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Articles A multifaceted intervention to improve treatment with oral anticoagulants in atrial fibrillation (IMPACT-AF): an international, cluster-randomised trial
A multifaceted and multilevel educational intervention, aimed to improve use of oral anticoagulation in patients with atrial fibrillation and at risk for stroke, resulted in a significant increase in the proportion of patients treated with oral anticoagulants. Such an intervention has the potential to improve stroke prevention around the world for patients with atrial fibrillation.
Source: LANCET - August 28, 2017 Category: General Medicine Authors: Dragos Vinereanu, Renato D Lopes, M Cecilia Bahit, Denis Xavier, Jie Jiang, Hussein R Al-Khalidi, Wensheng He, Ying Xian, Andrea O Ciobanu, Deepak Y Kamath, Kathleen A Fox, Meena P Rao, Sean D Pokorney, Otavio Berwanger, Carlos Tajer, Pedro G M de Barros Tags: Articles Source Type: research

Comment Cerebral amyloid angiopathy and implications for atrial fibrillation management
Atrial fibrillation, the most common arrhythmia in adults, will increase in prevalence as the population ages.1 The risk of embolic stroke in atrial fibrillation also increases with age. Treatments for the prevention of embolic stroke include warfarin, direct oral anticoagulant agents, and non-anticoagulation strategies such as left atrial appendage occlusion.1 Current scores to estimate the risk of ischaemic stroke (CHA2DS2-VaSc score) or haemorrhage (HAS-BLED score) help guide intervention, but do not account for cerebral amyloid angiopathy (CAA), a prevalent, but overlooked condition.
Source: LANCET - June 29, 2017 Category: General Medicine Authors: Christopher V DeSimone, Jonathan Graff-Radford, Majd A El-Harasis, Alejandro A Rabinstein, Samuel J Asirvatham, David R Holmes Tags: Comment Source Type: research

Seminar The future of atrial fibrillation management: integrated care and stratified therapy
Atrial fibrillation is one of the major cardiovascular health problems: it is a common, chronic condition, affecting 2 –3% of the population in Europe and the USA and requiring 1–3% of health-care expenditure as a result of stroke, sudden death, heart failure, unplanned hospital admissions, and other complications. Early diagnosis of atrial fibrillation, ideally before the first complication occurs, remains a ch allenge, as shown by patients who are only diagnosed with the condition when admitted to hospital for acute cardiac decompensation or stroke.
Source: LANCET - April 28, 2017 Category: General Medicine Authors: Paulus Kirchhof Tags: Seminar Source Type: research

Correspondence Risk of mortality and stroke after atrial fibrillation
Jeff Healey and colleagues (Sept 17, p 1161)1 should take credit for their study about mortality and stroke 1 year after a diagnosis of atrial fibrillation. The main findings of the study were the almost two-times higher mortality in South America (17%) and Africa (20%) compared with North America, western Europe, and Australia (10%), and the higher stroke frequency in Africa (8%) and China (7%) compared with the aforementioned regions (3%).
Source: LANCET - March 3, 2017 Category: Journals (General) Authors: Constantinos Mihas, Anargiros Mariolis, Konstantinos P Letsas, Maria Kantzanou Tags: Correspondence Source Type: research

Correspondence Risk of mortality and stroke after atrial fibrillation – Authors' reply
On behalf our colleagues, we would like to thank Zitian Huo and Constantinos Mihas and colleagues for their interest in our Article and for their questions. We agree with Mihas and colleagues that it would be informative to examine regional differences in haemorrhagic stroke. However, given the large size of our study,1 we needed to minimise the burden of data collection to keep costs affordable. As a result, we did not collect any data on stroke subtypes. The decision not to collect these data was also influenced by the fact that not all participating regions in this study had equal access to advanced neurological imaging...
Source: LANCET - March 3, 2017 Category: Journals (General) Authors: Jeff S Healey, Jonas Oldgren, RE-LY Atrial Fibrillation and Cohort Study Investigators Tags: Correspondence Source Type: research

Department of Error Department of Error
Healey JS, Oldgren J, Ezekowitz M, et al. Occurrence of death and stroke in patients in 47 countries 1 year after presenting with atrial fibrillation: a cohort study. Lancet 2016; 388: 1161 –69—In this Article, the author's name Albertino Demasceno should have been spelled Albertino Damasceno. This correction has been made to the online version as of Oct 4, 2016.
Source: LANCET - October 3, 2016 Category: Journals (General) Tags: Department of Error Source Type: research

Seminar Stroke
In the past decade, the definition of stroke has been revised and major advances have been made for its treatment and prevention. For acute ischaemic stroke, the addition of endovascular thrombectomy of proximal large artery occlusion to intravenous alteplase increases functional independence for a further fifth of patients. The benefits of aspirin in preventing early recurrent ischaemic stroke are greater than previously recognised. Other strategies to prevent recurrent stroke now include direct oral anticoagulants as an alternative to warfarin for atrial fibrillation, and carotid stenting as an alternative to endarterect...
Source: LANCET - September 12, 2016 Category: Journals (General) Authors: Graeme J Hankey Tags: Seminar Source Type: research

