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Atrial Fibrillation and end-stage renal failure patients on dialysis: balancing the risks and benefits of stroke prevention
Publication date: Available online 28 February 2017 Source:Canadian Journal of Cardiology Author(s): Christos Voukalis, Gregory YH. Lip
Source: Canadian Journal of Cardiology - February 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 20, 2017 Category: Cardiology Source Type: research

Rational medical therapy is the key to effective cardiovascular disease prevention
Publication date: Available online 19 January 2017 Source:Canadian Journal of Cardiology Author(s): J. David Spence In an era in which personalized medicine based on genotyping is being proposed, it is timely to recognize that existing therapies could be markedly improved if based on available phenotyping. Blood pressure control, which is poor on a worldwide basis, is a major opportunity to reduce cardiovascular risk. There are many genetic variants that have a small effect on blood pressure, but specific therapies are not available for most of them. Individualized therapy for hypertension using plasma renin and aldostero...
Source: Canadian Journal of Cardiology - January 18, 2017 Category: Cardiology Source Type: research

At What Age Does Stroke Risk Increase in Patients With Atrial Fibrillation? Does It Depend on Where You Live?
Publication date: December 2016 Source:Canadian Journal of Cardiology, Volume 32, Issue 12 Author(s): Jeff S. Healey
Source: Canadian Journal of Cardiology - November 21, 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 25, 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 14, 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 24, 2016 Category: Cardiology Source Type: research

Uninterrupted New Oral Anticoagulants Compared With Uninterrupted Vitamin K Antagonists in Ablation of Atrial Fibrillation: A Meta-analysis
Conclusions Use of uninterrupted NOACs in ablation appears to be as safe and efficacious as use of uninterrupted VKAs.
Source: Canadian Journal of Cardiology - May 24, 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 13, 2016 Category: Cardiology Source Type: research

The Development And Feasibility Assessment Of Canadian Quality Indicators For Atrial Fibrillation
Publication date: Available online 27 February 2016 Source:Canadian Journal of Cardiology Author(s): Jafna L. Cox, Sulan Dai, Yanyan Gong., Robert McKelvie, M. Sean McMurtry, Garth H. Oakes, Allan Skanes, Atul Verma, Stephen B. Wilton, D. George Wyse In 2010, the Canadian Cardiovascular Society (CCS) embarked on an initiative to develop pan-Canadian quality indicators (QIs) and standardized data definitions with the ultimate goal of monitoring, comparing, and contrasting national cardiovascular care and its outcomes. One of the first working groups to be established was tasked with identifying and then defining...
Source: Canadian Journal of Cardiology - February 28, 2016 Category: Cardiology Source Type: research

Left Atrial Appendage Closure for Atrial Fibrillation Is Safe and Effective After Intracranial or Intraocular Hemorrhage
Conclusions In our consecutive series, LAA closure was found to be safe and effective in patients with AF and a history of ICH or IOH.
Source: Canadian Journal of Cardiology - February 25, 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

AF Genetics: Is There a Practical Clinical Value Now or In The Future?
Publication date: Available online 12 February 2016 Source:Canadian Journal of Cardiology Author(s): William J. Hucker, Harsimran Saini, Steven A. Lubitz, Patrick T. EllinorTeaser Atrial fibrillation (AF) is heritable and in recent years many genetic loci have been associated with the arrhythmia. Current efforts are directed at determining if AF genetic data can be used to refine clinical risk prediction, predict response to medical or procedural treatments, or help to determine the sequelea of AF such as heart failure and stroke.
Source: Canadian Journal of Cardiology - February 12, 2016 Category: Cardiology Source Type: research

Net Clinical Benefit of Dabigatran over Warfarin in Patients with Atrial Fibrillation Stratified by CHA2DS2-VASc Score and Time in Therapeutic Range
Conclusion The combination of CHA2DS2-VASc score and TTR facilitates patient prioritization for dabigatran. The best net clinical benefit for switching warfarin to dabigatran was found in those with both high CHA2DS2-VASc score and poor TTR. Teaser Non-vitamin K antagonist oral anticoagulants (NOAC) are now preferred to warfarin for stroke prevention in atrial fibrillation. In this study, we have shown that combination of CHA2DS2-VASc score and time in therapeutic range (TTR) facilitates patient prioritization for Dabigatran – one of the NOACs. The best net clinical benefit for switching from Dabigatran to warfarin was o...
Source: Canadian Journal of Cardiology - January 26, 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

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