BACKGROUND The quality of warfarin therapy can be determined by the time in the therapeutic range(TTR)of international normalized ratio(INR).The estimated minimum TTR needed to achieve a benefit from warfarin therapy...BACKGROUND The quality of warfarin therapy can be determined by the time in the therapeutic range(TTR)of international normalized ratio(INR).The estimated minimum TTR needed to achieve a benefit from warfarin therapy is≥60%.AIM To determine TTR and the predictors of poor TTR among atrial fibrillation patients who receive warfarin therapy.METHODS A retrospective observational study was conducted at a cardiology referral center in Selangor,Malaysia.A total of 420 patients with atrial fibrillation and under follow-up at the pharmacist led Warfarin Medication Therapeutic Adherence Clinic between January 2014 and December 2018 were included.Patients’clinical data,information related to warfarin therapy,and INR readings were traced through electronic Hospital Information system.A data collection form was used for data collection.The percentage of days when INR was within range was calculated using the Rosendaal method.The poor INR control category was defined as a TTR<60%.Predictors for poor TTR were further determined by using logistic regression.RESULTS A total of 420 patients[54.0%male;mean age 65.7(10.9)years]were included.The calculated mean and median TTR were 60.6%±20.6%and 64%(interquartile range 48%-75%),respectively.Of the included patients,57.6%(n=242)were in the good control category and 42.4%(n=178)were in the poor control category.The annual calculated mean TTR between the year 2014 and 2018 ranged from 59.7%and 67.3%.A high HAS-BLED score of≥3 was associated with poor TTR(adjusted odds ratio,2.525;95%confidence interval:1.6-3.9,P<0.001).CONCLUSION In our population,a high HAS-BLED score was associated with poor TTR.This could provide an important insight when initiating an oral anticoagulant for these patients.Patients with a high HAS-BLED score may obtain less benefit from warfarin therapy and should be considered for other available oral anticoagulants for maximum benefit.展开更多
Background Atrial fibrillation （AF） and coronary artery disease （CAD） often coexist, however, the clinical characteristics and the impact of stable CAD on the outcomes in Chinese patients with AF has not been well...Background Atrial fibrillation （AF） and coronary artery disease （CAD） often coexist, however, the clinical characteristics and the impact of stable CAD on the outcomes in Chinese patients with AF has not been well understood. Methods Consecutive AF patients in 20 hospitals in China from November 2008 to October 2011 were enrolled. The primary endpoints included 1-year all-cause mortality, stroke, non-central nervous system （non-CNS） embolism, and major bleeding. Results A total of 1947 AF patients were analyzed, of whom 40.5% had stable CAD. The mean CHADS2 scores in CAD patients were significantly higher than that of non-CAD patients （2.4 - 1.4 vs. 1.4 - 1.2, P 〈 0.001）. During follow-up period, warfarin use is low in both groups, with relatively higher proportion in non-CAD patients compared with CAD patients （22.3% vs. 10.7%, P 〈 0.001）. Compared with non-CAD patients, CAD patients had higher one-year all-cause mortality （16.8% vs. 12.9%, P = 0.017） and incidence of stroke （9.0% vs. 6.4%, P = 0.030）, while the non-CNS embolism and major bleeding rates were comparable between the two groups. After multivariate adjustment, stable CAD was independently associated with increased risk of 1-year all-cause mortality （HR = 1.35, 95% CI： 1.01-1 .80, P = 0.040）, but not associated with stroke （HR = 1.07, 95% CI： 0.72-1.58, P = 0.736）. Conclusions Stable CAD was prevalent in Chinese AF patients and was independently associated with increased risk of 1-year all-cause mortality. Chinese AF patients with stable CAD received inadequate antithrombotic therapy and this grim status of antithrombotic therapy needed to be improved urgently.展开更多
Background:The age,biomarkers,and clinical history(ABC)-atrial fibrillation(AF)-Stroke score have been proposed to refine stroke risk stratification,beyond what clinical risk scores such as the CHA2DS2-VASc score can ...Background:The age,biomarkers,and clinical history(ABC)-atrial fibrillation(AF)-Stroke score have been proposed to refine stroke risk stratification,beyond what clinical risk scores such as the CHA2DS2-VASc score can offer.This study aimed to identify risk factors associated with thromboembolism and evaluate the performance of the ABC-AF-Stroke score in predicting thromboembolism in non-anticoagulated AF patients following successful ablations.Methods:A total of 2692 patients who underwent successful ablations with discontinued anticoagulation after a 3-month blanking period in the Chinese Atrial Fibrillation Registry(CAFR)between 2013 and 2019 were included.Cox regression analysis was conducted to present the association of risk factors with thromboembolism risk.The ABC-AF-Stroke score was evaluated in terms of discrimination,including concordance