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1,593 results on '"Shantsila A"'

152. Prognostic implication of monocytes in atrial fibrillation: The West Birmingham Atrial Fibrillation Project.

Author

Farhan Shahid, Nur A Rahmat, Gregory Y H Lip, and Eduard Shantsila

Subjects
Medicine, Science
Abstract

BACKGROUND AND OBJECTIVES:High monocyte counts are related to adverse outcomes in cardiovascular disease. Their role in prognostication in patients with atrial fibrillation (AF) is unknown. We investigated whether monocyte counts are useful as a marker of prognosis in patients with AF. METHODS:Monocyte counts were obtained from blood samples in 881 AF patients. Study outcomes were (i) all-cause death; (ii) major adverse cardiovascular events; (iii) stroke, TIA or other systemic embolism (SSE); and (iv) major bleeding. RESULTS:Median follow up was 7.2 years; 44% of patients died, 48% developed MACE; 9% had SSE and 5% had major bleeding. On Cox regression, after adjustment for CHA2DS2-VASc score, the highest quartile of monocyte counts (i.e., ≥580 μL vs. other quartiles) was associated with increased risk of death (hazard ratio [HR] 1.64, 95% confidence interval [CI] 1.31-2.05, p

Published
2018
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153. Sex-related differences in presentation, treatment, and outcomes of Asian patients with atrial fibrillation: a report from the prospective APHRS-AF Registry.

Author

Bucci, Tommaso, Shantsila, Alena, Romiti, Giulio Francesco, Teo, Wee-Siong, Park, Hyung-Wook, Shimizu, Wataru, Mei, Davide Antonio, Tse, Hung-Fat, Proietti, Marco, Chao, Tze-Fan, Lip, Gregory Y. H., David, Chun-Wah Siu, Yodogawa, Kenji, Tsutsui, Hiroyuki, Mukai, Yasushi, Tomita, Hirofumi, Horiuchi, Daisuke, Hagii, Joji, Aonuma, Kazutaka, and Okumura, Yasuo

Subjects
ASIANS, ATRIAL fibrillation, ACUTE coronary syndrome, CARDIOVASCULAR diseases risk factors, CORONARY artery disease, ORAL medication
Abstract

We aimed to investigate the sex-related differences in the clinical course of patients with Atrial Fibrillation (AF) enrolled in the Asia–Pacific-Heart-Rhythm-Society Registry. Logistic regression was utilized to investigate the relationship between sex and oral anticoagulant, rhythm control strategies and the 1-year chance to maintain sinus rhythm. Cox-regression was utilized to assess the 1-year risk of all-cause, and cardiovascular death, thromboembolic events, acute coronary syndrome, heart failure, and major bleeding. In the whole cohort (4121 patients, 69 ± 12 years,34.3% female), females had different cardiovascular risk factors, clinical manifestations, and disease perceptions than men, with more advanced age (72 ± 11 vs 67 ± 12 years, p < 0.001) and dyslipidemia (36.7% vs 41.7%, p = 0.002). Coronary artery disease was more prevalent in males (21.1% vs 16.1%, p < 0.001) as well as the use of antiplatelet drugs. Females had a higher use of oral anticoagulant (84.9% vs 81.3%, p = 0.004) but this difference was non-significant after adjustment for confounders. On multivariable analyses, females were less often treated with rhythm control strategies (Odds Ratio [OR] 0.44,95% Confidence Interval [CI] 0.38–0.51) and were less likely to maintain sinus rhythm (OR 0.27, 95% CI 0.22–0.34) compared to males. Cox-regressions analysis showed no sex-related differences for the risk of death, cardiovascular, and bleeding. The clinical management of Asian AF patients should consider several sex-related differences. [ABSTRACT FROM AUTHOR]

Published
2023
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157. Hypertensive emergencies

Author

Alena Shantsila

Abstract

Hypertensive emergencies can manifest with a range of acute hypertension-mediated organ damage. This chapter reviews the epidemiology and common pathophysiological mechanisms causing the development of such emergencies. It discusses differences in clinical presentations of specific organ-specific damage such as hypertensive encephalopathy, malignant hypertension with retinal lesions, pre-eclampsia and eclampsia, acute left ventricular failure with pulmonary oedema, coronary ischaemia, acute aortic dissection, and renal failure. The chapter also reviews the evidence and current recommendations on appropriate management of these acute states and justification of preferable strategies for blood pressure reduction. Overall, the chapter aims to encourage a holistic approach to the management of these potentially life-threatening and often underdiagnosed forms of clinical emergency.

Published
2022
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158. Relationship between systolic blood pressure and renal function on clinical outcomes in patients with atrial fibrillation: a report from the AF-GEN-UK registry

Author

A Shantsila, G Y H Lip, and D A Lane

Subjects
Cardiology and Cardiovascular Medicine
Abstract

Background European guidelines on AF management recommend a systolic blood pressure (SBP) target of 120–129 mmHg as this level is associated with the lowest risk of poor outcomes. Elevated blood pressure and AF both negatively affect renal function, but the interactions between SBP and renal function in patients with AF remains unclear. In the UK extension of the EURObservational Research Programme (EORP) Long-term Registry of patients with atrial fibrillation (AF) [AF-GEN-UK study], we assessed the combined impact of BP levels and renal (dys)function on mortality, thromboembolic and haemorrhagic events. Methods 1580 patients (60.1% males, mean (SD) age 70.6 (11.2) years) from the AF-GEN-UK registry had SBP available at baseline and were stratified into groups based on SBP: 120–129 mmHg (reference group, n=289), Results Overall OAC use was 84% and was similar between all SBP groups. Renal function (eGFR), was preserved across SBP groups; those with SBP 110–119 mmHg had the lowest level. Prevalence of heart failure was highest in those with SBP 140 mmHg) were older, more likely female and higher rates of hypertension, with correspondingly higher CHA2DS2VASc scores. SBP Adjusted Cox regression revealed that SBP Conclusion In anticoagulated patients with AF, SBP Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): This project was supported by the BMS/Pfizer European Thrombosis Investigator Initiated Research Program

Published
2022
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159. Management of atrial fibrillation by different medical specialties in the UK: AF-GEN-UK study

Author

A Shantsila, G Y H Lip, and D A Lane

Subjects
Cardiology and Cardiovascular Medicine
Abstract

Background The AF-GEN-UK study is an extension of the EURObservational Research Programme (EORP) Long-term Registry on patients with atrial fibrillation (AF) in the UK (AF-GEN). The study aimed to establish a registry of the contemporary management of patients with AF by cardiologists, general practitioners, stroke, acute and emergency medicine physicians at baseline and 1-year of follow-up, to allow comparison between medical specialties. Methods Data on patients with AF diagnosed within the previous 12-months were collected using electronic case records from 101 sites, to permit comparison of patient characteristics and treatments between medical specialties. The impact of guideline-adherent oral anticoagulation (OAC) use on outcomes was assessed using Cox regression analysis. Results 1595 patients (mean (SD) age 70.5 (11.2) years; 60.1% male; 97.4% white) with ECG-documented AF were included (recruited between June 2017 and June 2018) and followed-up for 1-year. Overall OAC prescription rates were 84.2% at baseline and 87.1% at 1-year follow-up, with NOACs predominating (74.9% at baseline and 79.2% at 1-year) Figure, mainly apixaban. Prescription of VKA was significantly higher in primary care, with NOAC prescription higher among stroke physicians. Guideline-adherent OAC (CHA2DS2-VASc ≥2) at baseline significantly reduced risk of composite endpoint of death and stroke at 1-year (adjusted hazard ratio 0.42; 95% confidence intervals 0.25–0.70). Rhythm control was evident in approximately one-quarter, with only 1.6% receiving catheter ablation. Most patients (56.6%) reported AF symptoms, but these were severe in only 17.9%. Symptomatic patients were mainly managed by cardiologists or acute/emergency medicine; among patients managed by stroke physicians, 81.5% were asymptomatic. Quality of life did not appear significantly impaired however there was a slight but significant improvement at follow-up (70.3% vs. 71.5%; p=0.044). Symptomatic patients reported poorer quality of life related to usual activities, mental health and overall quality of life. Conclusion Overall OAC use was high (>80%) with NOAC prescription predominating but rates varied by specialty, with VKA prescription significantly higher in primary care. Guideline-adherent OAC therapy at baseline was associated with significant reduction in composite outcome of death and stroke at 1-year, regardless of specialty. Rhythm control management was only evident in around one-quarter despite AF symptoms being reported in 56.6%. This registry extends the knowledge of contemporary management of AF outside of cardiology by including other specialties and demonstrates good implementation of clinical guidelines for the management of AF, particularly in relation to stroke prevention. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): This project was supported by the BMS/Pfizer European Thrombosis Investigator Initiated Research Program

Published
2022
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160. Quality indicators of the atrial fibrillation management from the European (EORP) and Asia-Pacific (APHRS) registries

