BackgroundOral anticoagulants substantially reduce the risk of stroke in atrial fibrillation but are underutilised in current practice. AimTo measure the distribution of stroke risk in patients with atrial fibrillation (using the CHADS 2 and CHA 2 DS 2 -VASc scores) and changes in oral anticoagulant use during 2007-2010. Design and settingLongitudinal series of cross-sectional survey in 583 UK practices linked to the QResearch ® database providing 99 351 anonymised electronic records from people with atrial fibrillation. MethodThe proportion of patients in each CHADS 2 and CHA 2 DS 2 -VASc risk band in 2010 was calculated; for each of the years 2007-2010, the proportions with risk scores ≥2 that were using anticoagulants or antiplatelet agents were estimated. The proportions identified at high risk were re-estimated using alternative definitions of hypertension based on coded data. Finally, the prevalence of comorbid conditions in treated and untreated high-risk (CHADS 2 ≥2) groups was derived. ResultsThe proportion at high risk of stroke in 2010 was 56.9% according to the CHADS 2 ≥2 threshold, and 84.5% according to CHA 2 DS 2 -VASc ≥2 threshold. The proportions of these groups receiving anticoagulants were 53.0% and 50.7% respectively and increased during 2007-2010. The means of identifying the population of individuals with hypertension significantly influenced the estimated proportion at high risk. Comorbid conditions associated with avoidance of anticoagulants included history of falls, use of nonsteroidal anti-inflammatory drugs, and dementia. ConclusionOral anticoagulant use in atrial fibrillation has increased in UK practice since 2007, but remains suboptimal. Improved coding of hypertension is required to support systematic identification of individuals at high risk of stroke and could be assisted by practice-based software.

Background-Patients with atrial fibrillation (AF) face significant risks of stroke and heart failure. The objective of this study was to determine whether AF ablation reduces the long-term risk of stroke or heart failure compared with antiarrhythmic drug therapy. Methods and Results-A coding algorithm was used to identify AF patients treated with catheter ablation (nϭ3194) The rates for heart failure hospitalization were 1.5% per year in the ablation group and 2.2% per year in the antiarrhythmic drug group, with an unadjusted hazard ratio of 0.69 (95% CI, 0.42-1.15; Pϭ0.158). These results were minimally altered in Cox proportional hazards models, which further adjusted for potential confounders not well balanced by the propensity matching. Conclusions-In a large propensity-matched community sample, AF ablation was associated with a reduced risk of stroke/TIA and no significant difference in heart failure hospitalizations compared with antiarrhythmic drug therapy. These findings require confirmation with randomized study designs. (Circ Cardiovasc Qual Outcomes. 2012;5:171-181.)

Despite the importance of radiology reports in communicating radiologists' interpretations of imaging studies, little appears to be known about the preferences and attitudes of referring physicians regarding the format and content of such reports. The authors surveyed all physicians who referred patients to the radiology department for their opinions of radiology reports. Two hundred fifty-one physicians (42%) responded. The overall quality of the reports was rated an average of 8 on a ten-point scale, with 10 representing the highest quality. Fifty-nine percent said the reports usually were clear, but 40% thought the reports were occasionally confusing. Forty-nine percent noted the reports sometimes did not sufficiently address the clinical questions. Thirty-two percent preferred the summary statement to be at the beginning of the report, while 29% preferred this portion at the end. Forty respondents (16%) thought that it took too much time to receive the reports. This survey can serve as a model for other radiology departments interested in assessing the attitudes of referring physicians toward radiology reports.

In a large commercially insured US population, disease-related expenditures for patients having ESS for CRS are substantial, as are the additive impacts of NP and revision surgery.

