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The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701).

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Screening for AFC should be performed even in the absence of red flags in patients with HCM older than 25 years.

Background and purpose Prospectively collected data comparing the safety and effectiveness of individual non-vitamin K antagonists (NOACs) are lacking. Our objective was to directly compare the effectiveness and safety of NOACs in patients with newly diagnosed atrial fibrillation (AF). Methods In GLORIA-AF, a large, prospective, global registry program, consecutive patients with newly diagnosed AF were followed for 3 years. The comparative analyses for (1) dabigatran vs rivaroxaban or apixaban and (2) rivaroxaban vs apixaban were performed on propensity score (PS)-matched patient sets. Proportional hazards regression was used to estimate hazard ratios (HRs) for outcomes of interest. Results The GLORIA-AF Phase III registry enrolled 21,300 patients between January 2014 and December 2016. Of these, 3839 were prescribed dabigatran, 4015 rivaroxaban and 4505 apixaban, with median ages of 71.0, 71.0, and 73.0 years, respectively. In the PS-matched set, the adjusted HRs and 95% confidence intervals (CIs) for dabigatran vs rivaroxaban were, for stroke: 1.27 (0.79–2.03), major bleeding 0.59 (0.40–0.88), myocardial infarction 0.68 (0.40–1.16), and all-cause death 0.86 (0.67–1.10). For the comparison of dabigatran vs apixaban, in the PS-matched set, the adjusted HRs were, for stroke 1.16 (0.76–1.78), myocardial infarction 0.84 (0.48–1.46), major bleeding 0.98 (0.63–1.52) and all-cause death 1.01 (0.79–1.29). For the comparison of rivaroxaban vs apixaban, in the PS-matched set, the adjusted HRs were, for stroke 0.78 (0.52–1.19), myocardial infarction 0.96 (0.63–1.45), major bleeding 1.54 (1.14–2.08), and all-cause death 0.97 (0.80–1.19). Conclusions Patients treated with dabigatran had a 41% lower risk of major bleeding compared with rivaroxaban, but similar risks of stroke, MI, and death. Relative to apixaban, patients treated with dabigatran had similar risks of stroke, major bleeding, MI, and death. Rivaroxaban relative to apixaban had increased risk for major bleeding, but similar risks for stroke, MI, and death. Registration URL: https://www.clinicaltrials.gov. Unique identifiers: NCT01468701, NCT01671007. Date of registration: September 2013. Graphical abstract

We present the case of a 53 years-old woman presenting with congestive heart failure and pleural and pericardial effusions, in whom transthoracic and transesophageal echocardiography revealed multilocular cardiac tumor involving the left atrium wall, extending into the pericardium. Tumor was excised surgically and proved to be a malignant fibrous histiocytoma, primarily confined to the heart. Despite surgery followed by chemotherapy, the patient died a few months later. This is the 47th case of primary cardiac fibrous malignant histiocytoma reported in the literature. The pericardial involvement has been only rarely reported. Echocardiography was the method of diagnosis before rapid referral to surgery.

There is little information on the incidence and prognostic significance of arterial hypertension (HTN) in acute coronary syndromes (ACSs), especially in the east European countries. We sought to investigate a registry of ACS patients in Romania, in order to better elucidate whether hypertensive patients are at higher risk of death and deserve a tailored approach for management and follow-up. The data of this study are a framework of the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC) (ClinicalTrials.gov, NCT01218776). The present analysis focused on 2286 retrospective patients admitted to 23 hospitals in Romania with a diagnosis of ACS. Among 1450 hypertensive patients, 64.5% were admitted with a diagnosis of STelevation myocardial infarction (STEMI), while the remaining was admitted with a diagnosis of non-STEMI (NSTEMI). When compared with non-hypertensive patients, hypertensive patients were older (mean age 60.3 vs. 66.7 years, P , 0.001), were prevalently female (25.8% vs. 35.5%, P , 0.001), and had higher rates of cardiovascular risk factors as well as higher rates of prior myocardial infarction (11.2% vs. 18.3%, P , 0.001). Additionally, they had higher rates of prior stroke (4.2% vs. 11.7%, P , 0.001) and chronic heart failure (11.5% vs. 18.4%, P , 0.001). Despite this adverse clinical profile, hypertensive patients were less likely be to be admitted with Killip class ≥2 (23.1% vs. 26.6%, P , 0.001) but they were more likely to be discharged with NYHA class ≥III (10.6% vs. 7.1%, P , 0.006). There were significant higher rates of unadjusted in-hospital mortality among hypertensive older (.65 years) patients with both STEMI and NSTEMI. Hypertensive ACS patients in Romania represent a higher risk group, since they are more often discharged with NYHA class ≥ III, are older and have an adverse clinical profile. In the elderly, the outcomes of the hypertensive patients are worse than non-hypertensive patients.

The Romanian registry of HCM illustrates patient characteristics at a national level as well as the gaps in management which need improvement - accessibility to high-end diagnostic tests and invasive methods of treatment.