Author
Charlotte Hespe
Other affiliations: University of Melbourne, Royal Australian College of General Practitioners, University of Notre Dame
Bio: Charlotte Hespe is an academic researcher from University of Notre Dame Australia. The author has contributed to research in topics: Medicine & Atrial fibrillation. The author has an hindex of 10, co-authored 34 publications receiving 406 citations. Previous affiliations of Charlotte Hespe include University of Melbourne & Royal Australian College of General Practitioners.
Papers
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University of Sydney1, Geelong Football Club2, University of Newcastle3, University of Technology, Sydney4, Royal Prince Alfred Hospital5, National Heart Foundation of Australia6, University of Western Sydney7, University of Queensland8, Royal Adelaide Hospital9, University of Notre Dame Australia10, University of Western Australia11, Royal Melbourne Hospital12, University of Wollongong13
185 citations
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Concord Repatriation General Hospital1, Geelong Football Club2, John Hunter Hospital3, University of Newcastle4, University of Sydney5, Royal Prince Alfred Hospital6, National Heart Foundation of Australia7, Royal Adelaide Hospital8, University of Adelaide9, University of Notre Dame Australia10, Sir Charles Gairdner Hospital11, University of Melbourne12, Royal Melbourne Hospital13, University of Wollongong14
TL;DR: These clinical practice guidelines will assist Australian practitioners in the diagnosis and management of adult patients with Atrial fibrillation.
Abstract: INTRODUCTION Atrial fibrillation (AF) is increasing in prevalence and is associated with significant morbidity and mortality. The optimal diagnostic and treatment strategies for AF are continually evolving and care for patients requires confidence in integrating these new developments into practice. These clinical practice guidelines will assist Australian practitioners in the diagnosis and management of adult patients with AF. Main recommendations: These guidelines provide advice on the standardised assessment and management of patients with atrial fibrillation regarding: screening, prevention and diagnostic work-up; acute and chronic arrhythmia management with antiarrhythmic therapy and percutaneous and surgical ablative therapies; stroke prevention and optimal use of anticoagulants; and integrated multidisciplinary care. Changes in management as a result of the guideline: Opportunistic screening in the clinic or community is recommended for patients over 65 years of age. The importance of deciding between a rate and rhythm control strategy at the time of diagnosis and periodically thereafter is highlighted. β-Blockers or non-dihydropyridine calcium channel antagonists remain the first line choice for acute and chronic rate control. Cardioversion remains first line choice for acute rhythm control when clinically indicated. Flecainide is preferable to amiodarone for acute and chronic rhythm control. Failure of rate or rhythm control should prompt consideration of percutaneous or surgical ablation. The sexless CHA2DS2-VA score is recommended to assess stroke risk, which standardises thresholds across men and women; anticoagulation is not recommended for a score of 0, and is recommended for a score of ≥ 2. If anticoagulation is indicated, non-vitamin K oral anticoagulants are recommended in preference to warfarin. An integrated care approach should be adopted, delivered by multidisciplinary teams, including patient education and the use of eHealth tools and resources where available. Regular monitoring and feedback of risk factor control, treatment adherence and persistence should occur.
107 citations
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TL;DR: This review highlights the interplay of both clinician's awareness of guideline recommendations and understanding of individual patient-level factors which impact adherence and persistence, which are required to reduce the incidence of preventable stroke attributable to AF.
Abstract: Atrial fibrillation (AF) is a significant risk factor for avoidable stroke. Among high-risk patients with AF, stroke risk can be mitigated using oral anticoagulants (OACs), however reduction is largely contingent on physician prescription and patient persistence with OAC therapy. Over the past decade significant advances have occurred, with revisions to clinical practice guidelines relating to management of stroke risk in AF in several countries, and the introduction of non-vitamin K antagonist OACs (NOACs). This paper summarises the evolving body of research examining guideline-based clinician prescription over the past decade, and patient-level factors associated with OAC persistence. The review shows clinicians' management over the past decade has increasingly reflected guideline recommendations, with an increasing proportion of high-risk patients receiving OACs, driven by an upswing in NOACs. However, a treatment gap remains, as 25-35% of high-risk patients still do not receive OAC treatment, with great variation between countries. Reduction in stroke risk directly relates to level of OAC prescription and therapy persistence. Persistence and adherence to OAC thromboprophylaxis remains an ongoing issue, with 2-year persistence as low as 50%, again with wide variation between countries and practice settings. Multiple patient-level factors contribute to poor persistence, in addition to concerns about bleeding. Considered review of individual patient's factors and circumstances will assist clinicians to implement appropriate strategies to address poor persistence. This review highlights the interplay of both clinician's awareness of guideline recommendations and understanding of individual patient-level factors which impact adherence and persistence, which are required to reduce the incidence of preventable stroke attributable to AF.