Background-The risk of recurrence after an initial ischemic stroke or transient ischemic attack (TIA) may be impacted by undiagnosed atrial fibrillation (AF). We therefore assessed the impact of AF diagnosis and timing on stroke/TIA recurrence rates in a large real-world sample of patients. Methods and Results-Using commercial claims data (Truven Health Analytics MarketScan), we performed a retrospective cohort study of patients with an index stroke or TIA event recorded in years 2008 through 2011. Patients were characterized by baseline oral anticoagulation, CHADS 2 and CHA 2 DS 2 -VASc scores, AF diagnosis and timing with respect to the index stroke, and presence or absence of post-index ambulatory cardiac monitoring. The primary outcome was the recurrence of an ischemic stroke or TIA. Of 179 160 patients (age 67±16.2 years; 53.7% female), the Kaplan-Meier estimate for stroke/TIA recurrence within 1 year was 10.6%. Not having oral anticoagulation prescribed at baseline and having AF first diagnosed >7 days post-stroke (late AF) was highly associated with recurrent stroke/TIA (hazard ratio, 2.0; 95% confidence interval, 1.9-2.1). Among patients with at least 1 year of follow-up, only 2.6% and 9.7% had ambulatory ECG monitoring in the 7 days and 12 months post-stroke, respectively. Conclusions-AF diagnosed after stroke is an important hallmark of recurrent stroke risk. Increasing the low utilization of cardiac monitoring after stroke could identify undiagnosed AF earlier, leading to appropriate oral anticoagulation treatment and a reduction in stroke/TIA recurrence. (Circ Cardiovasc Qual Outcomes.

Research on additional sources of variability is still needed to help explain the remaining differences in outcomes after bariatric surgery.

BackgroundThe incremental effects of risk factor combinations for atrial fibrillation (AF) and stroke are incompletely understood. We sought to quantify the risks of incident AF and stroke for combinations of established risk factors in a large US sample.Methods and ResultsPatients with no evidence of AF or stroke in 2007 were stratified by combinations of the following risk factors: heart failure, hypertension, diabetes, age 65 to 74, age ≥75, coronary artery disease, and chronic kidney disease. Patients with ≥2 of the first 5 or ≥3 of the first 7, classified as “high-risk,” and an age-matched sample of patients with fewer risk factors, classified as “low-risk,” were followed over 2008–2010 for incident AF and stroke. Annualized incidence rates and risks were quantified for each combination of factors by using Cox regression. Annualized incidence rates for AF, stroke, and both were 3.59%, 3.27%, and 0.62% in 1 851 653 high-risk patients and 1.32%, 1.48%, and 0.18% in 1 156 221 low-risk patients, respectively. Among patients with 1 risk factor, those with age ≥75 had the highest hazards of incident AF and stroke (HR 9.2, 6.9). Among patients with 2 risk factors, those with age ≥75 and heart failure had the highest annualized incidence rates of AF and stroke (10.2%, 5.9%). The combination of age ≥75 and hypertension was prevalent and had the highest incidences of AF and stroke.ConclusionsAdults with combinations of known risk factors are at increased risk of incident AF and stroke, but combinations of risk factors are not always additive.

Purpose Overnight stays associated with catheter ablation (CA) for paroxysmal atrial fibrillation (PAF) account for a significant proportion of treatment cost. Same-day discharge (SDD) after CA may be attractive to both patients and hospitals, especially in light of current restrictions on overnight stays due to COVID-19. This study reports on the selection criteria, protocol, and safety of SDD after CA of PAF. Methods Patients undergoing CA for PAF were evaluated to assess the risk of groin, respiratory, cardiac, or bleeding complications. SDD eligibility criteria were stable anticoagulation with no bleeding history, systolic heart failure, respiratory conditions, or interventional procedures within 60 days, and recommended BMI < 35. Patient proximity to the hospital was also considered. Anesthesia with propofol was used, and ablations were performed with a contact force catheter. Patients rested for 6 h postprocedure and then ambulated over 1-2 h. Discharge followed if they were stable without evidence of complications. A nurse called all patients the following morning to elicit evidence of complications. Results Of 44 planned SDD procedures between April 2017 and June 2018, 41 resulted in SDD after 7.2 ± 1.0 h, 2 patients stayed overnight for observation, and one by choice. Average age was 59 ± 10 years with CHA 2 DS 2-VASc of 1.6 ± 1.1. No SDD-related complications occurred, and no return visits resulted from the follow-up calls. Conclusion Appropriate low-risk patients identified by well-defined clinical criteria can be safely discharged the same day after CA for PAF. Evaluation in a larger population across different centers is required for generalizability of this SDD protocol.