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Source: Canadian Journal of Cardiology

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Total 244 results found since Jan 2013.

Clinical impact of valvular heart disease in elderly patients admitted for acute coronary syndrome: insights from the Elderly-ACS 2 Study
ConclusionsIn a contemporary cohort of elderly patients admitted for ACS, VHD was found in one out of five subjects and had an independent, consistent impact on prognosis.
Source: Canadian Journal of Cardiology - November 21, 2019 Category: Cardiology Source Type: research

The unique clinical phenotype and exercise adaptation of Fontan patients with normal exercise capacity
ConclusionsApproximately 1 in 5 Fontan patients who undergo cardiopulmonary exercise testing have normal exercise capacity despite chronotropic impairment. This implies a better preserved stroke volume, perhaps due to greater muscle pump-mediated preload. Additionally, a complicated perioperative Fontan course is associated with eventual impaired functional capacity.
Source: Canadian Journal of Cardiology - November 17, 2019 Category: Cardiology Source Type: research

Dual antithrombotic therapy with DOACs after ACS or PCI in Atrial Fibrillation: A meta-analysis of Randomized Controlled Trials
ConclusionsIn patients with AF and recent ACS or PCI, the use of dual antithrombotic therapy with DOACs was associated with less major bleeding, and major bleeding or clinically relevant non-major bleeding, compared to triple therapy. The use of dual therapy also shows non-significantly higher composite of death/ischemic events but no difference in mortality.
Source: Canadian Journal of Cardiology - November 14, 2019 Category: Cardiology Source Type: research

Short and long-term outcomes of medically treated isolated left-sided endocarditis: a retrospective study with 5-year longitudinal follow-up
ConclusionNon-operative management of LSIE carries a poor prognosis but may have a role in select cases. Surgical management remains the mainstay for patients with clear surgical indications, including severe regurgitation and PVE. Further prospective analyses are required to better delineate appropriate patient selection for non-surgical management.
Source: Canadian Journal of Cardiology - November 7, 2019 Category: Cardiology Source Type: research

Antithrombotic Management After Transcatheter Aortic Valve Replacement: A Survey of Canadian Physicians
Publication date: November 2019Source: Canadian Journal of Cardiology, Volume 35, Issue 11Author(s): Seleman Reza, Natalia Pinilla, Emilie P. Belley-Côté, Kevin J. Um, Serena Sibilio, Madhu K. Natarajan, Richard P. WhitlockAbstractOptimal postprocedural antithrombotic regimen is uncertain after transcatheter aortic valve replacement (TAVR). We developed an online questionnaire on post-TAVR antithrombotic management. After research ethics board approval, we distributed the survey to TAVR implanters across Canada. A total of 24 TAVR implanters from 17 centres responded to the survey for a response rate of 75%. Dual antipla...
Source: Canadian Journal of Cardiology - November 2, 2019 Category: Cardiology Source Type: research

Routine Glycoprotein IIb/IIIa Inhibitor Therapy in ST-Segment Elevation Myocardial Infarction: A Meta-analysis
ConclusionsRoutine GPI administration in STEMI resulted in a reduction in mortality, driven by reductions in recurrent ischemic events—however predominantly in pre-prasugrel/ticagrelor trials. Trials with contemporary STEMI management are needed to confirm these findings.RésuméContexteLes lignes directrices recommandent le traitement d’appoint par des inhibiteurs des glycoprotéines IIb-IIIa (IGP) uniquement chez certains patients ayant subi un infarctus du myocarde avec élévation du segment ST (STEMI) aigu. Cette étude visait à évaluer l’utilisation systématique des IGP chez les patients ayant subi un STEMI ...
Source: Canadian Journal of Cardiology - November 2, 2019 Category: Cardiology Source Type: research

