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Abstract 267: A Single-page Best Practice Algorithm Reduces Stroke Risk and Improves Arrhythmia Management Decisions in Patients With Acute Atrial Fibrillation: A Quality Improvement Project Session Title: Poster Session PM
Conclusions: Using established quality improvement methodology and cost-neutral multi-disciplinary expertise, this novel management algorithm has significantly improved the quality and safety of care for patients with acute AF at NMUH. Prospective analysis of long-term adverse outcomes is now required to establish morbidity or mortality benefit.
Source: Circulation: Cardiovascular Quality and Outcomes - April 5, 2018 Category: Cardiology Authors: Maclean, E., Patel, S., Joseph, O., de Block Golding, D., Maden, S., Boot, J., Denning, M., Rear, R. Tags: Session Title: Poster Session PM Source Type: research

Abstract 175: Atrial Fibrillation in the USF Resident Clinics: Quality-Driven Medical Therapy Session Title: Poster Session AM
Patients with atrial fibrillation (afib) have a high rate of serious complications including stroke and decompensated heart failure. While patients with afib are five times more likely to suffer a stroke in their lifetime than the general population, this risk can be reduced by 64% with appropriate anticoagulation using warfarin or approved novel oral anticoagulants (NOACs). Reducing the morbidity and mortality from excess strokes is a common interest nationwide due to unsustainable healthcare costs, increasing human resource gaps in medicine, and payment reforms that hold physicians and healthcare organizations financiall...
Source: Circulation: Cardiovascular Quality and Outcomes - April 5, 2018 Category: Cardiology Authors: Sadic, E. Tags: Session Title: Poster Session AM Source Type: research

Sex-Specific Comparative Effectiveness of Oral Anticoagulants in Elderly Patients With Newly Diagnosed Atrial Fibrillation Original Articles
Conclusions— The reduced risk of ischemic stroke in patients taking rivaroxaban, compared with dabigatran and warfarin, seems to be limited to men, whereas the higher risk of bleeding seems to be limited to women.
Source: Circulation: Cardiovascular Quality and Outcomes - April 13, 2017 Category: Cardiology Authors: Palamaner Subash Shantha, G., Bhave, P. D., Girotra, S., Hodgson-Zingman, D., Mazur, A., Giudici, M., Chrischilles, E., Vaughan Sarrazin, M. S. Tags: Anticoagulants, Cerebrovascular Disease/Stroke Original Articles Source Type: research

Abstract 126: The Association Between Medication Aherence and Time in Therapeutic Range (TTR) Among Patients with Atrial Fibrillation Treated With Warfarin: Lessons From the Parkland Health and Hospital System Session Title: Poster Session I
Conclusions: TTR to Warfarin in this underserved population is suboptimal. Given that adherence to Warfarin is independently associated with poor TTR, in the absence of strong adherence interventions, a policy of universal NOAC adoption is unlikely to significantly improve outcomes. If patients are transitioned to NOACs, this data implies that a targeted adherence intervention will be necessary to ensure that the medication is effective in reducing the risk of stroke.
Source: Circulation: Cardiovascular Quality and Outcomes - March 31, 2017 Category: Cardiology Authors: Wang, J., Vigen, R., Clark, C., Das, S. Tags: Session Title: Poster Session I Source Type: research

Abstract 159: Evaluation of Clinical Outcomes among Nonvalvular Atrial Fibrillation Patients Treated With Warfarin or Rivaroxaban Stratified by Presence or Absence of CKD in a Claims Database Session Title: Poster Session II
Conclusions: This study suggests that, in an adult population with NVAF, rivaroxaban-treated patients had fewer ischemic strokes across all patients, including patients with renal impairment. Rivaroxaban-treated patients also had significantly better outcomes for the composite (VTE, MI, or stroke) measure across all groups. Bleeding rates were comparable across all groups.
Source: Circulation: Cardiovascular Quality and Outcomes - March 31, 2017 Category: Cardiology Authors: Weir, M. R., Haskell, L., Berger, J. S., Ashton, V., Laliberte, F., Crivera, C., Brown, K., Lefebvre, P., Schein, J. Tags: Session Title: Poster Session II Source Type: research

