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Source: The American Journal of Medicine

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Total 259 results found since Jan 2013.

Variation in the Use of Warfarin and Direct Oral Anticoagulants in Atrial Fibrillation and Associated Cost Implications
Atrial fibrillation is the most common arrhythmia in the United States and affects between 2.7 million and 6.1 million adults in the United States, with a lifetime risk of up to 1 in 4 adults over age 40 and a prevalence that is projected to double over the next 25 years.1,2 Though warfarin has long been the cornerstone of therapy to reduce the risk of stroke, several new direct oral anticoagulants (DOACs) have recently become available, beginning with FDA approval of dabigatran in October 2010, and followed by rivaroxaban in 2011, apixaban in 2014, and most recently edoxaban in 2015.
Source: The American Journal of Medicine - October 3, 2018 Category: General Medicine Authors: Benjamin A. Rodwin, Joseph A. Salami, Erica S. Spatz, Javier Valero-Elizondo, Salim S. Virani, Ron Blankstein, Michael J. Blaha, Khurram Nasir, Nihar R. Desai Tags: Clinical Research Study Source Type: research

Of Cardiac Holes and Crew Leaders
I enjoyed reading, and learned a lot from, Drs. Dalen and Alpert's article1 on closure of a foramen ovale to prevent cryptogenic stroke. It is a timely review that organizes evidence that, until now, had been somewhat confusing. In the article, the word foramen (from the Latin forare, meaning to pierce or bore a hole) was meant to appear 61 times. Unfortunately, it was mistakenly replaced by the word foremen (from the Dutch voormen, meaning the leaders of work crews, usually men, or the spokesmen for juries) on 27 of the 61 occasions.
Source: The American Journal of Medicine - October 1, 2018 Category: General Medicine Authors: Fernando Elijovich Tags: Letter Source Type: research

Improved Outcomes by Integrated Care of Anticoagulated Patients with Atrial Fibrillation Using the Simple ABC (Atrial Fibrillation Better Care) Pathway
Integrated care for the clinical management of atrial fibrillation patients is advocated as a holistic way to improve outcomes; the simple Atrial fibrillation Better Care (ABC) pathway has been proposed. The ABC pathway streamlines care as follows: ‘A’ Avoid stroke; ‘B’ Better symptom management; ‘C’ Cardiovascular and Comorbidity optimization.
Source: The American Journal of Medicine - August 25, 2018 Category: General Medicine Authors: Marco Proietti, Giulio Francesco Romiti, Brian Olshansky, Deirdre A. Lane, Gregory Y.H. Lip Tags: Clinical Research Study Source Type: research

Periprocedural Bridging Anticoagulation: Measuring the Impact of a Clinical Trial on Care Delivery
Warfarin remains the most commonly prescribed oral anticoagulant in North America for patients with atrial fibrillation.1 –3 Historically, when patients underwent surgical procedures, many clinicians chose to give shorter acting “bridging” anticoagulants to help reduce the risk of stroke while the effect of warfarin was wearing off before surgery or building back up after surgery. In response to observational stu dies, the BRIDGE trial was conducted to test the safety and efficacy of short acting low-molecular-weight heparin (LMWH) as a bridge before and after surgery in patients with atrial fibrillation treated with warfarin.
Source: The American Journal of Medicine - August 1, 2018 Category: General Medicine Authors: Geoffrey D Barnes, Yun Li, Xiaokui Gu, Brian Haymart, Eva Kline-Rogers, Steven Almany, Jay Kozlowski, Gregory Krol, Michael McNamara, James B Froehlich, Scott Kaatz Tags: Clinical Research Study Source Type: research