Perioperative Atrial Fibrillation in Noncardiac Surgeries for Malignancies and One-Year Recurrence
ConclusionsAF recurs in approximately 30% of patients with POAF with malignancy in the subsequent year; most recurrences are asymptomatic.RésuméContexteIl arrive fréquemment qu’un patient subissant une intervention chirurgicale non cardiaque présente une fibrillation auriculaire périopératoire (FAPO). On ne sait toutefois pas si d’autres épisodes de fibrillation auriculaire (FA) surviennent par la suite.MéthodologieLes auteurs ont mené une étude d’observation prospective unicentrique auprès de patients ayant subi une intervention chirurgicale non cardiaque visant à retirer une tumeur. Les patients ont fai...
Source: Canadian Journal of Cardiology - November 2, 2019 Category: Cardiology Source Type: research

Efficacy and Safety of High-intensity Statins in Patients with Acute Myocardial Infarction: An Asian Perspective
ConclusionsAMI patients in Taiwan with HIS had similar clinical outcomes to those with non-HIS. Using HIS for effective reduction of low-density lipoprotein cholesterol is safe in Taiwan.
Source: Canadian Journal of Cardiology - November 2, 2019 Category: Cardiology Source Type: research

Outcomes Among Clopidogrel, Prasugrel, and Ticagrelor in ST-Elevation Myocardial Infarction Patients Who Underwent Primary Percutaneous Coronary Intervention From the TOTAL Trial
ConclusionsIn this observational analysis of STEMI patients who underwent primary percutaneous coronary intervention, ticagrelor was associated with improved outcomes compared with clopidogrel and prasugrel. An appropriately powered randomized trial is needed to confirm these findings.RésuméContexteIl n’existe pas d’analyse robuste comparant les inhibiteurs P2Y12 à prise orale (clopidogrel, prasugrel et ticagrélor) chez les patients ayant subi un infarctus du myocarde avec élévation du segment ST (STEMI) traités par une intervention coronaire percutanée (ICP) primaire. Nous avons entrepris d’évaluer les rés...
Source: Canadian Journal of Cardiology - October 9, 2019 Category: Cardiology Source Type: research

Medical Management of LVAD Patients: A Practical Guide for the Non-Expert Clinician
This article provides a concise overview of the medical management of LVAD patients aimed for non-expert clinicians. Our presentation includes the basics of LVAD physiology, design and operation, patient selection, patient assessment, medical management, adverse event identification and management, multidisciplinary care, and management of special circumstances such as non-cardiac surgery, cardiac arrest, and end-of-life care. The clinical examination of LVAD patients is unique in terms of blood-pressure and heart-rate assessment, LVAD ‘hum’ auscultation, driveline/insertion-site inspection, and device-parameter record...
Source: Canadian Journal of Cardiology - October 5, 2019 Category: Cardiology Source Type: research

Bleeding tolerance among patients with atrial fibrillation on oral anticoagulation
ConclusionsThe key determinants of the Bleeding Ratio among anticoagulated AF patients are age, prior thromboembolic and bleeding episodes. The study could support identification of AF patients who need additional effort to increase their acceptance of a life-long OAC therapy.
Source: Canadian Journal of Cardiology - September 19, 2019 Category: Cardiology Source Type: research

Flow, Reflected by Stroke Volume Index, is a Risk Marker in High Gradient Aortic Stenosis Patients Undergoing Transcatheter Aortic Valve Replacement
ConclusionsSVi can further characterise patients with HG-AS and may help to identify those who are at increased risk following TAVR.
Source: Canadian Journal of Cardiology - August 30, 2019 Category: Cardiology Source Type: research

Peritonitis affects the relationship between low-density lipoprotein cholesterol and cardiovascular events in peritoneal dialysis patients
ConclusionsPD patients with lower baseline LDL-C had a higher risk of peritonitis. The effect of LDL-C on CV events and mortality was different by the presence of peritonitis events.
Source: Canadian Journal of Cardiology - August 30, 2019 Category: Cardiology Source Type: research

Glomerular Filtration Rate-Specific Cutoffs Can Refine the Prognostic Value of Circulating Cardiac Biomarkers in Advanced Chronic Kidney Disease
ConclusionsAmong asymptomatic patients with advanced chronic kidney disease, optimal cutoffs for hs-cTnT and NT-proBNP differed according to GFR level and outperformed standard cutoffs for discrimination of cardiovascular risk.RésuméContexteÀ l’aune des valeurs seuils standard établies chez les adultes en bonne santé, on constate que les taux de troponines cardiaques hypersensibles et de propeptide natriurétique de type B N-Terminal (NT-proBNP) sont fréquemment élevés chez les patients présentant un débit de filtration glomérulaire (DFG) réduit. Les implications de cette observation restent à élucider. Nou...
Source: Canadian Journal of Cardiology - August 30, 2019 Category: Cardiology Source Type: research

