Journal ArticleDOI
Stroke and thromboembolism in atrial fibrillation: a systematic review of stroke risk factors, risk stratification schema and cost effectiveness data.
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A systematic review of studies examining the attributable stroke risk of various clinical, demographic and echocardiographic patient characteristics in AF populations identified history of stroke or TIA, increasing age, hypertension and structural heart disease to be good predictors of stroke risk in AF patients.Abstract:
The risk of stroke in atrial fibrillation (AF) needs to be assessed in each patient to determine the clinical and cost-effectiveness of thromboprophylaxis, with the aim of appropriate use of antithrombotic therapy. To achieve this, stroke risk factors in AF populations need to be identified and stroke risk stratification models have been devised on the basis of these risk factors. In this article, we firstly provide a systematic review of studies examining the attributable stroke risk of various clinical, demographic and echocardiographic patient characteristics in AF populations. Secondly, we performed a systematic review of published stroke risk stratification models, in terms of the results of the review of stroke risk factors and their ability to accurately discriminate between different levels of stroke risk. Thirdly, we review the health economic evidence relating to the cost-effectiveness of anticoagulation and antiplatelet therapy as thromboprophylaxis in AF patients. The studies included in the systematic review of stroke risk factors identified history of stroke or TIA, increasing age, hypertension and structural heart disease (left-ventricular dysfunction or hypertrophy) to be good predictors of stroke risk in AF patients. The evidence regarding diabetes mellitus, gender and other patient characteristics was less consistent. Three stroke risk stratification models were identified that were able to discriminate between different categories of stroke risk to at least 95% accuracy. Few models had addressed the cumulative nature of risk factors where a combination of risk factors would confer a greater risk than either factor alone. In patients at high risk of stroke, anticoagulation is cost effective, but not for those with a low risk of stroke. With the evidence available for stroke risk factors and the various alternative stroke risk stratification models, a review of these models in terms of the evidence on which they are devised and their performance in representative AF populations is important. The appropriate administration of thromboprophylaxis in AF patients would need to balance the risks and benefits of antithrombotic therapy with its cost-effectiveness.read more
Citations
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Journal ArticleDOI
2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
Clyde W. Yancy,Mariell Jessup,Biykem Bozkurt,Javed Butler,Donald E. Casey,Mark H. Drazner,Gregg C. Fonarow,Stephen A. Geraci,Tamara B. Horwich,James L. Januzzi,Maryl R. Johnson,Edward K. Kasper,Wayne C. Levy,Frederick A. Masoudi,Patrick E. McBride,John J.V. McMurray,Judith E. Mitchell,Pamela N. Peterson,Barbara Riegel,Flora Sam,Lynne W. Stevenson,W.H. Wilson Tang,Emily J. Tsai,Bruce L. Wilkoff +23 more
TL;DR: In this article, Anderson et al. proposed a new FAHA Chair, Jeffrey L. Anderson, MD, FACC, FAHA, Chair-Elect, Alice K. Jacobs et al., this article and Biykem Bozkurt.
Journal ArticleDOI
Guidelines for the management of atrial fibrillation The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC)
A. John Camm,Paulus Kirchhof,Irene Savelieva,Isabelle C. Van Gelder,Gerhard Hindricks,Ottavio Alfieri,Johan De Sutter,Andreas Goette,Stefan H. Hohloser,Piotr Ponikowski,Frans H. Rutten +10 more
TL;DR: Estimates of expected health outcomes for larger societies are included, where data exist, and the level of evidence and the strength of recommendation of particular treatment options are weighed and graded according to pre-defined scales.
Journal ArticleDOI
2012 focused update of the ESC Guidelines for the management of atrial fibrillation: An update of the 2010 ESC Guidelines for the management of atrial fibrillation * Developed with the special contribution of the European Heart Rhythm Association
A. John Camm,Jeroen J. Bax,Robert Fagard,Christian Funck-Brentano,David Hasdai,Theresa McDonagh,Bogdan A. Popescu,Udo Sechtem,Stephan Windecker,Ottavio Alfieri,Annalisa Angelini,Andreas Goette,Robert Hatala,Philippe Kolh,Piotr Ponikowski,Frans H. Rutten,Isabelle C. Van Gelder +16 more
TL;DR: An update of the 2010 ESC Guidelines for the management of atrial fibrillation with the special contribution of the European Heart Rhythm Association is developed.
