Design and rationale of a pragmatic trial integrating routine screening for atrial fibrillation at primary care visits: The VITAL-AF trial

Publication date: Available online 22 June 2019Source: American Heart JournalAuthor(s): Jeffrey M. Ashburner, Steven J. Atlas, David D. McManus, Yuchiao Chang, Ana T. Trisini Lipsanopoulos, Leila H. Borowsky, Wyliena Guan, Wei He, Patrick T. Ellinor, Daniel E. Singer, Steven A. LubitzAbstractGiven the preventable morbidity and mortality associated with atrial fibrillation (AF), increased awareness of undiagnosed AF, and advances in mobile ECG technology, there is a critical need to assess the effectiveness of using such technology to routinely screen for AF in clinical practice. VITAL-AF is a pragmatic trial that will test whether screening for AF using a single lead handheld ECG in individuals aged 65 or older during primary care visits will lead to an increased rate of AF detection. The study is a cluster-randomized trial, with 8 primary care practices randomized to AF screening and 8 primary care practices randomized to usual care. We anticipate studying approximately 16,000 patients in each arm. During the one-year enrollment period, practice medical assistants will screen eligible patients who agree to participate during office visits using a single-lead ECG device. Automated screening results are documented in the electronic health record and patients can discuss screening results with their provider during the scheduled visit. All single-lead ECGs are over-read by a cardiologist. Screen-detected AF is managed at the discretion of the patient's physician. The primary st...
Source: American Heart Journal - Category: Cardiology Source Type: research

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Conclusion: Intracranial artery calcification is common in patients with ischemic cerebrovascular disease and the intracranial carotid artery is most frequently affected. Intracranial arterial calcifications might be associated with imaging markers of SVD and are highly correlated with WMHs, lacunes, and CMBs. Quantification of calcification on CT provides additional information on the pathophysiology of SVD. Intracranial arterial calcification could act as a potential marker of SVD. Introduction Atherosclerosis is a systemic vascular process that is considered a major cause of cerebrovascular and cardiovascular di...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Conclusions: Embolism associated with asymptomatic carotid stenosis shows circadian variation with highest rates 4–6 h before midday. This corresponds with peak circadian incidence of stroke and other vascular complications. These and ASED Study results show that monitoring frequency, duration, and time of day are important in ES detection. Introduction Transcranial Doppler (TCD) detected microembolism in the ipsilateral middle cerebral artery (MCA) may help stratify the risk of stroke and other arterial disease complications in persons with advanced (≥60%) asymptomatic carotid stenosis. If so, this techniqu...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Ahmed Mohamed Elhfnawy1*, Peter U. Heuschmann2, Mirko Pham3†, Jens Volkmann1† and Felix Fluri1,4 1Department of Neurology, University Hospital Würzburg, Würzburg, Germany 2Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany 3Institute of Diagnostic and Interventional Neuroradiology, University Hospital of Würzburg, Würzburg, Germany 4Department of Neurology, Kantonssptial St. Gallen, St. Gallen, Switzerland Background and Purpose: Internal carotid artery stenosis (ICAS)≥70% is a leading cause of ischemic cerebrovascular event...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
ConclusionsThe frequency of nAF in our patients was 6.0%. Insular damage was a risk factor for nAF and an independent predictor of death at 3 months.
Source: European Journal of Neurology - Category: Neurology Authors: Tags: Original Article Source Type: research
ConclusionThe frequency of nAF in our patients was 6.0%. Insular damage was a risk factor for nAF and an independent predictor of death at 3 months.This article is protected by copyright. All rights reserved.
Source: European Journal of Neurology - Category: Neurology Authors: Tags: Original Article Source Type: research
Conclusions About 4 in 5 acute stroke patients in this African cohort had evidence of a baseline ECG abnormality, but presence of any atrial enlargement was the only independent ECG predictor of death or disability.
Source: Global Heart - Category: Cardiology Source Type: research
This study found that though it is often associated with coronary artery disease (CAD), it can also occur in those without significant CAD. It was not specifically associated with disease of right coronary artery disease. This cardioinhibitory response may be a manifestation of the Bezold-Jarisch reflex. Bezold-Jarisch reflex inhibits sympathetic activity (sympathetic withdrawal) and increases parasympathetic activity, resulting in bradycardia, which may be associated with vasodilatation, nausea and hypotension. Bezold-Jarisch has been described in the setting of inferior wall infarction and coronary angiography. Origin...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiology MCQ Cardiology X-ray Featured Source Type: blogs
Authors: Manea MM, Comsa M, Minca A, Dragos D, Popa C Abstract UNLABELLED: There has been a large confirmation over the last decades that stroke may produce cardiac changes (echocardiographic, electrocardiographic, enzymatic). In ischemic stroke, systolic dysfunction is associated with a high risk of mortality during hospitalization. A recent study demonstrated that cardiac diastolic dysfunction could also accompany acute stroke besides the systolic dysfunction already pointed out by previous studies, being a predictive marker of acute cerebrovascular events. Increased sympathetic activity is contributory, inducing...
Source: Journal of Medicine and Life - Category: Journals (General) Tags: J Med Life Source Type: research
A woman in her 70s with a medical history significant for atrial fibrillation and cardioembolic stroke who was receiving long-term anticoagulation therapy with warfarin (international normalized ratio, 2.3) presented to an outside facility with sudden onset of nausea and vertigo. Her mental status declined and she was unable to protect her airway, prompting intubation. Computed tomographic scan (CT) at that time was negative for any intracranial pathologic findings. On arrival to our facility, the patient remained lethargic and unresponsive; therefore, a second noncontrast head CT was performed, which showed no evidence fo...
Source: JAMA Internal Medicine - Category: Internal Medicine Source Type: research
Background— Atrial fibrillation (AF) is a major cause of stroke. Although standard investigations after an event include electrocardiographic monitoring, the optimal duration to detect AF is unclear. We performed a systematic review and meta-analysis to determine whether the duration of electrocardiographic monitoring after an ischemic event is related to the detection of AF. Methods and Results— Prospective studies that reported the proportion of new AF diagnosed using electrocardiographic monitoring for>12 hours in patients with recent stroke or transient ischemic attack were analyzed. Studies were exclud...
Source: Circulation: Arrhythmia and Electrophysiology - Category: Cardiology Authors: Tags: Other diagnostic testing, Embolic stroke Original Articles Source Type: research
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