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1. Prevalence and clinical predictors of inappropriate direct oral anticoagulant dosage in octagenarians with atrial fibrillation.

Author

Carbone A, Santelli F, Bottino R, Attena E, Mazzone C, Parisi V, D'Andrea A, Golino P, Nigro G, and Russo V

Subjects
Administration, Oral, Aged, 80 and over, Anticoagulants, Hemorrhage chemically induced, Hemorrhage epidemiology, Humans, Male, Prevalence, Risk Factors, Atrial Fibrillation complications, Coronary Artery Disease drug therapy, Stroke drug therapy
Abstract

Purpose: Older age is associated with inappropriate dose prescription of direct oral anticoagulants. The aim of our study was to describe the prevalence and the clinical predictors of inappropriate DOACs dosage among octogenarians in real-world setting., Methods: Data for this study were sourced from the multicenter prospectively maintained Atrial Fibrillation (AF) Research Database (NCT03760874). Of the AF patients aged ≥ 80 who received DOACs treatment, 253 patients were selected. Participants were categorized as appropriate dosage, overdosage, or underdosage. Underdosage and overdosage were, respectively, defined as administration of a lower or higher DOAC dose than recommended in the EHRA consensus., Results: A total of 178 patients (71%) received appropriate DOACs dose and 75 patients (29%) inappropriate DOACs dose; among them, 19 patients (25.6%) were overdosed and 56 (74.4%) were underdosed. Subgroup analysis demonstrated that underdosage was independently associated with male gender [OR = 3.15 (95% IC; 1.45-6.83); p < 0.001], coronary artery disease [OR = 3.60 (95% IC 1.45-9.10); p < 0.001] and body mass index [OR = 1.27 (1.14-1.41); p < 0.001]. Overdosage was independently associated with diabetes mellitus [OR = 18 (3.36-96); p < 0.001], with age [OR = 0.76 (95% IC; 0.61-0.96; p = 0.045], BMI [OR = 0.77 (95% IC; 0.62-0.97; p = 0.043] and with previous bleedings [OR = 6.40 (0.7; 1.43-28); p = 0.039]. There wasn't significant difference in thromboembolic, major bleeding events and mortality among different subgroups. Underdosage group showed a significatively lower survival compared with appropriate dose group (p < 0.001)., Conclusion: In our analysis, nearly one-third of octogenarians with AF received an inappropriate dose of DOAC. Several clinical factors were associated with DOACs' overdosage (diabetes mellitus type II, previous bleeding) or underdosage (male gender, coronary artery disease, and higher body mass index). Octogenarians with inappropriate DOACs underdosage showed less survival., (© 2022. The Author(s).)

Published
2022
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2. Clinical profile of direct oral anticoagulants versus vitamin K anticoagulants in octogenarians with atrial fibrillation: a multicentre propensity score matched real-world cohort study.

Author

Russo V, Attena E, Di Maio M, Mazzone C, Carbone A, Parisi V, Rago A, D'Onofrio A, Golino P, and Nigro G

Subjects
Administration, Oral, Aged, 80 and over, Disease-Free Survival, Follow-Up Studies, Humans, Incidence, Propensity Score, Prospective Studies, Risk Factors, Survival Rate, Anticoagulants administration & dosage, Anticoagulants adverse effects, Atrial Fibrillation drug therapy, Atrial Fibrillation mortality, Databases, Factual, Hemorrhage chemically induced, Hemorrhage mortality, Thromboembolism mortality, Thromboembolism prevention & control, Vitamin K administration & dosage, Vitamin K adverse effects
Abstract

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and its prevalence increases with age. Few data are available about the clinical performance of direct oral anticoagulant (DOACs) in patients aged ≥ 80 years with AF. The aim of our propensity score matched cohort study was to compare the safety and efficacy of DOACs versus well-controlled VKA therapy among octogenarians with AF in real life setting. Data for this study were sourced from the multicenter prospectively maintained Atrial Fibrillation Research Database (NCT03760874), which includes all AF patients followed by the participating centers, through outpatient visits every 3 to 6 months. The database was queried for AF patients aged ≥ 80 years who received DOACs or VKAs treatment. The primary effectiveness endpoint was the occurrence of thromboembolic events (a composite of stroke, transient ischemic attack, systemic embolism); the primary safety endpoint was the occurrence of major bleeding; the secondary endpoint was all-cause mortality. The database query identified 774 AF patients aged ≥ 80 years treated with VKAs and 279 with DOACs. Propensity score (2:1) matching selected 252 DOAC and 504 VKA recipients. The mean follow-up was 31.07 ± 14.09 months. The incidence rate of thromboembolic events was 13.79 per 1000 person-years [14.80 in DOAC vs 13.34 in VKA group, Hazard Ratio 1.10; 95% confidence interval (CI) 0.49 to 2.45; P = 0.823]. The incidence rate of intracranial hemorrhage (ICH) was 8.06 per 1000 person-years (3.25 in DOAC vs 10.23 in VKA group, HR 0.33; 95% CI 0.07 to 1.45; P = 0.600). Through these incidence rates, we found a positive net clinical benefit (NCB) of DOACs over VKAs, equal to + 9.01. The incidence rate of all-cause mortality was 105.05 per 1000 person-years (74.67 in DOAC vs 118.67 in VKA group, Hazard Ratio 0.65; 95% CI 0.47 to 0.90; P = 0.010). The concomitant use of antiinflammatory drugs (HR 7.90; P < 0.001) were found to be independent predictor of major bleeding. Moreover, age (HR 1.17; P < 0.002) and chronic kidney disease (HR 0.34; P = 0.019) were found to be independently associated with thromboembolic events. In our study no significant difference in terms of both thromboembolic and major bleeding events, but a significant lower incidence of all-cause mortality, was detected in AF patients aged ≥ 80 years treated with DOACs vs VKAs.

Published
2020
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3. Clinical Benefit of Direct Oral Anticoagulants Versus Vitamin K Antagonists in Patients with Atrial Fibrillation and Bioprosthetic Heart Valves.

Author

Russo V, Carbone A, Attena E, Rago A, Mazzone C, Proietti R, Parisi V, Scotti A, Nigro G, Golino P, and D'Onofrio A

Subjects
Administration, Oral, Anticoagulants administration & dosage, Anticoagulants adverse effects, Humans, Retrospective Studies, Anticoagulants therapeutic use, Atrial Fibrillation complications, Heart Valve Prosthesis, Thromboembolism drug therapy, Thromboembolism epidemiology, Thromboembolism etiology, Thromboembolism prevention & control, Vitamin K antagonists & inhibitors
Abstract

Purpose: The use of direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) and bioprosthetic heart valve is still controversial. The aim of this study was to compare the tolerability and effectiveness of treatment with DOACs versus vitamin K antagonists (VKAs) in patients with AF and a bioprosthetic heart valve in clinical practice., Methods: Data for this study were sourced from the multicenter, prospectively maintained AF Research Database (NCT03760874), which includes all patients with AF undergoing follow-up at participating centers through outpatient visits every 3-6 months. The rates of occurrence of thromboembolic events (ischemic stroke, transient ischemic attack, systemic embolism), major bleed, and intracranial hemorrhage (ICH) were assessed. These data were used for quantifying the net clinical benefit (NCB) of DOACs versus VKAs, in accordance with the following formula: (Thromboembolic events incidence rate with VKAs - Thromboembolic events incidence rate with DOACs) - Weighting factor × (ICH rate with DOACs - ICH incidence rate with VKAs). The database was retrospectively queried for patients with AF who were prescribed a DOAC or VKA and had a history of bioprosthetic heart valve replacement., Findings: A total of 434 patients with AF (DOACs, n = 211; VKAs, n = 223) were identified. Propensity score matching identified 130 patients prescribed DOACs (apixaban, 55.4%; rivaroxaban, 30.0%; dabigatran, 13.1%; edoxaban, 1.4%) and the same number of VKA recipients (warfarin, 89.2%; acenocoumarol, 10.8%). The mean (SD) duration of follow-up was 26.8 (2.3) months. The incidence rates of thromboembolic events were 1.3 per 100 person-years in the DOAC group versus 2.0 per 100 person-years in the VKA group (P = 0.14). The incidence rates of major bleed events were 2.6 per 100 person-years in the DOAC group versus 4.9 per 100 person-years in the VKA group (P = 0.47). The incidence rates of ICH were 0.38 per 100 person-years in the DOAC group versus 1.16 in the VKA group (hazard ratio = 0.33; 95% CI, 0.05-2.34; P = 0.3). A positive NCB of DOACs over VKAs of +1.87 was found., Implications: According to these data from clinical practice, DOACs seem to be associated with a greater NCB versus VKAs in patients with AF with a bioprosthetic heart valve, primarily due to lower rates of both major bleeds and thromboembolic events., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Published
2019
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4. Real-life Performance of Edoxaban in Elderly Patients With Atrial Fibrillation: a Multicenter Propensity Score-Matched Cohort Study.

Author

Russo V, Attena E, Mazzone C, Melillo E, Rago A, Galasso G, Riegler L, Parisi V, Rotunno R, Nigro G, and D'Onofrio A

Subjects
Aged, Aged, 80 and over, Cohort Studies, Female, Hemorrhage chemically induced, Humans, Ischemic Attack, Transient prevention & control, Male, Propensity Score, Stroke prevention & control, Thromboembolism prevention & control, Treatment Outcome, Vitamin K antagonists & inhibitors, Atrial Fibrillation drug therapy, Factor Xa Inhibitors therapeutic use, Pyridines therapeutic use, Thiazoles therapeutic use
Abstract

Purpose: The purpose of the current study was to compare the efficacy and safety of edoxaban versus vitamin K antagonist (VKA) therapy among a cohort of elderly patients (ie, those aged ≥75 years) with atrial fibrillation (AF) in a real-life setting., Methods: A propensity score-matched cohort observational study was performed comparing the safety and efficacy of edoxaban versus VKA therapy among a cohort of elderly (aged ≥75 years) patients with AF in a real-life setting. Follow-up data were obtained through outpatient visits at 1, 3, and every 6 months. The primary safety outcome was major bleeding. The primary efficacy outcome was the composite of stroke, transient ischemic attack, and systemic embolism., Findings: A total of 130 patients receiving edoxaban 60 mg (EDO) treatment were compared with the same number of VKA recipients. The mean follow-up was 16 (2.6) months. The cumulative incidence of thromboembolic events in the EDO and VKA groups was 1.5% (2 of 130) and 2.3% (3 of 130), respectively (P < 0.6). The cumulative incidence of major bleeding events was 1.5% (2 of 130) in the EDO group and 3.1% (4 of 130) in the VKA group (P < 0.4). The total anticoagulant therapy discontinuation rate was 2.3% (3 of 130) in the EDO group and 4.6% (6 of 130) in the VKA group (P < 0.3). A nonsignificant trend in improved adherence was observed between the EDO and VKA groups (81% vs 78%; P = 0.6)., Implications: Edoxaban therapy showed a good real-life performance among elderly patients (aged ≥75 years) with AF., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Published
2019
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5. Persistence on apixaban in atrial fibrillation patients: a retrospective multicentre study.

Author

Verdecchia P, D'Onofrio A, Russo V, Fedele F, Adamo F, Benedetti G, Ferrante F, Lodigiani C, Paciullo F, Aita A, Bartolini C, Molini MG, Di Lenarda A, Mazzone C, Scotti L, Lanati EP, and Iorio A

Subjects
Administration, Oral, Aged, Aged, 80 and over, Atrial Fibrillation diagnosis, Atrial Fibrillation mortality, Drug Administration Schedule, Drug Substitution, Factor Xa Inhibitors adverse effects, Female, Hemorrhage chemically induced, Hemorrhage epidemiology, Humans, Incidence, Italy epidemiology, Male, Middle Aged, Pyrazoles adverse effects, Pyridones adverse effects, Retrospective Studies, Risk Factors, Stroke diagnosis, Stroke mortality, Time Factors, Treatment Outcome, Atrial Fibrillation drug therapy, Factor Xa Inhibitors administration & dosage, Pyrazoles administration & dosage, Pyridones administration & dosage, Stroke prevention & control
Abstract

Aims: Real-world data on treatment persistence, safety and effectiveness of non-Vitamin K antagonist oral anticoagulants (NOACs) play an important role in the assessment of risks and benefits of these drugs. Our aim was to evaluate persistence on treatment, incidence of major bleeding and incidence of a composite endpoint of major events, including all-cause death, myocardial infarction, stroke and systemic thromboembolism, during treatment with apixaban in a cohort of patients with nonvalvular atrial fibrillation (NVAF)., Methods: In this multicentre retrospective observational study, we retrieved data from medical records of five Italian hospitals on patients with a diagnosis of NVAF who initiated apixaban between 1 January 2014 and 31 March 2016 and had a first subsequent visit at the same hospital., Results: We studied 766 patients with mean age of 74.2 (standard deviation 11.1) years and median CHADS2 and CHA2DS2VASc scores of 2.0 and 4.0, respectively. Over a median follow-up period of 339 days, persistence on treatment was 83.5% [95% confidence interval (95% CI) 75.5-89.1%]. The rate of major bleeding (per 100 person-years) was 1.15 (95% CI 0.39-1.90 per 100 person-years), while the cumulative incidence was 4.4% (95% CI 1.6-12.0). The rate of major events was 1.97 (95% CI 1.08-2.86) per 100 patient-years, with a cumulative incidence over the entire follow-up period of 7.7% (95% CI 4.6-12.8)., Conclusion: In real-life conditions, NVAF patients treated with apixaban show rates of treatment discontinuation and major bleedings, which are comparable to those found in the ARISTOTLE pivotal study, thus supporting its external validity.

Published
2019
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6. Nonvitamin K Antagonist Oral Anticoagulants Use in Patients with Atrial Fibrillation and Bioprosthetic Heart Valves/Prior Surgical Valve Repair: A Multicenter Clinical Practice Experience.

Author

Russo V, Attena E, Mazzone C, Esposito F, Parisi V, Bancone C, Rago A, Nigro G, Sangiuolo R, and D' Onofrio A

Subjects
Administration, Oral, Aged, Aged, 80 and over, Atrial Fibrillation blood, Female, Follow-Up Studies, Humans, International Normalized Ratio, Male, Middle Aged, Registries, Vitamin K, Anticoagulants administration & dosage, Atrial Fibrillation therapy, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation
Abstract

This is an observational study to investigate the efficacy and safety of nonvitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation (AF) patients with bioprosthetic valves or prior surgical valve repair in clinical practice. A total of 122 patients (mean age: 74.1 ± 13.2; 54 females) with bioprosthetic heart valve or surgical valve repair and AF treated with NOACs were included in the analysis. The mean CHA 2 DS 2 -VASc (Congestive heart failure, Hypertension, Age >75 years, Diabetes mellitus, prior Stroke or transient ischemic attack, Vascular disease) and HAS-BLED (Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile INR [international normalized ratio], Elderly, Drugs or alcohol) score values were 3.6 ± 1.2 and 2.6 ± 1.4, respectively. Of the total study population, 28.6% was taking apixaban 5 mg twice daily (BID), 24.5% apixaban 2.5 mg BID, 18% dabigatran 150 mg BID, 13% dabigatran 110 mg BID, 9.8% rivaroxaban 20 mg daily (QD), and 5.7% rivaroxaban 15 mg QD. Also, 92% of the study population previously had warfarin replaced with NOACs due to lack compliance and labile INR control (time in therapeutic range < 60%). NOAC therapy for AF was started on average 934 ± 567 days after bioprosthetic heart valve implantation or surgical repair for an average duration of 835 ± 203 days. The study population included 24 (19.6%) patients with bioprosthetic mitral valve, 52 (43%) patients with bioprosthetic aortic valve, 41 (33.6%) patients with previous surgical mitral repair, 5 (4%) patients with previous surgical aortic repair, and concomitant use of NOACs. All patients were evaluated for thromboembolic events (ischemic stroke, transient ischemic attack, systemic embolism) as well as major bleeding events during the follow-up period. In our study population, we recorded a low mean annual incidence of thromboembolism (0.8%) and major bleeding (1.3%). According to our data, anticoagulation therapy with NOACs seems to be an effective and a safe treatment strategy for nonvalvular AF patients with bioprosthetic valves or prior surgical valve repair., Competing Interests: None., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Published
2018
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7. [Nonvalvular atrial fibrillation: data from the Observatory of Cardiovascular Diseases in the province of Trieste (Italy)].

