Patterns of Amiodarone use and outcomes in clinical practice for atrial fibrillation

Publication date: Available online 23 October 2019Source: American Heart JournalAuthor(s): Sean D. Pokorney, DaJuanicia N. Holmes, Peter Shrader, Laine Thomas, Gregg C. Fonarow, Kenneth W. Mahaffey, Bernard J Gersh, Peter R. Kowey, Gerald V. Naccarelli, James V. Freeman, Daniel E. Singer, Jeffrey B. Washam, Eric D. Peterson, Jonathan P. Piccini, James A. ReiffelAbstractBackgroundAmiodarone is the most effective antiarrhythmic drug (AAD) for atrial fibrillation (AF), but it has a high incidence of adverse effects.MethodsUsing the ORBIT AF registry, patients with AF on amiodarone at enrollment, prescribed amiodarone during follow-up, or never on amiodarone were analyzed for the proportion treated with a guideline-based indication for amiodarone, the variability in amiodarone use across sites, and the outcomes (mortality, hospitalization, and stroke) among patients treated with amiodarone. Hierarchical logistic regression modeling with site-specific random intercepts compared rates of amiodarone use across 170 sites. A logistic regression model for propensity to receive amiodarone created a propensity-matched cohort. Cox proportional hazards modeling, stratified by matched pairs evaluated the association between amiodarone and outcomes.ResultsAmong 6987 AF patients, 867 (12%) were on amiodarone at baseline and 451 (6%) started on incident amiodarone during the 3-year follow-up. Use of amiodarone varied among sites from 3% in the lowest tertile to 21% in the highest (P 
Source: American Heart Journal - Category: Cardiology Source Type: research

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CONCLUSIONS: Although with a low number of pooled events, there was a trend for a lower post-procedure stroke in TMVR when compared with SMVR and a similar one between TMVR and OMT alone. PMID: 31829941 [PubMed - as supplied by publisher]
Source: EuroIntervention - Category: Cardiovascular & Thoracic Surgery Tags: EuroIntervention Source Type: research
We appreciate the thoughtful feedback regarding our manuscript by Drs. Lattanzi and Silvestrini. We agree that serologic and physiologic biomarkers of other occult stroke mechanisms would add to our understanding and management of these patients. In regard to occult cardiac sources of embolism, elevations in the brain natriuretic peptide,1 and larger P-wave terminal force (PWTF)2 or left atrial diameter3 are increasingly thought to be markers of a prothrombotic cardiopathy. As previously shown by Dr.
Source: Journal of Stroke and Cerebrovascular Diseases - Category: Neurology Authors: Tags: Letter to the Editor Source Type: research
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research
AliveCor is close to our hearts. Literally. David Albert, the co-founder of the company, started experimenting with handheld, wireless ECG devices in the late 90s. Approximately 10 years later we tried out their FDA-cleared, medical grade gadget. It was a truly inspiring moment. Needless to say, we’ve been keeping track of their journey ever since. In our eyes Kardia is the textbook example of technology shaping health care, empowering and supporting not only e-patients, but medical professionals as well. So, let’s take a look at their newest creation, the KardiaMobile6L! Why did the chicken cross the ro...
Source: The Medical Futurist - Category: Information Technology Authors: Tags: Health Sensors & Trackers cardiology ecg fda Healthcare heart technology Source Type: blogs
Publication date: Available online 10 December 2019Source: Journal of Clinical NeuroscienceAuthor(s): Junya Aoki, Kentaro Suzuki, Satoshi Suda, Seiji Okubo, Masahiro Mishina, Kazumi KimuraAbstractBackgroundSince acute fluid-attenuated inversion recovery vascular hyperintensity (FVH) is indicative of disordered blood flow, FVH is considered a marker of acute major arterial occlusion. Conversely, the role of the absence of FVH (negative-FVH) remains unknown.MethodsConsecutive stroke patients were studied via magnetic resonance angiography, within 24 h of onset and major arterial occlusion. All patients were examined usi...
Source: Journal of Clinical Neuroscience - Category: Neuroscience Source Type: research
Premature atrial complexes (PACs) meet increased attention as a potential intermediary between sinus rhythm and atrial fibrillation (AF). Patients with even high numbers of PACs do not fulfill current guidelines for oral anticoagulation treatment though an associated stroke risk is suspected. Objective: We aimed to determine whether a high number of PACs or runs of AF less than 30 seconds in 2-day continuous electrocardiogram (ECG) recording was associated with risk of recurrent ischemic stroke/transient ischemic attack (TIA) or death in a large cohort of patients with acute ischemic stroke or TIA and no prior AF.
Source: Journal of Stroke and Cerebrovascular Diseases - Category: Neurology Authors: Source Type: research
In this study, we examined the safety of WATCHMAN implantation followed by 6 months of anti-thrombotic therapy in patients with a history of ICH.MethodsThis is a retrospective analysis of 63 patients with a history of ICH prior to WATCHMAN implantation (Group I) and 95 patients without a history of ICH who underwent WATCHMAN placement (Group II). The primary outcome was death, stroke, or major bleeding within 6  months of WATCHMAN placement.ResultsThe average CHA2DS2-VASc of Group I was 4.9  ± 1.7 vs 4.7 ± 1.4 for Group II (p = 0.34). The most common type of...
Source: Journal of Interventional Cardiac Electrophysiology - Category: Cardiology Source Type: research
CONCLUSIONS: In patients referred for typical AFL ablation, the CHADS2 score can be applied for prognosis assessment. A successful AFL ablation procedure should not divert the attention from recognizing and addressing other medical issues that have an impact on long-term mortality, which remains very high in this particular population. PMID: 31827060 [PubMed - as supplied by publisher]
Source: Polish Heart Journal - Category: Cardiology Authors: Tags: Kardiol Pol Source Type: research
AbstractPatients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) should be triaged to an endovascular-capable hospital by the emergency medical service (EMS). We designed a prehospital LVO prediction scale based on EMS assessments. In the derivation cohort, 1157 patients transferred to our hospital by the EMS because of suspected stroke within 24 h of onset were retrospectively examined. Factors associated with AIS due to LVO were identified based on the EMS assessment, and a prehospital scale identifying LVO was developed. The accuracy of this scale was validated in 502 consecutive patients who were t...
Source: Translational Stroke Research - Category: Neurology Source Type: research
We thank Wang et al. for their comments and for bringing forward the challenges in managing care of patients with pulmonary hypertension (PH) and stroke. We acknowledge multiple possible mechanisms of stroke in patients with PH, and we highlighted them in our work, including paradoxical emboli and atrial fibrillation [1]. However, polycythemia (increased red cells) or other myeloproliferative disorders are considered to be a cause and not a consequence of PH [2,3]. In mice models, Sala et al. have showed that chronic hypoxia could lead to both PH and polycythemia [4].
Source: International Journal of Cardiology - Category: Cardiology Authors: Tags: Letter to the Editor Source Type: research
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