index(C-index),net reclassification improvement(NRI)and integrated discrimination improvement(IDI),clinical utilization by decision curve analysis(DCA),and calibration by comparing the predicted risk with the observed annualized event rate.Results:After a median follow-up of 3.5 years,64 patients experienced thromboembolism events.Age,prior history of stroke/transient ischemic attack(TIA),high-sensitivity cardiac troponin T(cTnT-hs),and N-terminal pro-B-type natriuretic peptide(NT-proBNP)were independently associated with thromboembolism risk.The ABC-AF-Stroke score performed statistically significantly better than the CHA2DS2-VASc score in terms of C-index(0.67,95%confidence interval[CI]:0.59-0.74 vs.0.60,95%CI:0.52-0.67,P=0.030)and reclassification capacity.The DCA implied that the ABC-AF-Stroke score could identify more thromboembolism events without increasing the false positive rate compared to the CHA2DS2-VASc score.The calibration curve showed that the ABC-AF-Stroke score was well calibrated in this population.Conclusions:In this real-world study enrolling non-anticoagulated AF patients following successful ablations,age,prior history of stroke/TIA,level of NT-proBNP,and cTnT-hs were independently associated with an increased risk of thromboembolism.The ABC-AF-Stroke score was well-calibrated and statistically significantly outperformed the CHA2DS2-VASc score in predicting thromboembolism risk.展开更多
BACKGROUND Inpatient telemetry heart rhythm monitoring overuse has been linked to higher healthcare costs.AIM To evaluate if CHA2DS2-VASc score could be used to indicate if a patient admitted with possible cerebrovasc...BACKGROUND Inpatient telemetry heart rhythm monitoring overuse has been linked to higher healthcare costs.AIM To evaluate if CHA2DS2-VASc score could be used to indicate if a patient admitted with possible cerebrovascular accident(CVA)or transient ischemic attack(TIA)requires inpatient telemetry monitoring.METHODS A total of 257 patients presenting with CVA or TIA and placed on telemetry monitoring were analyzed retrospectively.We investigated the utility of telemetry monitoring to diagnose atrial fibrillation/flutter and the CHA2DS2-VASc scoring tool to stratify the risk of having CVA/TIA in these patients.RESULTS In our study population,63(24.5%)of the patients with CVA/TIA and telemetry monitoring were determined to have no ischemic neurologic event.Of the 194(75.5)patients that had a confirmed CVA/TIA,only 6(2.3%)had an arrhythmia detected during their inpatient telemetry monitoring period.Individuals with a confirmed CVA/TIA had a statistically significant higher CHA2DS2-VASc score compared to individuals without an ischemic event(3.59 vs 2.61,P<0.001).CONCLUSION Given the low percentage of inpatient arrhythmias identified,further research should focus on discretionary use of inpatient telemetry on higher risk patients to diagnose the arrhythmias commonly leading to CVA/TIA.A prospective study assessing event rate of CVA/TIA in patients with higher CHA2DS2-VASc score should be performed to validate the CHA2DS2-VASc score as a possible risk stratifying tool for patients at risk for CVA/TIA.展开更多
文摘BACKGROUND The quality of warfarin therapy can be determined by the time in the therapeutic range(TTR)of international normalized ratio(INR).The estimated minimum TTR needed to achieve a benefit from warfarin therapy is≥60%.AIM To determine TTR and the predictors of poor TTR among atrial fibrillation patients who receive warfarin therapy.METHODS A retrospective observational study was conducted at a cardiology referral center in Selangor,Malaysia.A total of 420 patients with atrial fibrillation and under follow-up at the pharmacist led Warfarin Medication Therapeutic Adherence Clinic between January 2014 and December 2018 were included.Patients’clinical data,information related to warfarin therapy,and INR readings were traced through electronic Hospital Information system.A data collection form was used for data collection.The percentage of days when INR was within range was calculated using the Rosendaal method.The poor INR control category was defined as a TTR<60%.Predictors for poor TTR were further determined by using logistic regression.RESULTS A total of 420 patients[54.0%male;mean age 65.7(10.9)years]were included.The calculated mean and median TTR were 60.6%±20.6%and 64%(interquartile range 48%-75%),respectively.Of the included patients,57.6%(n=242)were in the good control category and 42.4%(n=178)were in the poor control category.The annual calculated mean TTR between the year 2014 and 2018 ranged from 59.7%and 67.3%.A high HAS-BLED score of≥3 was associated with poor TTR(adjusted odds ratio,2.525;95%confidence interval:1.6-3.9,P<0.001).CONCLUSION In our population,a high HAS-BLED score was associated with poor TTR.This could provide an important insight when initiating an oral anticoagulant for these patients.Patients with a high HAS-BLED score may obtain less benefit from warfarin therapy and should be considered for other available oral anticoagulants for maximum benefit.