Author

A Shantsila, H F Tse, W S Teo, C W Siu, T F Chao, H W Park, and W Shimizu

Subjects
Cardiology and Cardiovascular Medicine
Abstract

Background The 2020 ESC guideline for atrial fibrillation (AF) recommends universal quality indicators to identify areas for improvement in clinical practice. It also recommends using clinical registries to monitor clinical practice and identify areas for improvement. We have analysed two large comprehensive prospective clinical registries of patients with AF, the EURObservational Research Programme (EORP) and the Asia Pacific Heart Rhythm Society (APHRS), to compare the achievement of the ESC quality indicators in two major world populations. Methods The EORP and APHRS registries used the same electronic case report forms to collect data. T-test and Chi-squared test were used to compare registries. Logistic regression was used to identify pharmacological rate control therapy predictors in permanent AF. The model was adjusted for age, oral anticoagulation (OAC), EHRA and CHA2DS2-VASc scores, heart rate on the latest ECG and the region of recruitment (Europe or Asia) (STATA Corp, version 13). Results All 11096 EORP patients (59.3% males, age 69±11 years) and 5460 APHRS patients (66.3% males, age 68±12 years) had CHA2DS2-VASc and HAS-BLED scores documented at enrolment. The EORP register included a higher proportion of patients with CHA2DS2VASc ≥2 (81% vs 70%, p In patients with permanent AF, heart rate (82±20 vs 78±20, p APHRS vs EORP patients with non-permanent AF were less symptomatic (EHRA score I in 56% vs 38%) with less frequent use of antiarrhythmics (25% vs 37%), rhythm-management interventions (32% vs 46%), but higher use of catheter ablation (p Conclusion There are significant regional variations in achievement of the ESC quality indicator for AF. The variations may be due to differences in healthcare systems, but they may also reflect the population characteristics. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Since the start of EORP, the following companies have supported theprogramme: Abbott Vascular Int. (2011-2014), Amgen Cardiovascular(2009-2018), AstraZeneca (2014-2017), Bayer AG (2009-2018),Boehringer Ingelheim (2009-2019), Boston Scientific (2009-2012), TheBristol Myers Squibb and Pfizer Alliance (2011-2016), The Alliance DaiichiSankyo Europe GmbH and Eli Lilly and Company (2011-2017), Edwards(2016-2019), Gedeon Richter Plc. (2014-2017), Menarini Int. Op. (2009-2012), MSD-Merck & Co. (2011-2014), Novartis Pharma AG (2014-2017), ResMed (2014-2016), Sanofi (2009-2011), and SERVIER (2009-2018).The Atrial Fibrillation NETwork (AFNET), conducting the registryin Germany, received support from The Bristol Myers Squibb/PfizerAlliance (2014-2018) and the German Centre for CardiovascularResearch (DZHK).

Published
2022
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162. Epidemiology and impact of frailty in patients with atrial fibrillation in Europe