Editorial Atrial fibrillation and stroke: unrecognised and undertreated
When did you or your primary care physician last palpate your wrist to check for a regular heart rate? This simple action, followed by an electrocardiogram if the heart rate is irregular, might be crucial in preventing death and disability from ischaemic stroke, heart failure, or myocardial infarction. In this week's issue, we publish a clinical Series of three papers on atrial fibrillation ahead of the annual European Society of Cardiology (ESC) meeting held in Rome, Italy, Aug 27 –31. Atrial fibrillation is estimated to affect 33 million people worldwide.
Source: LANCET - August 19, 2016 Category: Journals (General) Authors: The Lancet Tags: Editorial Source Type: research

Series Stroke prevention in atrial fibrillation
Atrial fibrillation is found in a third of all ischaemic strokes, even more after post-stroke atrial fibrillation monitoring. Data from stroke registries show that both unknown and untreated or under treated atrial fibrillation is responsible for most of these strokes, which are often fatal or debilitating. Most could be prevented if efforts were directed towards detection of atrial fibrillation before stroke occurs, through screening or case finding, and treatment of all patients with atrial fibrillation at increased risk of stroke with well-controlled vitamin K antagonists or non-vitamin K antagonist anticoagulants.
Source: LANCET - August 19, 2016 Category: Journals (General) Authors: Ben Freedman, Tatjana S Potpara, Gregory Y H Lip Tags: Series Source Type: research

Comment Stroke and mortality after atrial fibrillation —a global struggle
Atrial fibrillation is a widely recognised health-care challenge with increasing prevalence across the world. Epidemiological observations mainly attribute this increase to an ageing population and better prognosis in distinguishing it from other cardiac disorders such as myocardial infarction.1 Research into atrial fibrillation has focused on antithrombotic management for stroke prevention and mortality, in the era of non-vitamin K antagonist oral anticoagulants.2 However, although these large, phase 3 trials enrolled patients from many centres in different countries and included broad populations, regional differences an...
Source: LANCET - August 7, 2016 Category: Journals (General) Authors: Torben Bjerregaard Larsen, Peter Br ønnum Nielsen Tags: Comment Source Type: research

Articles Occurrence of death and stroke in patients in 47 countries 1 year after presenting with atrial fibrillation: a cohort study
Marked unexplained inter-regional variations in the occurrence of stroke and mortality suggest that factors other than clinical variables might be important. Prevention of death from heart failure should be a major priority in the treatment of atrial fibrillation.
Source: LANCET - August 7, 2016 Category: Journals (General) Authors: Jeff S Healey, Jonas Oldgren, Michael Ezekowitz, Jun Zhu, Prem Pais, Jia Wang, Patrick Commerford, Petr Jansky, Alvaro Avezum, Alben Sigamani, Albertino Demasceno, Paul Reilly, Alex Grinvalds, Juliet Nakamya, Akinyemi Aje, Wael Almahmeed, Andrew Moriarty, Tags: Articles Source Type: research

Comment Can biomarkers balance stroke and bleeding risk?
Age and previous stroke, together with other clinical risk factors (often summarised in the CHA2DS2VASc score), identify patients with atrial fibrillation at high risk for stroke. Dose-adjusted warfarin prevents ischaemic strokes, prolongs life, and maintains autonomy in such patients.1,2 Hence, oral anticoagulation is currently recommended for all patients with atrial fibrillation with two of the CHA2DS2VASc risk factors, and should be considered in those with one of them.1,2 Although even reinitiation of anticoagulation after an intracerebral bleed seems to be associated with improved outcomes,3,4 bleeding is a major rea...
Source: LANCET - April 3, 2016 Category: Journals (General) Authors: Paulus Kirchhof, Larissa Fabritz Tags: Comment Source Type: research

Correspondence Intracerebral haemorrhage, atrial fibrillation, and anticoagulation
The Review by Freek Verheugt and colleagues (July 18, p 303)1 provides an excellent overview of non-vitamin K antagonist oral anticoagulants (NOACs) and stroke prevention in atrial fibrillation. However, we emphasise another factor that was omitted: survivors of intracranial haemorrhage who also have atrial fibrillation. Observational studies show up to 37% of patients with an intracerebral haemorrhage have concurrent atrial fibrillation,2 with absolute numbers of patients who have anticoagulant-related intracranial haemorrhage expected to increase because of the increased use of oral anticoagulation and an ageing population.
Source: LANCET - October 30, 2015 Category: Journals (General) Authors: Duncan Wilson, Rustam Al-Shahi Salman, Catharina J M Klijn, Gregory Y H Lip, David J Werring Tags: Correspondence Source Type: research

Correspondence Intracerebral haemorrhage, atrial fibrillation, and anticoagulation – Authors' reply
We thank Duncan Wilson and colleagues for their comments about our Review.1 These authors discuss an important issue and suggest that non-vitamin K antagonist oral anticoagulants might provide a strong option to reduce ischaemic stroke in patients who have atrial fibrillation and have suffered an intracranial haemorrhage. A fundamental advantage of non-vitamin K antagonist oral anticoagulants over warfarin is the substantially lower risk of intracranial haemorrhage,2 and this feature might be particularly important for patients at high risk of intracranial haemorrhage, including those with previous history of this disorder.
Source: LANCET - October 30, 2015 Category: Journals (General) Authors: Freek W A Verheugt, Christopher B Granger Tags: Correspondence Source Type: research

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