Journal ArticleDOI
Guidelines for the management of atrial fibrillation
A. John Camm,Paulus Kirchhof,Gregory Lip,Ulrich Schotten,Irene Savelieva,Sabine Ernst,Isabelle C. Van Gelder,Nawwar Al-Attar,Gerhard Hindricks,Bernard Prendergast,Hein Heidbuchel,Ottavio Alfieri,Annalisa Angelini,Dan Atar,Paolo Colonna,Raffaele De Caterina,Johan De Sutter,Andreas Goette,Bulent Gorenek,Magnus Heldal,Stefan H. Hohloser,Philippe Kolh,Jean-Yves Le Heuzey,Piotr Ponikowski,Frans H. Rutten,Alec Vahanian,Angelo Auricchio,Jeroen J. Bax,Claudio Ceconi,Veronica Dean,Gerasimos Filippatos,Christian Funck-Brentano,Richard Hobbs,Peter Kearney,Theresa McDonagh,Bogdan A. Popescu,Zeljko Reiner,Udo Sechtem,Per Anton Sirnes,Michal Tendera,Panos E. Vardas,Petr Widimsky,Vazha Agladze,Etienne Aliot,Tosho L. Balabanski,Carina Blomström-Lundqvist,Alessandro Capucci,Harry J.G.M. Crijns,Björn Dahlöf,Thierry Folliguet,Michael Glikson,Marnix Goethals,Dietrich C. Gulba,Siew Yen Ho,Robert J.M. Klautz,Sedat Kose,John McMurray,Pasquale Perrone Filardi,Pekka Raatikainen,Maria Jesus Salvador,Martin J. Schalij,Alexander Shpektor,João de Sousa,Janina Stepinska,Hasso Uuetoa,José Luis Zamorano,Igor Zupan +66 more
TL;DR: Guidelines summarize and evaluate all currently available evidence on a particular issue with the aim of assisting physicians in selecting the best management strategy for an individual patient suffering from a given condition, taking into account the impact on outcome, as well as the risk–benefit ratio of particular diagnostic or therapeutic means.
Journal ArticleDOI
Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials
Christian T. Ruff,Robert P. Giugliano,Eugene Braunwald,Elaine B. Hoffman,Naveen Deenadayalu,Michael D. Ezekowitz,A. John Camm,Jeffrey I. Weitz,Basil S. Lewis,Alexander Parkhomenko,Takeshi Yamashita,Elliott M. Antman +11 more
TL;DR: A prespecified meta-analysis of all 71,683 participants included in the RE-LY, ROCKET AF, ARISTOTLE, and ENGAGE AF-TIMI 48 trials offered clinicians a more comprehensive picture of the new oral anticoagulants as a therapeutic option to reduce the risk of stroke in this patient population.
References
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Journal ArticleDOI
Validation of Clinical Classification Schemes for Predicting Stroke: Results From the National Registry of Atrial Fibrillation
Brian F. Gage,Amy D. Waterman,William D. Shannon,Michael Boechler,Michael W. Rich,Martha J. Radford +5 more
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.
Journal ArticleDOI
Impact of Atrial Fibrillation on the Risk of Death The Framingham Heart Study
Emelia J. Benjamin,Philip A. Wolf,Ralph B. D'Agostino,Halit Silbershatz,William B. Kannel,Daniel Levy +5 more
TL;DR: There was a significant AF-sex interaction: AF diminished the female advantage in survival and AF remained significantly associated with excess mortality, with about a doubling of mortality in both sexes in subjects free of valvular heart disease and preexisting cardiovascular disease.
Journal ArticleDOI
Meta-analysis: Antithrombotic Therapy to Prevent Stroke in Patients Who Have Nonvalvular Atrial Fibrillation
TL;DR: An updated meta-analysis of all currently available randomized trials that extends observations about the efficacy and safety of antithrombotic therapies for preventing stroke in patients who have atrial fibrillation is presented.
Journal ArticleDOI
ACC/AHA/ESC Guidelines for the Management of Patients With Atrial Fibrillation: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the North American Society of Pacing and Electrophysiology
Valentin Fuster,Lars Rydén,Richard W. Asinger,David S. Cannom,Harry J.G.M. Crijns,Robert L. Frye,Jonathan L. Halperin,G. Neal Kay,Werner Klein,Samuel Lévy,Robert L. McNamara,Eric N. Prystowsky,L. Samuel Wann,D. George Wyse,Raymond J. Gibbons,Elliott M. Antman,Joseph S. Alpert,David P. Faxon,Gabriel Gregoratos,Loren F. Hiratzka,Alice K. Jacobs,Richard O. Russell,Sidney C. Smith,Angeles Alonso-Garcia,Carina Blomström-Lundqvist,Guy De Backer,Marcus Flather,Jaromír Hradec,Ali Oto,A. Parkhomenko,Sigmund Silber,Adam Torbicki +31 more
TL;DR: New guidelines for management of supraventricular tachyarrhythmia characterized by uncoordinated atrial activation with consequent deterioration of atrial mechanical function are published.
Journal ArticleDOI
Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial
Jonathan Mant,FD Richard Hobbs,Kate Fletcher,Andrea K Roalfe,David Fitzmaurice,Gregory Y.H. Lip,Ellen Murray +6 more
TL;DR: These data support the use of anticoagulation therapy for people aged over 75 who have atrial fibrillation, unless there are contraindications or the patient decides that the benefits are not worth the inconvenience.