Author

Mazzone C, Carriere C, Grande E, Iorio AM, Barbati G, Zecchin M, Serdoz LV, Cioffi G, Tarantini L, Sinagra G, Scardi S, and Di Lenarda A

Subjects
Anticoagulants adverse effects, Anticoagulants therapeutic use, Atrial Fibrillation complications, Atrial Fibrillation therapy, Cause of Death, Factor Xa Inhibitors adverse effects, Factor Xa Inhibitors therapeutic use, Female, Hemorrhage chemically induced, Hemorrhage epidemiology, Hospitalization statistics & numerical data, Humans, Incidence, Italy epidemiology, Male, Metabolic Syndrome epidemiology, Prevalence, Prognosis, Prospective Studies, Registries, Risk Factors, Severity of Illness Index, Stroke epidemiology, Stroke etiology, Stroke prevention & control, Thromboembolism epidemiology, Thromboembolism etiology, Thromboembolism prevention & control, Thrombophilia drug therapy, Treatment Outcome, Atrial Fibrillation epidemiology
Abstract

Background: Nonvalvular atrial fibrillation (NVAF) is the most common arrhythmia in outpatients and is associated with increased mortality, thromboembolic and hemorrhagic events. Although several international studies have evaluated its prognostic impact in the real world, Italian data are still lacking. Our aim was to define the prevalence, comorbidity, treatment and outcome in a population of "real-life" outpatients with NVAF., Methods: From 2009 to 2013, 21 282 consecutive patients referred to the Cardiovascular Center of Trieste were enrolled in the study. NVAF was defined in the absence of moderate-to-severe valvular disease, valvular interventions, rheumatic heart disease. Events evaluated in the follow-up included mortality, hospitalizations, thromboembolism and hemorrhage. Clinical data and events were derived from the cardiac regional electronic patient records and the ICD-9 hospital discharge records., Results: 3379 patients (15.8%) had NVAF (35.6% paroxysmal, 34.5% persistent, 29.9% permanent); compared to the general population these patients were older, predominantly male, with hypertension, diabetes and history of stroke/transient ischemic attack and heart failure. Oral anticoagulant therapy was prescribed in 54% of cases, above all in persistent or permanent forms, in patients with higher CHA2DS2-VASc score and younger age. The rate of all-cause mortality, cardiovascular hospitalization, thromboembolic and hemorrhagic events during follow-up was higher in patients with NVAF than in the general population. The use of oral anticoagulant therapy reduced the incidence of thromboembolic events. CHA2DS2-VASc score emerged as an independent predictor of thromboembolic events in patients with paroxysmal (35% higher risk), persistent (40% higher risk) and permanent atrial fibrillation (34% higher risk than patients without atrial fibrillation)., Conclusions: In "real-life" outpatients NVAF is associated with older age, more comorbidities and increased cardiovascular events. CHA2DS2-VASc and HAS-BLED scores predict accurately the risk for thromboembolic and hemorrhagic events. Oral anticoagulation reduces thromboembolic events, but its use is limited to just half of the patients.

Published
2015
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8. Predicting atrial fibrillation recurrence with circulating inflammatory markers in patients in sinus rhythm at high risk for atrial fibrillation: data from the GISSI atrial fibrillation trial.

Author

Masson S, Aleksova A, Favero C, Staszewsky L, Bernardinangeli M, Belvito C, Cioffi G, Sinagra G, Mazzone C, Bertocchi F, Vago T, Peri G, Cuccovillo I, Masuda N, Barlera S, Mantovani A, Maggioni AP, Franzosi MG, Disertori M, and Latini R

Subjects
Aged, Biomarkers metabolism, Female, Humans, Kaplan-Meier Estimate, Male, Prognosis, Prospective Studies, Recurrence, Risk Factors, Atrial Fibrillation diagnosis, C-Reactive Protein metabolism, Interleukin-6 metabolism, Serum Amyloid P-Component metabolism
Abstract

Background: Inflammation may play a significant role in the pathogenesis of atrial fibrillation (AF)., Objectives: To examine the roles of three systemic inflammatory markers in predicting recurrent AF., Methods: The association between the plasma concentrations of high-sensitivity C reactive protein (hsCRP), interleukin-6 (IL-6) and pentraxin-3 (PTX3) with echocardiographic parameters and with the time to first recurrence of AF was tested in 382 patients with a history of AF but in sinus rhythm at randomisation, enrolled in the GISSI-AF biohumoral study., Results: Baseline PTX3 was related to left atrial, but not to left ventricular chamber volume. During one year of follow-up, 204 patients (53.1%) had a recurrent AF. There were no significant differences in baseline median [Q1-Q3] plasma concentrations of IL-6, hsCRP and PTX3 among patients with (2.11 [1.47-3.74] pg/ml, 3.30 [1.40-6.80] mg/l and 4.66 [3.27-6.97] ng/ml, respectively) or without recurrent AF (2.09 [1.37-2.90] pg/ml, p=0.182; 3.00 [1.10-6.20] mg/l, p=0.333; 5.09 [3.22-7.98] ng/ml, p=0.637). At 6 and 12 months follow-up, AF patients had significantly higher concentrations of IL-6 and PTX3 than those in sinus rhythm, and those with most recent episodes of AF had higher hsCRP. Baseline levels of IL-6, hsCRP or PTX3 were not significantly associated with a higher risk of recurrence of AF., Conclusion: In patients with a history of AF, but without significant left ventricular dysfunction or heart failure, inflammatory biomarkers may be raised but are, at best, weak predictors of the risk for first recurrence of AF.

Published
2010
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9. Morbidity and mortality in 229 elderly patients with nonrheumatic atrial fibrillation. A five-year follow-up.

Author

Bordin P, Mazzone C, Pandullo C, Goldstein D, and Scardi S

Subjects
Age Distribution, Aged, Anticoagulants therapeutic use, Atrial Fibrillation diagnostic imaging, Atrial Fibrillation drug therapy, Atrial Fibrillation mortality, Cardiovascular Diseases epidemiology, Chronic Disease, Comorbidity, Diabetes Mellitus epidemiology, Female, Follow-Up Studies, Hospitalization statistics & numerical data, Humans, Italy epidemiology, Male, Platelet Aggregation Inhibitors therapeutic use, Prognosis, Prospective Studies, Regression Analysis, Rheumatic Diseases epidemiology, Risk Factors, Sex Distribution, Smoking epidemiology, Ultrasonography, Atrial Fibrillation epidemiology
Abstract

Background: In the elderly the impact of atrial fibrillation on mortality and morbidity is substantial. Oral anticoagulant therapy reduces the risk of stroke by 70%; nevertheless, it remains largely underused. We evaluated, in a community prospective study, the factors associated with embolic events and death and the feasibility of oral anticoagulant therapy managed by general practitioners., Methods: We enrolled at the Trieste Cardiovascular Center 229 patients aged > or = 65 years with non-rheumatic atrial fibrillation. At baseline, each patient underwent a transesophageal echocardiography and received instructions about oral anticoagulation. Patients were regularly followed by their general practitioner and finally evaluated at the Center., Results: At baseline, the mean age was 73 years, 14% of patients were free of heart disease, 27% had had a previous embolic event, and 33% had an atrial thrombus. After a 5-year follow-up, 85% of the patients had been admitted to hospital, 17% had suffered an embolic event, and 35% were dead. Diabetes and the presence of a low flow in the left atrial appendage were predictive of embolic events. Heart failure, spontaneous echocontrast and aortic plaques were predictive of death. Anticoagulant therapy increased from 14 to 34% but the incidence of major bleeding did not change. The patients on anticoagulant therapy at follow-up constituted the group with the worst cardiovascular profile and embolic rate, but had a lower death rate (19%) compared with those on antiplatelet therapy (32%) and with those without antithrombotic therapy (67%). The hospitalization rates were respectively 78, 83 and 100%., Conclusions: In a group of elderly patients followed by their general practitioner with the support of a specialized cardiologic unit, oral anticoagulant therapy was well tolerated and associated with a significant decrease in mortality and hospitalization.

Published
2003

10. [Atrial fibrillation and heart failure: cause or effect?].

Author

Scardi S and Mazzone C

Subjects
Atrial Fibrillation etiology, Atrial Fibrillation physiopathology, Heart Failure etiology, Heart Failure physiopathology, Heart Rate, Hemodynamics, Humans, Atrial Fibrillation complications, Heart Failure complications
Abstract

The association between atrial fibrillation and heart failure is well documented. Heart failure is one of the established predisposing conditions for the development of atrial fibrillation; conversely, heart failure is a common condition in patients with atrial fibrillation. In patients with heart failure the atrial electrophysiologic properties might be modified by hemodynamic overloading and neurohumoral activation. Atrial fibrillation promotes heart failure with multiple mechanisms including uncontrolled heart rate, loss of atrioventricular synchrony, irregularity in the ventricular rhythm, valvular regurgitation and neurohormonal effects. Treatment includes correction of neurohumoral activation, prevention of thromboembolism, maintenance of sinus rhythm, and pharmacologic and interventional control of ventricular rate. The results of recent trials (PIAF-Pharmacological Intervention in Atrial Fibrillation, RACE-RAte Control versus Electrical cardioversion for persistent atrial fibrillation, AFFIRM-Atrial Fibrillation Follow-up Investigation of Rhythm Management) suggest that a rate control strategy can be better than rhythm control, particularly in patients at high risk of relapse, like those with left ventricular dysfunction.

Published
2002

11. Cardioversion in patients with newly diagnosed non-valvular atrial fibrillation: Observational study using prospectively collected registry data

