Adherence to Anticoagulation and Risk of Stroke Among Medicare Beneficiaries Newly Diagnosed with Atrial Fibrillation

The objective of this study was to compare the risk of stroke in atrial fibrillation (AF) with adherent use of oral anticoagulation (OAC), non-adherent use, and non-use of OAC.MethodsUsing 2013 –2016 Medicare claims data, we identified patients newly diagnosed with AF in 2014–2015 and collected prescriptions filled for OAC in the 12 months after AF diagnosis (n = 39,272). We categorized participants each day into three time-dependent exposures: adherent use (≥ 80% of the previous 30 days covered with OAC), non-adherent use (0–80% covered with OAC), and non-use (0%). We constructed Cox proportional hazards models to estimate the association betw een time-dependent exposures and time to stroke, adjusting for demographics and clinical characteristics.ResultsThe sample included 39,272 patients. Study participants spent 35.0% of the follow-up period in the adherent use exposure category, 10.9% in the non-adherent category, and 54.0% in the non-use category. OAC adherent use [hazard ratio (HR) 0.62; 95% confidence interval (CI) 0.52 –0.74] and non-adherent use (HR 0.74; 95% CI 0.57–0.95) were associated with lower hazards of stroke than non-use. Adherent use of DOAC (HR 0.54; 95% CI 0.42–0.69) and warfarin (HR 0.70; 95% CI 0.56–0.89) was associated with lower risk of stroke than non-use, but the risk of stroke did not s tatistically differ between DOAC and warfarin adherent use (HR 0.77; 95% CI 0.56–1...
Source: American Journal of Cardiovascular Drugs - Category: Cardiology Source Type: research

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AbstractPercutaneous left atrial appendage closure (LAAC) may decrease risks of stroke and bleeding in elderly patients with non-valvular atrial fibrillation (NVAF), but it is still lacking of evidence. The present study aimed at evaluating the efficacy and safety of LAAC in patients with NVAF over 75  years. 351 patients with NVAF who underwent LAAC were retrospectively analyzed on the LAAC procedure characteristics and the clinical follow-up according to age (age ≥ 75 years or 
Source: Heart and Vessels - Category: Cardiology Source Type: research
AbstractFor Japanese patients with non-valvular atrial fibrillation (NVAF), the risk of stroke and major bleeding events was assessed by using the CHADS2, CHA2DS2-VASc, and HAS-BLED scores. The risk factors for embolism and major bleeding under DOAC may be different from current reports. We analyzed the data set of the EXPAND Study to determine the risk factors for events among Japanese NVAF patients in the era of direct oral anticoagulant. Using the data of EXPAND Study, the validity for predictability of the CHADS2, CHA2DS2-VASc, and HAS-BLED scores was identified using the receiver operating characteristic curve analysi...
Source: Heart and Vessels - Category: Cardiology Source Type: research
Direct oral anticoagulants (DOACs) have been approved for the prevention of stroke and systemic embolism in atrial fibrillation, treatment and secondary prevention of venous thromboembolism (VTE), and thromboprophylaxis after major orthopedic surgery. DOACs achieve anticoagulation by inhibiting specific coagulation factors; apixaban, betrixaban, edoxaban, and rivaroxaban inhibit activated factor X, whereas dabigatran inhibits thrombin (factor IIa). In contrast to vitamin K antagonists such as warfarin, DOACs have more predictable pharmacokinetics and pharmacodynamics and fewer interactions with other medications and food, ...
Source: Anesthesiology - Category: Anesthesiology Source Type: research
Conditions:   Atrial Fibrillation;   Atrial Flutter Intervention:   Other: AF Detection Intervention Sponsor:   Bristol-Myers Squibb Not yet recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
ConclusionThe likelihood of AF detection by an ILR in the first month post-CS is low. Thus, the diagnostic yield of 30  days of AECG monitoring is likely to be limited. These data suggest a rationale for proceeding directly to ILR implantation prior to hospital discharge in CS patients, as many have AF detected during longer follow-up.
Source: Journal of Interventional Cardiac Electrophysiology - Category: Cardiology Source Type: research
Authors: Bashir MU, Bhagra A, Kapa S, McLeod CJ Abstract Atrial fibrillation is the most common symptomatic arrhythmia that is associated with stroke. Contemporary management of the disease is focused on anticoagulation to prevent stroke, coupled with catheter ablation to limit symptoms and prevent deleterious cardiac remodeling. Emerging data highlights the importance of lifestyle modification by managing sleep apnea, increasing physical activity, and weight loss. There is significant data that supports a link between the autonomic nervous system, arrhythmia development, and atrial fibrillation therapy. It is like...
Source: Reviews in Cardiovascular Medicine - Category: Cardiology Tags: Rev Cardiovasc Med Source Type: research
This study aimed to report the procedural data and initial results of a combined ablation technique using AI ‐guided high‐power (AI‐HP; 50 W) ablation for PVI.MethodsSymptomatic AF patients were consecutively enrolled and underwent wide ‐area contiguous circumferential PVI. Contact‐force catheters were used, ablation power was set to 50 W targeting AI values (550 anterior and 400 posterior). Esophageal temperature was monitored during procedure, all patients underwent postablation esophageal endoscopy.ResultsPVI was achieved in all (n  = 50, mean age: 68 ± 9 years,...
Source: Journal of Cardiovascular Electrophysiology - Category: Cardiology Authors: Tags: ORIGINAL ARTICLE Source Type: research
Conclusions: The rhythm control strategy demonstrated a beneficial effect to lower the risk of ischemic stroke during a 1-year follow-up compared to the rate control strategy. PMID: 31597907 [PubMed - as supplied by publisher]
Source: The Korean Journal of Internal Medicine - Category: Internal Medicine Authors: Tags: Korean J Intern Med Source Type: research
iRhythm and Verily announced a partnership last month to “co-develop solutions intended to provide early warning, diagnosis and management for patients, particularly for those with silent or undiagnosed AF.” We spoke with iRhythm CEO Kevi...
Source: Medgadget - Category: Medical Devices Authors: Tags: Cardiology Diagnostics Exclusive irhythm verily Source Type: blogs
Publication date: Available online 9 October 2019Source: Life SciencesAuthor(s): Youcheng Wang, Xiaoxing Xiong, Baojun Xie, Jia Liu, Mei Yang, Junkui Yin, Liuliu Zi, Xi Wang, Yanhong Tang, Congxin Huang, Haixia Fu, Qingyan ZhaoAbstractAimsNew-onset atrial fibrillation (AF) is frequently observed following acute stroke. The aim of this study was to investigate the effects of the brain-stellate ganglion-atrium network on AF vulnerability in a canine model with acute middle cerebral artery occlusion (MCAO).Materials and methodsTwenty-six dogs were randomly divided into the sham-operated group (n = 6), acute stroke (AS) gr...
Source: Life Sciences - Category: Biology Source Type: research
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