Author

Proietti, Marco, Romiti, Giulio Francesco, Vitolo, Marco, Harrison, Stephanie L., Lane, Deirdre A., Fauchier, Laurent, Marin, Francisco, Näbauer, Michael, Potpara, Tatjana S., Dan, Gheorghe-Andrei, Maggioni, Aldo P., Cesari, Matteo, Boriani, Giuseppe, Lip, Gregory Y. H., Zëra, E., Ekmekçiu, U., Paparisto, V., Tase, M., Gjergo, H., Dragoti, J., Goda, A., Ciutea, M., Ahadi, N., el Husseini, Z., Raepers, M., Leroy, J., Haushan, P., Jourdan, A., Lepiece, C., Desteghe, L., Vijgen, J., Koopman, P., van Genechten, G., Heidbuchel, H., Boussy, T., de Coninck, M., van Eeckhoutte, H., Bouckaert, N., Friart, A., Boreux, J., Arend, C., Evrard, P., Stefan, L., Hoffer, E., Herzet, J., Massoz, M., Celentano, C., Sprynger, M., Pierard, L., Melon, P., van Hauwaert, B., Kuppens, C., Faes, D., van Lier, D., van Dorpe, A., Gerardy, A., Deceuninck, O., Xhaet, O., Dormal, F., Ballant, E., Blommaert, D., Yakova, D., Hristov, M., Yncheva, T., Stancheva, N., Tisheva, S., Tokmakova, M., Nikolov, F., Gencheva, D., Shalganov, T., Kunev, B., Stoyanov, M., Marchov, D., Gelev, V., Traykov, V., Kisheva, A., Tsvyatkov, H., Shtereva, R., Bakalska-Georgieva, S., Slavcheva, S., Yotov, Y., Kubíčková, M., Marni Joensen, A., Gammelmark, A., Hvilsted Rasmussen, L., Dinesen, P., Riahi, S., Krogh Venø, S., Sorensen, B., Korsgaard, A., Andersen, K., Fragtrup Hellum, C., Svenningsen, A., Nyvad, O., Wiggers, P., May, O., Aarup, A., Graversen, B., Jensen, L., Andersen, M., Svejgaard, M., Vester, S., Hansen, S., Lynggaard, V., Ciudad, M., Vettus, R., Muda, P., Maestre, A., Castaño, S., Cheggour, S., Poulard, J., Mouquet, V., Leparrée, S., Bouet, J., Taieb, J., Doucy, A., Duquenne, H., Furber, A., Dupuis, J., Rautureau, J., Font, M., Damiano, P., Lacrimini, M., Abalea, J., Boismal, S., Menez, T., Mansourati, J., Range, G., Gorka, H., Laure, C., Vassalière, C., Elbaz, N., Lellouche, N., Djouadi, K., Roubille, F., Dietz, D., Davy, J., Granier, M., Winum, P., Leperchois-Jacquey, C., Kassim, H., Marijon, E., le Heuzey, J., Fedida, J., Maupain, C., Himbert, C., Gandjbakhch, E., Hidden-Lucet, F., Duthoit, G., Badenco, N., Chastre, T., Waintraub, X., Oudihat, M., Lacoste, J., Stephan, C., Bader, H., Delarche, N., Giry, L., Arnaud, D., Lopez, C., Boury, F., Brunello, I., Lefèvre, M., Mingam, R., Haissaguerre, M., le Bidan, M., Pavin, D., le Moal, V., Leclercq, C., Piot, O., Beitar, T., Martel, I., Schmid, A., Sadki, N., Romeyer-Bouchard, C., da Costa, A., Arnault, I., Boyer, M., Piat, C., Fauchier, L., Lozance, N., Nastevska, S., Doneva, A., Fortomaroska Milevska, B., Sheshoski, B., Petroska, K., Taneska, N., Bakrecheski, N., Lazarovska, K., Jovevska, S., Ristovski, V., Antovski, A., Lazarova, E., Kotlar, I., Taleski, J., Poposka, L., Kedev, S., Zlatanovik, N., Jordanova, S., Bajraktarova Proseva, T., Doncovska, S., Maisuradze, D., Esakia, A., Sagirashvili, E., Lartsuliani, K., Natelashvili, N., Gumberidze, N., Gvenetadze, R., Etsadashvili, K., Gotonelia, N., Kuridze, N., Papiashvili, G., Menabde, I., Glöggler, S., Napp, A., Lebherz, C., Romero, H., Schmitz, K., Berger, M., Zink, M., Köster, S., Sachse, J., Vonderhagen, E., Soiron, G., Mischke, K., Reith, R., Schneider, M., Rieker, W., Boscher, D., Taschareck, A., Beer, A., Oster, D., Ritter, O., Adamczewski, J., Walter, S., Frommhold, A., Luckner, E., Richter, J., Schellner, M., Landgraf, S., Bartholome, S., Naumann, R., Schoeler, J., Westermeier, D., William, F., Wilhelm, K., Maerkl, M., Oekinghaus, R., Denart, M., Kriete, M., Tebbe, U., Scheibner, T., Gruber, M., Gerlach, A., Beckendorf, C., Anneken, L., Arnold, M., Lengerer, S., Bal, Z., Uecker, C., Förtsch, H., Fechner, S., Mages, V., Martens, E., Methe, H., Schmidt, T., Schaeffer, B., Hoffmann, B., Moser, J., Heitmann, K., Willems, S., Klaus, C., Lange, I., Durak, M., Esen, E., Mibach, F., Mibach, H., Utech, A., Gabelmann, M., Stumm, R., Ländle, V., Gartner, C., Goerg, C., Kaul, N., Messer, S., Burkhardt, D., Sander, C., Orthen, R., Kaes, S., Baumer, A., Dodos, F., Barth, A., Schaeffer, G., Gaertner, J., Winkler, J., Fahrig, A., Aring, J., Wenzel, I., Steiner, S., Kliesch, A., Kratz, E., Winter, K., Schneider, P., Haag, A., Mutscher, I., Bosch, R., Taggeselle, J., Meixner, S., Schnabel, A., Shamalla, A., Hötz, H., Korinth, A., Rheinert, C., Mehltretter, G., Schön, B., Schön, N., Starflinger, A., Englmann, E., Baytok, G., Laschinger, T., Ritscher, G., Gerth, A., Dechering, D., Eckardt, L., Kuhlmann, M., Proskynitopoulos, N., Brunn, J., Foth, K., Axthelm, C., Hohensee, H., Eberhard, K., Turbanisch, S., Hassler, N., Koestler, A., Stenzel, G., Kschiwan, D., Schwefer, M., Neiner, S., Hettwer, S., Haeussler-Schuchardt, M., Degenhardt, R., Sennhenn, S., Brendel, M., Stoehr, A., Widjaja, W., Loehndorf, S., Logemann, A., Hoskamp, J., Grundt, J., Block, M., Ulrych, R., Reithmeier, A., Panagopoulos, V., Martignani, C., Bernucci, D., Fantecchi, E., Diemberger, I., Ziacchi, M., Biffi, M., Cimaglia, P., Frisoni, J., Boriani, G., Giannini, I., Boni, S., Fumagalli, S., Pupo, S., di Chiara, A., Mirone, P., Pesce, F., Zoccali, C., Malavasi, V. L., Mussagaliyeva, A., Ahyt, B., Salihova, Z., Koshum-Bayeva, K., Kerimkulova, A., Bairamukova, A., Mirrakhimov, E., Lurina, B., Zuzans, R., Jegere, S., Mintale, I., Kupics, K., Jubele, K., Erglis, A., Kalejs, O., Vanhear, K., Burg, M., Cachia, M., Abela, E., Warwicker, S., Tabone, T., Xuereb, R., Asanovic, D., Drakalovic, D., Vukmirovic, M., Pavlovic, N., Music, L., Bulatovic, N., Boskovic, A., Uiterwaal, H., Bijsterveld, N., de Groot, J., Neefs, J., van den Berg, N., Piersma, F., Wilde, A., Hagens, V., van Es, J., van Opstal, J., van Rennes, B., Verheij, H., Breukers, W., Tjeerdsma, G., Nijmeijer, R., Wegink, D., Binnema, R., Said, S., Erküner, Philippens, S., van Doorn, W., Crijns, H., Szili-Torok, T., Bhagwandien, R., Janse, P., Muskens, A., van Eck, M., Gevers, R., van der Ven, N., Duygun, A., Rahel, B., Meeder, J., Vold, A., Holst Hansen, C., Engset, I., Atar, D., Dyduch-Fejklowicz, B., Koba, E., Cichocka, M., Sokal, A., Kubicius, A., Pruchniewicz, E., Kowalik-Sztylc, A., Czapla, W., Mróz, I., Kozlowski, M., Pawlowski, T., Tendera, M., Winiarska-Filipek, A., Fidyk, A., Slowikowski, A., Haberka, M., Lachor-Broda, M., Biedron, M., Gasior, Z., Kołodziej, M., Janion, M., Gorczyca-Michta, I., Wozakowska-Kaplon, B., Stasiak, M., Jakubowski, P., Ciurus, T., Drozdz, J., Simiera, M., Zajac, P., Wcislo, T., Zycinski, P., Kasprzak, J., Olejnik, A., Harc-Dyl, E., Miarka, J., Pasieka, M., Zieminska-Łuć, M., Bujak, W., Sliwinski, A., Grech, A., Morka, J., Petrykowska, K., Prasał, M., Hordynski, G., Feusette, P., Lipski, P., Wester, A., Streb, W., Romanek, J., Wozniak, P., Chlebus, M., Szafarz, P., Stanik, W., Zakrzewski, M., Kazmierczak, J., Przybylska, A., Skorek, E., Błaszczyk, H., Stepien, M., Szabowski, S., Krysiak, W., Szymanska, M., Karasinski, J., Blicharz, J., Skura, M., Hałas, K., Michalczyk, L., Orski, Z., Krzyzanowski, K., Skrobowski, A., Zielinski, L., Tomaszewska-Kiecana, M., Dłuzniewski, M., Kiliszek, M., Peller, M., Budnik, M., Balsam, P., Opolski, G., Tyminska, A., Ozieranski, K., Wancerz, A., Borowiec, A., Majos, E., Dabrowski, R., Szwed, H., Musialik-Lydka, A., Leopold-Jadczyk, A., Jedrzejczyk-Patej, E., Koziel, M., Lenarczyk, R., Mazurek, M., Kalarus, Z., Krzemien-Wolska, K., Starosta, P., Nowalany-Kozielska, E., Orzechowska, A., Szpot, M., Staszel, M., Almeida, S., Pereira, H., Brandão Alves, L., Miranda, R., Ribeiro, L., Costa, F., Morgado, F., Carmo, P., Galvao Santos, P., Bernardo, R., Adragão, P., Ferreira da Silva, G., Peres, M., Alves, M., Leal, M., Cordeiro, A., Magalhães, P., Fontes, P., Leão, S., Delgado, A., Costa, A., Marmelo, B., Rodrigues, B., Moreira, D., Santos, J., Santos, L., Terchet, A., Darabantiu, D., Mercea, S., Turcin Halka, V., Pop Moldovan, A., Gabor, A., Doka, B., Catanescu, G., Rus, H., Oboroceanu, L., Bobescu, E., Popescu, R., Dan, A., Buzea, A., Daha, I., Dan, G., Neuhoff, I., Baluta, M., Ploesteanu, R., Dumitrache, N., Vintila, M., Daraban, A., Japie, C., Badila, E., Tewelde, H., Hostiuc, M., Frunza, S., Tintea, E., Bartos, D., Ciobanu, A., Popescu, I., Toma, N., Gherghinescu, C., Cretu, D., Patrascu, N., Stoicescu, C., Udroiu, C., Bicescu, G., Vintila, V., Vinereanu, D., Cinteza, M., Rimbas, R., Grecu, M., Cozma, A., Boros, F., Ille, M., Tica, O., Tor, R., Corina, A., Jeewooth, A., Maria, B., Georgiana, C., Natalia, C., Alin, D., Dinu-Andrei, D., Livia, M., Daniela, R., Larisa, R., Umaar, S., Tamara, T., Ioachim Popescu, M., Nistor, D., Sus, I., Coborosanu, O., Alina-Ramona, N., Dan, R., Petrescu, L., Ionescu, G., Vacarescu, C., Goanta, E., Mangea, M., Ionac, A., Mornos, C., Cozma, D., Pescariu, S., Solodovnicova, E., Soldatova, I., Shutova, J., Tjuleneva, L., Zubova, T., Uskov, V., Obukhov, D., Rusanova, G., Odinsova, S., Arhipova, T., Kazakevich, E., Serdechnaya, E., Zavyalova, O., Novikova, T., Riabaia, I., Zhigalov, S., Drozdova, E., Luchkina, I., Monogarova, Y., Hegya, D., Rodionova, L., Nevzorova, V., Lusanova, O., Arandjelovic, A., Toncev, D., Milanov, M., Sekularac, N., Zdravkovic, M., Hinic, S., Dimkovic, S., Acimovic, T., Saric, J., Polovina, M., Potpara, T., Vujisic-Tesic, B., Nedeljkovic, M., Zlatar, M., Asanin, M., Vasic, V., Popovic, Z., Djikic, D., Sipic, M., Peric, V., Dejanovic, B., Milosevic, N., Stevanovic, A., Andric, A., Pencic, B., Pavlovic-Kleut, M., Celic, V., Pavlovic, M., Petrovic, M., Vuleta, M., Petrovic, N., Simovic, S., Savovic, Z., Milanov, S., Davidovic, G., Iric-Cupic, V., Simonovic, D., Stojanovic, M., Stojanovic, S., Mitic, V., Ilic, V., Petrovic, D., Deljanin Ilic, M., Ilic, S., Stoickov, V., Markovic, S., Kovacevic, S., García Fernandez, A., Perez Cabeza, A., Anguita, M., Tercedor Sanchez, L., Mau, E., Loayssa, J., Ayarra, M., Carpintero, M., Roldán Rabadan, I., Gil Ortega, M., Tello Montoliu, A., Orenes Piñero, E., Manzano Fernández, S., Marín, F., Romero Aniorte, A., Veliz Martínez, A., Quintana Giner, M., Ballesteros, G., Palacio, M., Alcalde, O., García-Bolao, I., Bertomeu Gonzalez, V., Otero-Raviña, F., García Seara, J., Gonzalez Juanatey, J., Dayal, N., Maziarski, P., Gentil-Baron, P., Shah, D., Koç, M., Onrat, E., Dural, I. E., Yilmaz, K., Özin, B., Tan Kurklu, S., Atmaca, Y., Canpolat, U., Tokgozoglu, L., Dolu, A. K., Demirtas, B., Sahin, D., Ozcan Celebi, O., Diker, E., Gagirci, G., Turk, U. O., Ari, H., Polat, N., Toprak, N., Sucu, M., Akin Serdar, O., Taha Alper, A., Kepez, A., Yuksel, Y., Uzunselvi, A., Yuksel, S., Sahin, M., Kayapinar, O., Ozcan, T., Kaya, H., Yilmaz, M. B., Kutlu, M., Demir, M., Gibbs, C., Kaminskiene, S., Bryce, M., Skinner, A., Belcher, G., Hunt, J., Stancombe, L., Holbrook, B., Peters, C., Tettersell, S., Shantsila, A., Lane, D., Senoo, K., Proietti, M., Russell, K., Domingos, P., Hussain, S., Partridge, J., Haynes, R., Bahadur, S., Brown, R., McMahon, S., Lip, G. Y. H., McDonald, J., Balachandran, K., Singh, R., Garg, S., Desai, H., Davies, K., Goddard, W., Galasko, G., Rahman, I., Chua, Y., Payne, O., Preston, S., Brennan, O., Pedley, L., Whiteside, C., Dickinson, C., Brown, J., Jones, K., Benham, L., Brady, R., Buchanan, L., Ashton, A., Crowther, H., Fairlamb, H., Thornthwaite, S., Relph, C., McSkeane, A., Poultney, U., Kelsall, N., Rice, P., Wilson, T., Wrigley, M., Kaba, R., Patel, T., Young, E., Law, J., Runnett, C., Thomas, H., McKie, H., Fuller, J., Pick, S., Sharp, A., Hunt, A., Thorpe, K., Hardman, C., Cusack, E., Adams, L., Hough, M., Keenan, S., Bowring, A., Watts, J., Zaman, J., Goffin, K., Nutt, H., Beerachee, Y., Featherstone, J., Mills, C., Pearson, J., Stephenson, L., Grant, S., Wilson, A., Hawksworth, C., Alam, I., Robinson, M., Ryan, S., Egdell, R., Gibson, E., Holland, M., Leonard, D., Mishra, B., Ahmad, S., Randall, H., Hill, J., Reid, L., George, M., McKinley, S., Brockway, L., Milligan, W., Sobolewska, J., Muir, J., Tuckis, L., Winstanley, L., Jacob, P., Kaye, S., Morby, L., Jan, A., Sewell, T., Boos, C., Wadams, B., Cope, C., Jefferey, P., Andrews, N., Getty, A., Suttling, A., Turner, C., Hudson, K., Austin, R., Howe, S., Iqbal, R., Gandhi, N., Brophy, K., Mirza, P., Willard, E., Collins, S., Ndlovu, N., Subkovas, E., Karthikeyan, V., Waggett, L., Wood, A., Bolger, A., Stockport, J., Evans, L., Harman, E., Starling, J., Williams, L., Saul, V., Sinha, M., Bell, L., Tudgay, S., Kemp, S., Frost, L., Ingram, T., Loughlin, A., Adams, C., Adams, M., Hurford, F., Owen, C., Miller, C., Donaldson, D., Tivenan, H., Button, H., Nasser, A., Jhagra, O., Stidolph, B., Brown, C., Livingstone, C., Duffy, M., Madgwick, P., Roberts, P., Greenwood, E., Fletcher, L., Beveridge, M., Earles, S., McKenzie, D., Beacock, D., Dayer, M., Seddon, M., Greenwell, D., Luxton, F., Venn, F., Mills, H., Rewbury, J., James, K., Roberts, K., Tonks, L., Felmeden, D., Taggu, W., Summerhayes, A., Hughes, D., Sutton, J., Felmeden, L., Khan, M., Walker, E., Norris, L., O’Donohoe, L., Mozid, A., Dymond, H., Lloyd-Jones, H., Saunders, G., Simmons, D., Coles, D., Cotterill, D., Beech, S., Kidd, S., Wrigley, B., Petkar, S., Smallwood, A., Jones, R., Radford, E., Milgate, S., Metherell, S., Cottam, V., Buckley, C., Broadley, A., Wood, D., Allison, J., Rennie, K., Balian, L., Howard, L., Pippard, L., Board, S., Pitt-Kerby, T., Pulmonary medicine, Rehabilitation medicine, Internal medicine, Radiology and nuclear medicine, Laboratory Medicine, Cardiology, and ACS - Heart failure & arrhythmias