Author

Pope, Marita Knudsen, Hall, Trygve S, Schirripa, Valentina, Radic, Petra, Virdone, Saverio, Pieper, Karen S, Le Heuzey, Jean-Yves, Jansky, Petr, Fitzmaurice, David A, Cappato, Riccardo, Atar, Dan, Camm, A John, Kakkar, Ajay K, Bassand, Jean-Pierre, Fox, Keith A A, Gersh, Bernard J, Goldhaber, Samuel Z, Goto, Shinya, Haas, Sylvia, Hacke, Werner, Mantovani, Lorenzo G, Misselwitz, Frank, Turpie, Alexander G G, van Eickels, Martin, Verheugt, Freek W A, Luciardi, Hector Lucas, Gibbs, Harry, Brodmann, Marianne, Cools, Frank, Barretto, Antonio Carlos Pereira, Connolly, Stuart J, Eikelboom, John, Corbalan, Ramon, Jing, Zhi-Cheng, Nielsen, Jørn Dalsgaard, Ragy, Hany, Raatikainen, Pekka, Darius, Harald, Keltai, Matyas, Sawhney, Jitendra Pal Singh, Agnelli, Giancarlo, Ambrosio, Giuseppe, Koretsune, Yukihiro, Sánchez Díaz, Carlos Jerjes, Ten Cate, Hugo, Stepinska, Janina, Panchenko, Elizaveta, Lim, Toon Wei, Jacobson, Barry, Oh, Seil, Viñolas, Xavier, Rosenqvist, Marten, Steffel, Jan, Angchaisuksiri, Pantep, Oto, Ali, Parkhomenko, Alex, Al Mahmeed, Wael, Hu, Dayi, Chen, Kangning, Zhao, Yusheng, Zhang, Huaiqin, Chen, Jiyan, Cao, Shiping, Wang, Daowen, Yang, Yuejin, Li, Weihua, Li, Hui, Yin, Yuehui, Tao, Guizhou, Yang, Ping, Chen, Yingmin, He, Shenghu, Wang, Yong, Fu, Guosheng, Li, Xin, Wu, Tongguo, Cheng, Xiaoshu, Yan, Xiaowei, Zhao, Ruiping, Chen, Moshui, Xiong, Longgen, Chen, Ping, Jiao, Yang, Guo, Ying, Xue, Li, Yang, Zhiming, Jadhavm, Praveen, Sarma, Raghava, Kulkarni, Govind, Chandwani, Prakash, Pothiwala, Rasesh Atulbhai, Purayil, Mohanan Padinhare, Chawla, Kamaldeep, Kothiwale, Veerappa Annasaheb, Raghuraman, Bagirath, Vijan, Vinod Madan, Sawhney, Jitendra, Bantwal, Ganapathi, Khan, Aziz, Meena, Ramdhan, Chopada, Manojkumar, Abraham, Sunitha, Bisne, Vikas, Vijayaraghavan, Govindan, Roy, Debabrata, Durgaprasad, Rajashekhar, Shankar, A G Ravi, Kumar, Sunil, Jain, Dinesh, Bhargava, Kartikeya, Kumar, Vinay, Nagamalesh, Udigala Madappa, Rajput, Rajeeve Kumar, Kanamori, Seishu, Yamamoto, Kenichi, Kumagai, Koichiro, Katsuda, Yosuke, Yoshida, Keiki, Toyota, Fumitoshi, Mizuno, Yuji, Misumi, Ikuo, Noguchi, Hiroo, Ando, Shinichi, Suetsugu, Tetsuro, Minamoto, Masahiro, Oda, Hiroyuki, Adachi, Susumu, Chiba, Kei, Norita, Hiroaki, Tsuruta, Makoto, Koyanagi, Takeshi, Yamamoto, Kunihiko, Ando, Hiroshi, Higashi, Takayuki, Okada, Megumi, Azakami, Shiro, Komaki, Shinichiro, Kumeda, Kenshi, Murayama, Takashi, Matsumura, Jun, Oba, Yurika, Sonoda, Ryuji, Goto, Kazuo, Minoda, Kotaro, Haraguchi, Yoshikuni, Suefuji, Hisakazu, Miyagi, Hiroo, Kato, Hitoshi, Nakamura, Tsugihiro, Nakamura, Tadashi, Nandate, Hidekazu, Zaitsu, Ryuji, Fujiura, Yoshihisa, Yoshimura, Akira, Numata, Hiroyuki, Ogawa, Jun, Kamogawa, Yasuyuki, Murakami, Kinshiro, Wakasa, Yutaka, Yamasawa, Masanori, Maekawa, Hiromitsu, Abe, Sumihisa, Kihara, Hajime, Tsunoda, Satoru, Saito, Katsumi, Tachibana, Hiroki, Oba, Ichiro, Kuwahata, Takashi, Higa, Satoshi, Gushiken, Masamichi, Eto, Takuma, Chibana, 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Mita, Teruaki, Nagao, Kazuhiko, Mito, Takafumi, Minami, Junichi, Abe, Mitsunori, Fujii, Masako, Okawa, Makoto, Fujito, Tsuneo, Taniguchi, Toshiya, Ko, Tenei, Kubo, Hiroshi, Imamaki, Mizuho, Akiyama, Masahiro, Ueda, Takashi, Odakura, Hironori, Inagaki, Masahiko, Katsube, Yoshiki, Nakata, Atsuyuki, Tomimoto, Shinobu, Shibuya, Mitsuhiro, Nakano, Masayuki, Ito, Kenichiro, Matsuta, Masahiro, Ishiguro, Motoyuki, Minagawa, Taro, Wada, Masamichi, Mukawa, Hiroaki, Mizuguchi, Masato, Okuda, Fumio, Kimura, Teruaki, Taga, Kuniaki, Techigawara, Masaaki, Igarashi, Morio, Watanabe, Hiroshi, Seo, Toshihiko, Hiramitsu, Shinya, Hosokawa, Hiroaki, Hoshiai, Mitsumoto, Hibino, Michitaka, Miyagawa, Koichi, Horie, Hideki, Sugishita, Nobuyoshi, Shiga, Yukio, Soma, Akira, Neya, Kazuo, Yoshida, Tetsuro, Akahane, Kunio, Adachi, Sen, Takanaka, Chiei, Matsui, Saori, Kanda, Hirofumi, Kaneko, Masanori, Nagasaka, Shiro, Taguchi, Atsushi, Toru, Shuta, Saito, Kazuyuki, Miyashita, Akiko, Sasaguri, Hiroki, Nariyama, Jin, Hatsuno, Taketo, Iwase, Takash, Sato, Kazuki, Kawai, Kazuya, Kotani, Tomobumi, Tsuji, Tsuyoshi, Sakai, Hirosumi, Nishino, Kiyoshi, Ikeda, Kenichi, Maeda, Kazuo, Shinozuka, Tomohiro, Inoue, Takeshi, Kawakami, Koichi, Kitazumi, Hiromichi, Takagi, Tsutomu, Hamaoka, Mamoru, Kojima, Jisho, Sasaki, Akitoshi, Tsuchiya, Yoshihiro, Betsuyaku, Tetsuo, Higuchi, Koji, Honda, Masaaki, Hasegawa, Koichi, Baba, Takao, Mineoi, Kazuaki, Koeda, Toshihiko, Hirasawa, Kunihiko, Kumazaki, Toshihide, Nakagomi, Akira, Otaki, Eiji, Shindo, Takashi, Hirayama, Hiroyoshi, Sugimoto, Chikako, Yamagishi, Takashi, Mizuguchi, Ichiro, Sezaki, Kazunori, Niwa, Isamu, Takenaka, Ken, Iiji, Osamu, Taya, Koichi, Kitazawa, Hitoshi, Ueda, Samu, Kakuda, Hirokazu, Ono, Takuya, Oriso, Seizo, Kamata, Junya, Nanke, Toshihiko, Maeda, Itaru, Matsuura, Yoshifusa, Teragawa, Hiroki, Maruyama, Yasuyuki, Takei, Kazuo, Horie, Hajime, Kito, Tetsutaro, Asano, Hiroshi, Matsushita, Koji, Nakamura, Masaichi, Washizuka, Takashi, Yoshida, Tomoki, Sawano, Masato, Arima, Shinichi, Arai, Hidekazu, Shinohara, Hisanori, Takai, Hiroyuki, Furukawa, Nobufusa, Ota, Akira, Yamamoto, Kentaro, Aoki, Kenji, Yamamoto, Taku, Kasai, Takeaki, Suzuki, Shunji, Suzuki, Shu, Shibata, Nitaro, Watanabe, Masayuki, Nishihata, Yosuke, Arino, Toru, Okuyama, Masaki, Wakiyama, Tetsushi, Kato, Tomoko, Sasagawa, Yasuo, Tana, Takeshi, Hayashi, Yoshihito, Hirota, Shinichi, Abe, Yukihiko, Saito, Yoshihiro, Uchiyama, Hirohide, Takeda, Hiroshi, Ono, Hiroshi, Tohyo, Shuichi, Hanazono, Naoto, Miyajima, Seiichi, Shimono, Hisashi, Aoyama, Takuma, Shozawa, Yasunobu, Niijima, Yawara, Murai, Osamu, Inaba, Hideko, Nomura, Katsumasa, Nozoe, Masatsugu, Suzuki, Kazuo, Furukawa, Toshiyuki, Shiraiwa, Toshihiko, Ito, Nobuhisa, Nagai, Shunichi, Sato, Kiyoharu, Nakahara, Shiro, Shimoyama, Yujin, Ohara, Naoko, Kozuka, Teruhiko, Okita, Hideaki, Endo, Masato, Goto, Tsutomu, Hirose, Makoto, Nagata, Emiko, Nakanishi, Noriyuki, Mori, Toshizumi, Seki, Shuichi, Okamoto, Katsuhiro, Moriai, Osamu, Emura, Yoko, Fukuda, Tsuyoshi, Date, Haruhiko, Kawakami, Shuichi, Nagai, Sho, Ueyama, Yuya, Fudo, Tetsuro, Imaizumi, Mitsuru, Ogawa, Takuo, Take, Shunsuke, Ikeda, Hideo, Nishioka, Hiroaki, Sakamoto, Norihiko, Ikeoka, Kiyomitsu, Wakaki, Nobuo, Abe, Masatake, Doiuchi, Junji, Kira, Tetsuya, Tada, Masato, Tsuzaki, Ken, Miura, Naoya, Fujisawa, Yasuaki, Furumoto, Wataru, Suzuki, Susumu, Fujisawa, Akinori, Nakamura, Ryosai, Komatsu, Hiroyasu, Fujiki, Rei, Kawano, Shuichi, Nishizawa, Keijiro, Kato, Yoji, Azuma, Junya, Yasui, Kiyoshi, Amano, Toshio, Sekine, Yasuhiro, Honzawa, Tatsuo, Koshibu, Yuichiro, Sakamoto, Yasuhide, Seta, Yukihiro, Miyaguchi, Shingo, Morishita, Kojuro, Samejima, Yasuko, Sasaki, Toyoshi, Iseki, Fumiko, Kobayashi, Toshiyuki, Kano, Hiroshi, Kim, Jaeyoung, Yamaguchi, Hiroshi, Takagi, Yoichi, Pearce, Yoko Onuki, Suzuki, Yasuyuki, Fukui, Takayuki, Nakayama, Toru, Kanai, Hideaki, Kawano, Yoshiyuki, Ino, Tetsuji, Miyoshi, Hironori, Miyamoto, Yasufumi, Shigekiyo, Masahito, Ono, Shimato, Okamoto, Yutaka, Ubukata, Satoshi, Kodera, Kojiro, Oriuchi, Tatsuo, Matsumoto, Naoki, Inagaki, Koichi, Iseki, Atsushi, Yoshida, Tomohiro, Goda, Toshihiro, Katsuki, Tsukasa, Sato, Atsushi, Mori, Etsuo, Tsubokura, Toshio, Shudo, Hiroshi, Fujimoto, Shunichi, Katsuya, Tomohiro, Furukawa, Yoshiyuki, Hosokawa, Hiroshi, Narumi, Jun, Yamamoto, Kiichiro, Owari, Masaki, Inakura, Takuya, Anno, Takafumi, Shirakawa, Kazuyuki, Ching, Chi Keong, Foo, David, Wong, Kelvin, Yuyang, Tan, Park, Hui Nam, Kim, Woo-Shik, Lee, HyeYoung, Jang, Sung-Won, Kim, Dae Hyeok, Kim, Jun, Ryu, DongRyeol, Shim, Jaemin, Kim, Dae-Kyeong, Choi, Dong Ju, Oh, Yong Seog, Cho, Myeong-Chan, Kim, Hack-Lyoung, Jeon, Hui-Kyung, Shin, Dong-Gu, Park, Sang Weon, Park, Hoon Ki, Han, Sang-Jin, Sung, Jung Hoon, Park, Hyung-Wook, Nam, Gi-Byoung, On, Young Keun, Lim, Hong Euy, Kwak, JaeJin, Cha, Tae-Joon, Hong, Taek Jong, Park, Seong Hoon, Yoon, Jung Han, Kim, Nam-Ho, Kim, Kee-Sik, Jung, Byung Chun, Hwang, 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Muñoz, Ernesto Cardona, Hernandez, Norberto Matadamas, Rendon, Adolfo Leyva, Hernandez, Norberto Garcia, de los Rios Ibarra, Manuel, Carrillo, Luis Ramon Virgen, Villezca, David Lopez, Herrera, Carlos Hernandez, Lopez Prieto, Juan Jose, Rodriguez, Rodolfo Gaona, Espinosa, Efrain Villeda, Martinez, David Flores, Barcena, Jose Velasco, Fierro, Omar Fierro, Briones, Ignacio Rodriguez, Leiva Pons, Jose Luis, Lopez, Humberto Alvarez, Ruiz, Rafael Olvera, Brito, Carlos Gerardo Cantu, Valenzuela, Eduardo Julian Jose Roberto Chuquiure, Sanchez, Roxana Reyes, Bazzoni Ruiz, Alberto Esteban, Lopez Ruiz, Oscar Martin, Nava, Roberto Arriaga, Morales Cerda, Jesus David, Campos, Pedro Fajardo, Gonzalez, Mario Benavides, Lenz, Kurt, Hagn, Claus, Foechterle, Johannes, Drexel, Heinz, Huber, Kurt, Podczeck-Schweighofer, Andrea, Winkler, Michael, Schneeweiss, Bruno, Gegenhuber, Alfons, Lang, Wilfried, Eichinger-Hasenauer, Sabine, Kaserer, Peter, Sykora, Josef, Rasch, Heribert, Strohmer, Bernhard, Capiau, 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Mertz, Jacob, Schou, Morten, Olsen, Michael, Airaksinen, K E Juhani, Paganelli, Franck, Ohayon, Joël, Casassus, Frédéric, Galinier, Michel, Gottwalles, Yannick, Loiselet, Philippe, Muller, Jean-Joseph, Koujan, Mohamed Bassel, Marquand, André, Destrac, Sylvain, Piot, Olivier, Delarche, Nicolas, Cebron, Jean-Pierre, Guenoun, Maxime, Guedj-Meynier, Dominique, Lokesh, A G, Zuber, Mathieu, Amarenco, Pierre, Ellie, Emmanuel, Kadouch, James, Fournier, Pierre-Yves, Huberman, Jean-Pierre, Lemaire, Nestor, Rodier, Gilles, Vandamme, Xavier, Sibon, Igor, Neau, Jean-Philippe, Mahagne, Marie Hélène, Mielot, Antoine, Bonnefoy, Marc, Churet, Jean-Baptiste, Navarre, Vincent, Sellem, Frederic, Monniot, Gilles, Boyes, Jean-Paul, Doucet, Bernard, Martelet, Michel, Obadia, Désiré, Crousillat, Bernard, Mouallem, Joseph, Bearez, Etienne, Brugnaux, Jean Philippe, Fedorowsky, Alain, Nazeyrollas, Pierre, Berneau, Jean-Baptiste, Chemin, Frédéric, Schellong, Sebastien, Koeniger, Georg, Kopf, Andreas, Gerbaulet, 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Barbarash, Olga, Miller, Olga, Mazur, Evgeniy, Zrazhevskiy, Konstantin, Novikova, Tatyana, Moiseeva, Yulia, Polkanova, Elena, Sobolev, Konstantin, Rossovskaya, Maria, Shapovalova, Yulia, Kolesnikova, Alla, Nikolaev, Konstantin, Zemlianskaia, Oksana, Zateyshchikova, Anna, Kostenko, Victor, Popov, Sergey, Poltavskaya, Maria, Edin, Anton, Aleksandrova, Elena, Drapkina, Oksana, Vishnevsky, Alexander, Nagibovich, Oleg, Chizhov, Petr, Rachkova, Svetlana, Sergeev, Mikhail, Kurylo, Borys, Ushakov, Alexey, Vinolas, Xavier, Garcia, Pere Alvarez, Lopez Fernandez, Maria Fernanda, Sanchez, Luis Tercedor, Iparraguirre, Salvador Tranche, Monserrat, Pere Toran, Contreras, Emilio Marquez, Rafecas, Jordi Isart, Carrasco, Juan Motero, Pavia, Pablo Garcia, Pajuelo, Casimiro Gomez, Rincon Diaz, Luis Miguel, Iglesias Alonso, Luis Fernando, Ruiz, Angel Grande, Klein, Jordi Merce, Gonzalez Juanatey, Jose Ramon, Collado, Ines Monte, Piquero, Herminia Palacin, Cuixart, Carles Brotons, Escobar, Esther Fernandez, Bayo i Llibre, Joan, Vicente, Cecilia Corros, Gutierrez, Manuel Vida, Gonzalo, Francisco Epelde, Almeida Fernandez, Carlos Alexandre, Navarro, Encarnacion Martinez, Alia, Juan Jose Montero, Gonzalez, Maria Barreda, Oliva, Maria Angels Moleiro, Sanmartin, Jose Iglesias, Gonzalez, Mercedes Jimenez, Alvarez, Maria del Mar Rodriguez, Melenchon, Juan Herreros, Vera, Tomas Ripoll, Navarro, Manuel Jimenez, Caamano, Maria Vazquez, Arcocha Torres, Maria Fe, Gomez, Gonzalo Marcos, Romo, Andres Iniguez, Prieto Diaz, Miguel Angel, Rosenqvist, Mårten, Wirdby, Alexander, Lindén, Jan, Henriksson, Kerstin, Elmersson, Micael, Egilsson, Arnor, Börjesson, Ulf, Svärd, Gunnar, Liu, Bo, Lindh, Anders, Olsson, Lars-Bertil, Gustavsson, Mikael, Andersson, Lars, Benson, Lars, Bothin, Claes, Hajimirsadeghi, Ali, Martinsson, Björn, Ericsson, Marianne, Ohlsson, Åke, Lindvall, Håkan, Svensson, Peter, Thörne, Katarina, Händel, Hans, Platonov, Pyotr, Bernsten, Fredrik, Timberg, Ingar, Crisby, Milita, Karlsson, Jan-Erik, Andersson, Agneta, Malmqvist, Lennart, Engdahl, Johan, Thulin, Jörgen, Hot-Bjelak, Aida, Jensen, Steen, Stalby, Per, Debrunner, Johann, Beer, Juerg H, Shah, Dipen, Rudyk, Iurii, Tseluyko, Vira, Karpenko, Oleksandr, Zhurba, Svitlana, Kraiz, Igor, Parkhomenko, Oleksandr, Kupnovytska, Iryna, Seredyuk, Nestor, Mostovoy, Yuriy, Ushakov, Oleksiy, Koval, Olena, Kovalskiy, Igor, Svyshchenko, Yevgeniya, Sychov, Oleg, Stanislavchuk, Mykola, Yagensky, Andriy, Tykhonova, Susanna, Fushtey, Ivan, Murdoch, Will, Chauhan, Naresh, Goodwin, Daryl, Lumley, Louise, Patel, Ramila, Saunders, Philip, Wong, Bennett, Cameron, Alex, Patel, Niranjan, Jhittay, P, Ross, Andrew, Kainth, M S, Ladha, Karim, Douglas, Kevin, Pickavance, Gill, McDonnell, Joanna, Handscombe, Laura, Gooding, Trevor, Wagner, Helga, Bradshaw, Colin, Bromham, Catherine, Jones, Kevin, Suryani, Shoeb, Coates, Richard, Sarai, Bhupinder, Willcock, W, Sircar, S, Cairns, John, Gilliand, A, Bilas, Roman, Strieder, E, Hutchinson, Peter, Wakeman, Anne, Stokes, Michael, Kirby, Graham, Vishwanathan, Bhaskhar, Bird, Nigel, Evans, Paul, Clark, M, Bisatt, John, Litchfield, Jennifer, Fisher, E, Fooks, Tim, Kelsall, Richard, Paul, Neil, Alborough, Elizabeth, Aziz, Michael, Ramesh, C, Wilson, Pete, Franklin, Simon, Fairhead, Sue, Thompson, Julian, Chowan, Hasan, Taylor, Gary, Tragen, Dawn, Parfitt, Matt, Seamark, Claire, Paul, Carolyn, Richardson, Mark, Jefferies, Angus, Sharp, Helen, Jones, Hywel, Giles, Claire, Bramley, Matthew, Williams, Philip, Aldegather, Jehad, Wetherell, Simon, Lumb, William, Evans, Phil, Scouller, Frances, Macey, Neil, Rogers, Stephen, Stipp, Yvette, West, Richard, Pinney, Philip, Wadeson, Paul, Matthews, John, Pandya, Preeti, Gallagher, Andrew, Railton, T, Davies, Emyr, McClure, Jonathan, Jacobs, Marc, Hutton, Claire, Thompson, R, Sinha, Bijoy, Butter, Keith, Barrow, Susan, Little, Helen, Russell, David, Choudhary, Ulka, Haq, Ikram, Ainsworth, Paul, Jones, Claire, Weeks, Phil, Eden, Jane, Gibbons, Lisa, Glencross, Janet, MacLeod, Alison, Poland, K, Mulolland, Conor, Warke, A, Conn, Paul, Burns, D, Smith, R, Kamath, R, Webster, Jonathan, Hodgins, Ian, Vercoe, Stephen, Roome, Paul, Pinnock, Hilary, Patel, Jayesh, Ali, Amar, Hart, Nigel, Davies, Richard, De-Sousa, Nigel, Neden, Catherine, Danielsen, Mark, Sharma, Purnima, Galloway, Sophia, Hawkins, Charlotte, Oliver, Raife, Aylward, Martin, Pattni, Mira, Irvine, Gordon, Ahmad, Shahid, Rothwell, Catherine, Choudhary, Fiaz, Khalaque, Sabrina, Short, Stephanie, Peters, Sharon, Coulson, Warwick, Roberts, Neil, Butler, Amy, Coates, Steven, Ward, Ben, Jackson, Daniel, Walton, Steve, Shepherd, Diane, Wong, Toh, Boon, Mark, Deacon, Melanie, Cornelius, David, Davies, Sarah, Frankel, Ben, Hargreaves, Nick, Choi, Henry, Sumner, Jon, Myhill, Tim, Estifanos, Salah, Geatch, Diane, Wilkinson, Justin, Veale, Richard, Forshaw, Karen, Hirst, Rob, Zaman, Kashif, Liley, Catherine, Wastling, Rebecca, McEleny, Paul, Beattie, Andre, Cooke, Philip, Wong, Mike, Pugsley, Mark, Dooldeniya, Chaminda, Rogers, Greg, Bennett, James, Jacobs, Polly, Muvva, Rajesh, Adam, Matthew, Fox, Robin, Thomas, Nicolas, Cartwright, Simon, Reed, Rory, Randfield, Simon, A’Court, Christine, Flynn, Ann, Halpin, Andrew, Dobson, Simon, Lomax, Louise, Nadaph, Minnal, Munro, Iain, Goram, Jane, Stoddart, Helen, Simmons, Phil, Shewring, John, Bowen-Simpkins, Emma, Rickenbach, Mark, Blenkhorn, Adam, Singh, Bhuwanendu, Astridge, Penny, van Gaal, William, Abhayaratna, Walter, Thomson, Philip, Lehman, Ron, Kilian, Jens, Coulshed, David, Catanchin, Andrei, Colquhoun, David, Kiat, Hosen, Eccleston, David, French, John, Ayres, Bronte, Blombery, Peter, Phan, Thanh, Rogers, James, O’Donnell, David, Bae, Sang Cheol, Carroll, Patrick, Starmer, Greg, Arstall, Margaret, Binnekamp, Maurits, Lee, Astin, Luton, Robert, Gupta, Milan, Pandey, Amritanshu Shekhar, Cheung, Stephen, Leader, Rolland, Beaudry, Philippe, Ayala-Paredes, Félix, Berlingieri, Joseph, Heath, John, Poirier, Germain, du Preez, Miranda, Schweitzer, Bradley, Nadeau, Reginald, Dhillon, Ripple, Hruczkowski, Tomasz, Lavoie, Andrea, Parkash, Ratika, Cha, James, Coutu, Benoit, MacDonald, Paul, Ramjattan, Brian, Bonet, Jorge, Vizel, Saul, Angaran, Paul, Fikry, Sameh, Mowafy, Ahmed, Katta, Azza, Tawfik, Mazen, Nawar, Moustafa, Sobhy, Mohamed, Abou Seif, Seif Kamal, Khairy, Tarek, El-Aziz, Ahmed Abd, Taha, Nasser, Reda, Ashraf, Elbahry, Atef, Setiha, Mohamed, El Din, Mohamed Gamal, Elkhadem, Magdi, El-Etreby, Adel, Kettles, David, Bayat, Junaid, Siebert, Heidi, Horak, Adrian, Kelfkens, Ynez, Garda, Riaz, Pillay, Thayabran, Guerra, Michele, van Zyl, Louis, Theron, Hendrik, Murray, Andrew, Louw, Rikus, Greyling, Deon, Mntla, Pindile, Ismail, Siddique, Ahmed, Fayzal, Engelbrecht, Johannes, Maharajh, Shambu, Oosthuysen, Wessel, Loghdey, Rehana, Ueckermann, Veronica, Al Naeemi, Abdullah, Yousef, Ghazi, Bazargani, Nooshin, AlOmairi, Munther, Maruthanayagam, Rajan, Singh, Rupesh, Naguib, Ahmed, Ibrahim, Mohamed, Agrawal, Amrish, Nathani, Mukesh, Esheiba, Ehab M, Wassef, Adel, Gupta, Rajeev, Cox, Michael, Beach, Scott, Duffy, Peter, Falkowski, Stephen, Ferrick, Kevin, Franco, Miguel, Kutayli, W Michael, Quick, Annette, Sharma, Niraj, Wilson, Vance, Miller, Stephen, Alberts, Mark, Blumberg, Edwin, Canosa, Roddy, Gutowski, Ted, Ison, Rodney, Garcia, Jorge, Mullen, Paul, Noveck, Howard, Rama, Pamela, Reddy, Rajneesh, Williams, Marcus, Nishijima, Daniel, Ferdinand, Keith, Haque, Ihsan, Mendelson, Robert, Pitta, Sridevi, Theodoro, Daniel, Treasure, Charles, Moustafa, Moustafa, Cader, Cas, Pharr, Walter, Oropallo, Alisha, Platt, George, Gujral, Jaspal, Welker, James, and Koura, Firas