Antithrombotic Management Following Transcatheter Aortic Valve Replacement: A Survey of Canadian Physicians
Publication date: Available online 22 August 2019Source: Canadian Journal of CardiologyAuthor(s): Seleman Reza Bsc, Natalia Pinilla, Emilie P. Belley-Côté, Kevin J. Um, Serena Sibilio, Madhu K. Natarajan, Richard P. WhitlockAbstractOptimal post-procedural antithrombotic regimen is uncertain after transcatheter aortic valve replacement (TAVR). We developed an online questionnaire on post-TAVR antithrombotic management. After research ethics board approval, we distributed the survey to TAVR implanters across Canada. A total of 24 TAVR implanters from 17 centres responded to the survey for a response rate of 75%. Dual antip...
Source: Canadian Journal of Cardiology - August 22, 2019 Category: Cardiology Source Type: research

Clot lysis time predicts stroke during anticoagulant therapy in patients with atrial fibrillation
ConclusionsImpaired fibrinolysis may predict thromboembolic events in AF patients receiving VKA.
Source: Canadian Journal of Cardiology - August 8, 2019 Category: Cardiology Source Type: research

Self-Reported Daytime Sleepiness and Sleep-Disordered Breathing in Patients with Atrial Fibrillation: SNOozE-AF
ConclusionsIn an ambulatory AF population, SDB was common but most patients reported low daytime sleepiness levels. Clinical features, rather than daytime sleepiness, were predictive of patients with moderate-to-severe SDB. Lack of excessive daytime sleepiness should not preclude patients from being investigated for the potential presence of concomitant SDB
Source: Canadian Journal of Cardiology - August 2, 2019 Category: Cardiology Source Type: research

Arrhythmias in Adults with Congenital Heart Disease: What the Practicing Cardiologist Needs to Know
Publication date: Available online 16 July 2019Source: Canadian Journal of CardiologyAuthor(s): Paul KhairyAbstractThe expanding population of adults with congenital heart disease (CHD) combined with the pervasiveness of arrhythmias has resulted in the rapid growth of a dedicated sector of cardiology at the intersection between two subspecialties: electrophysiology and adult CHD. Herein, practical considerations are offered regarding urgent referral for catheter ablation of atrial arrhythmias, anticoagulation, and primary prevention implantable cardioverter-defibrillators (ICDs). Patients with Ebstein anomaly and ventricul...
Source: Canadian Journal of Cardiology - July 17, 2019 Category: Cardiology Source Type: research

Blinded Randomized trial of Anticoagulation to prevent Ischemic stroke and Neurocognitive impairment in AF (BRAIN-AF): Methods and design
ConclusionBRAIN-AF will determine whether oral anticoagulation therapy with rivaroxaban compared with standard of care reduces the risk of stroke, TIA or cognitive decline in patients with non-valvular AF and a low risk of stroke.
Source: Canadian Journal of Cardiology - May 8, 2019 Category: Cardiology Source Type: research

Stroke in HIV
Publication date: Available online 6 December 2018Source: Canadian Journal of CardiologyAuthor(s): Milana Bogorodskaya, Felicia C. Chow, Virginia A. TriantAbstractStroke is a heterogeneous disease in persons living with HIV (PLWH). HIV is thought to increase the risk of stroke through both HIV-related and traditional stroke risk factors, which vary with respect to the patient’s age and clinical characteristics. Numerous studies show that detectable viremia and immunosuppression increase the risk of stroke across all ages while traditional risk factors are more common in the aging HIV population. As PLWH age and acquire t...
Source: Canadian Journal of Cardiology - December 6, 2018 Category: Cardiology Source Type: research