Subjects
Oral, Male, Aging, Administration, Oral, frailty, Frailty/chemically induced, outcomes, Europe/epidemiology, older people, Risk Factors, atrial fibrillation, chronicity, epidemiology, oral anticoagulant therapy, Aged, Anticoagulants, Europe, Female, Humans, Quality of Life, Registries, Atrial Fibrillation, Frailty, Stroke, Atrial Fibrillation/diagnosis, General Medicine, Administration, Geriatrics and Gerontology, Anticoagulants/adverse effects, Stroke/complications
Abstract

Background Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent. Objectives We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients. Methods A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined. Results Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55–0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty. Conclusions In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.

Published
2022
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165. Arterial stiffness and atrial fibrillation: shared mechanisms, clinical implications and therapeutic options

Author

Riccardo Vio, Andrea S. Giordani, Maria Stefil, Jillian Madine, Timothy Fairbairn, Sakis Themistoclakis, Paolo Salvi, Alida L.P. Caforio, Alena Shantsila, Eduard Shantsila, Riaz Akhtar, Mark Field, Gregory Y.H. Lip, and Riccardo Proietti

Subjects
cardiovascular risk, arterial stiffness, cardiovascular remodeling, Vascular Stiffness, Physiology, atrial fibrillation, cardiovascular prevention, Aorta, Humans, Pulse Wave Analysis, Atrial Fibrillation, Internal Medicine, Cardiology and Cardiovascular Medicine
Abstract

Arterial stiffness (AS) and atrial fibrillation (AF) share commonalities in molecular and pathophysiological mechanisms and numerous studies have analyzed their reciprocal influence. The gold standard for AS diagnosis is represented by aortic pulse wave velocity, whose measurement can be affected by arrhythmias characterized by irregularities in heart rhythm, such as AF. Growing evidence show that patients with AS are at high risk of AF development. Moreover, the subset of AF patients with AS seems to be more symptomatic and rhythm control strategies are less effective in this population. Reducing AS through de-stiffening interventions may be beneficial for patients with AF and can be a new appealing target for the holistic approach of AF management. In this review, we discuss the association between AS and AF, with particular interest in shared mechanisms, clinical implications and therapeutic options.

Published
2022

166. Altered cardiac and vascular stiffness in pregnancy after a hypertensive pregnancy

Author

James S, Castleman, Alena, Shantsila, Richard A, Brown, Eduard, Shantsila, and Gregory Y H, Lip

Abstract

Hypertensive disorders of pregnancy are an important cause of morbidity and mortality, impacting on both maternal and fetal wellbeing. Affected women are at higher risk of future cardiovascular morbidity and mortality. Our study objective was to assess differences in cardiovascular function in pregnant women previously affected by gestational hypertension or preeclampsia. Pregnant women diagnosed with gestational hypertension or preeclampsia in a previous pregnancy were recruited at the start of a subsequent pregnancy and compared to healthy pregnant and non-pregnant controls. All patients underwent pulse wave analysis and echocardiography. Indexes of echocardiography-derived arterial and left ventricular elastance were calculated. In our study women with prior hypertension (n = 25) were more likely to have blood pressure in the 120-139/80-99 mmHg (prehypertension) range. Women with previous hypertension in pregnancy had increased late diastolic transmitral flow velocities (A wave) and increased augmentation index. Women without prior hypertension (n = 50) demonstrated more compliance (reduced EaI and Ees) compared to the non-pregnant controls (n = 40). This adaptation was not seen in pregnancy with prior hypertension, where increased arterial stiffness was observed. In conclusion we have shown increased prevalence of prehypertension and increased arterial stiffness in pregnant women previously affected by gestational hypertensive disease. An increased atrial component to ventricular filling reflects altered diastolic function after hypertensive pregnancy. These women are at increased future cardiovascular risk due to altered cardiac and vascular function and require effective risk mitigation.

Published
2021

171. Saúde Cardiovascular e Fibrilação ou Flutter Atrial: Um Estudo Transversal do ELSA-Brasil

Author

Santos, Itamar S., primary, Lotufo, Paulo A., additional, Goulart, Alessandra C., additional, Brant, Luisa C. C., additional, Pinto, Marcelo M, additional, Pereira, Alexandre C., additional, Barreto, Sandhi M., additional, Ribeiro, Antonio L. P., additional, Thomas, G Neil, additional, Lip, Gregory Y. H., additional, Bensenor, Isabela M., additional, Arasalingam, Ajini, additional, Beane, Abi, additional, Bensenor, Isabela M, additional, Brocklehurst, Peter, additional, Cheng, Kar Keung, additional, El-Bouri, Wahbi, additional, Feng, Mei, additional, Goulart, Alessandra C, additional, Greenfield, Sheila, additional, Guo, Yutao, additional, Guruparan, Mahesan, additional, Gusso, Gustavo, additional, Gooden, Tiffany E, additional, Haniffa, Rashan, additional, Humphreys, Lindsey, additional, Jolly, Kate, additional, Jowett, Sue, additional, Kumarendran, Balachandran, additional, Lancashire, Emma, additional, Lane, Deirdre A, additional, Li, Xuewen, additional, Lip (Co-PI), Gregory Y.H., additional, Li, Yan-guang, additional, Lobban, Trudie, additional, Lotufo, Paulo A, additional, Manseki-Holland, Semira, additional, Moore, David J, additional, Nirantharakumar, Krishnarajah, additional, Olmos, Rodrigo D, additional, Paschoal, Elisabete, additional, Pirasanth, Paskaran, additional, Powsiga, Uruthirakumar, additional, Romagnolli, Carla, additional, Santos, Itamar S, additional, Shantsila, Alena, additional, Sheron, Vethanayagam Antony, additional, Shribavan, Kanesamoorthy, additional, Szmigin, Isabelle, additional, Subaschandren, Kumaran, additional, Surenthirakumaran, Rajendra, additional, Tai, Meihui, additional, Neil Thomas (Co-PI), G, additional, Varella, Ana C, additional, Wang, Hao, additional, Wang, Jingya, additional, Zhang, Hui, additional, and Zhong, Jiaoyue, additional