Subjects
Male, medicine.medical_specialty, medicine.drug_class, medicine.medical_treatment, Electric Countershock, Therapeutics, Cardioversion, Lower risk, Cause of Death, Internal medicine, Atrial Fibrillation, medicine, Humans, Prospective Studies, Registries, Propensity Score, Stroke, Aged, Proportional Hazards Models, business.industry, Proportional hazards model, Research, Anticoagulant, Hazard ratio, Atrial fibrillation, General Medicine, Middle Aged, medicine.disease, Propensity score matching, Cardiology, Female, business, RC
Abstract

OBJECTIVE To investigate the clinical outcomes of patients who underwent cardioversion compared with those who did not have cardioverson in a large dataset of patients with recent onset non-valvular atrial fibrillation. DESIGN Observational study using prospectively collected registry data (Global Anticoagulant Registry in the FIELD-AF-GARFIELD-AF). SETTING 1317 participating sites in 35 countries. PARTICIPANTS 52 057 patients aged 18 years and older with newly diagnosed atrial fibrillation (up to six weeks' duration) and at least one investigator determined stroke risk factor. MAIN OUTCOME MEASURES Comparisons were made between patients who received cardioversion and those who had no cardioversion at baseline, and between patients who received direct current cardioversion and those who had pharmacological cardioversion. Overlap propensity weighting with Cox proportional hazards models was used to evaluate the effect of cardioversion on clinical endpoints (all cause mortality, non-haemorrhagic stroke or systemic embolism, and major bleeding), adjusting for baseline risk and patient selection. RESULTS 44 201 patients were included in the analysis comparing cardioversion and no cardioversion, and of these, 6595 (14.9%) underwent cardioversion at baseline. The propensity score weighted hazard ratio for all cause mortality in the cardioversion group was 0.74 (95% confidence interval 0.63 to 0.86) from baseline to one year follow-up and 0.77 (0.64 to 0.93) from one year to two year follow-up. Of the 6595 patients who had cardioversion at baseline, 299 had a follow-up cardioversion more than 48 days after enrolment. 7175 patients were assessed in the analysis comparing type of cardioversion: 2427 (33.8%) received pharmacological cardioversion and 4748 (66.2%) had direct current cardioversion. During one year follow-up, event rates (per 100 patient years) for all cause mortality in patients who received direct current and pharmacological cardioversion were 1.36 (1.13 to 1.64) and 1.70 (1.35 to 2.14), respectively. OBJECTIVE To investigate the clinical outcomes of patients who underwent cardioversion compared with those who did not have cardioverson in a large dataset of patients with recent onset non-valvular atrial fibrillation. DESIGN Observational study using prospectively collected registry data (Global Anticoagulant Registry in the FIELD-AF-GARFIELD-AF). SETTING 1317 participating sites in 35 countries. PARTICIPANTS 52 057 patients aged 18 years and older with newly diagnosed atrial fibrillation (up to six weeks' duration) and at least one investigator determined stroke risk factor. MAIN OUTCOME MEASURES Comparisons were made between patients who received cardioversion and those who had no cardioversion at baseline, and between patients who received direct current cardioversion and those who had pharmacological cardioversion. Overlap propensity weighting with Cox proportional hazards models was used to evaluate the effect of cardioversion on clinical endpoints (all cause mortality, non-haemorrhagic stroke or systemic embolism, and major bleeding), adjusting for baseline risk and patient selection. RESULTS 44 201 patients were included in the analysis comparing cardioversion and no cardioversion, and of these, 6595 (14.9%) underwent cardioversion at baseline. The propensity score weighted hazard ratio for all cause mortality in the cardioversion group was 0.74 (95% confidence interval 0.63 to 0.86) from baseline to one year follow-up and 0.77 (0.64 to 0.93) from one year to two year follow-up. Of the 6595 patients who had cardioversion at baseline, 299 had a follow-up cardioversion more than 48 days after enrolment. 7175 patients were assessed in the analysis comparing type of cardioversion: 2427 (33.8%) received pharmacological cardioversion and 4748 (66.2%) had direct current cardioversion. During one year follow-up, event rates (per 100 patient years) for all cause mortality in patients who received direct current and pharmacological cardioversion were 1.36 (1.13 to 1.64) and 1.70 (1.35 to 2.14), respectively. CONCLUSION In this large dataset of patients with recent onset non-valvular atrial fibrillation, a small proportion were treated with cardioversion. Direct current cardioversion was performed twice as often as pharmacological cardioversion, and there appeared to be no major difference in outcome events for these two cardioversion modalities. For the overall cardioversion group, after adjustments for confounders, a significantly lower risk of mortality was found in patients who received early cardioversion compared with those who did not receive early cardioversion. STUDY REGISTRATION ClinicalTrials.gov NCT01090362.

