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Stroke and death in elderly patients with atrial fibrillation in Japan compared with the United Kingdom
Conclusions Elderly (age ≥75 years) patients with AF in both Japan and the UK are at similarly high risk of stroke and death, with OAC still underused in both populations. Ethnicity was not independently associated with the risk of stroke, regardless of OAC use or non-use.
Source: Heart - November 10, 2016 Category: Cardiology Authors: Senoo, K., An, Y., Ogawa, H., Lane, D. A., Wolff, A., Shantsila, E., Akao, M., Lip, G. Y. H. Tags: Drugs: cardiovascular system, Heart failure, Hypertension, Epidemiology, Diabetes, Metabolic disorders Health care delivery, economics and global health care Source Type: research

Prediction of stroke in patients without atrial fibrillation using the CHADS2 and CHA2DS2-VASc scores: a justification for more widespread thromboprophylaxis?
The CHADS2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, previous stroke/transient ischaemic attack (TIA) (double)) and more recently, the CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years (double score), diabetes mellitus, previous stroke/TIA (double score), vascular disease, age 65–74 years, sex category (female)) scores are validated clinical prediction tools commonly used to estimate the stroke risk in atrial fibrillation (AF) patients. More recently, the focus has been on initially identifying those patients at ‘low risk’ (ie, CHA2DS...
Source: Heart - September 9, 2014 Category: Cardiology Authors: Senoo, K., Lip, G. Y. H. Tags: Drugs: cardiovascular system, Heart failure, Hypertension, Epidemiology, Diabetes, Metabolic disorders Editorials Source Type: research

Risk of left atrial appendage thrombus and stroke in patients with atrial fibrillation and mitral regurgitation
Conclusions Among patients with NVAF, the presence or severity of MR was not associated with a decreased risk of LAAT or stroke.
Source: Heart - December 10, 2021 Category: Cardiology Authors: Melduni, R., Nkomo, V. T., Wysokinski, W., Gersh, B. J., Deshmukh, A., Padang, R., Greene, E. L., Oh, J. K., Lee, H.-C. Tags: Arrhythmias and sudden death Source Type: research

Rivaroxaban and other novel anticoagulants for stroke prevention in atrial fibrillation: time to embrace the future
Atrial fibrillation (AF) is now said to be at epidemic proportions.1 Although symptoms and heart failure are two of the main reasons that patients with AF suffer from reduced quality of life, thromboembolic complications, particularly stroke, remain the major determinant of significant morbidity and mortality.2 Importantly, the risk of thromboembolism (TE) is completely irrespective of symptoms, and hence the sad fact that people continue to present with catastrophic stroke in AF with no prior history of its detection.3 Appropriate anticoagulation is imperative to reduce the TE/stroke risk. Numerous large scale studies hav...
Source: Heart - February 18, 2013 Category: Cardiology Authors: Rajappan, K. Tags: Drugs: cardiovascular system, Epidemiology Editorials Source Type: research

Heartbeat: Left atrial appendage occlusion for stroke prevention
Stroke prevention is the primary goal of therapy in patients with atrial fibrillation (AF).1 Heart has published numerous papers on early AF detection,2 approaches for restoring normal sinus rhythm, risk scores for determining which AF patients benefit most from anti-thrombotic therapy, and transcatheter occlusion of the left atrial appendage (LAA) to prevent thrombus formation.3–6 Early studies of LAA occlusion compared this procedure to vitamin K antagonist (VKA) therapy for stroke prevention. Now, direct oral anticoagulants (DOACs) have replaced VKA therapy in many AF patients due to an improved risk/benefit profi...
Source: Heart - January 4, 2017 Category: Cardiology Authors: Otto, C. M. Tags: Heartbeat Source Type: research