Association Between Patient and Physician Sex and Physician-Estimated Stroke and Bleeding Risks in Atrial Fibrillation
ConclusionsOur study is the first to examine the association between patient and physician sex influences and stroke and bleeding risk estimation in AF. While there were differences in agreement between physician estimated stroke risk and calculated CHADS2 scores, these differences were small and unlikely to impact clinical practice; further, despite any perceived differences in the accuracy of risk assessment by sex, most patients received anticoagulation.
Source: Canadian Journal of Cardiology - December 4, 2018 Category: Cardiology Source Type: research

The multiple causes of stroke in atrial fibrillation: Thinking broadly
Publication date: Available online 30 August 2018Source: Canadian Journal of CardiologyAuthor(s): Atlantic D’Souza, Kenneth S. Butcher, Brian H. BuckAbstract:Atrial Fibrillation (AF) is numerically the most important risk factor for stroke. It is well established that patients with AF have a five-fold increased risk of stroke relative to those without, and that anticoagulation reduces the risk of stroke by approximately two-thirds. Definitively attributing the mechanism of an individual stroke to AF is much more problematic, however. In fact, there is no way to reliably establish the etiology of any ischemic infarction. ...
Source: Canadian Journal of Cardiology - August 31, 2018 Category: Cardiology Source Type: research

Integrating Individuals with Stroke into Cardiac Rehabilitation Following Traditional Stroke Rehabilitation: Promoting a Continuum of Care
Publication date: Available online 11 July 2018Source: Canadian Journal of CardiologyAuthor(s): Susan Marzolini, R. KinUnstructured AbstractIndividuals following stroke are at a high risk for a repeat stroke and for complications related to coronary artery disease. Indeed, stroke and coronary artery disease share many of the same risk factors. Unfortunately, patients become sedentary after stroke leading to cardiorespiratory deconditioning as well as muscle atrophy and weakness that leads to deterioration in metabolic, cardiorespiratory, and functional health. Access to intensive secondary prevention programs with a struct...
Source: Canadian Journal of Cardiology - July 12, 2018 Category: Cardiology Source Type: research

Telehealth for Remote Stroke Management
Publication date: July 2018Source: Canadian Journal of Cardiology, Volume 34, Issue 7Author(s): Charlotte Zerna, Thomas Jeerakathil, Michael D. HillAbstractStroke is a leading cause of adult disability and the fourth leading cause of death in Canada. Most strokes are ischemic and functional outcome is highly time-dependent, making fast diagnosis and treatment initiation crucial. This poses a challenge in vast geographical areas where stroke neurology expertise is only available in urban centres. In this article we review the rationale for telestroke networks and their current implementation in Canada. Telestroke networks e...
Source: Canadian Journal of Cardiology - July 10, 2018 Category: Cardiology Source Type: research

Elevated Incidence of Atrial Fibrillation and Stroke in Patients With Atrial Flutter—A Population-Based Study
ConclusionsPatients with isolated atrial flutter develop AF and stroke at a higher rate than the general population. Catheter ablation reduces but does not eliminate future AF incidence and stroke risk and continued anticoagulation after successful atrial flutter ablation might therefore be warranted.RésuméIntroductionOn ignore le risque d’accident vasculaire cérébral (AVC) dû au flutter auriculaire et sa relation avec la progression de la fibrillation auriculaire (FA). La présente étude décrit l’incidence de la FA et de l'AVC chez les patients atteints de flutter auriculaire, et montre si l’ablation du flutt...
Source: Canadian Journal of Cardiology - July 10, 2018 Category: Cardiology Source Type: research

Telehealth for Remote Stroke Management
Publication date: July 2018Source: Canadian Journal of Cardiology, Volume 34, Issue 7Author(s): Charlotte Zerna, Thomas Jeerakathil, Michael D. HillAbstractStroke is a leading cause of adult disability and the fourth leading cause of death in Canada. Most strokes are ischemic and functional outcome is highly time-dependent, making fast diagnosis and treatment initiation crucial. This poses a challenge in vast geographical areas where stroke neurology expertise is only available in urban centres. In this article we review the rationale for telestroke networks and their current implementation in Canada. Telestroke networks e...
Source: Canadian Journal of Cardiology - July 5, 2018 Category: Cardiology Source Type: research