Published
2021

12. Outcomes in Newly Diagnosed Atrial Fibrillation and History of Acute Coronary Syndromes: Insights from GARFIELD-AF

Author

Butler, Amy, Elmersson, Micael, Egilsson, Arnor, Borjesson, Ulf, Svard, Gunnar, Liu, Bo, Lindh, Anders, Olsson, Lars-Bertil, Gustaysson, Mikael, Andersson, Lars, Benson, Lars, Bothin, Claes, Hajimirsadeghi, Ali, Martinsson, Bjorn, Ericsson, Marianne, Ohlsson, Ake, Lindvall, Hakan, Svensson, Peter, Thorne, Katarina, Handel, Hans, Platonov, Pyotr, Bernsten, Fredrik, Timberg, Ingar, Crisby, Milita, Karlsson, Jan-Erik, Andersson, Agneta, Malmqvist, Lennart, Engdahl, Johan, Thulin, Jorgen, Hot-Bjelak, Aida, Jensen, Steen, Debrunner, Johann, Beer, Juerg H., Shah, Dipen, Rudyk, Iurii, Tseluyko, Vira, Karpenko, Oleksandr, Zhurba, Svitlana, Kraiz, Igor, Parkhomenko, Oleksandr, Kupnovytska, Iryna, Seredyuk, Nestor, Mostovoy, Yuriy, Ushakov, Oleksiy, Koval, Olena, Kovalskiy, Igor, Svyshchenko, Yevgeniya, Sychov, Oleg, Stanislavchuk, Mykola, Tykhonova, Susanna, Fushtey, Ivan, Murdoch, Will, Chauhan, Naresh, Goodwin, Daryl, Lumley, Louise, Patel, Ramila, Saunders, Philip, Wong, Bennett, Patel, Niranjan, Jhittay, P., Ross, Andrew, Kainth, M. S., Ladha, Karim, Douglas, Kevin, Pickavance, Gill, McDonnell, Joanna, Handscombe, Laura, Gooding, Trevor, Wagner, Helga, Bradshaw, Colin, Bromham, Catherine, Jones, Kevin, Suryani, Shoeb, Coates, Richard, Sarai, Bhupinder, Willcock, W., Sircar, S., Cairns, John, Gilliand, A., Bilas, Roman, Strieder, E., Hutchinson, Peter, Wakeman, Anne, Stokes, Michael, Kirby, Graham, Vishwanathan, Bhaskhar, Vormann, Reinhold, Mueller, Thomas, Mayer, Peter, Horstmeier, Uwe, Eissing, Volker, Hey, Heinz, Leuchtgens, Heinz, Lilienweiss, Volker, Mueller, Heiner, Schubert, Christian, Lauer, Hellmann, Buchner, Thomas, Brauer, Gunter, Kamin, Susanne, Mueller, Karsten, Baumbach, Sylvia, Abdel-Qader, Muwafeg, Ebert, Hans-Holger, Schwencke, Carsten, Bernhardt, Peter, Karolyi, Laszlo, Sievers, Britta, Haverkamp, Wilhelm, Roehnisch, Jens-Uwe, Vertes, Andras, Szantai, Gabor, Menke, Holger, Matoltsy, Andras, Kanakaridisz, Nikosz, Boda, Zoltan, Kis, Erno, Gaszner, Balazs, Juhasz, Ferenc, Kamogawa, Yasuyuki, Fournier, Pierre-Yves, Muller, Jean-Joseph, Marquand, Andre, Delarche, Nicolas, Bantwal, Ganapathi, Faes, Dirk, Verstraete, Stefan, Dominguez, Helena, Topsakal, Ramazan, Centurion, Nestor, Alfredo Sinisi, Victor, Minc, Piotr, Nagy, Andras, Bilo, Grzegorz, Bongiorni, Maria Grazia, Bird, Nigel, Paul, Carolyn, Wadeson, Paul, Hargreaves, Nick, Kostenko, Victor, Tercedor Sanchez, Luis, Tranche Iparraguirre, Salvador, Jimenez Gonzalez, Mercedes, Herreros Melenchon, Juan, Stalby, Per, Yagensky, Andriy, Cameron, Alex, Jacobs, Polly, Juhasz, Gizella, Kancz, Sandor, Laszlo, Zoltan, May, Zsolt, Astridge, Penny, Loghdey, Rehana, Quick, Annette, Yang, Ping, Chen, Yingmin, He, Shenghu, Wang, Yong, Fu, Guosheng, Li, Xin, Wu, Tongguo, Cheng, Xiaoshu, Yan, Xiaowei, Zhao, Ruiping, Chen, Moshui, Xiong, Longgen, Chen, Ping, Jiao, Yang, Guo, Ying, Xue, Li, Yang, Zhiming, Jadhavm, Praveen, Merkely, Bela, Noon, Ebrahim, Habon, Tamas, Polgar, Peter, Szalai, Gabriella, Vangel, Sandor, Sarma, Raghava, Kulkarni, Govind, Engelthaler, Gabriella, Ferenczi, Judit, Chandwani, Prakash, Pothiwala, Rasesh Atulbhai, Purayil, Mohanan Padinhare, Chawla, Kamaldeep, Verheugt, Freek W. A., Ambrosio, Giuseppe, Atar, Dan, Bassand, Jean-Pierre, Costabel, Juan Pablo, Goldhaber, Samuel Z., Goto, Shinya, Egyutt, Mihaly, Martini, Giuliana, Cristina, Leone Maria, Tirafern, Eros, Santoro, Rita, Testa, Sophie, Di Minno, Giovanni, Moia, Marco, Caimi, Teresa Maria, Tessitori, Maria, Cappelli, Roberto, Accogli, Michele, Mariani, Antonio, Feola, Mauro, Raisaro, Arturo, Fattore, Luciano, Mauric, Andrea, Germini, Fabrizio, Tedeschi, Luca, Settimi, Maria, Nicoli, Sergio, Ricciarini, Paolo, Argena, Antonio, Ronchini, Paolo, Bulla, Claudio, Tradati, Filippo, Volpe, Massimo, Avino, Maria D., Seven, Silva, Capucci, Alessandro, Lodigiani, Corrado, Salomone, Enrico, Serviddio, Gaetano, Tondo, Claudio, Golino, Paolo, Mazzone, Carmine, Iacopino, Saverio, Ruiter, J. H., Lucassen, Andreas, Adriaansen, Henk, Bongaerts, Maarten, Pieterse, Mathijs, van Guldener, Coen, Herrman, Johannes, Nierop, S. H. K. P. R., Hoogslag, Pieter, Hermans, Walter, Groenemeijer, B. E., Terpstra, W., Buiks, Cees, Boersma, L. V. A., Berge, Eivind, Sirnes, Per Anton, Gjertsen, Erik, Hole, Torstein, Erga, Knut, Hallaraker, Arne, Skjelvan, Gunnar, Ostrem, Anders, Ghezai, Beraki, Svilaas, Arne, Christersson, Peter, Oien, Torbjorn, Henrichsen, Svein Hoegh, Otterstad, Jan Erik, Berg-Johansen, Jan, Gieroba, Andrzej, Biedrzycka, Malgorzata, Ogorek, Michal, Wozakowska-Kaplon, Beata, Loboz-Grudzien, Krystyna, Jaroslaw, Jaroslaw, Supinski, Wieslaw, Kuzniar, Jerzy, Zaluska, Roman, Hiczkiewicz, Jaroslaw, Swiatkowska-Byczynska, Lucyna, Kucharski, Lech, Gruchala, Marcin, Olszewski, Maciej, Kania, Grzegorz, Krzciuk, Malgorzata, Lajkowski, Zbigniew, Ostrowska-Pomian, Bozenna, Lewczuk, Jerzy, Zinka, Elzbieta, Karczmarczyk, Agnieszka, Chmielnicka-Pruszczynska, Malgorzata, Wozniak-Skowerska, Iwona, Opolski, Grzegorz, Bronisz, Marek, Ogorek, Marcin, Glanowska, Grazyna, Ruszkowski, Piotr, Skonieczny, Grzegorz, Sciborski, Ryszard, Okopien, Boguslaw, Kukla, Piotr, Galbas, Krzysztof, Cymerman, Krzysztof, Jurowiecki, Jaroslaw, Miekus, Pawel, Myszka, Waldemar, Mazur, Stanislaw, Lysek, Roman, Baszak, Jacek, Rusicka-Piekarz, Teresa, Raczak, Grzegorz, Domanska, Ewa, Nessler, Jadwiga, Catanchin, Andrei, Colquhoun, David, Kiat, Hosen, Eccleston, David, French, John, Ayres, Bronte, Blombery, Peter, Phan, Thanh, Rogers, James, O'Donnell, David, Cheol, Sang, Carroll, Patrick, Starmer, Greg, Arstall, Margaret, Binnekamp, Maurits, Lee, Astin, Luton, Robert, Gupta, Milan, Pandey, Amritanshu Shekhar, Cheung, Stephen, Leader, Rolland, Beaudry, Philippe, Ayala-Paredes, Felix, Berlingieri, Joseph, Heath, John, Poirier, Germain, du Preez, Miranda, Schweitzer, Bradley, Nadeau, Reginald, Dhillon, Ripple, Hruczkowski, Tomasz, Lavoie, Andrea, Parkash, Ratika, Cha, James, Coutu, Benoit, MacDonald, Paul, Ramjattan, Brian, Bonet, Jorge, Vizel, Saul, Angaran, Paul, Fikry, Sameh, Mowafy, Ahmed, Katta, Azza, Tawfik, Mazen, Nawar, Moustafa, Sobhy, Mohamed, Abou Seif, Seif Kamal, Khairy, Tarek, Abd El-Aziz, Ahmed, Taha, Nasser, Reda, Ashraf, Elbahry, Atef, Setiha, Mohamed, El Din, Mohamed Gamal, Elkhadem, Magdi, El-Etreby, Adel, Kettles, David, Bayat, Junaid, Siebert, Heidi, Horak, Adrian, Kelfkens, Ynez, Garda, Riaz, Pillay, Thayabran, Guerra, Michele, van Zyl, Louis, Theron, Hendrik, Murray, Andrew, Louw, Rikus, Greyling, Deon, Mntla, Pindile, Ismail, Siddique, Ahmed, Fayzal, Engelbrecht, Johannes, Maharajh, Shambu, Oosthuysen, Wessel, Ueckermann, Veronica, Al Naeemi, Abdullah, Yousef, Ghazi, Bazargani, Nooshin, Alomairi, Munther, Maruthanayagam, Rajan, Singh, Rupesh, Naguib, Ahmed, Ibrahim, Mohamed, Agrawal, Amrish, Nathani, Mukesh, Esheiba, Ehab M., Wassef, Adel, Gupta, Rajeev, Cox, Michael, Beach, Scott, Duffy, Peter, Falkowski, Stephen, Ferrick, Kevin, Franco, Miguel, Kutayli, W. Michael, Sharma, Niraj, Wilson, Vance, Miller, Stephen, Alberts, Mark, Blumberg, Edwin, Canosa, Roddy, Gutowski, Ted, Ison, Rodney, Garcia, Jorge, Mullen, Paul, Noveck, Howard, Rama, Pamela, Reddy, Rajneesh, Williams, Marcus, Nishijima, Daniel, Ferdinand, Keith, Hague, Ihsan, Mendelson, Robert, Pitta, Sridevi, Theodoro, Daniel, Treasure, Charles, Moustafa, Moustafa, Cader, Cas, Pharr, Walter, Oropallo, Alisha, Platt, George, Gujral, Jaspal, Welker, James, Koura, Firas, Lesnik, Jozef, Eltishcheva, Vera, Libis, Roman, Kamalov, Gadel, Belenky, Dmitry, Egorova, Liudmila, Khokhlov, Alexander, Yakupov, Eduard, Zateyshchikov, Dmitry, Barbarash, Olga, Miller, Olga, Mazur, Evgeniy, Zrazhevskiy, Konstantin, Novikova, Tatyana, Moiseeva, Yulia, Polkanova, Elena, Sobolev, Konstantin, Rossovskaya, Maria, Shapovalova, Yulia, Kolesnikova, Alla, Nikolaev, Konstantin, Zemlianskaia, Oksana, Zateyshchikova, Anna, Popov, Sergey, Poltayskaya, Maria, Edin, Anton, Aleksandrova, Elena, Drapkina, Oksana, Vishnevsky, Alexander, Nagibovich, Oleg, Chizhov, Petr, Rachkova, Svetlana, Sergeev, Mikhail, Kurylo, Borys, Ushakov, Alexey, Alvarez Garcia, Pere, Lopez Fernandez, Maria Fernanda, Toran Monserrat, Pere, Marquez Contreras, Emilio, Isart Rafecas, Jordi, Motero Carrasco, Juan, Garcia Pavia, Pablo, Gomez Pajuelo, Casimiro, Rincon Diaz, Luis Miguel, Iglesias Alonso, Luis Fernando, Grande Ruiz, Angel, Merce Klein, Jordi, Gonzalez Juanatey, Jose Ramon, Monte Collado, Ines, Palacin Piquero, Herminia, Brotons Cuixart, Carles, Fernandez Escobar, Esther, Bayo i Llibre, Joan, Corros Vicente, Cecilia, Vida Gutierrez, Manuel, Evans, Paul, Clark, M., Bisatt, John, Litchfield, Jennifer, Fisher, E., Fooks, Tim, Kelsall, Richard, Paul, Neil, Alborough, Elizabeth, Aziz, Michael, Ramesh, C., Wilson, Pete, Franklin, Simon, Fairhead, Sue, Thompson, Julian, Chowan, Hasan, Taylor, Gary, Tragen, Dawn, Parfitt, Matt, Seamark, Claire, Richardson, Mark, Jefferies, Angus, Sharp, Helen, Jones, Hywel, Giles, Claire, Bramley, Matthew, Williams, Philip, Aldegather, Jehad, Wetherell, Simon, Lumb, William, Evans, Phil, Scouller, Frances, Macey, Neil, Rogers, Stephen, Stipp, Yvette, West, Richard, Pinney, Philip, Matthews, John, Pandya, Preeti, Gallagher, Andrew, Railton, T., Davies, Emyr, McClure, Jonathan, Jacobs, Marc, Hutton, Claire, Thompson, R., Sinha, Bijoy, Butter, Keith, Barrow, Susan, Little, Helen, Russell, David, Choudhary, Ulka, Haq, Ikram, Ainsworth, Paul, Jones, Claire, Weeks, Phil, Eden, Jane, Gibbons, Lisa, Glencross, Janet, MacLeod, Alison, Poland, K., Mulolland, Conor, Warke, A., Conn, Paul, Burns, D., Smith, R., Kamath, R., Webster, Jonathan, Hodgins, Ian, Vercoe, Stephen, Roome, Paul, Pinnock, Hilary, Patel, Jayesh, Ali, Amar, Hart, Nigel, Davies, Richard, De-Sousa, Nigel, Neden, Catherine, Danielsen, Mark, Sharma, Purnima, Galloway, Sophia, Hawkins, Charlotte, Oliver, Raife, Aylward, Martin, Pattni, Mira, Irvine, Gordon, Ahmad, Shahid, Rothwell, Catherine, Choudhary, Fiaz, Khalaque, Sabrina, Short, Stephanie, Peters, Sharon, Coulson, Warwick, Roberts, Neil, Coates, Steven, Ward, Ben, Jackson, Daniel, Walton, Steve, Shepherd, Diane, Wong, Toh, Boon, Mark, Deacon, Melanie, Cornelius, David, Davies, Sarah, Ben Frankel, Ben Frankel, Choi, Henry, Sumner, Jon, Myhill, Tim, Estifanos, Salah, Geatch, Diane, Wilkinson, Justin, Veale, Richard, Forshaw, Karen, Hirst, Rob, Zaman, Kashif, Liley, Catherine, Wastling, Rebecca, McEleny, Paul, Beattie, Andre, Cooke, Philip, Wong, Mike, Pugsley, Mark, Dooldeniya, Chaminda, Rogers, Greg, Bennett, James, Muvva, Rajesh, Adam, Matthew, Fox, Robin, Thomas, Nicolas, Cartwright, Simon, Reed, Rory, Randfield, Simon, ACourt, Christine, Flynn, Ann, Halpin, Andrew, Dobson, Simon, Lomax, Louise, Nadaph, Minnal, Goram, Jane, Stoddart, Helen, Simmons, Phil, Shewring, John, Bowen-Simpkins, Emma, Rickenbach, Mark, Munro, Iain, Blenkhorn, Adam, Singh, Bhuwanendu, van Gaal, William, Abhayaratna, Walter, Thomson, Philip, Lehman, Ron, Kilian, Jens, Coulshed, David, Camm, A. John, Fitzmaurice, David A., Illingworth, Laura, Kayani, Gloria, Kakkar, Ajay K., YILMAZ, MEHMET BİRHAN, Taga, Kuniaki, Techigawara, Masaaki, Igarashi, Mono, Watanabe, Hiroshi, Seo, Toshihiko, Hiramitsu, Shinya, Hosokawa, Hiroaki, Hoshiai, Mitsumoto, Hibino, Michitaka, Miyagawa, Koichi, Horie, Hideki, Turpie, Alexander G. G., van Eickels, Martin, Hacke, Werner, Mantovani, Lorenzo G., Misselwitz, Frank, Pieper, Karen S., Kayani, Glo-ria, Fox, Keith A. A., Gersh, Bernard J., Lucas Luciardi, Hector, Gibbs, Harry, Brodmann, Marianne, Cools, Frank, Pereira Barrett, Antonio Carlos, Connolly, Stuart J., Spyropoulos, Alex, Eikelboom, John, Corbalan, Ramon, Hu, Dayi, Nielsen, JOrn Dalsgaard, Ragy, Hany, Raatikainen, Pekka, Le Heuzey, Jean-Yves, Darius, Harald, Keltai, Matyas, Kakkar, Sanjay, Sawhney, Jitendra Pal Singh, Agnelli, Giancarlo, Koretsune, Yukihiro, Sanchez Diaz, Carlos Jerjes, Ten Cate, Hugo, Panchenko, Elizaveta, Lim, Toon Wei, Jacobson, Barry, Oh, Seil, Vinolas, Xavier, Rosenqvist, Marten, Steffel, Jan, Angchaisuksiri, Pantep, Oto, Ali, Parkhomenko, Alex, Al Mahmeed, Wael, Fitzmaurice, David, Chen, Kangning, Zhao, Yusheng, Zhang, Huaiqin, Chen, Jiyan, Cao, Shiping, Wang, Daowen, Yang, Yuejin, Li, Weihua, Li, Hui, Yin, Yuehui, Tao, Guizhou, Kothiwale, Veerappa Annasaheb, Kimura, Teruaki, Raghuraman, Bagirath, Vijan, Vinod Madan, Sawhney, Jitendra, Khan, Aziz, Meena, Ramdhan, Okuda, Fumio, Mizuguchi, Masato, Mukawa, Hiroaki, Chopada, Manojkumar, Abraham, Sunitha, Bisne, Vikas, Vijayaraghavan, Govindan, Roy, Debabrata, Durgaprasad, Rajashekhar, Shankar, A. G. Ravi, Kumar, Sunil, Jain, Dinesh, Bhargava, Kartikeya, Kumar, Vinay, Nagamalesh, Udigala Madappa, Rajput, Rajeeve