Abstract 160: Impact of Medication Adherence on Risk of Stroke, Major Bleeding and Other Outcomes in Atrial Fibrillation Patients Using Novel Oral Anticoagulants (Dabigatran and Rivaroxaban) Session Title: Poster Session II
Conclusion: In our sample, adherence to NOACs was associated with a reduction in stroke and DVTPE risk but did not substantially increase bleeding risk. Further studies with newer NOACs are warranted.
Source: Circulation: Cardiovascular Quality and Outcomes - March 31, 2017 Category: Cardiology Authors: Deshpande, C. G., Willey Temkin, C., Laforge, R., Kogut, S. Tags: Session Title: Poster Session II Source Type: research

Long-Term Persistence of Newly Initiated Warfarin Therapy in Chinese Patients With Nonvalvular Atrial Fibrillation Original Articles
Conclusions— Nonpersistence of warfarin treatment becomes a serious problem for stroke prevention in Chinese patients with nonvalvular AF. Our findings can be used to identify patients who require closer attention or to develop better management strategy for oral anticoagulation therapy.
Source: Circulation: Cardiovascular Quality and Outcomes - July 18, 2016 Category: Cardiology Authors: Wang, Z.-Z., Du, X., Wang, W., Tang, R.-B., Luo, J.-G., Li, C., Chang, S.-S., Liu, X.-H., Sang, C.-H., Yu, R.-H., Long, D.-Y., Wu, J.-H., Bai, R., Liu, N., Ruan, Y.-F., Dong, J.-Z., Ma, C.-S. Tags: Atrial Fibrillation, Compliance/Adherence, Treatment Original Articles Source Type: research

Safety and Use of Anticoagulation After Aortic Valve Replacement With Bioprostheses: A Meta-Analysis Original Articles
Conclusions— Contrary to the current guidelines, a meta-analysis of previous studies suggests that anticoagulation in the setting of an aortic bioprosthesis significantly increases bleeding risk without a favorable effect on thromboembolic events. Larger, randomized controlled studies should be performed to further guide this clinical practice.
Source: Circulation: Cardiovascular Quality and Outcomes - May 16, 2016 Category: Cardiology Authors: Riaz, H., Alansari, S. A. R., Khan, M. S., Riaz, T., Raza, S., Luni, F. K., Khan, A. R., Riaz, I. B., Krasuski, R. A. Tags: Anticoagulants, Aortic Valve Replacement/Transcatheter Aortic Valve Implantation Original Articles Source Type: research

Dabigatran Versus Warfarin for Atrial Fibrillation in Real-World Clinical Practice: A Systematic Review and Meta-Analysis Original Articles
Conclusions— In real-world clinical practice, dabigatran is comparable with warfarin in preventing ischemic stroke among patients with nonvalvular atrial fibrillation. However, dabigatran is associated with a lower risk for intracranial bleeding relative to warfarin, but—particularly among the elderly—a greater risk for gastrointestinal bleeding. Bleeding outcomes from observational studies are consistent with those from the pivotal Randomized Evaluation of Long-Term Anticoagulation Therapy trial.
Source: Circulation: Cardiovascular Quality and Outcomes - March 15, 2016 Category: Cardiology Authors: Romanelli, R. J., Nolting, L., Dolginsky, M., Kym, E., Orrico, K. B. Tags: Meta Analysis, Ischemic Stroke Original Articles Source Type: research

Reimagining Anticoagulation Clinics in the Era of Direct Oral Anticoagulants Cardiovascular Perspective
Anticoagulation clinics were initially developed to provide safe and effective care for warfarin-treated patients with atrial fibrillation, venous thromboembolism, and mechanical valve replacement. Traditionally, these patients required ongoing laboratory monitoring and warfarin dose adjustment by expert providers. With the introduction of direct oral anticoagulants (dabigatran, rivaroxaban, apixaban, and edoxaban), many have questioned the need for anticoagulation clinic. However, we think that the growing number of oral anticoagulant choices creates an urgent need for expanding the traditional role of the anticoagulation...
Source: Circulation: Cardiovascular Quality and Outcomes - March 15, 2016 Category: Cardiology Authors: Barnes, G. D., Nallamothu, B. K., Sales, A. E., Froehlich, J. B. Tags: Atrial Fibrillation, Ethics and Policy, Health Services, Ischemic Stroke, Thrombosis Cardiovascular Perspective Source Type: research