文摘Background Atrial fibrillation （AF） and coronary artery disease （CAD） often coexist, however, the clinical characteristics and the impact of stable CAD on the outcomes in Chinese patients with AF has not been well understood. Methods Consecutive AF patients in 20 hospitals in China from November 2008 to October 2011 were enrolled. The primary endpoints included 1-year all-cause mortality, stroke, non-central nervous system （non-CNS） embolism, and major bleeding. Results A total of 1947 AF patients were analyzed, of whom 40.5% had stable CAD. The mean CHADS2 scores in CAD patients were significantly higher than that of non-CAD patients （2.4 - 1.4 vs. 1.4 - 1.2, P 〈 0.001）. During follow-up period, warfarin use is low in both groups, with relatively higher proportion in non-CAD patients compared with CAD patients （22.3% vs. 10.7%, P 〈 0.001）. Compared with non-CAD patients, CAD patients had higher one-year all-cause mortality （16.8% vs. 12.9%, P = 0.017） and incidence of stroke （9.0% vs. 6.4%, P = 0.030）, while the non-CNS embolism and major bleeding rates were comparable between the two groups. After multivariate adjustment, stable CAD was independently associated with increased risk of 1-year all-cause mortality （HR = 1.35, 95% CI： 1.01-1 .80, P = 0.040）, but not associated with stroke （HR = 1.07, 95% CI： 0.72-1.58, P = 0.736）. Conclusions Stable CAD was prevalent in Chinese AF patients and was independently associated with increased risk of 1-year all-cause mortality. Chinese AF patients with stable CAD received inadequate antithrombotic therapy and this grim status of antithrombotic therapy needed to be improved urgently.
基金funded by the National Key Research and Development Program of China(2020YFC2004803)the National Natural Science Foundation of China(82100326,82103904)+2 种基金the Beijing Municipal Science and Technology Commission(D171100006817001)the Beijing Municipal Education Commission(KM202210025012)The construction of CARF was supported by grants from Bristol-Myers Squibb,Pfizer,Johnson&Johnson,Boehringer Ingelheim,and Bayer.
文摘Background:The age,biomarkers,and clinical history(ABC)-atrial fibrillation(AF)-Stroke score have been proposed to refine stroke risk stratification,beyond what clinical risk scores such as the CHA2DS2-VASc score can offer.This study aimed to identify risk factors associated with thromboembolism and evaluate the performance of the ABC-AF-Stroke score in predicting thromboembolism in non-anticoagulated AF patients following successful ablations.Methods:A total of 2692 patients who underwent successful ablations with discontinued anticoagulation after a 3-month blanking period in the Chinese Atrial Fibrillation Registry(CAFR)between 2013 and 2019 were included.Cox regression analysis was conducted to present the association of risk factors with thromboembolism risk.The ABC-AF-Stroke score was evaluated in terms of discrimination,including concordance index(C-index),net reclassification improvement(NRI)and integrated discrimination improvement(IDI),clinical utilization by decision curve analysis(DCA),and calibration by comparing the predicted risk with the observed annualized event rate.Results:After a median follow-up of 3.5 years,64 patients experienced thromboembolism events.Age,prior history of stroke/transient ischemic attack(TIA),high-sensitivity cardiac troponin T(cTnT-hs),and N-terminal pro-B-type natriuretic peptide(NT-proBNP)were independently associated with thromboembolism risk.The ABC-AF-Stroke score performed statistically significantly better than the CHA2DS2-VASc score in terms of C-index(0.67,95%confidence interval[CI]:0.59-0.74 vs.0.60,95%CI:0.52-0.67,P=0.030)and reclassification capacity.The DCA implied that the ABC-AF-Stroke score could identify more thromboembolism events without increasing the false positive rate compared to the CHA2DS2-VASc score.The calibration curve showed that the ABC-AF-Stroke score was well calibrated in this population.Conclusions:In this real-world study enrolling non-anticoagulated AF patients following successful ablations,age,prior history of stroke/TIA,level of NT-proBNP,and cTnT-hs were independently associated with an increased risk of thromboembolism.The ABC-AF-Stroke score was well-calibrated and statistically significantly outperformed the CHA2DS2-VASc score in predicting thromboembolism risk.
文摘BACKGROUND Inpatient telemetry heart rhythm monitoring overuse has been linked to higher healthcare costs.AIM To evaluate if CHA2DS2-VASc score could be used to indicate if a patient admitted with possible cerebrovascular accident(CVA)or transient ischemic attack(TIA)requires inpatient telemetry monitoring.METHODS A total of 257 patients presenting with CVA or TIA and placed on telemetry monitoring were analyzed retrospectively.We investigated the utility of telemetry monitoring to diagnose atrial fibrillation/flutter and the CHA2DS2-VASc scoring tool to stratify the risk of having CVA/TIA in these patients.RESULTS In our study population,63(24.5%)of the patients with CVA/TIA and telemetry monitoring were determined to have no ischemic neurologic event.Of the 194(75.5)patients that had a confirmed CVA/TIA,only 6(2.3%)had an arrhythmia detected during their inpatient telemetry monitoring period.Individuals with a confirmed CVA/TIA had a statistically significant higher CHA2DS2-VASc score compared to individuals without an ischemic event(3.59 vs 2.61,P<0.001).CONCLUSION Given the low percentage of inpatient arrhythmias identified,further research should focus on discretionary use of inpatient telemetry on higher risk patients to diagnose the arrhythmias commonly leading to CVA/TIA.A prospective study assessing event rate of CVA/TIA in patients with higher CHA2DS2-VASc score should be performed to validate the CHA2DS2-VASc score as a possible risk stratifying tool for patients at risk for CVA/TIA.