Kumar, Kanamori, Seishu, Wada, Masamichi, Minagawa, Taro, Ishiguro, Motoyuki, Yamamoto, Kenichi, Kumagai, Koichiro, Katsuda, Yosuke, Yoshida, Keiki, Toyota, Fumitoshi, Mizuno, Yuji, Misumi, Ikuo, Noguchi, Hiroo, Ando, Shinichi, Suetsugu, Tetsuro, Minamoto, Masahiro, Oda, Hiroyuki, Adachi, Susumu, Chiba, Kei, Norita, Hiroaki, Tsuruta, Makoto, Koyanagi, Takeshi, Matsuta, Masahiro, Ito, Kenichiro, Nakano, Masayuki, Shibuya, Mitsuhiro, Stepinska, Janina, Jansky, Petr, Yamamoto, Kunihiko, Haas, Sylvia, Ando, Hiroshi, Higashi, Takayuki, Okada, Megumi, Azakami, Shiro, Komaki, Shinichiro, Kumeda, Kenshi, Murayama, Takashi, Matsumura, Jun, Oba, Yurika, Sonoda, Ryuji, Goto, Kazuo, Minoda, Kotaro, Haraguchi, Yoshikuni, Suefuji, Hisakazu, Miyagi, Hiroo, Kato, Hitoshi, Nakamura, Tsugihiro, Nakamura, Tadashi, Nandate, Hidekazu, Zaitsu, Ryuji, Fujiura, Yoshihisa, Yoshimura, Akira, Numata, Hiroyuki, Ogawa, Jun, Murakami, Kinshiro, Wakasa, Yutaka, Yamasawa, Masanori, Maekawa, Hiromitsu, Abe, Sumihisa, Kihara, Hajime, Tsunoda, Satoru, Saito, Katsumi, Tachibana, Hiroki, Oba, Ichiro, Kuwahata, Takashi, Higa, Satoshi, Gushiken, Masamichi, Eto, Takuma, Chibana, Hidetoshi, Fujisawa, Kazuaki, Shiga, Yuhei, Sumi, Hirokuni, Nagatomo, Toshihisa, Atsuchi, Yoshihiko, Nagoshi, Toshiro, Sanno, Kazuhisa, Hoshino, Fumihiro, Yokota, Naoto, Kameko, Masahiro, Tabuchi, Toshifumi, Ishizawa, Munesumi, Fujiura, Yoshitake, Ikeda, Daisuke, Seto, Taku, Iwao, Tetsu, Ishioka, Norio, Oshiro, Koichi, Tsuchida, Keizo, Hatori, Yutaka, Takeuchi, Motoshi, Takezawa, Hiroto, Kira, Tetsuya, Tada, Masato, Tsuzaki, Ken, Miura, Naoya, Fujisawa, Yasuaki, Furumoto, Wataru, Suzuki, Susumu, Fujisawa, Akinori, Nakamura, Ryosai, Komatsu, Hiroyasu, Fujiki, Rei, Kawano, Shuichi, Nishizawa, Keijiro, Kato, Yoji, Azuma, Junya, Yasui, Kiyoshi, Amano, Toshio, Sekine, Yasuhiro, Honzawa, Tatsuo, Koshibu, Yuichiro, Sakamoto, Yasuhide, Seta, Yukihiro, Miyaguchi, Shingo, Morishita, Kojuro, Samejima, Yasuko, Sasaki, Toyoshi, Iseki, Fumiko, Kobayashi, Toshiyuki, Kano, Hiroshi, Kim, Jaeyoung, Yamaguchi, Hiroshi, Takagi, Yoichi, Pearce, Yoko Onuki, Suzuki, Yasuyuki, Fukui, Takayuki, Nakayama, Toni, Kanai, Hideaki, Kawano, Yoshiyuki, Ino, Tetsuji, Miyoshi, Hironori, Miyamoto, Yasufumi, Shigekiyo, Masahito, Ono, Shimato, Okamoto, Yutaka, Ubukata, Satoshi, Kodera, Kojiro, Oriuchi, Tatsuo, Matsumoto, Naoki, Nagano, Shinjiro, Iwaki, Masaaki, Nakamura, Yuichiro, Miyamoto, Naomasa, Taguchi, Toshifumi, Ashida, Ko, Yoshizawa, Naoto, Agata, Jun, Matsukawa, Seishiro, Arasaki, Osamu, Fukuoka, Shuji, Murakami, Hirofumi, Mishima, Kazuya, Hata, Yoshiki, Sakuma, Ichiro, Obunai, Kotaro, Takamura, Ichiro, Akutsu, Mitsuyuki, Unoki, Toshihide, Go, Yoshinori, Ikemura, Makoto, Morii, Shoji, Marusaki, Shigem, Doi, Hideo, Tanaka, Mitsuru, Kusu-moto, Takaaki, Kakinoki, Shigeo, Ogurusu, Chiga, Murata, Kazuya, Shimoyama, Masaki, Nakatsuka, Masami, Kitami, Yutaka, Nakamura, Yoichi, Oda, Hiroshi, Oyama, Rikimaru, Ageta, Masato, Mita, Teruaki, Nagao, Kazuhiko, Mito, Takafumi, Minami, Junichi, Abe, Mitsunori, Fujii, Masako, Okawa, Makoto, Fujito, Tsuneo, Taniguchi, Toshiya, Ko, Tenei, Kubo, Hiroshi, Imamaki, Mizuho, Akiyama, Masahiro, Ueda, Takashi, Odakura, Hironori, Inagaki, Masahiko, Katsube, Yoshiki, Nakata, Atsuyuki, Tomimoto, Shinobu, Sugishita, Nobuyoshi, Shiga, Yukio, Soma, Akira, Neya, Kazuo, Yoshida, Tetsuro, Akahane, Kunio, Adachi, Sen, Takanaka, Chiei, Matsui, Saori, Kanda, Hirofumi, Kaneko, Masanori, Nagasaka, Shiro, Taguchi, Atsushi, Toru, Shuta, Saito, Kazuyuki, Miyashita, Akiko, Sasaguri, Hiroki, Nariyama, Jin, Hatsuno, Taketo, Iwase, Takash, Sato, Kazuki, Kawai, Kazuya, Kotani, Tomobumi, Tsuji, Tsuyoshi, Sakai, Hirosumi, Nishino, Kiyoshi, Ikeda, Kenichi, Maeda, Kazuo, Shinozuka, Tomohiro, Inoue, Takeshi, Kawakami, Koichi, Kitazumi, Hiromichi, Takagi, Tsutomu, Hamaoka, Mamoru, Kojima, Jisho, Sasaki, Akitoshi, Tsuchiya, Yoshihiro, Bet-suyaku, Tetsuo, Higuchi, Koji, Honda, Masaaki, Hasegawa, Koichi, Baba, Takao, Mineoi, Kazuaki, Koeda, Toshihiko, Hirasawa, Kunihiko, Kumazaki, Toshihide, Nakagomi, Akira, Otaki, Eiji, Shindo, Takashi, Hirayama, Hiroyoshi, Sugimoto, Chikako, Yamagishi, Takashi, Mizuguchi, Ichiro, Sezaki, Kazunori, Niwa, Isamu, Takenaka, Ken, Iiji, Osamu, Taya, Koichi, Kitazawa, Hitoshi, Ueda, Samu, Kakuda, Hirokazu, Ono, Takuya, Oriso, Seizo, Kamata, Junya, Nanke, Toshihiko, Maeda, Itaru, Matsuura, Yoshifusa, Teragawa, Hiroki, Maruyama, Yasuyuki, Takei, Kazuo, Hone, Hajime, Kito, Tetsu-taro, Asano, Hiroshi, Matsushita, Koji, Nakamura, Masaichi, Washizuka, Takashi, Yoshida, Tomoki, Sawano, Masato, Arima, Shinichi, Arai, Hidekazu, Shinohara, Hisanori, Takai, Hiroyuki, Furukawa, Nobufusa, Ota, Akira, Yamamoto, Kentaro, Aoki, Kenji, Yamamoto, Taku, Kasai, Takeaki, Suzuki, Shunji, Suzuki, Shu, Shibata, Nitaro, Watanabe, Masayuki, Nishihata, Yosuke, Arino, Torn, Okuyama, Masaki, Wakiyama, Tetsushi, Kato, Tomoko, Sasagawa, Yasuo, Tana, Takeshi, Tumelero, Rogerio Tadeu, Maia, Lilia, de Almeida, Roberto Simoes, Carmo Borges, Ney Carter, Gomes Ferreira, Luis Gustavo, Stockins Fernandez, Benjamin Aleck Joseh, Montecinos, Humberto, Lanas, Fernando, Larico Gomez, Martin, Astudillo, Carlos, Conejeros, Carlos, Marin Cuevas, Patricio, Forero, Alejandro, Bugueno Gutierrez, Claudio, Aguilar, Juan, Potthoff Cardenas, Sergio, Eggers, German, Houzvic, Cesar, Rey, Carlos, Arriagada, German, Charme Vilches, Gustavo, Illescas Diaz, Jesus Jaime, Leal Cantu, Raul, Ramos Zavala, Maria Guadalupe, Cabrera Jardines, Ricardo, Espinola Zavaleta, Nilda, Lopez Rosas, Enrique, Llamas Esperon, Guillermo Antonio, Pozas, Gerardo, Cardona Munoz, Ernesto, Her-nandez, Norberto Matadamas, Leyva Rendon, Adolfo, Garcia Hernandez, Norberto, de los Rios Ibarra, Manuel, Virgen Carrillo, Luis Ramon, Lopez Villezca, David, Hernandez Herrera, Carlos, Lopez Prieto, Juan Jose, Gaona Rodriguez, Rodolfo, Villeda Espinosa, Efrain, Flores Martinez, David, Velasco Barcena, Jose, Fierro Fierro, Omar, Rodriguez Briones, Ignacio, Leiva Pons, Jose Luis, Alvarez Lopez, Humberto, Olvera Ruiz, Rafael, Cantu Brito, Carlos Gerardo, Chuquiure Valenzuela, Eduardo Julian Jose Roberto, Reyes Sanchez, Roxana, Bazzoni Ruiz, Alberto Esteban, Lopez Ruiz, Oscar Martin, Arriaga Nava, Roberto, Morales Cerda, Jesus David, Fajardo Campos, Pedro, Benavides Gonzalez, Mario, Lenz, Kurt, Hagn, Claus, Foechterle, Johannes, Drexel, Heinz, Huber, Kurt, Podczeck-Schweighofer, Andrea, Winkler, Michael, Schneeweiss, Bruno, Gegenhuber, Alfons, Lang, Wilfried, Eichinger-Hasenauer, Sabine, Kaserer, Peter, Sykora, Josef, Rasch, Heribert, Strohmer, Bernhard, Capiau, Luc, Vervoort, Geert, Wollaert, Bart, Hollanders, Geert, Vercammen, Jan, Balthazar, Yohan, Delforge, Marc, Xhaet, Olivier, Striekwold, Harry, Thoeng, John, Hermans, Kurt, Mairesse, Georges, Anne, Wim, Blankoff, Ivan, Beutels, Michel, Vandergoten, Peter, Purnode, Philippe, Godart, Pascal, Boussy, Tim, Desfontaines, Philippe, Heyse, Alex, Voet, Joeri, De Wolf, Axel, Zidkova, Eva, Spacek, Rudolf, Machova, Vilma, Ludka, Ondrej, Olsr, Josef, Kotik, Lubos, Racz, Blazej, Ferkl, Richard, Hubac, Jan, Kotik, Ilja, Monhart, Zdenek, Burianova, Hana, Jerabek, Ondrej, Pisova, Jana, Petrova, Iveta, Dedek, Vratislav, Honkova, Michaela, Podrazil, Petr, Reichert, Petr, Spinar, Jindrich, Novak, Miroslav, Durdil, Vaclav, Plocova, Katarina, Lastuvka, Jiri, Nielsen, Jorn, Hayashi, Yoshihito, Hirota, Shinichi, Abe, Yukihiko, Saito, Yoshihiro, Uchiyama, Hirohide, Takeda, Hiroshi, Ono, Hiroshi, Tohyo, Shuichi, Hanazono, Naoto, Miyajima, Seiichi, Shimono, Hisashi, Aoyama, Takuma, Shozawa, Yasunobu, Niijima, Yawara, Murai, Osamu, Inaba, Hideko, Nomura, Katsumasa, Nozoe, Masatsugu, Suzuki, Kazuo, Furukawa, Toshiyuki, Shiraiwa, Toshihiko, Ito, Nobuhisa, Nagai, Shunichi, Sato, Kiyoharu, Nakahara, Shiro, Shimoyama, Yujin, Ohara, Naoko, Kozuka, Teruhiko, Okita, Hideaki, Endo, Masato, Goto, Tsutomu, Hirose, Makoto, Nagata, Emiko, Nakanishi, Noriyuki, Mori, Toshizumi, Seki, Shuichi, Okamoto, Katsuhiro, Moriai, Osamu, Emura, Yoko, Fukuda, Tsuyoshi, Date, Haruhiko, Kawakami, Shuichi, Nagai, Sho, Ueyama, Yuya, Fudo, Tetsuro, Imaizumi, Mitsuru, Ogawa, Takuo, Take, Shunsuke, Ikeda, Hideo, Nishioka, Hiroaki, Sakamoto, Norihiko, Ikeoka, Kiyomitsu, Wakaki, Nobuo, Abe, Masatake, Doiuchi, Junji, Inagaki, Koichi, Iseki, Atsushi, Yoshida, Tomohiro, Goda, Toshihiro, Katsuki, Tsukasa, Sato, Atsushi, Mori, Etsuo, Tsubokura, Toshio, Shudo, Hiroshi, Fujimoto, Shunichi, Katsuya, Tomohiro, Furukawa, Yoshiyuki, Hosokawa, Hiroshi, Narumi, Jun, Yamamoto, Kiichiro, Owari, Masaki, Inakura, Takuya, Anno, Takafumi, Shirakawa, Kazuyuki, Ching, Chi Keong, Foo, David, Wong, Kelvin, Yuyang, Tan, Park, Hui Nam, Kim, Woo-Shik, Lee, HyeYoung, Jang, Sung-Won, Kim, Dae Hyeok, Kim, Jun, Ryu, DongRyeol, Shim, Jaemin, Kim, Dae-Kyeong, Choi, Dong Ju, Oh, Yong Seog, Cho, Myeong-Chan, Kim, Hack-Lyoung, Jeon, Hui-Kyung, Shin, Dong-Gu, Park, Sang Weon, Park, Hoon Ki, Han, Sang-Jin, Sung, Jung Hoon, Park, Hyung-Wook, Nam, Gi-Byoung, On, Young Keun, Lim, Hong Euy, Kwak, JaeJin, Cha, Tae-Joon, Hong, Taek Jong, Park, Seong Hoon, Yoon, Jung Han, Kim, Nam-Ho, Kim, Kee-Sik, Jung, Byung Chun, Hwang, Gyo-Seung, Kim, Chong-Jin, Rungaramsin, Sakda, Katekangplu, Peerapat, Khunrong, Porames, Bunyapipat, Thanita, Wongcharoen, Wanwarang, Kaewsuwanna, Pinij, Siriwattana, Khanchai, Tiyanon, Waraporn, Pattanaprichakul, Supalerk, Likittanasombat, Khanchit, Cholsaringkarl, Doungrat, Boonyapisit, Warangkana, Cheewatanakornkul, Sirichai, Silaruks, Songkwan, Hutayanon, Pisit, Chawanadelert, Seksan, Chattranukulchai, Pairoj, Chatlaong, Boonsert, Santanakorn, Yingsak, Kanokphatcharakun, Khompiya, Mongkolwongroj, Piya, Jai-Aue, Sasivimon, Komson, Ongkarn, Altun, Armagan, Aydinlar, Ali, Ongen, Zeki, Acikel, Sadik, Sahin, Durmus Yildiray, Yilmaz, Ozcan, Pekdemir, Hasan, Demir, Mesut, Sucu, Murat, Sahiner, Levent, Ersanli, Murat, Okuyan, Ertugrul, Aras, Dursun, Rolandi, Florencia, Cesar Ingaramo, Adrian, Alberto Sambadaro, Gustavo, Fernandez Caputi, Vanina, Luciardi, Hector, Graciela Berman, Sofia, Dragotto, Pablo, Poli, Daniela, Quintavalla, Roberto, Cosmi, Franco, Fanelli, Raffaele, Oriana, Vincenzo, Reggio, Raffaele, Anti, Roberto S., Pancaldi, Leonardo, De Cristofaro, Raimondo, Guazzaloca, Giuliana, De Blasio, Angelo, Uriate, Jorge Salerno, Lillo, Flavia, Pogliani, Enrico Maria, Javier Kleiban, Andres, Ahuad Guerrero, Rodolfo Andres, Adalberto Di Paola, Leonel, Dario Dran, Ricardo, Egido, Javier, Jose Fosco, Matias, Rodolfo Cartasegna, Luis, Gomez Vilamajo, Oscar, Luis Ramos, Jose, Sassone, Sonia, Zapata, Gerardo, Conde, Diego, Giacomi, Guillermo, Alfredo Fernandez, Alberto, Alberto Berli, Mario, Ferroni, Fabian, Sobral Filho, Dario Celestino, Jaber, Jefferson, Armaganijan, Luciana Vidal, Frack Costantini, Costantino Roberto, Steffens, Andre, Sebba Barroso de Souzaem, Weimar Kunz, de Souza Neto, Joao David, Ribeiro, Jose Marcio, Teixeira, Marcelo Silveira, Rossi, Paulo, Pires, Leonardo, Moreira, Daniel, Moura Jorge, Jose Carlos, Lorga Filho, Adalberto Menezes, Bodanese, Luiz, Montera, Marcelo Westerlund, Del Carlo, Carlos Henrique, Saad, Jamil Abdalla, Alves Costa, Fernando Augusto, Lopes, Renato, de Aranjo, Gilson Roberto, Manenti, Euler Roberto, Kerr Saraiva, Jose Francisco, Ferreira Braga, Joao Carlos, Negri, Alexandre, Moncada, Carlos, Precoma, Dalton, Roquette, Fernando, Reis, Gilmar, Ramos Filho, Roberto Alvaro, Figueiredo, Estevao Lanna, Botelho, Roberto Vieira, Fontoura Tavares, Claudio Munhoz, Finimundi, Helius Carlos, Kochi, Adriano, Broilo Franca, Cesar Cassio, Alban, Fabio, Aranha Rosito, Guido Bernardo, de Moura Xavier Moraes Junior, Joao Batista, Husted, Steen, Hintze, Ulrik, Rasmussen, Soren, Sygehus, Nwstved, Bremmelgaard, Arne, Markenvard, John, Borger, Jan, Solgaard, Jorgen, Eriksen, Ebbe, Lokkegaard, Thomas, Bruun, Michael, Mertz, Jacob, Schou, Morten, Olsen, Michael, Viitanen, Carmela, Paganelli, Franck, Ohayon, Joel, Casassus, Frederic, Galinier, Michel, Gottwalles, Yannick, Loiselet, Philippe, Koujan, Mohamed Bassel, Destrac, Sylvain, Piot, Olivier, Cebron, Jean-Pierre, Guenoun, Maxime, Guedj-Meynier, Dominique, Lokesh, A. G., Zuber, Mathieu, Amarenco, Pierre, Ellie, Emmanuel, Kadouch, James, Huberman, Jean-Pierre, Lemaire, Nestor, Rodier, Gilles, Vandamme, Xavier, Sibon, Igor, Neau, Jean-Philippe, Mahagne, Marie Helene, Mielot, Antoine, Bonnefoy, Marc, Churet, Jean-Baptiste, Navarre, Vincent, Sellem, Frederic, Monniot, Gilles, Boyes, Jean-Paul, Doucet, Bernard, Martelet, Michel, Obadia, Desire, Crousillat, Bernard, Mouallem, Joseph, Bearez, Etienne, Brugnaux, Jean Philippe, Fedorowsky, Alain, Nazeyrollas, Pierre, Berneau, Jean-Baptiste, Chemin, Frederic, Schellong, Sebastien, Koeniger, Georg, Kopf, Andreas, Gerbaulet, Uwe, Kellner, Bernd-Thomas, Schaefer, Thomas, Purr, Jan, Eissfeller, Enno, Zauzig, Heinz-Dieter, Riegel, Peter, Axthelm, Christoph, Heinz, Gerd-Ulrich, Pustelnik, Andreas, Zutz, Stefan, Eder, Wolfgang, Rehling, Guenter, Glatzel, Dirk, Ludwig, Norbert, Sandow, Petra, Wiswedel, Henning, Wildenauer, Cosmas, Schoen, Steffen, Schwarz, Toralf, Babyesiza, Adyeri, Kropp, Maximilian, Zimny, Hans-Hermann, Kahl, Friedhelm, Caspar, Andreas, Omankowsky, Sabine, Laessig, Torsten, Hartmann, Hermann-Josef, Lehmann, Gunter, Bindig, Hans-Walter, Hergdt, Gunter, Reimer, Dietrich, Hauk, Joachim, Michel, Holger, Dres, Praxis, Erdle, Werner, Dorsch, Wilfried, Dshabrailov, Janna, Rapp, Karl-Albrecht, Epelde Gonzalo, Francisco, Almeida Fernandez, Carlos Alexandre, Martinez Navarro, Encarnacion, Montero Alia, Juan Jose, Barreda Gonzalez, Maria, Moleiro Oliva, Maria Angels, Iglesias Sanmartin, Jose, Rodriguez Alvarez, Maria del Mar, Ripoll Vera, Tomas, Jimenez Navarro, Manuel, Vazquez Caamano, Maria, Arcocha Tones, Maria Fe, Marcos Gomez, Gonzalo, Iniguez Romo, Andres, Prieto Diaz, Miguel Angel, Wirdby, Alexander, Linden, Jan, and Henriksson, Kerstin