Elevated Incidence of Atrial Fibrillation and Stroke in Patients With Atrial Flutter—A Population-Based Study
ConclusionsPatients with isolated atrial flutter develop AF and stroke at a higher rate than the general population. Catheter ablation reduces but does not eliminate future AF incidence and stroke risk and continued anticoagulation after successful atrial flutter ablation might therefore be warranted.RésuméIntroductionOn ignore le risque d’accident vasculaire cérébral (AVC) dû au flutter auriculaire et sa relation avec la progression de la fibrillation auriculaire (FA). La présente étude décrit l’incidence de la FA et de l'AVC chez les patients atteints de flutter auriculaire, et montre si l’ablation du flutt...
Source: Canadian Journal of Cardiology - July 5, 2018 Category: Cardiology Source Type: research

Elevated Incidence of Atrial Fibrillation and Stroke in Patients With Atrial Flutter —A Population-Based Study
Conclusions Patients with isolated atrial flutter develop AF and stroke at a higher rate than the general population. Catheter ablation reduces but does not eliminate future AF incidence and stroke risk and continued anticoagulation after successful atrial flutter ablation might therefore be warranted.
Source: Canadian Journal of Cardiology - May 26, 2018 Category: Cardiology Source Type: research

Stroke Prevention for High-Risk Atrial Fibrillation in the Emergency Setting: The Emergency Physician Perspective
Publication date: February 2018 Source:Canadian Journal of Cardiology, Volume 34, Issue 2 Author(s): Clare L. Atzema Atrial fibrillation is a frequent reason for presentation to an emergency department (ED), and the number of these visits are increasing. This creates an opportunity to improve the suboptimal rate of oral anticoagulation (OAC) use in patients with atrial fibrillation who are at high risk of stroke. However, there are very few data on whether OAC initiation in the ED, compared with referral to the longitudinal health care provider to initiate it, results in better long-term use. Moreover, for ethical and med...
Source: Canadian Journal of Cardiology - February 3, 2018 Category: Cardiology Source Type: research

Elevated Incidence of Atrial Fibrillation and Stroke in Patients with Atrial Flutter – A Population-Based Study
Conclusions Patients with isolated atrial flutter develop atrial fibrillation and stroke at a higher rate than the general population. Catheter ablation reduces but does not eliminate future AF incidence and stroke risk and continued anticoagulation after successful atrial flutter ablation may therefore be warranted. Teaser We examine the incidence of atrial fibrillation and stroke in a large real-world cohort of patients with atrial flutter, and the impact of atrial flutter ablation. Patients with atrial flutter developed atrial fibrillation and stroke at a higher rate than the general population. Atrial flutter ablation ...
Source: Canadian Journal of Cardiology - January 6, 2018 Category: Cardiology Source Type: research

Telehealth for remote stroke management
This article reviews the rationale for telestroke networks and their current implementation in Canada. Telestroke networks enable stroke-specific procedures to be performed by less experiences physicians under the guidance of stroke neurology experts. The article also presents evidence that the safety and effectiveness of intravenous alteplase in community hospitals in a telestroke network seems to be comparable to that achieved in dedicated stroke centres. It is thus a viable option to guarantee an aging population access to stroke care across large geographic regions with faster treatment and access to more advanced trea...
Source: Canadian Journal of Cardiology - December 27, 2017 Category: Cardiology Source Type: research

Warfarin and the risk of stroke and bleeding in patients with atrial fibrillation receiving dialysis: A systematic review and meta-analysis
Conclusion Observational studies suggest that warfarin was not associated with a clear benefit or harm among patients who have atrial fibrillation and are receiving dialysis. These estimates were limited by study heterogeneity including the inability to account for a number of important confounders such as the time in the therapeutic range. Given the high prevalence of atrial fibrillation, stroke, and bleeding complications in this population, well-designed clinical trials of warfarin and other anti-coagulants are urgently needed. Teaser Patients with atrial fibrillation receiving maintenance dialysis are at a high risk of...
Source: Canadian Journal of Cardiology - February 21, 2017 Category: Cardiology Source Type: research