Published
2022
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172. Impact of diabetes on the management and outcomes in atrial fibrillation: an analysis from the ESC-EHRA EORP-AF Long-Term General Registry

Author

Ding, Wern Yew, primary, Kotalczyk, Agnieszka, additional, Boriani, Giuseppe, additional, Marin, Francisco, additional, Blomström-Lundqvist, Carina, additional, Potpara, Tatjana S., additional, Fauchier, Laurent, additional, Lip, Gregory.Y.H., additional, Boriani, G., additional, Lip, G.Y.H., additional, Tavazzi, L., additional, Maggioni, A.P., additional, Dan, G.-A., additional, Potpara, T., additional, Nabauer, M., additional, Marin, F., additional, Kalarus, Z., additional, Goda, A., additional, Mairesse, G., additional, Shalganov, T., additional, Antoniades, L., additional, Taborsky, M., additional, Riahi, S., additional, Muda, P., additional, García Bolao, I., additional, Piot, O., additional, Etsadashvili, K., additional, Simantirakis, E., additional, Haim, M., additional, Azhari, A., additional, Najafian, J., additional, Santini, M., additional, Mirrakhimov, E., additional, Kulzida, K.A., additional, Erglis, A., additional, Poposka, L., additional, Burg, M., additional, Crijns, H., additional, Erküner, Ö., additional, Atar, D., additional, Lenarczyk, R., additional, Martins Oliveira, M., additional, Shah, D., additional, Serdechnaya, E., additional, Diker, E., additional, Lane, D., additional, Zëra, E., additional, Ekmekçiu, U., additional, Paparisto, V., additional, Tase, M., additional, Gjergo, H., additional, Dragoti, J., additional, Ciutea, M., additional, Ahadi, N., additional, el Husseini, Z., additional, Raepers, M., additional, Leroy, J., additional, Haushan, P., additional, Jourdan, A., additional, Lepiece, C., additional, Desteghe, L., additional, Vijgen, J., additional, Koopman, P., additional, Van Genechten, G., additional, Heidbuchel, H., additional, Boussy, T., additional, De Coninck, M., additional, Van Eeckhoutte, H., additional, Bouckaert, N., additional, Friart, A., additional, Boreux, J., additional, Arend, C., additional, Evrard, P., additional, Stefan, L., additional, Hoffer, E., additional, Herzet, J., additional, Massoz, M., additional, Celentano, C., additional, Sprynger, M., additional, Pierard, L., additional, Melon, P., additional, Van Hauwaert, B., additional, Kuppens, C., additional, Faes, D., additional, Van Lier, D., additional, Van Dorpe, A., additional, Gerardy, A., additional, Deceuninck, O., additional, Xhaet, O., additional, Dormal, F., additional, Ballant, E., additional, Blommaert, D., additional, Yakova, D., additional, Hristov, M., additional, Yncheva, T., additional, Stancheva, N., additional, Tisheva, S., additional, Tokmakova, M., additional, Nikolov, F., additional, Gencheva, D., additional, Kunev, B., additional, Stoyanov, M., additional, Marchov, D., additional, Gelev, V., additional, Traykov, V., additional, Kisheva, A., additional, Tsvyatkov, H., additional, Shtereva, R., additional, Bakalska-Georgieva, S., additional, Slavcheva, S., additional, Yotov, Y., additional, Kubíčková, M., additional, Marni Joensen, A., additional, Gammelmark, A., additional, Hvilsted Rasmussen, L., additional, Dinesen, P., additional, Krogh Venø, S., additional, Sorensen, B., additional, Korsgaard, A., additional, Andersen, K., additional, Fragtrup Hellum, C., additional, Svenningsen, A., additional, Nyvad, O., additional, Wiggers, P., additional, May, O., additional, Aarup, A., additional, Graversen, B., additional, Jensen, L., additional, Andersen, M., additional, Svejgaard, M., additional, Vester, S., additional, Hansen, S., additional, Lynggaard, V., additional, Ciudad, M., additional, Vettus, R., additional, Maestre, A., additional, Castaño, S., additional, Cheggour, S., additional, Poulard, J., additional, Mouquet, V., additional, Leparrée, S., additional, Bouet, J., additional, Taieb, J., additional, Doucy, A., additional, Duquenne, H., additional, Furber, A., additional, Dupuis, J., additional, Rautureau, J., additional, Font, M., additional, Damiano, P., additional, Lacrimini, M., additional, Abalea, J., additional, Boismal, S., additional, Menez, T., additional, Mansourati, J., 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K., additional, Axthelm, C., additional, Hohensee, H., additional, Eberhard, K., additional, Turbanisch, S., additional, Hassler, N., additional, Koestler, A., additional, Stenzel, G., additional, Kschiwan, D., additional, Schwefer, M., additional, Neiner, S., additional, Hettwer, S., additional, Haeussler-Schuchardt, M., additional, Degenhardt, R., additional, Sennhenn, S., additional, Brendel, M., additional, Stoehr, A., additional, Widjaja, W., additional, Loehndorf, S., additional, Logemann, A., additional, Hoskamp, J., additional, Grundt, J., additional, Block, M., additional, Ulrych, R., additional, Reithmeier, A., additional, Panagopoulos, V., additional, Martignani, C., additional, Bernucci, D., additional, Fantecchi, E., additional, Diemberger, I., additional, Ziacchi, M., additional, Biffi, M., additional, Cimaglia, P., additional, Frisoni, J., additional, Giannini, I., additional, Boni, S., additional, Fumagalli, S., additional, Pupo, S., additional, Di Chiara, A., 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additional, Slowikowski, A., additional, Haberka, M., additional, Lachor-Broda, M., additional, Biedron, M., additional, Gasior, Z., additional, Kołodziej, M., additional, Janion, M., additional, Gorczyca-Michta, I., additional, Wozakowska-Kaplon, B., additional, Stasiak, M., additional, Jakubowski, P., additional, Ciurus, T., additional, Drozdz, J., additional, Simiera, M., additional, Zajac, P., additional, Wcislo, T., additional, Zycinski, P., additional, Kasprzak, J., additional, Olejnik, A., additional, Harc-Dyl, E., additional, Miarka, J., additional, Pasieka, M., additional, Ziemińska-Łuć, M., additional, Bujak, W., additional, Śliwiński, A., additional, Grech, A., additional, Morka, J., additional, Petrykowska, K., additional, Prasał, M., additional, Hordyński, G., additional, Feusette, P., additional, Lipski, P., additional, Wester, A., additional, Streb, W., additional, Romanek, J., additional, Woźniak, P., additional, Chlebuś, M., additional, Szafarz, P., additional, Stanik, 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Published
2022
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178. Recent advances in the understanding and management of atrial fibrillation: a focus on stroke prevention [version 1; referees: 3 approved]

Author

Farhan Shahid, Eduard Shantsila, and Gregory Y. H. Lip

Subjects
Review, Articles, Arrhythmias, Electrophysiology & Pacing, Bleeding & Coagulation Disorders, Cardiovascular Physiology/Circulation, Cerebrovascular Disease, Immunopharmacology & Hematologic Pharmacology, Atrial Fibrillation, screening, stroke, CHA2DS2VASc, HAS BLED, anti-coagulation, warfarin, non-vitamin k anti coagulants
Abstract

Atrial fibrillation (AF) is associated with an increased risk of stroke compared with the general population. It is anticipated that by 2030 an estimated 14–17 million patients will be diagnosed with this most prevalent arrhythmia within the European Union. AF-related stroke confers a higher mortality and morbidity risk, and thus early detection and assessment for the initiation of effective stroke prevention with oral anticoagulation (OAC) is crucial. Recent guidelines point to the use of non-vitamin K antagonist OACs (NOACs) where appropriate in stroke prevention of patients with non-valvular AF. At present, there are four NOACS available, with no direct head-to-head comparisons to suggest the superiority of one drug over another. Simple and practical risk assessment tools have evolved over the years to facilitate stroke and bleeding risk assessment in busy clinics and wards to aid decision-making. At present, the CHA 2DS 2VASc (congestive heart failure, hypertension, age 65–74/>75, diabetes mellitus, stroke/transient ischemic attack/thromboembolism, vascular disease, female sex) score is recommended by many international guidelines as a simple and practical method of assessing stroke risk in such patients. Alongside this, use of the HAS BLED (hypertension systolic blood pressure >160 mmHg, abnormal liver/renal function [with creatinine ≥200 μmol/L], stroke, bleeding history or predisposition, labile international normalized ratio [range 65], concomitant drugs/alcohol) score aims to identify patients at high risk of bleeding for more regular review and follow-up and draws attention to potentially reversible bleeding risk factors. The aim of this review article is to provide an overview of recent advances in the understanding and management of AF with a focus on stroke prevention.