51 citations
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TL;DR: In this paper, a three-arm pragmatic RCT was conducted to determine the efficacy of primary care physicians' referral of insufficiently active patients for counseling to increase physical activity, compared with usual care.
33 citations
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TL;DR: In this paper, a cross-sectional online survey of GPs members of the Royal Australian College of General Practitioners (RACGP) was conducted between June and September 2020.
Abstract: Background COVID-19 has brought unprecedented demands to general practitioners (GPs) worldwide. We examined their knowledge, preparedness, and experiences managing COVID-19 in Australia. Methods A cross-sectional online survey of GPs members of the Royal Australian College of General Practitioners (RACGP) was conducted between June and September 2020. Results Out of 244 survey responses, a majority of GPs (76.6%) indicated having good knowledge of COVID-19, relying mostly on state/territory department of health (84.4%) and the RACGP (76.2%) websites to source up-to-date information. Most felt prepared to manage patients with COVID-19 (75.7%), yet over half reported not receiving training in the use of PPE. The majority were concerned about contracting SARS-CoV-2, more stressed than usual, and have heavier workloads. Their greatest challenges included scarcity of PPE, personal distress, and information overload. Conclusion Access to PPE, training, accurate information, and preparedness are fundamental for the successful role of general practices during outbreaks.
30 citations
Cited by
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Leipzig University1, University of Belgrade2, Leiden University3, Uppsala University4, University of Modena and Reggio Emilia5, University of Barcelona6, Carol Davila University of Medicine and Pharmacy7, National and Kapodistrian University of Athens8, François Rabelais University9, Royal Melbourne Hospital10, University of Melbourne11, University of Lisbon12, University of Birmingham13, University Medical Center Groningen14, University of Groningen15, University of Central Lancashire16
TL;DR: The content of these European Society of Cardiology (ESC) Guidelines has been published for personal and educational use only and no commercial use is authorized.
Abstract: Supplementary Table 9, column 'Edoxaban', row 'eGFR category', '95 mL/min' (page 15). The cell should be coloured green instead of yellow. It should also read "60 mg"instead of "60 mg (use with caution in 'supranormal' renal function)."In the above-indicated cell, a footnote has also been added to state: "Edoxaban should be used in patients with high creatinine clearance only after a careful evaluation of the individual thromboembolic and bleeding risk."Supplementary Table 9, column 'Edoxaban', row 'Dose reduction in selected patients' (page 16). The cell should read "Edoxaban 60 mg reduced to 30 mg once daily if any of the following: creatinine clearance 15-50 mL/min, body weight <60 kg, concomitant use of dronedarone, erythromycin, ciclosporine or ketokonazole"instead of "Edoxaban 60 mg reduced to 30 mg once daily, and edoxaban 30 mg reduced to 15mg once daily, if any of the following: creatinine clearance of 30-50 mL/min, body weight <60 kg, concomitant us of verapamil or quinidine or dronedarone."
4,285 citations
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TL;DR: The 2 existing classification schemes and especially a new stroke risk index, CHADS, can quantify risk of stroke for patients who have AF and may aid in selection of antithrombotic therapy.
Abstract: a c statistic of 0.82 (95% CI, 0.80-0.84), the CHADS2 index was the most accurate predictor of stroke. The stroke rate per 100 patient-years without antithrombotic therapy increased by a factor of 1.5 (95% CI, 1.3-1.7) for each 1-point increase in the CHADS2 score: 1.9 (95% CI, 1.2-3.0) for a score of 0; 2.8 (95% CI, 2.0-3.8) for 1; 4.0 (95% CI, 3.1-5.1) for 2; 5.9 (95% CI, 4.6-7.3) for 3; 8.5 (95% CI, 6.3-11.1) for 4; 12.5 (95% CI, 8.2-17.5) for 5; and 18.2 (95% CI, 10.5-27.4) for 6. Conclusion The 2 existing classification schemes and especially a new stroke risk index, CHADS2, can quantify risk of stroke for patients who have AF and may aid in selection of antithrombotic therapy.
1,446 citations
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TL;DR: Dr Starfield, in this well-written and easily readable book, objectively reviews the concept of primary care in its entirety and constructs the argument for primary care starting with a historical review.
Abstract: Primary Care: Concept, Evaluation, and Policy is a comprehensive treatise that should be obligatory reading for all physicians and for legislators planning the future of health care in the United States. Dr Starfield, in this well-written and easily readable book, objectively reviews the concept of primary care in its entirety. She constructs the argument for primary care starting with a historical review. Within the book's first chapter, the need for restructuring from a primary medical to a primary health care model is introduced. Such a change requires new focus (eg, from illness to health), new content (eg, from treatment to health promotion), new organization (eg, from specialists to generalists), and new responsibility (eg, from professional dominance to community participation). To evaluate the rationale and the success of such a change, Dr Starfield reviews the 1978 Institute of Medicine approach to assessing the success of a health care system, noting accessibility,
406 citations