Lack of Association Between Extracranial Carotid and Vertebral Artery Disease and Stroke After Transcatheter Aortic Valve Replacement
Conclusions The presence or absence of carotid or vertebral artery stenosis was not significantly related to the occurrence of stroke after TAVR. Routine screening for carotid and vertebral artery disease before TAVR does not appear justified.
Source: Canadian Journal of Cardiology - November 22, 2016 Category: Cardiology Source Type: research

Antithrombotic Treatments for Stroke Prevention in Elderly Patients With Nonvalvular Atrial Fibrillation: Drugs and Doses
Publication date: September 2016 Source:Canadian Journal of Cardiology, Volume 32, Issue 9 Author(s): Mustafa Kilickap, Jackie Bosch, John W. Eikelboom, Robert G. Hart Atrial fibrillation (AF) is a common cardiac rhythm disturbance and is associated with a 5-fold increased risk of stroke. The most important risk factors for stroke in patients with AF are previous stroke and age ≥ 75 years. Canadian guidelines recommend anticoagulant therapy for patients with AF who are older than the age of 65 years, but the elderly often remain undertreated, primarily because of concerns regarding bleeding. Non-vitamin K oral anticoagu...
Source: Canadian Journal of Cardiology - August 26, 2016 Category: Cardiology Source Type: research

Antithrombotic treatments for stroke prevention in elderly patients with non-valvular atrial fibrillation: Drugs and doses
Publication date: Available online 14 June 2016 Source:Canadian Journal of Cardiology Author(s): Mustafa Kilickap, Jackie Bosch, John W. Eikelboom, Robert G. Hart Atrial fibrillation (AF) is a common cardiac rhythm disturbance and is associated with a 5-fold increased risk of stroke. The most important risk factors for stroke in patients with AF are prior stroke and age ≥75 years. Canadian guidelines recommend anticoagulant therapy for AF patients over the age of 65 but the elderly often remain undertreated, primarily because of concerns regarding bleeding. Non-vitamin K oral anticoagulants appear to be safer, at l...
Source: Canadian Journal of Cardiology - June 15, 2016 Category: Cardiology Source Type: research

Values and Preferences of Physicians and Patients With Nonvalvular Atrial Fibrillation Who Receive Oral Anticoagulation Therapy for Stroke Prevention
Conclusions Real-world prescriptions do not reflect reported values, which suggests that other factors influence patient-physician decision-making around OAC therapy. Data on self-reported adherence to OAC therapy and discordance in the use of OACs from prescribed regimens are concerning and warrant further investigation.
Source: Canadian Journal of Cardiology - May 25, 2016 Category: Cardiology Source Type: research

CHA2DS2-VASc Recalibration with an Additional Age Category (50-64 years) Enhances Stroke Risk Stratification in Chinese Atrial Fibrillation Patients
CONCLUSION Chinese patients with AF and low CHA2DS2-VASc score were at a disproportionally high risk of ischemic stroke. Chinese patients between 50-64 are at a high risk for stroke despite a low CHA2DS2-VASc score and have low bleeding risk. Only patients aged <50 years are truly low risk. Teaser Chinese atrial fibrillation (AF) patients with low CHA2DS2-VASc scores had a higher ischemic stroke risk than the Caucasians’ counterparts. In this study, we identified that even for Chinese AF patients aged 50-64 years, stroke risk is still markedly elevated. Only patients aged <50 belong to the truly low risk group.
Source: Canadian Journal of Cardiology - May 14, 2016 Category: Cardiology Source Type: research

Lack of Association Between Extracranial Carotid and Vertebral Artery Disease and Stroke Following Trans-catheter Aortic Valve Replacement
Conclusions The presence or absence of carotid or vertebral artery stenosis was not significantly related to the occurrence of post-TAVR stroke. Routine screening for carotid and vertebral artery disease prior to trans-catheter aortic valve replacement does not appear justified. Teaser In a retrospective cohort study, 19% (n=51) of 263 trans-catheter aortic valve replacement (TAVR) patients had CVD (> 50% stenosis of a carotid or vertebral artery). Post-TAVR stroke occurred in 7% (n=18). All strokes occurred in patients without CVD, and both 30-day mortality rates (10% vs 4%, p=0.11) and overall survival (log-rank t...
Source: Canadian Journal of Cardiology - March 29, 2016 Category: Cardiology Source Type: research