Published
2016
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181. Patient and Public Involvement and Engagement (PPIE): first steps in the process of the engagement in research projects in Brazil

Author

Bensenor, IM, Goulart, AC, Thomas, GN, Lip, GYH, Arasalingam, Ajini, Beane, Abi, Bensenor, Isabela M, Brocklehurst, Peter, Cheng, Kar Keung, El-Bouri, Wahbi, Feng, Mei, Goulart, Alessandra C, Greenfield, Sheila, Guo, Yutao, Guruparan, Mahesan, Gusso, Gustavo, Gooden, Tiffany E, Haniffa, Rashan, Humphreys, Lindsey, Jolly, Kate, Jowett, Sue, Kodippily, Chamira, Kumarendran, Balachandran, Lancashire, Emma, Lane, Deirdre A, Li, Xuewen, Lip, Gregory YH, Li, Yan-guang, Lobban, Trudie, Lotufo, Paulo A, Manaseki-Holland, Semira, Moore, David, Nirantharakumar, Krishnarajah, Olmos, Rodrigo D, Paschoal, Elisabete, Pirasanth, Paskaran, Powsiga, Uruthirakumar, Romagnolli, Carla, Santos, Itamar S, Shantsila, Alena, Sheron, Vethanayagan Antony, Shribavan, Kanesamoorthy, Szmigin, Isabelle, Subaschandren, Kumaran, Surenthirakumaran, Rajendra, Tai, Meihui, Thavarajah, Bamini, Thomas, G Neil, Toippa, Timo, Varella, Ana C, Wang, Hao, Wang, Jingya, Zhang, Hui, Zhong, Jiaoyue, and Fi, NIHR Global Hlth Res Grp Atrial

Subjects
Patient and Public Involvement and Engagement, Physiology, General Neuroscience, Engagements, Immunology, Community Participation, Biophysics, Ocean Engineering, Cell Biology, General Medicine, Biochemistry, First process, Research projects, Humans, Patient Participation, General Pharmacology, Toxicology and Pharmaceutics, Brazil
Abstract

Patient and Public Involvement and Engagement (PPIE) - sometimes called Community Engagement and Involvement (CEI) - comes as a big challenge but one that can be very helpful for health care professionals and stakeholders in planning better health policies for attending to the main needs of the community. PPIE involves three pillars: public involvement, public engagement, and participation. Public involvement occurs when members of the general population are actively involved in developing the research question, designing, and conducting the research. Public engagement tells people about new studies, why they are important, the impact of results, the possible implication of the main findings for the community, and the possible impact of these new findings in society, as well as, in the dissemination of knowledge to the general population. Participation is being a volunteer in the study. Our experience with PPIE, to the best of our knowledge the first initiative in Brazil, is a partnership with the University of Birmingham, the University of Liverpool, and the NIHR Global Health Group on Atrial Fibrillation (AF) Management focusing on the AF care pathway exploring the important aspects of diagnosis and treatment in the primary care system from a low-middle income area in São Paulo. The involvement of patients/public in the research represents a new step in the process of inclusion of all segments of our society based on patient illness and the gaps in knowledge aiming to open new horizons for continuous improvement and better acceptance of research projects.

Published
2022

182. Clinical utility and prognostic implications of the novel 4S-AF scheme to characterize and evaluate patients with atrial fibrillation:a report from ESC-EHRA EORP-AF Long-Term General Registry

