Management of atrial fibrillation in diabetes

Abstract Diabetes is an important risk factor for cardiovascular morbidity and mortality, and atrial fibrillation is linked to cardiovascular complications. The prevalence of both is increasing and they commonly co‐exist with a longer duration of diabetes and poorer control putting individuals at higher risk of atrial fibrillation. The complications of atrial fibrillation include heart failure and thromboembolism. There is an association between diabetes and atrial fibrillation and there are many theories as to the specific pathophysiology, including sharing similar precursors, but it is not clearly understood. What is understood is that the risk of developing the main consequences of atrial fibrillation can be reduced by treatment. Broadly speaking, this involves controlling the heart rhythm and/or heart rate to improve cardiac function in addition to anticoagulation. The development of risk stratification strategies and direct oral anticoagulants has led to safer anticoagulation with more individuals thought to benefit balanced against any potential risk of bleeding. The evidence base for treatment of atrial fibrillation includes many individuals with diabetes and, in this group, prevention of complications is equally as relevant. In those with diabetes and atrial fibrillation the evidence overwhelmingly supports a treatment strategy similar to that for individuals with atrial fibrillation but without diabetes. This should be done in addition to identifying and treating o...
Source: Practical Diabetes - Category: Endocrinology Authors: Tags: Review Source Type: research

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This study included 1962 patients who underwent transesophageal echocardiographic examination (TEE) prior to cardioversion or ablation in the years 2014-2018 in three cardiac centers. RESULTS: More than a quarter of AF patients had decreased eGFR (
Source: Cardiology Journal - Category: Cardiology Authors: Tags: Cardiol J Source Type: research
RARITAN, N.J., March 20, 2020 – The Janssen Pharmaceutical Companies of Johnson &Johnson announced today that it will unveil late-breaking data from its leading cardiovascular and metabolism portfolio during the virtual American College of Cardiology’s 69th Annual Scientific Session together with the World Congress of Cardiology (ACC.20/WCC) on March 28-30, 2020. Notably, four late-breaking abstracts for XARELTO® (rivaroxaban) will be presented, including data from the Phase 3 VOYAGER PAD study in patients with symptomatic peripheral artery disease (PAD) after lower-extremity revascularization.Click to ...
Source: Johnson and Johnson - Category: Pharmaceuticals Source Type: news
Conclusion: Our findings describe the most reported risk factors for preventability of oral anticoagulant-induced bleedings. These factors may be useful for targeting interventions to improve pharmacovigilance activities in our regional territory and to reduce the burden of medication errors and inappropriate prescription. Introduction Oral anticoagulant therapy is widely used for the prevention of stroke and systemic embolism in patients with atrial fibrillation, or for the prevention and treatment of deep vein thrombosis and pulmonary embolism (Raj et al., 1994; Monaco et al., 2017). Oral anticoagulants can be di...
Source: Frontiers in Pharmacology - Category: Drugs & Pharmacology Source Type: research
ConclusionsIncidence rates of IS/TE, mortality and bleeding increased with worsening eGFR. Worsening eGFR was an independent predictor of IS/TE and bleeding, and a better predictor of IS/TE than renal impairment in AF. We were able to identify predictors of worsening renal function, which may help to tag patients needing regular FU for appropriate adaptation of antithrombotic therapy.
Source: Archives of Cardiovascular Diseases Supplements - Category: Cardiology Source Type: research
This study investigated if statins would similarly reduce postoperative arrhythmias in patients undergoing THA. METHODS:: We queried a large Medicare and private-payer database from 2005 to 2012 and identified 12,075 patients who were on a statin prior to THA. We then age and sex matched 34,446 non-statin users who underwent THA. Baseline comorbidities and postoperative complications were obtained and assessed via standard descriptive statistics. RESULTS:: The statin users had more preoperative comorbidities including congestive heart failure, valvular heart disease, pulmonary and renal disease, diabetes, hyperte...
Source: Hip International - Category: Orthopaedics Authors: Tags: Hip Int Source Type: research
The CHA2DS2-VASc score estimates the risk of stroke in patients with atrial fibrillation.1,2 The CHA2DS2-VASc score accounts for congestive heart failure; hypertension; age of at least 75  years (doubled); diabetes mellitus; previous stroke, transient ischemic attack or thromboembolism (doubled); vascular disease; age 65 to 74 years; and sex category (female). Should the CHA2DS2-VASc score be considered as a categorical or a continuous factor, if the patients have an incremental in crease in risk of death, stroke, or bleeding?
Source: The Journal of Thoracic and Cardiovascular Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Editorial Commentary Source Type: research
Semin Thromb Hemost DOI: 10.1055/s-0037-1615261This 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, Vascul...
Source: Seminars in Thrombosis and Hemostasis - Category: Hematology Authors: Tags: Original Article Source Type: research
ConclusionObjective calculation of both the benefit and risks of anticoagulation in the post‐operative patient is significantly altered by including the effect on patient's quality of life utility value. Therapeutic anticoagulation in some common situations is probable to be of more detriment than benefit when considering health utility.
Source: ANZ Journal of Surgery - Category: Surgery Authors: Tags: Original Article Source Type: research
Conclusions In contemporary clinical practice, up to three-fourths of patients with new-onset AF are now initially treated with a NOAC for stroke prevention. Those selected for NOAC treatment had lower stroke and bleeding risk profiles, were more likely treated by cardiologists, and had higher socioeconomic status. Trial registration clinicaltrials.gov Identifier: NCT01701817
Source: American Heart Journal - Category: Cardiology Source Type: research
Conclusion Higher CHA2DS2-VASc scores are associated with increased incidence of major bleeding in nonvalvular atrial fibrillation patients receiving rivaroxaban.
Source: Annals of Emergency Medicine - Category: Emergency Medicine Source Type: research
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