Dementia and Atrial Fibrillation: Pathophysiological Mechanisms and Therapeutic Implications
Dementia and atrial fibrillation have several epidemiologic characteristics in common, including high overall prevalence, increasing incidence with aging, and an expected rise in incidence.1,2 Atrial fibrillation has been associated more closely with dementia3-18 than other potentially comorbid age-related conditions.19,20 However, while atrial fibrillation increases the risk of stroke by a factor of 4- to 5-fold,21 it is uncertain whether cognitive impairment in the context of atrial fibrillation is mediated by an increased risk of stroke or whether other factors are responsible.
Source: The American Journal of Medicine - August 1, 2018 Category: General Medicine Authors: Romain Chopard, Gregory Piazza, Seth Alan Gale, Umberto Campia, Ida Ehlers Albertsen, Jisoo Kim, Samuel Z. Goldhaber Tags: Review The American Journal of Medicine Source Type: research

Diastolic hypotension may attenuate benefits from intensive systolic targets: secondary analysis of a randomized controlled trial
The potential for harm due to excessive lowering of diastolic blood pressure as a result of antihypertensive treatment has been discussed for several decades.1 Numerous observational studies and secondary analyses of randomized data have suggested that treating diastolic blood pressure below a certain threshold may lead to adverse outcomes, including a higher incidence of coronary events, stroke, heart failure, and all-cause mortality.1 –6 Proposed mechanisms include reduced endocardial perfusion leading to coronary events,7 or flow limiting coronary stenosis.
Source: The American Journal of Medicine - June 12, 2018 Category: General Medicine Authors: Todd C. Lee, Rodrigo B. Cavalcanti, Emily G. McDonald, Louise Pilote, James M. Brophy Tags: A Clinical Research Study Source Type: research

Effectiveness and Safety of Anticoagulants in Adults with Non-valvular Atrial Fibrillation and Concomitant Coronary/Peripheral Artery Disease
Atrial fibrillation increases the risk of stroke by five-fold and is associated with 15-20% of all strokes.1,2 Prior studies have shown that the prevalence of coronary artery disease and peripheral artery disease among atrial-fibrillation-diagnosed patients ranges from 18-45%, and 4-17%, respectively.3 –9 Coronary and peripheral artery disease patients are at high risk for stroke, myocardial infarction, and cardiovascular-related death.10–13 Concomitant atrial fibrillation with coronary artery disease is associated with all-cause mortality, coronary death, and major coronary events.
Source: The American Journal of Medicine - May 26, 2018 Category: General Medicine Authors: Renato D. Lopes, Jan Steffel, Manuela Di Fusco, Allison Keshishian, Xuemei Luo, Xiaoyan Li, Cristina Masseria, Melissa Hamilton, Keith Friend, Kiran Gupta, Jack Mardekian, Xianying Pan, Onur Baser, W. Schuyler Jones Tags: Clinical Research Study Source Type: research

Arterial Ischemic Events Are a Major Complication in Cancer Patients with Venous Thromboembolism
A number of studies revealed that patients with venous thromboembolism are at increased risk of developing subsequent arterial ischemic events, such as myocardial infarction or stroke.1 –8 Prevention of such arterial ischemic events in addition to treating venous thromboembolismmay warrant combination therapy with antiplatelets and anticoagulants. Recent studies suggested an increased risk of arterial ischemic events in cancer patients.9,10 Accurate identification of patients at increased risk for arterial ischemic events during the course of anticoagulation for venous thromboembolismmay help to select those who would po...
Source: The American Journal of Medicine - May 26, 2018 Category: General Medicine Authors: Benjamin Brenner, Behnood Bikdeli, Inna Tzoran, Olga Madridano, Raquel L ópez-Reyes, José María Suriñach, Ángeles Blanco-Molina, Antonella Tufano, Juan José López Núñez, Javier Trujillo-Santos, Manuel Monreal, for the RIETE Investigators Tags: Clinical Research Study Source Type: research

Development and Preliminary Feasibility of an Automated Hypertension Self-Management System
Hypertension affects an estimated 30% of the world's adult population1 and is a primary source of all-cause death as well as stroke, heart disease and kidney failure. Despite significant improvements in hypertension diagnosis and treatment, over half of US adults with hypertension have uncontrolled blood pressure.2 Due to the recent changes to the ACC/AHA hypertension guidelines, specifically redefining stage 1 hypertension from 140-159/90-99 to 130-139/80-89 mm Hg and setting a goal of
Source: The American Journal of Medicine - May 25, 2018 Category: General Medicine Authors: Taya Irizarry, Matthew Allen, Brian P. Suffoletto, Julian Einhorn, Lora E. Burke, Thomas W. Kamarck, Bruce L. Rollman, Matthew F. Muldoon Tags: Clinical Research Study Source Type: research