Author

Ding, Wern Yew, Proietti, Marco, Boriani, Giuseppe, Fauchier, Laurent, Blomström-Lundqvist, Carina, Marin, Francisco, Potpara, Tatjana S., Lip, Gregory Y. H., Boriani, G., Lip, G. Y. H., Tavazzi, L., Maggioni, A. P., Dan, G. A., Potpara, T., Nabauer, M., Marin, F., Kalarus, Z., Fauchier, L., Goda, A., Mairesse, G., Shalganov, T., Antoniades, L., Taborsky, M., Riahi, S., Muda, P., García Bolao, I., Piot, O., Etsadashvili, K., Simantirakis, E., Haim, M., Azhari, A., Najafian, J., Santini, M., Mirrakhimov, E., Kulzida, K. A., Erglis, A., Poposka, L., Burg, M., Crijns, H., Erküner, Atar, D., Lenarczyk, R., Martins Oliveira, M., Shah, D., Serdechnaya, E., Diker, E., Lane, D., Zëra, E., Ekmekçiu, U., Paparisto, V., Tase, M., Gjergo, H., Dragoti, J., Ciutea, M., Ahadi, N., el Husseini, Z., Raepers, M., Leroy, J., Haushan, P., Jourdan, A., Lepiece, C., Desteghe, L., Vijgen, J., Koopman, P., van Genechten, G., Heidbuchel, H., Boussy, T., de Coninck, M., van Eeckhoutte, H., Bouckaert, N., Friart, A., Boreux, J., Arend, C., Evrard, P., Stefan, L., Hoffer, E., Herzet, J., Massoz, M., Celentano, C., Sprynger, M., Pierard, L., Melon, P., van Hauwaert, B., Kuppens, C., Faes, D., van Lier, D., van Dorpe, A., Gerardy, A., Deceuninck, O., Xhaet, O., Dormal, F., Ballant, E., Blommaert, D., Yakova, D., Hristov, M., Yncheva, T., Stancheva, N., Tisheva, S., Tokmakova, M., Nikolov, F., Gencheva, D., Kunev, B., Stoyanov, M., Marchov, D., Gelev, V., Traykov, V., Kisheva, A., Tsvyatkov, H., Shtereva, R., Bakalska-Georgieva, S., Slavcheva, S., Yotov, Y., Kubíčková, M., Marni Joensen, A., Gammelmark, A., Hvilsted Rasmussen, L., Dinesen, P., Krogh Venø, S., Sorensen, B., Korsgaard, A., Andersen, K., Fragtrup Hellum, C., Svenningsen, A., Nyvad, O., Wiggers, P., May, O., Aarup, A., Graversen, B., Jensen, L., Andersen, M., Svejgaard, M., Vester, S., Hansen, S., Lynggaard, V., Ciudad, M., Vettus, R., Maestre, A., Castaño, S., Cheggour, S., Poulard, J., Mouquet, V., Leparrée, S., Bouet, J., Taieb, J., Doucy, A., Duquenne, H., Furber, A., Dupuis, J., Rautureau, J., Font, M., Damiano, P., Lacrimini, M., Abalea, J., Boismal, S., Menez, T., Mansourati, J., Range, G., Gorka, H., Laure, C., Vassalière, C., Elbaz, N., Lellouche, N., Djouadi, K., Roubille, F., Dietz, D., Davy, J., Granier, M., Winum, P., Leperchois-Jacquey, C., Kassim, H., Marijon, E., le Heuzey, J., Fedida, J., Maupain, C., Himbert, C., Gandjbakhch, E., Hidden-Lucet, F., Duthoit, G., Badenco, N., Chastre, T., Waintraub, X., Oudihat, M., Lacoste, J., Stephan, C., Bader, H., Delarche, N., Giry, L., Arnaud, D., Lopez, C., Boury, F., Brunello, I., Lefèvre, M., Mingam, R., Haissaguerre, M., le Bidan, M., Pavin, D., le Moal, V., Leclercq, C., Beitar, T., Martel, I., Schmid, A., Sadki, N., Romeyer-Bouchard, C., da Costa, A., Arnault, I., Boyer, M., Piat, C., Lozance, N., Nastevska, S., Doneva, A., Fortomaroska Milevska, B., Sheshoski, B., Petroska, K., Taneska, N., Bakrecheski, N., Lazarovska, K., Jovevska, S., Ristovski, V., Antovski, A., Lazarova, E., Kotlar, I., Taleski, J., Kedev, S., Zlatanovik, N., Jordanova, S., Bajraktarova Proseva, T., Doncovska, S., Maisuradze, D., Esakia, A., Sagirashvili, E., Lartsuliani, K., Natelashvili, N., Gumberidze, N., Gvenetadze, R., Gotonelia, N., Kuridze, N., Papiashvili, G., Menabde, I., Glöggler, S., Napp, A., Lebherz, C., Romero, H., Schmitz, K., Berger, M., Zink, M., Köster, S., Sachse, J., Vonderhagen, E., Soiron, G., Mischke, K., Reith, R., Schneider, M., Rieker, W., Boscher, D., Taschareck, A., Beer, A., Oster, D., Ritter, O., Adamczewski, J., Walter, S., Frommhold, A., Luckner, E., Richter, J., Schellner, M., Landgraf, S., Bartholome, S., Naumann, R., Schoeler, J., Westermeier, D., William, F., Wilhelm, K., Maerkl, M., Oekinghaus, R., Denart, M., Kriete, M., Tebbe, U., Scheibner, T., Gruber, M., Gerlach, A., Beckendorf, C., Anneken, L., Arnold, M., Lengerer, S., Bal, Z., Uecker, C., Förtsch, H., Fechner, S., Mages, V., Martens, E., Methe, H., Schmidt, T., Schaeffer, B., Hoffmann, B., Moser, J., Heitmann, K., Willems, S., Klaus, C., Lange, I., Durak, M., Esen, E., Mibach, F., Mibach, H., Utech, A., Gabelmann, M., Stumm, R., Ländle, V., Gartner, C., Goerg, C., Kaul, N., Messer, S., Burkhardt, D., Sander, C., Orthen, R., Kaes, S., Baumer, A., Dodos, F., Barth, A., Schaeffer, G., Gaertner, J., Winkler, J., Fahrig, A., Aring, J., Wenzel, I., Steiner, S., Kliesch, A., Kratz, E., Winter, K., Schneider, P., Haag, A., Mutscher, I., Bosch, R., Taggeselle, J., Meixner, S., Schnabel, A., Shamalla, A., Hötz, H., Korinth, A., Rheinert, C., Mehltretter, G., Schön, B., Schön, N., Starflinger, A., Englmann, E., Baytok, G., Laschinger, T., Ritscher, G., Gerth, A., Dechering, D., Eckardt, L., Kuhlmann, M., Proskynitopoulos, N., Brunn, J., Foth, K., Axthelm, C., Hohensee, H., Eberhard, K., Turbanisch, S., Hassler, N., Koestler, A., Stenzel, G., Kschiwan, D., Schwefer, M., Neiner, S., Hettwer, S., Haeussler-Schuchardt, M., Degenhardt, R., Sennhenn, S., Brendel, M., Stoehr, A., Widjaja, W., Loehndorf, S., Logemann, A., Hoskamp, J., Grundt, J., Block, M., Ulrych, R., Reithmeier, A., Panagopoulos, V., Martignani, C., Bernucci, D., Fantecchi, E., Diemberger, I., Ziacchi, M., Biffi, M., Cimaglia, P., Frisoni, J., Giannini, I., Boni, S., Fumagalli, S., Pupo, S., di Chiara, A., Mirone, P., Pesce, F., Zoccali, C., Malavasi, V. 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A., Tanasic, D., Radakovic, G., Peranovic, J., Panic-Jelic, N., Vujadinovic, O., Pajic, P., Bekic, S., Kovacevic, S., García Fernandez, A., Perez Cabeza, A., Anguita, M., Tercedor Sanchez, L., Mau, E., Loayssa, J., Ayarra, M., Carpintero, M., Roldán Rabadan, I., Gil Ortega, M., Tello Montoliu, A., Orenes Piñero, E., Manzano Fernández, S., Marín, F., Romero Aniorte, A., Veliz Martínez, A., Quintana Giner, M., Ballesteros, G., Palacio, M., Alcalde, O., García-Bolao, I., Bertomeu Gonzalez, V., Otero-Raviña, F., García Seara, J., Gonzalez Juanatey, J., Dayal, N., Maziarski, P., Gentil-Baron, P., Koç, M., Onrat, E., Dural, I. E., Yilmaz, K., Özin, B., Tan Kurklu, S., Atmaca, Y., Canpolat, U., Tokgozoglu, L., Dolu, A. K., Demirtas, B., Sahin, D., Ozcan Celebi, O., Gagirci, G., Turk, U. O., Ari, H., Polat, N., Toprak, N., Sucu, M., Akin Serdar, O., Taha Alper, A., Kepez, A., Yuksel, Y., Uzunselvi, A., Yuksel, S., Sahin, M., Ozcan, O. T., Kaya, H., Yilmaz, M. B., Kutlu, M., Demir, M., Gibbs, C., Kaminskiene, S., Bryce, M., Skinner, A., Belcher, G., Hunt, J., Stancombe, L., Holbrook, B., Peters, C., Tettersell, S., Shantsila, A., Senoo, K., Proietti, M., Russell, K., Domingos, P., Hussain, S., Partridge, J., Haynes, R., Bahadur, S., Brown, R., McMahon, S., McDonald, J., Balachandran, K., Singh, R., Garg, S., Desai, H., Davies, K., Goddard, W., Galasko, G., Rahman, I., Chua, Y., Payne, O., Preston, S., Brennan, O., Pedley, L., Whiteside, C., Dickinson, C., Brown, J., Jones, K., Benham, L., Brady, R., Buchanan, L., Ashton, A., Crowther, H., Fairlamb, H., Thornthwaite, S., Relph, C., McSkeane, A., Poultney, U., Kelsall, N., Rice, P., Wilson, T., Wrigley, M., Kaba, R., Patel, T., Young, E., Law, J., Runnett, C., Thomas, H., McKie, H., Fuller, J., Pick, S., Sharp, A., Hunt, A., Thorpe, K., Hardman, C., Cusack, E., Adams, L., Hough, M., Keenan, S., Bowring, A., Watts, J., Zaman, J., Goffin, K., Nutt, H., Beerachee, Y., Featherstone, J., Mills, C., Pearson, J., Stephenson, L., Grant, S., Wilson, A., Hawksworth, C., Alam, I., Robinson, M., Ryan, S., Egdell, R., Gibson, E., Holland, M., Leonard, D., Mishra, B., Ahmad, S., Randall, H., Hill, J., Reid, L., George, M., McKinley, S., Brockway, L., Milligan, W., Sobolewska, J., Muir, J., Tuckis, L., Winstanley, L., Jacob, P., Kaye, S., Morby, L., Jan, A., Sewell, T., Boos, C., Wadams, B., Cope, C., Jefferey, P., Andrews, N., Getty, A., Suttling, A., Turner, C., Hudson, K., Austin, R., Howe, S., Iqbal, R., Gandhi, N., Brophy, K., Mirza, P., Willard, E., Collins, S., Ndlovu, N., Subkovas, E., Karthikeyan, V., Waggett, L., Wood, A., Bolger, A., Stockport, J., Evans, L., Harman, E., Starling, J., Williams, L., Saul, V., Sinha, M., Bell, L., Tudgay, S., Kemp, S., Frost, L., Ingram, T., Loughlin, A., Adams, C., Adams, M., Hurford, F., Owen, C., Miller, C., Donaldson, D., Tivenan, H., Button, H., Nasser, A., Jhagra, O., Stidolph, B., Brown, C., Livingstone, C., Duffy, M., Madgwick, P., Roberts, P., Greenwood, E., Fletcher, L., Beveridge, M., Earles, S., McKenzie, D., Beacock, D., Dayer, M., Seddon, M., Greenwell, D., Luxton, F., Venn, F., Mills, H., Rewbury, J., James, K., Roberts, K., Tonks, L., Felmeden, D., Taggu, W., Summerhayes, A., Hughes, D., Sutton, J., Felmeden, L., Khan, M., Walker, E., Norris, L., O'Donohoe, L., Mozid, A., Dymond, H., Lloyd-Jones, H., Saunders, G., Simmons, D., Coles, D., Cotterill, D., Beech, S., Kidd, S., Wrigley, B., Petkar, S., Smallwood, A., Jones, R., Radford, E., Milgate, S., Metherell, S., Cottam, V., Buckley, C., Broadley, A., Wood, D., Allison, J., Rennie, K., Balian, L., Howard, L., Pippard, L., Board, S., Pitt-Kerby, T., Pulmonary medicine, Rehabilitation medicine, Internal medicine, Radiology and nuclear medicine, Laboratory Medicine, Cardiology, and ACS - Heart failure & arrhythmias

Subjects
Characterization, Bleeding, 4S-AF, Atrial fibrillation, Classification, EORP-AF registry, Mortality, Prognostic implications, Stroke, Thromboembolism, Validation, Anticoagulants, Hemorrhage, Humans, Prognosis, Registries, Risk Factors, Atrial Fibrillation, Brain Ischemia, Ischemic Stroke, Physiology (medical), Cardiology and Cardiovascular Medicine
Abstract

Aims The 4S-AF classification scheme comprises of four domains: stroke risk (St), symptoms (Sy), severity of atrial fibrillation (AF) burden (Sb), and substrate (Su). We sought to examine the implementation of the 4S-AF scheme in the EORP-AF General Long-Term Registry and compare outcomes in AF patients according to the 4S-AF-led decision-making process. Methods and results Atrial fibrillation patients from 250 centres across 27 European countries were included. A 4S-AF score was calculated as the sum of each domain with a maximum score of 9. Of 6321 patients, 8.4% had low (St), 47.5% EHRA I (Sy), 40.5% newly diagnosed or paroxysmal AF (Sb), and 5.1% no cardiovascular risk factors or left atrial enlargement (Su). Median follow-up was 24 months. Using multivariable Cox regression analysis, independent predictors of all-cause mortality were (St) [adjusted hazard ratio (aHR) 8.21, 95% confidence interval (CI): 2.60–25.9], (Sb) (aHR 1.21, 95% CI: 1.08–1.35), and (Su) (aHR 1.27, 95% CI: 1.14–1.41). For CV mortality and any thromboembolic event, only (Su) (aHR 1.73, 95% CI: 1.45–2.06) and (Sy) (aHR 1.29, 95% CI: 1.00–1.66) were statistically significant, respectively. None of the domains were independently linked to ischaemic stroke or major bleeding. Higher 4S-AF score was related to a significant increase in all-cause mortality, CV mortality, any thromboembolic event, and ischaemic stroke but not major bleeding. Treatment of all 4S-AF domains was associated with an independent decrease in all-cause mortality (aHR 0.71, 95% CI: 0.55–0.92). For each 4S-AF domain left untreated, the risk of all-cause mortality increased substantially (aHR 1.35, 95% CI: 1.16–1.56). Conclusion Implementation of the novel 4S-AF scheme is feasible, and treatment decisions based on this scheme improve mortality rates in AF.