Subjects
Male, medicine.medical_specialty, Acute coronary syndrome, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Hemorrhage, 030204 cardiovascular system & hematology, antiplatelet therapy, Coronary artery disease, Anticoagulation, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Cause of Death, Internal medicine, Atrial Fibrillation, medicine, Humans, 030212 general & internal medicine, Acute Coronary Syndrome, bleeding, mortality, stroke, Stroke, Aged, Proportional Hazards Models, business.industry, Hazard ratio, Anticoagulants, Atrial fibrillation, General Medicine, Prognosis, medicine.disease, Blood pressure, Cardiovascular Diseases, Heart failure, Cardiology, Female, Liver function, business, Platelet Aggregation Inhibitors, Follow-Up Studies
Abstract

Item does not contain fulltext BACKGROUND: Many patients with atrial fibrillation have concomitant coronary artery disease with or without acute coronary syndromes and are in need of additional antithrombotic therapy. There are few data on the long-term clinical outcome of atrial fibrillation patients with a history of acute coronary syndrome. This is a 2-year study of atrial fibrillation patients with or without a history of acute coronary syndromes. METHODS: Adults with newly diagnosed atrial fibrillation and >/=1 investigator-defined stroke risk factor were enrolled in GARFIELD-AF between March 2010 and September 2015. The association between prior acute coronary syndromes and long-term outcomes was determined using a Cox proportional hazards model, adjusting for baseline risk factors, oral anticoagulation (OAC) +/- antiplatelet (AP) therapy, and usual care. RESULTS: Of 39,679 patients, 10.5% had a history of acute coronary syndromes. At 2-year follow-up, patients with prior acute coronary syndromes had higher adjusted risks of stroke/systemic embolism (hazard ratio [HR] 1.39; 95% confidence interval [CI], 1.08-1.78), major bleeding (HR 1.30; 95% CI, 0.95 -1.79), all-cause mortality (HR 1.34; 95% CI, 1.21 -1.49), cardiovascular mortality (HR 1.85; 95% CI, 1.51-2.26), and new acute coronary syndromes (HR 3.42; 95% CI, 2.62-4.45). Comparing antithrombotic therapy in the acute coronary syndromes vs no acute coronary syndromes groups, most patients received OAC +/- AP: 60.8% vs 66.1%, but AP therapy was more likely in the acute coronary syndromes group (68.1% vs 32.9%), either alone (34.9% vs 20.8%) or with OAC (33.2% vs 12.1%). Overall, 17.8% in the acute coronary syndromes group received dual AP therapy with (5.3%) or without OAC (12.5%). Among patients with moderate/high risk for stroke/systemic embolism, fewer in the acute coronary syndromes group received OAC with or without AP therapy (Congestive heart failure, Hypertension, Age 75 years, Diabetes mellitus, prior Stroke, TIA, or thromboembolism, Vascular disease, Age 65-74 years, Sex category [CHA2DS2-VASc] 2: 52.1% vs 64.6%; CHA2DS2-VASc >/=3: 62.0% vs 70.7%), and the majority with a Hypertension (uncontrolled systolic blood pressure >160 mm Hg), Abnormal renal or liver function, previous Stroke, Bleeding history or predisposition, Labile international normalized ratios, Elderly, and concomitant Drugs or alcohol excess (HAS-BLED) score >/=3 were on AP therapy (83.8% vs 65.5%). CONCLUSIONS: In GARFIELD-AF, previous acute coronary syndromes are associated with worse 2-year outcomes and a greater likelihood of under-treatment with OAC, while two-thirds of patients receive AP therapy. Major bleeding was more common with previous acute coronary syndromes, even after adjusting for all risk factors.

Published
2019
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13. La fibrillazione atriale non valvolare: dati dall’Osservatorio delle Malattie Cardiovascolari della provincia di Trieste [Nonvalvular atrial fibrillation: data from the Observatory of Cardiovascular Diseases in the province of Trieste (Italy)]

Author

MAZZONE, CARMINE, CARRIERE, COSIMO, Grande, Eliana, Iorio, Anna Maria, BARBATI, GIULIA, ZECCHIN, MASSIMO, Serdoz, Laura Vitali, Cioffi, Giovanni, Tarantini, Luigi, SINAGRA, GIANFRANCO, SCARDI, SABINO, DI LENARDA, ANDREA, Mazzone, Carmine, Carriere, Cosimo, Grande, Eliana, Iorio, Anna Maria, Barbati, Giulia, Zecchin, Massimo, Serdoz, Laura Vitali, Cioffi, Giovanni, Tarantini, Luigi, Sinagra, Gianfranco, Scardi, Sabino, and DI LENARDA, Andrea

Subjects
Registrie, Male, Prognosi, Hemorrhage, Severity of Illness Index, Risk Factors, Cause of Death, Thromboembolism, Atrial Fibrillation, Prevalence, Humans, Thrombophilia, Prospective Studies, Registries, Risk Factor, Incidence, Metabolic Syndrome X, Anticoagulant, Anticoagulants, Prognosis, Hospitalization, Stroke, Prospective Studie, Treatment Outcome, Italy, Factor Xa Inhibitors, Female, Factor Xa Inhibitor, Human
Abstract

Razionale. La fibrillazione atriale non valvolare (FANV) è la più frequente aritmia nei pazienti ambulatoriali e si associa ad un incremento della mortalità e degli eventi tromboembolici ed emorragici. Numerosi studi ne hanno analizzato l’impatto prognostico nel mondo reale, ma non sono disponibili dati epidemiologici su ampie popolazioni valutate in Italia. Il nostro obiettivo è definire prevalenza, comorbilità, terapia ed outcome in una vasta popolazione italiana “real-life” di pazienti ambulatoriali con FANV. Materiali e metodi. Dal 2009 al 2013 abbiamo arruolato 21 282 pazienti consecutivi afferenti al Centro Cardiovascolare di Trieste. La FANV era definita in assenza di valvulopatie moderato-severe, interventi valvolari, cardiopatia reumatica. Gli eventi valutati nel follow-up sono stati: mortalità, ospedalizzazioni, tromboembolismi ed emorragie. Dati clinici ed eventi sono stati estratti dalla cartella elettronica cardiologica regionale e dai codici ICD-9 di dimissione ospedaliera. Risultati. 3379 pazienti (15.8%) presentavano FANV (35.6% parossistica, 34.5% persistente, 29.9% permanente); rispetto alla popolazione senza fibrillazione atriale questi pazienti erano più anziani, prevalentemente uomini, ipertesi, diabetici, con storia di ictus/attacco ischemico transitorio e scompenso cardiaco. La terapia anticoagulante orale era prescritta nel 54% dei casi, soprattutto nelle forme persistenti o permanenti, all’aumentare del CHA2DS2-VASc e al diminuire dell’età. Il tasso di mortalità globale, ospedalizzazioni cardiovascolari, eventi tromboembolici ed emorragici nel follow-up era più elevato nei pazienti con FANV rispetto alla popolazione senza fibrillazione atriale. Il ricorso alla terapia anticoagulante orale riduceva l’incidenza di eventi tromboembolici. Il CHA2DS2-VASc score emergeva come predittore di rischio tromboembolico nei tre diversi tipi di FANV con un incremento del rischio di eventi del 35% nella forma parossistica, del 40% nella forma persistente e del 34% nella forma permanente rispetto ai soggetti senza fibrillazione atriale. Conclusioni. In un’ampia popolazione italiana di pazienti “real-life” ambulatoriali la FANV si associa ad età più avanzata, maggiori comorbilità ed incremento degli eventi cardiovascolari. Gli score CHA2DS2-VASc e HAS-BLED predicono accuratamente il rischio di eventi tromboembolici ed emorragici. La terapia anticoagulante orale riduce gli eventi tromboembolici, sebbene il suo utilizzo è limitato a circa la metà dei soggetti esaminati.

Published
2015

14. Prognostic role of cardiac calcifications in primary prevention: A powerful marker of adverse outcome highly dependent on underlying cardiac rhythm.

Author

Mazzone, Carmine, Cioffi, Gianni, Di Nora, Concetta, Barbati, Giulia, Guidetti, Federica, Faggiano, Pompilio, Gaibazzi, Nicola, Faganello, Giorgio, Borca, Endria Casanova, and Di Lenarda, Andrea

Subjects
*CARDIAC calcification, *CARDIOVASCULAR disease prevention, *CORONARY disease, *DIAGNOSIS, *CARDIOVASCULAR diseases risk factors, *ECHOCARDIOGRAPHY
Abstract

Background Increasing evidence exists regarding calcium detected in aortic cusps and/or mitral annulus (AOC_MAC) at transthoracic echocardiogram as a predictor of cardiovascular (CV) events and mortality. Purpose To verify whether AOC_MAC has a prognostic role in the setting of primary prevention independently of the presence of atrial fibrillation (AF). Methods All subjects consecutively referred from January 2011 to October 2014 to the Cardiovascular Centre for CV risk assessment in primary prevention were selected. AOC_MAC was assessed by transthoracic echocardiography. Primary study endpoint was a composite of CV hospitalizations/all-cause death. Results The 1389 study patients were 70 years old, 43% males, 24% had diabetes mellitus, 75% arterial hypertension, 56% dyslipidaemia. Of all, 997 (72%) were in sinus rhythm (SR), 392 (28%) in AF. Patients with AF were older and more frequently males, with larger atria than SR subjects. During a median follow-up of 32 months, 165 patients (12%) were hospitalized for CV cause, 68 (5%) died. The primary endpoint occurred more frequently in patients with than without AOC_MAC (18% vs 11%, p < 0.001). AF patients showed higher event-rate compared with patients in SR (20% vs 10%, respectively; p < 0.01). AOC_MAC emerged as an independent prognosticator of primary endpoint in SR patients (HR 1.74 [1.07–2.82], p = 0.02), together with increasing age and left ventricular hypertrophy, while AOC_MAC had no prognostic relevance in AF patients. Conclusions In subjects with multiple CV risk factors assessed in primary prevention, the presence of AF nullifies the prognostic power of AOC_MAC, on the contrary robustly confirmed in SR patients. [ABSTRACT FROM AUTHOR]

Published
2018
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15. Is it time to calculate renal function in non valvular atrial fibrillation patients to stratify the risk of future events?

Author

Di Lenarda, Andrea, Mazzone, Carmine, Barbati, Giulia, Carriere, Cosimo, Cioffi, Giovanni, Tarantini, Luigi, Cherubini, Antonella, Grande, Eliana, and Magnani, Silvia

Subjects
*KIDNEY diseases, *THROMBOEMBOLISM, *ATRIAL fibrillation, *PROGNOSIS, *OUTPATIENT medical care
Abstract

Purpose: Chronic kidney disease with renal dysfunction (RD) is associated with an increased risk of thromboembolic and hemorrhagic events in non-valvular atrial fibrillation (NVAF). Although the current European Guidelines on NVAF suggest that an accurate evaluation of the renal function is useful in hemorrhagic risk stratification, it has not been yet considered in thromboembolic risk score CHA2DS2VASc. The aim of our study was to evaluate the prognostic role of RD in a wide "real world" population of NVAF outpatients. Methods: From November 1, 2009 and October 31, 2013, we enrolled 3,398 consecutive NVAF patients. Clinical data were derived from the E-data chart for outpatient clinic (Cardionet®) of Cardiovascular Center of Trieste, Italy, and collected in a regional Data Warehouse. In 1,509 patients, glomerular filtration rate (GFR) was available at the first visit. Renal dysfunction (RD) was defined as GFR <60ml/min estimated using MDRD equation. The events recorded during the follow-up were death, cardiovascular hospitalization (CVH), major bleeding (including fatal bleeding or leading to transfusion, a decrease in hemoglobin level of 20 ≥g/L or hospital admission) and thromboembolism. Results: The median patient age was 75 (range 68-81), 39.7% were male, 38% had paroxysmal, 31.9% persistent and 30.1% permanent NVAF; 1,217 (80.1%) had hypertension, 466 (30.8%) diabetes mellitus, 295 (19.5%) heart failure, 491 (32%) coronary artery disease, 196 (13%) prior stroke or transient ischemic attack, 23 (1.5%) previous bleeding episode, 31.9% and 13.2% had Charlson Comorbid Index from 3 up to 5 and >5, respectively. 1,014 patients (67.2%) were treated with more than 5 drugs. Median HAS- BLED score was 3 (range 2-4) and ≥3 in 70% of patients; median CHA2DS2VASc score was 4 (range 3-5) and ≥2 points in 91.1% of patients. During a median follow-up of 27 months, 531 (35%) deaths or CVH, 113 (7.5%) thromboembolic events and 24 (1.6%) major bleedings were recorded. The presence of RD identified a group of older patients with more cardiovascular (CV) risk factors, more severe heart disease, higher Charlson Index, more concomitant medical therapies. During the follow-up, we recorded 48% vs 30% of deaths or CVH (p<0.001), 10% vs 7% of thromboembolic events (p=0.02) and 2.5% vs 1% of hemorrhagic events in those with and without RD (p=0.09). Patients with RD showed a global worse prognosis for CVH/death-free survival independently from the prescription of anticoagulant (p<0.001). Instead, considering thromboembolism/major bleeding free survival, patients with RD had a worse prognosis only if taking anticoagulants (p=0.038). We can hypothesize that it could be probably related to a relatively higher number of thromboembolic events in the past medical history in the anticoagulant group versus antiplatelets or not therapy (11,4% vs 9,5% vs 5,1%, respectively, p<0.001). Conclusions: In a "real world" of NVAF outpatients, RD identified a subgroup of older patients, with more complex CV and non CV disease at higher risk of CV, thromboembolic and hemorrhagic events. RD was associated with a higher rate of thromboembolism/major bleeding in patients on anticoagulants. [ABSTRACT FROM AUTHOR]

Published
2014
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16. Prognostic impact of CHA2DS2VASC and renal dysfunction in non valvular atrial fibrillation patients: which is the best equation to stratify risk of future events?