Prediction of incident atrial fibrillation in community-based electronic health records: a systematic review with meta-analysis
Conclusions Models externally validated for prediction of incident AF in community-based EHR demonstrate moderate predictive ability and high risk of bias. Novel methods may provide stronger discriminative performance. Systematic review registration PROSPERO CRD42021245093.
Source: Heart - June 10, 2022 Category: Cardiology Authors: Nadarajah, R., Alsaeed, E., Hurdus, B., Aktaa, S., Hogg, D., Bates, M. G. D., Cowan, C., Wu, J., Gale, C. P. Tags: Open access Arrhythmias and sudden death Source Type: research

Combined anticoagulation and antiplatelet therapy in AF patients: why do we not follow guidelines?
While current European guidelines recommend oral anticoagulation treatment over antiplatelet therapy for the prevention of ischaemic stroke in patients with non-valvular atrial fibrillation (AF) with a 64% stroke risk reduction by warfarin treatment versus placebo and a 39% risk reduction versus aspirin,1 single or dual antiplatelet therapy is the guideline recommended first-line treatment strategy for patients with peripheral and/or coronary artery disease with and without intervention to prevent recurrences and major adverse cardiac events.2–7 Antiplatelet therapy is also recommended in patients with ischaemic stro...
Source: Heart - September 23, 2014 Category: Cardiology Authors: Brandes, A. Tags: Drugs: cardiovascular system, Acute coronary syndromes, Venous thromboembolism Editorials Source Type: research

Not all thromboembolism comes from the left atrial appendage in atrial fibrillation
Atrial fibrillation (AF) confers a substantial risk of stroke and thromboembolism, which is effectively reduced by oral anticoagulation (OAC), whether as a vitamin K antagonist (VKA, eg, warfarin) or one of non-VKA oral anticoagulants (NOACs). With the use of OACs, the risk of bleeding remains a problem associated with these agents. Thus, a clinical dilemma remains in the optimal management of patients with AF who are at high risk of stroke but have a history of bleeding. Among patients with non-valvular AF, over 90% of the thrombus is formed in the left atrial appendage (LAA).1 Thus, the exclusion of LAA could greatly dec...
Source: Heart - May 12, 2015 Category: Cardiology Authors: Senoo, K., Lip, G. Y. H. Tags: Drugs: cardiovascular system, Heart failure, Hypertension, Epidemiology Editorials Source Type: research

Left atrial appendage occlusion in high-risk patients with non-valvular atrial fibrillation
Conclusions Our data suggest LAA occlusion in high-risk patients with NVAF not suitable for OACs is feasible and associated with low complication rates as well as low rates of stroke and major bleeding at long-term follow-up.
Source: Heart - November 24, 2016 Category: Cardiology Authors: Berti, S., Pastormerlo, L. E., Rezzaghi, M., Trianni, G., Paradossi, U., Cerone, E., Ravani, M., De Caterina, A. R., Rizza, A., Palmieri, C. Tags: Drugs: cardiovascular system, Echocardiography, Clinical diagnostic tests Cardiac risk factors and prevention Source Type: research

Atrial fibrillation and thromboembolism in patients with hypertrophic cardiomyopathy: systematic review
Conclusions AF is common in HCM and associated with high thromboembolic risk. LA dimension and age are independently associated with AF but the literature is insufficient to create robust clinical tools to predict AF or thromboembolism. Most data suggest that AF patients should be anticoagulated.
Source: Heart - February 19, 2014 Category: Cardiology Authors: Guttmann, O. P., Rahman, M. S., O'Mahony, C., Anastasakis, A., Elliott, P. M. Tags: Hypertrophic cardiomyopathy, Drugs: cardiovascular system, Epidemiology Heart failure and cardiomyopathies Source Type: research

Left atrial appendage occlusion
Left atrial appendage (LAA) occlusion for stroke and thromboembolism prevention in patients with atrial fibrillation (AF) represents a significant advancement in the field of cardiovascular disease. Prevention and avoidance of the devastating consequences of thromboembolic complications from AF continues to be central in the management of these patients. The role of LAA as a nidus for thrombus formation is well documented. Multiple approaches to exclude the LAA from the circulation either percutaneously or surgically have been described and are undergoing testing. Although pharmacological therapy for stroke prevention rema...
Source: Heart - May 12, 2015 Category: Cardiology Authors: Alli, O., Holmes, D. Tags: Review articles Reviews Source Type: research