Published
2022
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187. Blood pressure targets in atrial fibrillation

Author

Gregory Y.H. Lip, Eduard Shantsila, and Alena Shantsila

Subjects
medicine.medical_specialty, MEDLINE, Blood Pressure, 030204 cardiovascular system & hematology, Dabigatran, 03 medical and health sciences, 0302 clinical medicine, Thrombin, Text mining, Internal medicine, Atrial Fibrillation, Humans, Medicine, 030212 general & internal medicine, business.industry, Warfarin, Anticoagulants, Atrial fibrillation, medicine.disease, Blood pressure, Cardiology, Cardiology and Cardiovascular Medicine, business, medicine.drug
Published
2020
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191. The Impact of Atrial Fibrillation on Outcomes of Peripheral Arterial Disease: Analysis of Routinely Collected Primary Care Data

Author

Rajiv K. Vohra, Rasiah Thayakaran, Mark Kay, Alena Shantsila, Krishnarajah Nirantharakumar, Antonios Vitalis, and Gregory Y.H. Lip

Subjects
medicine.medical_specialty, Myocardial Ischemia, Peripheral Arterial Disease, Risk Factors, Internal medicine, Atrial Fibrillation, medicine, Risk of mortality, Humans, Risk factor, Stroke, Retrospective Studies, Heart Failure, Primary Health Care, business.industry, Hazard ratio, Anticoagulants, Atrial fibrillation, Retrospective cohort study, General Medicine, medicine.disease, Heart failure, Cohort, Cardiology, business
Abstract

BACKGROUND The combination of peripheral arterial disease and atrial fibrillation is linked with high risk of mortality and stroke. This study aims to investigate the impact of atrial fibrillation on patients with diagnosed peripheral arterial disease. METHODS This is a retrospective study using The Health Improvement Network (THIN) database, which contains prospectively collected data from participating primary care practices. Patients with a new diagnosis of peripheral arterial disease between 01/08/1995 and 01/05/2017 were identified in the database alongside relevant demographic information, clinical history and medications. Every patient in the dataset with peripheral arterial disease and baseline atrial fibrillation (case), was matched to a patient without atrial fibrillation (control) with similar characteristics using propensity score matching. Cox-regression analysis was performed and hazard ratios (HR) calculated for the outcomes of death, stroke, ischaemic heart disease, heart failure and major amputation. RESULTS Prevalence of atrial fibrillation in this cohort was 10.2%. All patients with peripheral arterial disease and atrial fibrillation (n=5685) were matched with 5685 patients without atrial fibrillation but otherwise similar characteristics. After multivariate analysis, atrial fibrillation was independently associated with mortality (HR: 1.18, 95% Confidence Interval (CI) 1.12- 1.26, p< 0.01), cerebrovascular events (HR: 1.35, 95%CI 1.17- 1.57, p< 0.01) and heart failure (HR: 1.87, 95%CI 1.62- 2.15, p< 0.01) but not with ischaemic heart disease or limb loss. CONCLUSION In peripheral arterial disease patients, atrial fibrillation is a risk factor for mortality, stroke and heart failure. This emphasizes the need for proactive surveillance and holistic management of these patients.

Published
2022

192. The Reply

Author

Antonios Vitalis, Alena Shantsila, and Gregory Y.H. Lip

Subjects
General Medicine
Published
2022
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193. Relationship between Chronic Kidney Disease, Time-in-Therapeutic Range, and Adverse Outcomes in Atrial Fibrillation:A post hoc Analysis from the AMADEUS Trial

Author

Wern Yew Ding, Alena Shantsila, and Gregory Y.H. Lip

Subjects
Male, medicine.medical_specialty, Anticoagulation control, medicine.drug_class, Renal function, Hemorrhage, Brain Ischemia, Adverse outcome, Risk Factors, Interquartile range, Internal medicine, Chronic kidney disease, Atrial Fibrillation, Post-hoc analysis, medicine, Time-in-therapeutic range, Humans, Renal Insufficiency, Renal Insufficiency, Chronic, Risk factor, Stroke, Aged, business.industry, Anticoagulants, Atrial fibrillation, Middle Aged, Vitamin K antagonist, medicine.disease, Neurology, Cardiology, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, Kidney disease
Abstract

Background: The benefit of anticoagulation therapy in atrial fibrillation (AF) and chronic kidney disease (CKD) remains controversial. We aimed to evaluate the impact of renal function on the quality of anticoagulation control, and the effects of both these factors on outcomes in AF. Methods: Post hoc analysis of the AMADEUS trial. Trial-related outcomes were adjudicated and we studied the composite of first stroke/major bleeding/all-cause mortality, ischaemic stroke, major bleeding, all-cause mortality, and cardiovascular mortality. Results: We included 2,282 vitamin K antagonist (VKA)-treated patients {n = 787 (34.5%) females; median age 72 (interquartile ranges [IQR] 64–77) years}. Median follow-up was 365 (IQR 189–460) days. There were 1,922 (84.2%) non-CKD and 360 (15.8%) CKD patients. Renal function was inversely correlated with time-in-therapeutic range (r = −0.047, p = 0.025). There was no statistical difference in terms of crude study outcomes based on renal function. Multivariable regression analysis demonstrated that moderate renal failure with estimated glomerular filtration rate of less than 60 mL/min/1.73 m2 (p = 0.032) and percentage of time-in-therapeutic range (p = 0.011) were independent predictors for the composite outcome of stroke, major bleeding, and all-cause mortality. Conclusion: Deteriorated renal function has a small negative impact on the quality of anticoagulation control with VKA which is linked to poor outcomes in AF. However, moderate renal failure itself was an independent risk factor for increased risk of stroke, major bleeding, and all-cause mortality amongst patients with AF.

Published
2022
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194. Cerebrovascular, Cognitive and Cardiac Benefits of SGLT2 Inhibitors Therapy in Patients with Atrial Fibrillation and Type 2 Diabetes Mellitus: Results from a Global Federated Health Network Analysis

Author

Riccardo Proietti, José Miguel Rivera-Caravaca, Raquel López-Gálvez, Stephanie L. Harrison, Francisco Marín, Paula Underhill, Eduard Shantsila, Garry McDowell, Manlio Vinciguerra, Rhys Davies, Clarissa Giebel, Deirdre A. Lane, and Gregory Y. H. Lip

Subjects
General Medicine, SGLT2, atrial fibrillation, dementia, stroke
Abstract

Background: Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are effective anti-diabetic drugs improving cardiovascular outcomes in type 2 diabetes mellitus (T2DM) patients. This study investigated cardiovascular, cerebrovascular and cognitive outcomes of SGLT2i therapy in patients with atrial fibrillation (AF) and T2DM. Methods: Observational study using TriNetX, a global health research network of anonymised electronic medical records from real-world patients between January 2018 and December 2019. The network includes healthcare organisations globally but predominately in the United States. AF patients (ICD-10-CM code: I48) with T2DM were divided according to SGLT2i use or not, and balanced using propensity score matching (PSM). Patients were followed-up for 3-years. The primary endpoints were ischaemic stroke/transient ischemic attack (TIA), intracranial haemorrhage (ICH), and incident dementia. Secondary endpoints were incident heart failure and mortality. Results: We identified 89,356 AF patients with T2DM of which 5061 (5.7%) were taking a SGLT2i. After PSM, 5049 patients (mean age 66.7 ± 10.6 years; 28.9% female) were included in each group. At 3-years follow-up, the risk of ischaemic stroke/TIA was higher in patients not receiving SGLT2i (HR 1.12, 95% CI 1.01–1.24) and for ICH (HR 1.57, 95% CI 1.25–1.99) and incident dementia (HR 1.66, 95% CI 1.30–2.12). Incident heart failure (HR 1.50, 95% CI 1.34–1.68) and mortality (HR 1.77, 95% CI 1.58–1.99) risks were increased in AF patients not receiving SGLT2i. Conclusions: In our large ‘real world’ analysis of patients with concomitant AF and T2DM, SGLT2i reduced the risk of cerebrovascular events, incident dementia, heart failure and death.

Published
2023
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195. Non-Vitamin K Antagonist Oral Anticoagulants

Author

Shantsila, Eduard and Lip, Gregory YH

Subjects
Hematology, Surgery, Cardiology, bic Book Industry Communication::M Medicine, bic Book Industry Communication::M Medicine::MN Surgery, bic Book Industry Communication::T Technology, engineering, agriculture::TC Biochemical engineering
Abstract

Hematology; Surgery; Cardiology

Published
2016
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197. Hypertension and sleep health: a multidimensional puzzle

Author

Eduard Shantsila, Gregory Y.H. Lip, and Alena Shantsila

Subjects
medicine.medical_specialty, Physiology, business.industry, MEDLINE, Sleep in non-human animals, Text mining, Hypertension, Internal Medicine, medicine, Humans, Cardiology and Cardiovascular Medicine, Psychiatry, business, Sleep
Published
2021

200. The Reply

Author

Vitalis, Antonios, primary, Shantsila, Alena, additional, and Lip, Gregory Y.H., additional

Published
2022
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