The Reply
We recently reported an updated meta-analysis of 5 randomized clinical trials demonstrating that transcatheter closure of patent foramen ovale reduces the risk of recurrent neurologic events compared with medical therapy after cryptogenic stroke.1 Key trials have collectively studied more than 10 different patent foramen ovale closure devices, including the US Food and Drug Administration –approved AMPLATZER PFO Occluder (Abbott Vascular, Santa Clara, Calif). These devices vary considerably in material, size, and profile and differ with respect to procedural deployment.
Source: The American Journal of Medicine - May 19, 2018 Category: General Medicine Authors: Muthiah Vaduganathan, Arman Qamar, Ankur Gupta, Navkaranbir Bajaj, Harsh B. Golwala, Ambarish Pandey, Deepak L. Bhatt Tags: Letter Source Type: research

To Reduce Stroke with PFO Closure, Respect the Shunt
We read with interest the very timely updated meta-analysis regarding closure of patent foramen ovale for cryptogenic stroke by Vaduganathan et  al.1 They suggest a marked benefit in stroke prevention with an increase in the incidence of atrial fibrillation. However, we would like to draw your attention to a few caveats that are important for clinicians dealing with this situation and expand on the pooled analysis using the same 5 trials i ncluded in the current paper.2-6
Source: The American Journal of Medicine - May 19, 2018 Category: General Medicine Authors: Arka Chatterjee, Mark A. Law Tags: Letter Source Type: research

Patent Foramen Ovale Closure Versus Medical Therapy After Cryptogenic Stroke
We read with great interest the recent updated meta-analysis by Vaduganathan et  al evaluating patent foramen ovale closure for prevention of cryptogenic stroke.1 Although we congratulate and applaud their excellent work, we would like to comment on several important issues in the study.
Source: The American Journal of Medicine - May 19, 2018 Category: General Medicine Authors: Hong-Tao Tie, Rui Shi Tags: Letter Source Type: research

Insulinoma Masquerading as Transient Neurocognitive Impairment
A 55-year-old man presented with 6 months of increasingly frequent episodes of confusion and abnormal behavior (Video 1). Neurologic examination and diagnostic work-up were unremarkable. He was evaluated for stroke, Huntington's disease, conversion disorder, and other neuropsychiatric conditions without a satisfactory diagnosis. Months later, he suffered another episode and was found to have a glucose of 33mg/dL. This improved with glucose administration but rapidly dropped to 30mg/dL. A 72-hour fast, which revealed a low serum glucose and elevated insulin, pro-insulin, and C-peptide levels, strongly suggested the diagnosis of insulinoma.
Source: The American Journal of Medicine - May 10, 2018 Category: General Medicine Authors: Daniel Varela, Amy Yu, David Saxon Tags: Clinical Communication to the Editor Source Type: research

Insulinoma Masquerading as Transient Neurocognitive Impairment ✰, ✰✰, ✰✰✰
A 55-year-old man presented with six months of increasingly frequent episodes of confusion and abnormal behavior (Video 1). Neurologic examination and diagnostic workup were unremarkable. He was evaluated for stroke, Huntington's disease, conversion disorder, and other neuropsychiatric conditions without a satisfactory diagnosis. Months later, he suffered another episode and was found to have a glucose of 33 mg/dL. This improved with glucose administration, but rapidly dropped to 30 mg/dL. A 72-hour fast, which revealed a low serum glucose and elevated insulin, pro-insulin, and c-peptide levels, strongly suggested the diagnosis of insulinoma.
Source: The American Journal of Medicine - May 10, 2018 Category: General Medicine Authors: Daniel Varela, Amy Yu, David Saxon Tags: Clinical Communication to the Editor Source Type: research