Cost-Effectiveness of Left Atrial Appendage Closure for Stroke Prevention in Atrial Fibrillation Patients with Contraindications to Anticoagulation
Conclusions LAAC is a novel stroke preventative therapy for non-valvular AF and is a cost-effective alternative to aspirin in patients with contraindications to OAC. Teaser We sought to evaluate the cost-effectiveness of left atrial appendage closure (LAAC) compared to aspirin in atrial fibrillation patients with contraindications to oral anticoagulation (OAC). A probabilistic patient-level Markov microsimulation model with lifetime horizon was performed. Aspirin was less effective than LAAC, with average discounted lifetime cost of $38,974±18,783 for aspirin and $30,748±11,600 for LAAC. LAAC was dominant, being more eff...
Source: Canadian Journal of Cardiology - February 25, 2016 Category: Cardiology Source Type: research

Values and preferences of physicians and patients with non-valvular atrial fibrillation receiving oral anticoagulation therapy for stroke prevention
Conclusions Real-world prescriptions do not reflect reported values, suggesting other factors influence patient-physician decision-making around OAC therapy. Data on self-reported adherence to OAC therapy and discordance in the use of OACs from prescribed regimens are concerning and warrant further investigation. Teaser Through a national survey we determined that the preferences of patients and physicians regarding oral anticoagulant (OAC) therapy for stroke prevention in atrial fibrillation differed, but largely focused on characteristics related to safety. However, real-world prescriptions do not reflect the reported va...
Source: Canadian Journal of Cardiology - November 10, 2015 Category: Cardiology Source Type: research

The Risk Stratification and Stroke Prevention Therapy Care Gap in Canadian Atrial Fibrillation Patients
Conclusions In a large Canadian AF population, primary care physicians did not provide a stroke or bleeding risk in a substantial proportion of their AF patients. When estimates were provided, they were on the basis of a predictive stroke and bleeding risk index in less than half of the patients. Furthermore, there was under- and overestimation of stroke and bleeding risk in a substantial proportion of patients. As many as 1 in 3 patients receiving warfarin have their TTR < 60%. These findings suggest an opportunity to enhance knowledge translation to primary care physicians.
Source: Canadian Journal of Cardiology - October 23, 2015 Category: Cardiology Source Type: research

Resident Physicians Choices of Anticoagulation for Stroke Prevention in Patients with Nonvalvular Atrial Fibrillation
This study revealed that, across a wide sampling of disciplines and centers, resident physician choices of anticoagulation in nonvalvular AF differ significantly from contemporary CCS guidelines. Teaser The mainstay of atrial fibrillation (AF) management is stroke prevention using oral anticoagulants. We surveyed 1014 resident physicians from family medicine, emergency medicine, internal medicine and adult cardiology specialties. We found that resident physicians provide care to large number of AF patients and their choices of anticoagulation for stroke prevention are not congruent with the Canadian Cardiovascular Society...
Source: Canadian Journal of Cardiology - August 15, 2015 Category: Cardiology Source Type: research

The Risk of Ischemic Heart Disease and Stroke Among Immigrant Populations: A Systematic Review
Conclusions The risks of ischemic heart disease and stroke vary widely in immigrant populations in Western Europe. Detailed studies of immigrants to Canada by country of birth and duration of residence should be undertaken to guide future cardiovascular health promotion initiatives. Teaser This review summarizes 17 studies on the risks of ischemic heart disease (IHD) and stroke among immigrants to high-income countries. The results varied by country-of-origin, host country, and duration of residence. Multiple studies of immigrants to Western Europe show that most immigrant groups are at similar or higher risk of developing...
Source: Canadian Journal of Cardiology - May 16, 2015 Category: Cardiology Source Type: research