Cochrane corner: vitamin K for improved anticoagulation control in patients receiving warfarin
There has been a substantial increase in the use of oral anticoagulants, notably in the ageing population. This is primarily driven by the use of warfarin in people with atrial fibrillation (AF) in order to reduce the risks of thromboembolic events such as stroke.1 In elderly patients with AF, warfarin use has been shown to reduce the relative risk of stroke by >50% compared with aspirin alone.2 Warfarin is also used to treat patients with deep vein thrombosis, mechanical heart valve replacement, cardioversion, cardiomyopathy and antiphospholipid syndrome.1 The clinical benefits of warfarin must also be balanced with po...
Source: Heart - October 11, 2015 Category: Cardiology Authors: Mahtani, K. R., Nunan, D., Heneghan, C. Tags: Drugs: cardiovascular system, Cochrane Corner, Venous thromboembolism, Epidemiology Editorials Source Type: research

Cochrane corner: oral hormone therapy and cardiovascular outcomes in post-menopausal women
Introduction Hormone therapy (HT) is commonly prescribed for the relief of climacteric symptoms in post-menopausal women; 54% (620490) of women enrolled in the Million Women Study1 in the UK (mean age 56 years) have tried it and 31% (358252) use it. Observational studies have shown oral HT is associated with lower rates of cardiovascular disease in post-menopausal women2; however randomised controlled trials (RCTs) have presented mixed results. The 2002 publication of the Women's Health Initiative I (WHI I) reported an association between combined oestrogen and progestin use and increased rates of both coronary heart...
Source: Heart - December 11, 2015 Category: Cardiology Authors: Boardman, H., Hartley, L., Eisinga, A., Main, C., Figuls, M. R. I. Tags: Drugs: cardiovascular system, Cochrane Corner, Acute coronary syndromes, Venous thromboembolism, Epidemiology Editorials Source Type: research

Non-vitamin K antagonist oral anticoagulants (NOACs) for the management of venous thromboembolism
Learning objectives Understand the importance of venous thrombosis in cardiovascular medicine. Appreciate the mode of action of different oral anticoagulants. Recall the uses, risks and benefits of each non-vitamin K antagonist oral anticoagulants. Introduction Thrombosis is the common pathophysiology responsible for ischaemic heart disease, ischaemic stroke and venous thromboembolism (VTE), and a major contributor to the global disease burden.1 This effect is markedly more pronounced by considering the view that cancer is also a thrombotic disease.2 3 Cardiovascular disease (CVD, manifesting as acute coronary syndromes, m...
Source: Heart - June 5, 2016 Category: Cardiology Authors: Blann, A. D., Lip, G. Y. H. Tags: Education in Heart, Drugs: cardiovascular system, Acute coronary syndromes, Venous thromboembolism, Epidemiology Source Type: research

Management and outcomes of patients with left atrial appendage thrombus prior to percutaneous closure
Conclusion In the presence of LAA thrombus, IAT was the initial management strategy in half of our cohort, with initial thrombus resolution in 60% of these, but with a relatively high bleeding rate (~10%). Direct LAAC was feasible, with high procedural success and absence of periprocedural embolic complications. However, a high rate of device-related thrombosis was detected during follow-up.
Source: Heart - June 24, 2022 Category: Cardiology Authors: Marroquin, L., Tirado-Conte, G., Pracon, R., Streb, W., Gutierrez, H., Boccuzzi, G., Arzamendi-Aizpurua, D., Cruz-Gonzalez, I., Ruiz-Nodar, J. M., Kim, J.-S., Freixa, X., Lopez-Minguez, J. R., De Backer, O., Ruiz-Salmeron, R., Dominguez, A., McInerney, A. Tags: Open access Arrhythmias and sudden death Source Type: research

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