Abstract 2: Comparative Effectiveness and Safety of Anticoagulant Therapy With Warfarin, Dabigatran, Apixaban, or Rivaroxaban in Patients With Nonvalvular Atrial Fibrillation Session Title: Abstract Oral Session: QCOR 2016 Young Investigator Awards
Conclusions: Our results demonstrated a lower risk of a thromboembolic event or stroke among dabigatran, apixaban, or rivaroxaban users compared to warfarin users. Among NOACs, risks of a thromboembolic event or stroke were similar. Further studies are needed to clarify the finding of a higher major bleeding risk in warfarin and rivaroxaban users.
Source: Circulation: Cardiovascular Quality and Outcomes - February 26, 2016 Category: Cardiology Authors: Adeboyeje, G., Sylwestrzak, G., White, J., Rosenberg, A., Abarca, J., Crawford, G., Barron, J. Tags: Session Title: Abstract Oral Session: QCOR 2016 Young Investigator Awards Source Type: research

Abstract 10: Pre-stroke Antithrombotic Therapy and Stroke Severity in Acute Ischemic Stroke Patients with Atrial Fibrillation Session Title: Abstract Oral Session: Outcomes
Conclusions: A majority of AF patients presenting with AIS are not on guideline recommended anticoagulation or are not therapeutic on their anticoagulation. Even when strokes occurred on therapeutic warfarin or a NOAC, the strokes were less severe. These findings highlight the huge opportunities to further improve proper use of oral anticoagulants in eligible AF patients.
Source: Circulation: Cardiovascular Quality and Outcomes - February 26, 2016 Category: Cardiology Authors: Xian, Y., OBrien, E. C., Liang, L., Pencina, M. J., Schwamm, L. H., Fonarow, G. C., Bhatt, D. L., Smith, E. E., Maisch, L., Hannah, D., Lindholm, B., Lytle, B. L., Hernandez, A. F., Peterson, E. D. Tags: Session Title: Abstract Oral Session: Outcomes Source Type: research

Abstract 22: Impact of CHA2DS2-VASc Risk Factors on Anticoagulant Prescription in Patients with Atrial Fibrillation: Insights From the NCDR(R) PINNACLE Registry Session Title: Abstract Oral Session
Conclusions: Among this cohort of AF patients with an indication for OAC use, older age and HTN were strongly associated with greater OAC use whereas female gender and vascular disease were associated with less OAC use. Further investigation is needed to understand reasons for these differences in how risk factors influence decisions to provide OAC, such as patient or provider preference or gender bias.
Source: Circulation: Cardiovascular Quality and Outcomes - February 26, 2016 Category: Cardiology Authors: Thompson, L. E., Maddox, T. M., Lei, L., Grunwald, G. K., Bradley, S. M., Peterson, P. N., Daugherty, S. L., Masoudi, F. A. Tags: Session Title: Abstract Oral Session Source Type: research

Abstract 154: Estimating Treatment Effects in More Than Two Treatment Groups via Propensity Score Weighting: Practical Guidance and Application from Anticoagulant Therapy in Atrial Fibrillation Study Session Title: Abstract Poster Session I and Reception
Conclusions: Our results showed IPTW methods, correctly employed under certain assumptions, are practical and relatively simple tools to control for selection bias and other baseline differences in observational studies evaluating the comparative treatment effects of more than two treatment arms. When preserving sample size is important and in the presence of time-varying confounders, IPTW methods have distinct advantages over propensity matching or adjustment.
Source: Circulation: Cardiovascular Quality and Outcomes - February 26, 2016 Category: Cardiology Authors: Adeboyeje, G., Sylwestrzak, G., Barron, J. Tags: Session Title: Abstract Poster Session I and Reception Source Type: research

Abstract 201: Are Patients With Atrial Fibrillation Willing to Consider New Strategies to Prevent Stroke? A Qualitative Analysis of Community-Based Focus Groups Session Title: Abstract Poster Session II
Conclusion: Focus group participants expressed a fear of debilitating stroke, with varying levels of acceptance of inconveniences and potential bleeding associated with blood thinners. Among a subset of participants, there was willingness to consider new stroke prevention therapies; however, this was preferred with a known, trusted physician. Subspecialized clinicians offering new therapies may be challenged to establish perceived mutual respect with patients, traditionally built over time, and this may be required for patients to consider new therapies. Future research is needed to determine best practices for both establ...
Source: Circulation: Cardiovascular Quality and Outcomes - February 26, 2016 Category: Cardiology Authors: ONeill, E. S., Grande, S. W., Coylewright, M. Tags: Session Title: Abstract Poster Session II Source Type: research

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