchi²,

Tarquinio³

et al. 2014

Journal of Cardiovascular Medicine

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“…A total of 5316 results were retrieved from the search (939 from PubMed and 4377 from EMBASE). After duplicates removal, and title and abstract screening, 130 full-texts were assessed for eligibility, and 46 studies were included for quantitative synthesis (Table 1 and Supplementary material online, Figure S1), with a total of 4 232 784 AF patients included: 3 studies were secondary analyses of randomized trials, 28,38,62 19 cohorts were based on administrative databases, 19,20,26,27,31,32,35,36,39,41,49,50,53,55,56,60,61,63,64 16 were observational multicentre studies, 21,22,24,25,33,34,37,40,42,[45][46][47][48]52,54,57 and 8 were observational single-centre studies 23,29,30,43,44,51,58,…”

Section: Resultsmentioning

confidence: 99%

Prevalence, management and impact of chronic obstructive pulmonary disease in atrial fibrillation: a systematic review and meta-analysis of 4,200,000 patients

et al. 2021

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Funding Acknowledgements Type of funding sources: None. OnBehalf AF-COMET Collaborative Group Background Multimorbidity is a major concern in patients with atrial fibrillation (AF). Among other diseases, the prevalence of chronic obstructive pulmonary disease (COPD) in these patients is unclear, and its association with adverse outcomes is often overlooked. Moreover, uncertainties on the treatment of patients with both AF and COPD still exist, and may lead to undertreatment. Purpose The aim of this study is to estimate the prevalence of COPD, and its impact on management and outcomes in patients with AF. Methods A systematic review and meta-analysis was conducted according to PRISMA guidelines. All studies reporting the prevalence of COPD in AF patients were included and pooled. Data on comorbidities, beta-blockers (BBs) and oral anticoagulant (OAC) prescription, and outcomes (all-cause death, cardiovascular death, ischemic stroke, major bleeding) were pooled and compared according to COPD status; the impact of BBs on outcomes in patients with COPD was also investigated. All analyses were performed using random-effect models; subgroup analysis and meta-regressions were also performed to account for heterogeneity. Results Among 46 studies, the pooled prevalence of COPD was 13% (95% Confidence Intervals (CI): 10-16%), with high heterogeneity between studies; significant differences were found according to geographical locations and definition of COPD. A multivariable meta-regression model which included age, female sex, history of hypertension, diabetes and chronic heart failure (CHF) was able to explain a significant proportion of the heterogeneity (R2 = 69.8%). COPD was associated with a higher prevalence of diabetes, coronary artery disease, CHF and stroke (Fig. 1, panel A), as well as higher CHA2DS2-VASc scores and age (Fig. 1, panel B), and lower probability of BB prescription (Odds Ratio (OR): 0.77, 95%CI: 0.61-0.98). Patients with COPD showed higher risk of all-cause death (OR: 2.22, 95%CI: 1.93-2.55), cardiovascular death (OR: 1.84, 95%CI: 1.39-2.43) and major bleeding (OR: 1.45, 95%CI: 1.17-1.80) (Fig.1, Panel C); no significant differences in outcomes were observed according to BBs use in AF patients with COPD (Fig. 1, panel D). Conclusion COPD is common in AF, being found in 1 every 8 patients, and is associated with an increased burden of comorbidities, differential management and worse outcomes, with more than two-fold higher risk of all-cause death and increased risk of CV death and major bleeding. Therapy with BBs does not increase the risk of adverse outcomes in these patients. Abstract Figure.

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Real-world management of atrial fibrillation in Internal Medicine units

Cited by 10 publications

References 47 publications

Adherence to antithrombotic therapy guidelines improves mortality among elderly patients with atrial fibrillation: insights from the REPOSI study

Adherence to antithrombotic therapy guidelines improves mortality among elderly patients with atrial fibrillation: insights from the REPOSI study

CHA2DS2-VASc in the prediction of early atrial fibrillation relapses after electrical or pharmacological cardioversion

Prevalence, management and impact of chronic obstructive pulmonary disease in atrial fibrillation: a systematic review and meta-analysis of 4,200,000 patients

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