Author

Di Lenarda, Andrea, Mazzone, Carmine, Barbati, Giulia, Carriere, Cosimo, Cioffi, Giovanni, Tarantini, Luigi, Cherubini, Antonella, Grande, Eliana, and Russo, Giulia

Subjects
*KIDNEY diseases, *THROMBOEMBOLISM risk factors, *PROGNOSIS, *HEMORRHAGE risk factors, *ATRIAL fibrillation
Abstract

Purpose: Renal dysfunction (RD) is associated with an increased risk of thromboembolic (TE) and hemorrhagic events (HE) in non-valvular atrial fibrillation (NVAF). Which method of RD evaluation can better stratify the risk of cardiovascular (CV) events in NVAF is still unknown. We evaluated the additive prognostic role of RD in a wide "real world" population of NVAF outpatients. Methods: From November 2009 and October 2013, we enrolled 3,398 consecutive NVAF patients (pts). Clinical data were derived from the E-data chart for outpatient clinic (Cardionet®) of Cardiovascular Center of Trieste, Italy. In 1,509 pts the glomerular filtration rate (GFR) was estimated at first clinic evaluation with Cochkroft-Gault (CG), Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology collaboration (CkD-EPI) equations. RD was defined as Gfr <60 ml/min. We recalculated CHA2DS2- VASc score, adding 1 point for RD, using all the three equations. The median follow-up was 27 months (Interquartile Range-IR- 15 to 40). We evaluated incidence of death, CV hospitalization (CVH), HE (fatal bleeding or leading to transfusion, a decrease in hemoglobin level of 20 g/L or hospitalization) and thromboembolism. Results: The median age was 75 years (IR 68-81), 39.7% were male; 38% of pts had paroxysmal, 31.9% persistent and 30.1% permanent NVAF. 1,217 (80.1%) pts had hypertension, 466 (30.8%) diabetes mellitus, 295 (19.5%) heart failure, 196 (13%) prior stroke or transient ischemic attack and 23 (1.5%) previous bleedings. Median GFR was 61.8 mL/min (IR 47-77) with CG, 72.4 (IR 59-87) with MDRD and 69.1 (IR 55-84) with CKD-EPI. Median HAS-BLED score was 3 (IR 2-4) and 3 in 70% of the pts; median CHA2DS2- VASc score was 4 (IR 3-5) and 2 points in 91.1% pts. 623 (41%) pts were on anticoagulant therapy (OAT). During the follow-up, we recorded 531 (35%) deaths or CVH, 113 (7.5%) TE and 24 (1.6%) HE. Adding 1 point for RD to CHA2DS2VASc score pts were reclassified in a worse-class of risk in 47% with CG, 34% with CKD-EPI and 27% with MDRD (p<0.001). Pts with combined TE/HE during the follow-up were reclassified by the presence of RD in a worst class of risk in 62% with CG, 46% with CKD-EPI and 35% with MDRD (p=0.009). Stratifying these pts by antithrombotic therapy, the presence of RD, estimated by CG and CKD EPI, were associated to a significant higher risk of TE/HE during the follow-up (p=0.006) only in pts not treated with OAT; conversely using MDRD there was a significant higher risk only in anticoagulated pts (p=0.04). These results could be related to an higher rate of TE in the past medical history in the OAT group versus antiplatelets or not therapy (11,4% v 9,5% vs 5,1%, respectively, p<0.001). Adding RD (1 point) to CHA2DS2VASc score, considering the pts that experienced death/CVH, 58.5%, 44.7% and 36.4% of pts with RD were reclassified in a worst class of risk with CG, CKD-EPI and MDRD respectively (p<0.001), independently from OAT. Conclusions: In NVAF pts the risk reclassification by CHA2DS2VASc and moderate RD seems to have an additive prognostic impact, considering death and CVH, TE and HE. CG was the best formula for global performance to reclassify pts for risk of events during the follow-up. [ABSTRACT FROM AUTHOR]

Published
2014
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17. Prevalence and clinical predictors of inappropriate direct oral anticoagulant dosage in octagenarians with atrial fibrillation

Author

Paolo Golino, Valentina Parisi, Giovanni Nigro, Antonello D'Andrea, E Attena, Francesco Santelli, Roberta Bottino, Vincenzo Russo, Carmine Mazzone, Andreina Carbone, Carbone, A., Santelli, F., Bottino, R., Attena, E., Mazzone, C., Parisi, V., D'Andrea, A., Golino, P., Nigro, G., Russo, V., Carbone, Andreina, Santelli, F, Bottino, Roberta, Attena, Emilio, Mazzone, Carmine, Parisi, Valentina, D’Andrea, Antonello, Golino, Paolo, Nigro, Gerardo, Russo, Vincenzo, and Santelli, Francesco

Subjects
Male, medicine.medical_specialty, Administration, Oral, Hemorrhage, Coronary Artery Disease, Elderly, Risk Factors, Internal medicine, Stroke prevention, Prevalence, medicine, Humans, Pharmacology (medical), Pharmacology, Aged, 80 and over, business.industry, Risk Factor, Direct oral anticoagulant, Inappropriate dosage, Eldery, Anticoagulant, Anticoagulants, Atrial fibrillation, General Medicine, medicine.disease, Stroke, Oral anticoagulant, Cardiology and Cardiovascular Medicine, business, Human
Abstract

Purpose Older age is associated with inappropriate dose prescription of direct oral anticoagulants. The aim of our study was to describe the prevalence and the clinical predictors of inappropriate DOACs dosage among octogenarians in real-world setting. Methods Data for this study were sourced from the multicenter prospectively maintained Atrial Fibrillation (AF) Research Database (NCT03760874). Of the AF patients aged ≥ 80 who received DOACs treatment, 253 patients were selected. Participants were categorized as appropriate dosage, overdosage, or underdosage. Underdosage and overdosage were, respectively, defined as administration of a lower or higher DOAC dose than recommended in the EHRA consensus. Results A total of 178 patients (71%) received appropriate DOACs dose and 75 patients (29%) inappropriate DOACs dose; among them, 19 patients (25.6%) were overdosed and 56 (74.4%) were underdosed. Subgroup analysis demonstrated that underdosage was independently associated with male gender [OR = 3.15 (95% IC; 1.45–6.83); p Conclusion In our analysis, nearly one-third of octogenarians with AF received an inappropriate dose of DOAC. Several clinical factors were associated with DOACs’ overdosage (diabetes mellitus type II, previous bleeding) or underdosage (male gender, coronary artery disease, and higher body mass index). Octogenarians with inappropriate DOACs underdosage showed less survival.

Published
2021
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18. Nonvitamin K Antagonist Oral Anticoagulants Use in Patients with Atrial Fibrillation and Bioprosthetic Heart Valves/Prior Surgical Valve Repair: A Multicenter Clinical Practice Experience

Author

Emilio Attena, Antonio D' Onofrio, Vincenzo Russo, Anna Rago, Gerardo Nigro, Valentina Parisi, Ciro Bancone, Carmine Mazzone, Raffaele Sangiuolo, Francesca Esposito, Russo, Vincenzo, Attena, Emilio, Mazzone, Carmine, Esposito, Francesca, Parisi, Valentina, Bancone, Ciro, Rago, Anna, Nigro, Gerardo, Sangiuolo, Raffaele, and D' Onofrio, Antonio

Subjects
Male, bioprosthetic valve, medicine.medical_specialty, Vitamin K, apixaban, Administration, Oral, 030204 cardiovascular system & hematology, Dabigatran, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, atrial fibrillation, dabigatran, International Normalized Ratio, Registries, NOAC, 030212 general & internal medicine, Heart valve, rivaroxaban, Stroke, Aged, Aged, 80 and over, Heart Valve Prosthesis Implantation, Rivaroxaban, business.industry, Warfarin, Anticoagulants, Atrial fibrillation, Hematology, Middle Aged, medicine.disease, stroke, surgical valve repair, medicine.anatomical_structure, major bleeding, Heart Valve Prosthesis, Cardiology, Female, Apixaban, Liver function, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies, medicine.drug
Abstract

This is an observational study to investigate the efficacy and safety of nonvitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation (AF) patients with bioprosthetic valves or prior surgical valve repair in clinical practice. A total of 122 patients (mean age: 74.1 ± 13.2; 54 females) with bioprosthetic heart valve or surgical valve repair and AF treated with NOACs were included in the analysis. The mean CHA2DS2-VASc (Congestive heart failure, Hypertension, Age >75 years, Diabetes mellitus, prior Stroke or transient ischemic attack, Vascular disease) and HAS-BLED (Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile INR [international normalized ratio], Elderly, Drugs or alcohol) score values were 3.6 ± 1.2 and 2.6 ± 1.4, respectively. Of the total study population, 28.6% was taking apixaban 5 mg twice daily (BID), 24.5% apixaban 2.5 mg BID, 18% dabigatran 150 mg BID, 13% dabigatran 110 mg BID, 9.8% rivaroxaban 20 mg daily (QD), and 5.7% rivaroxaban 15 mg QD. Also, 92% of the study population previously had warfarin replaced with NOACs due to lack compliance and labile INR control (time in therapeutic range

Published
2018
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19. Persistence on apixaban in atrial fibrillation patients: a retrospective multicentre study

Author

Adolfo Aita, Paolo Verdecchia, Lorenza Scotti, Andrea Di Lenarda, Fabio Ferrante, A. Iorio, Maria Gabriella Molini, Francesco Adamo, Vincenzo Russo, Giulia Benedetti, Corrado Lodigiani, Francesco Paciullo, Claudia Bartolini, Antonio D'Onofrio, EP Lanati, Carmine Mazzone, Francesco Fedele, Verdecchia, Paolo, D'Onofrio, Antonio, Russo, Vincenzo, Fedele, Francesco, Adamo, Francesco, Benedetti, Giulia, Ferrante, Fabio, Lodigiani, Corrado, Paciullo, Francesco, Aita, Adolfo, Bartolini, Claudia, Molini, Maria Gabriella, Di Lenarda, Andrea, Mazzone, Carmine, Scotti, Lorenza, Lanati, Elena Paola, Iorio, Arianna, Verdecchia, P, D'Onofrio, A, Russo, V, Fedele, F, Adamo, F, Benedetti, G, Ferrante, F, Lodigiani, C, Paciullo, F, Aita, A, Bartolini, C, Molini, M, Di Lenarda, A, Mazzone, C, Scotti, L, Lanati, E, and Iorio, A

Subjects
Male, Time Factors, Administration, Oral, Pyridone, Novel oral anticoagulant, Retrospective Studie, Risk Factors, Medicine, Cumulative incidence, Apixaban, Stroke, Aged, 80 and over, Drug Substitution, Incidence (epidemiology), Incidence, Effectivene, Atrial fibrillation, General Medicine, Middle Aged, Treatment Outcome, Italy, Cohort, Female, Cardiology and Cardiovascular Medicine, medicine.drug, Human, medicine.medical_specialty, Time Factor, Pyridones, Hemorrhage, Drug Administration Schedule, Persistence, Internal medicine, Humans, Aged, Retrospective Studies, business.industry, Risk Factor, Retrospective cohort study, medicine.disease, Administration oral, aged, aged 80 and over, atrial fibrillation, drug administration schedule, drug substitution, factor xa inhibitors, female, hemorrhage, humans, incidence, italy, male, middle aged, pyrazoles, pyridones, retrospective studies, risk factors, stroke, time factors, treatment outcome, Discontinuation, Pyrazole, Pyrazoles, business, Factor Xa Inhibitor, Factor Xa Inhibitors
Abstract

Aims Real-world data on treatment persistence, safety and effectiveness of non-Vitamin K antagonist oral anticoagulants (NOACs) play an important role in the assessment of risks and benefits of these drugs. Our aim was to evaluate persistence on treatment, incidence of major bleeding and incidence of a composite endpoint of major events, including all-cause death, myocardial infarction, stroke and systemic thromboembolism, during treatment with apixaban in a cohort of patients with nonvalvular atrial fibrillation (NVAF). Methods In this multicentre retrospective observational study, we retrieved data from medical records of five Italian hospitals on patients with a diagnosis of NVAF who initiated apixaban between 1 January 2014 and 31 March 2016 and had a first subsequent visit at the same hospital. Results We studied 766 patients with mean age of 74.2 (standard deviation 11.1) years and median CHADS2 and CHA2DS2VASc scores of 2.0 and 4.0, respectively. Over a median follow-up period of 339 days, persistence on treatment was 83.5% [95% confidence interval (95% CI) 75.5-89.1%]. The rate of major bleeding (per 100 person-years) was 1.15 (95% CI 0.39-1.90 per 100 person-years), while the cumulative incidence was 4.4% (95% CI 1.6-12.0). The rate of major events was 1.97 (95% CI 1.08-2.86) per 100 patient-years, with a cumulative incidence over the entire follow-up period of 7.7% (95% CI 4.6-12.8). Conclusion In real-life conditions, NVAF patients treated with apixaban show rates of treatment discontinuation and major bleedings, which are comparable to those found in the ARISTOTLE pivotal study, thus supporting its external validity.

Published
2019

20. Prognostic role of cardiac calcifications in primary prevention: A powerful marker of adverse outcome highly dependent on underlying cardiac rhythm

Author

Federica Guidetti, Andrea Di Lenarda, Gianni Cioffi, Giulia Barbati, Concetta Di Nora, Nicola Gaibazzi, Endria Casanova Borca, Giorgio Faganello, Carmine Mazzone, Pompilio Faggiano, Mazzone, Carmine, Cioffi, Gianni, Di Nora, Concetta, Barbati, Giulia, Guidetti, Federica, Faggiano, Pompilio, Gaibazzi, Nicola, Faganello, Giorgio, Borca, Endria Casanova, and Di Lenarda, Andrea

Subjects
Male, medicine.medical_specialty, Coronary Artery Disease, 030204 cardiovascular system & hematology, Atrial fibrillation, Calcium score, Echocardiography, Mitral annulus calcification, Primary prevention, Valve calcification, Cohort Studies, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Heart Rate, Interquartile range, Internal medicine, medicine, Clinical endpoint, Humans, Sinus rhythm, 030212 general & internal medicine, Vascular Calcification, Aged, Retrospective Studies, Framingham Risk Score, Ejection fraction, business.industry, Middle Aged, Prognosis, medicine.disease, Treatment Outcome, Cardiology, Female, Transthoracic echocardiogram, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract

BACKGROUND: Increasing evidence exists regarding calcium detected in aortic cusps and/or mitral annulus (AOC_MAC) at transthoracic echocardiogram as a predictor of cardiovascular (CV) events and mortality. PURPOSE: To verify whether AOC_MAC has a prognostic role in the setting of primary prevention independently of the presence of atrial fibrillation (AF). METHODS: All subjects consecutively referred from January 2011 to October 2014 to the Cardiovascular Centre for CV risk assessment in primary prevention were selected. AOC_MAC was assessed by transthoracic echocardiography. Primary study endpoint was a composite of CV hospitalizations/all-cause death. RESULTS: The 1389 study patients were 70 years old, 43% males, 24% had diabetes mellitus, 75% arterial hypertension, 56% dyslipidaemia. Of all, 997 (72%) were in sinus rhythm (SR), 392 (28%) in AF. Patients with AF were older and more frequently males, with larger atria than SR subjects. During a median follow-up of 32 months, 165 patients (12%) were hospitalized for CV cause, 68 (5%) died. The primary endpoint occurred more frequently in patients with than without AOC_MAC (18% vs 11%, p

Published
2018

21. Predictive role of CHA2DS2-VASc score for cardiovascular events and death in patients with arterial hypertension and stable sinus rhythm

Author

Giorgio Faganello, Nadia Zeriali, Giulia Barbati, Cosimo Carriere, Gianfranco Sinagra, Antonella Cherubini, Giovanni Cioffi, Giulia Russo, Carmine Mazzone, Andrea Di Lenarda, Mazzone, Carmine, Cioffi, Giovanni, Carriere, Cosimo, Barbati, Giulia, Faganello, Giorgio, Russo, Giulia, Cherubini, Antonella, Sinagra, Gianfranco, Zeriali, Nadia, and Di Lenarda, Andrea

Subjects
medicine.medical_specialty, arterial hypertension, Epidemiology, 030204 cardiovascular system & hematology, thomboembolic events, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, Internal medicine, medicine, Sinus rhythm, Stroke, Cause of death, thomboembolic event, business.industry, Atrial fibrillation, CHA2DS2-VASc, stroke, Cardiology and Cardiovascular Medicine, Hazard ratio, medicine.disease, Blood pressure, CHA2DS2–VASc score, Cardiology, business, 030217 neurology & neurosurgery
Abstract

Background The CHA2DS2-VASc score well stratifies the risk for thromboembolic events in non-valvular atrial fibrillation (NVAF) patients. This score may also predict thromboembolic events in sinus rhythm populations. Purpose The purpose of this study was to assess the prognostic role of CHA2DS2-VASc in a Caucasian community population of patients with arterial hypertension and sinus rhythm. Methods A total of 12,599 arterial hypertension residents not receiving anticoagulation were selected from a community population in Trieste between November 2009 and October 2014: 11,159 sinus rhythm and 1440 NVAF patients. We considered thromboembolic events, cardiovascular hospitalisation and all-cause death in all patients divided according to CHA2DS2-VASc. Results Sinus rhythm patients were 74 (interquartile range 65-81) years old, 50% were women, 32% with CAD, mean CHA2DS2-VASc 3.68 ± 1.47 points, significantly lower than NVAF patients (4.26 ± 1.50, P

Published
2017
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