Oral anticoagulation for stroke prevention in Canadian practice: Stroke Prevention and Rhythm Interventions in Atrial Fibrillation (SPRINT-AF) registry
Conclusions In this contemporary Canadian AF registry, the rate of guideline-concordant OAC use was high. About half of OAC-treated patients received NOAC agents. Patient- and physician-driven preferences such as side effect profile, perceived greater efficacy, and cost were strong determinants of NOAC over warfarin use. Teaser This is a cross-sectional, retrospective analysis of 936 patients with non-valvular atrial fibrillation enrolled from 106 practices in Canada between December 2012 and July 2013. We observed that the rate of guideline-concordant oral anticoagulation use was high (90%), with new direct oral anticoagu...
Source: Canadian Journal of Cardiology - May 2, 2015 Category: Cardiology Source Type: research

Relationship Between Insulin-like Growth Factor Binding Protein-2 and Left Ventricular Stroke Volume in Patients with Aortic Stenosis
Conclusions In this study, we documented that lower IGFBP-2 levels are independently associated with lower SVi, a powerful predictor of worse outcomes in the mild to moderate AS population. Teaser In aortic stenosis (AS) patients, LV remodeling and function vary extensively from one patient to another. Considering the associations between circulating IGFBP-2 and markers of the metabolic syndrome, the aim of the study was to examine the relationship between circulating IGFBP-2 and left ventricle (LV) pump function as measured by stroke volume index in AS patients with preserved LV ejection fraction.
Source: Canadian Journal of Cardiology - April 30, 2015 Category: Cardiology Source Type: research

Sleep Apnea and Stroke
Publication date: Available online 14 March 2015 Source:Canadian Journal of Cardiology Author(s): Owen D. Lyons , Clodagh M. Ryan Stroke is the second leading cause of death worldwide and often has devastating consequences for affected individuals in terms of chronic disability. Traditional risk factors such as age, male sex, ethnicity, hypertension and atrial fibrillation explain 60-80% of the risk of stroke. Obstructive sleep apnea (OSA) is highly prevalent in the post-stroke population and its emerging role as a potential modifiable risk factor for stroke has been recognised in the most recent American Heart Associati...
Source: Canadian Journal of Cardiology - March 14, 2015 Category: Cardiology Source Type: research

Association of Inflammatory and Hemostatic Markers With Stroke and Thromboembolic Events in Atrial Fibrillation: A Systematic Review and Meta-analysis
Conclusions In conclusion, increased circulating PAI-1 and TAT levels were significantly associated with subsequent stroke in patients with AF, and high levels of D-dimer were associated with thromboembolic events in AF. Further epidemiologic studies are needed to accumulate more evidence on the prognostic role of inflammatory and hemostatic markers in AF.
Source: Canadian Journal of Cardiology - March 5, 2015 Category: Cardiology Source Type: research

Overnight Effects of Obstructive Sleep Apnea and Its Treatment on Stroke Volume in Patients with Heart Failure
Conclusions In patients with HF, co-existing OSA causes overnight declines in SV and CO that are prevented through reversal of OSA by CPAP. 
Source: Canadian Journal of Cardiology - January 17, 2015 Category: Cardiology Source Type: research

Association of inflammatory and hemostatic markers with stroke and thromboembolic event in atrial fibrillation: a systematic review and meta-analysis
Conclusions In conclusion, increased circulating PAI-1 and TAT levels were significantly associated with subsequent stroke in patients with AF, and D-dimer was associated with thromboembolic events in AF. Further epidemiological studies are needed to accumulate more evidence on the prognostic role of inflammatory and hemostatic markers in AF. Teaser The prognostic value of inflammatory and hemostatic markers in atrial fibrillation (AF) remains inconclusive. We conducted a systematic review and meta-analysis to evaluate the association of inflammatory and hemostatic markers with stroke and thromboembolic events in patients ...
Source: Canadian Journal of Cardiology - December 10, 2014 Category: Cardiology Source Type: research

Echocardiography Underestimates Stroke Volume and Aortic Valve Area: Implications for Patients With Small-Area Low-Gradient Aortic Stenosis
Conclusions Echocardiography underestimated LVOTarea, stroke volume, and therefore AVA, compared with MRI. The thresholds based on current guidelines were also inconsistent. In combination, these factors explain > 40% of patients with discordant small-area low-gradient AS.
Source: Canadian Journal of Cardiology - November 1, 2014 Category: Cardiology Source Type: research