Newly Detected Atrial Fibrillation and Compliance With Antithrombotic Guidelines

Glazer, Nicole L.; Dublin, Sascha; Smith, Nicholas L.; French, Benjamin; Jackson, Lisa A.; Hrachovec, Jennifer; Siscovick, David S.; Psaty, Bruce M.; Heckbert, Susan R.

doi:10.1001/archinte.167.3.246

Cited by 156 publications

(135 citation statements)

References 27 publications

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“…23 Previous studies have demonstrated 95% sensitivity and 99% specificity for AF ICD-9-CM 427.3× claims. 13 We validated present on admission modifiers (see eSupplement) for severe sepsis and AF claims; agreement between severe sepsis present on admission status and blinded chart review was 91% (kappa 0.77) and an agreement between AF present on admission status and blinded chart review was 90% (kappa 0.74), similar to previous findings. 24 Prior validation of ischemic stroke ICD-9-CM codes has shown variable accuracy; 14,[25][26][27] however, a strategy using ICD-9-CM 433, 434, 436 at any diagnostic position previously demonstrated 86% sensitivity and 95% specificity (kappa=0.82).…”

Section: Sensitivity Analysessupporting

confidence: 81%

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Incident Stroke and Mortality Associated With New-Onset Atrial Fibrillation in Patients Hospitalized With Severe Sepsis

Walkey¹,

Wiener²,

Ghobrial³

et al. 2012

Survey of Anesthesiology

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Context-New-onset fibrillation (AF) has been reported in 6-20% of patients with severe sepsis. Whereas chronic AF is a known risk factor for stroke and death, the clinical significance of newonset AF in the setting of severe sepsis is uncertain.Objective-To determine the in-hospital stroke and in-hospital mortality risks associated with new-onset AF in patients with severe sepsis. Conclusion-Among patients with severe sepsis, patients with new-onset AF were at increased risk for in-hospital stroke and death compared with patients with no AF and patients with preexisting AF. Design-Retrospective

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Section: Sensitivity Analysessupporting

confidence: 81%

“…13 New-onset AF was defined as atrial fibrillation or atrial flutter that occurred during the hospital stay, excluding cases that were present on admission. In-hospital ischemic stroke was defined with ICD-9-CM codes of 433, 434, or 436 14 that were not present on admission.…”

Section: Discussionmentioning

confidence: 99%

Incident Stroke and Mortality Associated With New-Onset Atrial Fibrillation in Patients Hospitalized With Severe Sepsis

Walkey¹,

Wiener²,

Ghobrial³

et al. 2012

Survey of Anesthesiology

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“…Despite the fact that oral anticoagulation is effective in preventing strokes due to AF, there is extensive evidence suggesting that this therapy remains underused [7,[11][12][13][14]. In fact, although current guidelines clearly define indications for anticoagulation treatment and its vast impact in the prevention of stroke, barriers to the implementation of oral anticoagulation continue to exist among physicians and patients.…”

Section: Introductionmentioning

confidence: 99%

Untreated atrial fibrillation in the United Kingdom: Understanding the barriers and treatment options

Barra

Fynn

2015

Journal of the Saudi Heart Association

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Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a major preventable cause of stroke and hospitalization. Its prevalence is on the rise worldwide and experts believe it will continue to rise for the foreseeable future, due to the ageing population and increased survival from conditions associated with AF. Despite the fact that oral anticoagulation is effective in preventing strokes due to AF, there is extensive evidence suggesting this therapy remains underused. Barriers to the prescription of anticoagulation include patients' age per se, comorbidities, inadequate risk stratification, perceived risk of falls and bleeding, and the difficulty in achieving a stable international normalized ratio (INR) on warfarin. Also, asymptomatic patients with AF may not be identified and therefore not be candidates for anticoagulation. Physicians need continued better education on the identification of patients at risk of stroke and management of oral anticoagulation. This article reviews the barriers to anticoagulation in patients with AF in the United Kingdom and considers how those barriers may be overcome.

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“…Vitamin K antagonist drugs, such as warfarin and acenocumarol, reduce the risk of AF-related stroke by about 70%. 4,16 They are the only oral antico agulants currently recommended for the prevention of stroke in patients with a moderate to high risk of stroke 15 These pharmacological agents produce their anticoagulant effect by preventing the g-carboxylation of the vitamin K-dependent coagulation factors prothrombin and Factors VII, IX, and X.17 Despite the good clinical results obtained with these oral anticoagulants that are far from being ideal [ Table 1], there are some inconvenient factors which make their conventional use difficult to implement and follow. There is a consistent suboptimal utilization of oral anticoagulation therapy.…”

mentioning

confidence: 99%

“…[13][14][15] It looks very clear that all the difficulties we have to face in finding proper answer to its therapeutic management. Vitamin K antagonist drugs, such as warfarin and acenocumarol, reduce the risk of AF-related stroke by about 70%.…”

mentioning

confidence: 99%

Dabigatran, a direct thrombin inhibitor, in atrial fibrillation: Is it already time for a change in oral anticoagulation therapy?

Centurión¹

2010

J.A.F.I.B

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Atrial fibrillation (AF) is a common arrhythmia, and its prevalence increases with aging and the severity of heart disease. AF affects more than 2 million people in the US, and more than 4 million in Europe. It is expected that the age adjusted prevalence in US will excede 10 million people by the year 2050. [1][2][3][4][5] In the last decade, we were able to see the light shed by several trials that dealt with AF mechanisms and the appropriate management of AF patients. Clinical studies have focused mainly on the electrophysiological properties of the substrate in the atrial muscle during sinus rhythm and on the atrial electrical responses elicited by premature stimulation method.6-9 However, many fundamental aspects of this arrhythmia have been poorly understood until quite recently, and there are several features on the mechanisms of AF that makes it difficult to manage it properly. Increasing awareness of AF as a disease with possible fatal complications rather than as an acceptable alternative to sinus rhythm has led to search for clear arguments to support a certain strategy as a golden standard.There is no atrial contraction during AF, a situation that renders the pooled blood inside the atrium susceptible to develop thrombus formation particularly in the left atrium. AF increases the overall risk of stroke five-fold, and is associated with particularly severe strokes .10-12 About 76% of AF patients have a moderate to high risk of embolic complications, and they have also a significant risk factor for stroke recurrence. [13][14][15] It looks very clear that all the difficulties we have to face in finding proper answer to its therapeutic management. Vitamin K antagonist drugs, such as warfarin and acenocumarol, reduce the risk of AF-related stroke by about 70%. 4,16 They are the only oral antico agulants currently recommended for the prevention of stroke in patients with a moderate to high risk of stroke 15 These pharmacological agents produce their anticoagulant effect by preventing the g-carboxylation of the vitamin K-dependent coagulation factors prothrombin and Factors VII, IX, and X.17 Despite the good clinical results obtained with these oral anticoagulants that are far from being ideal [ Table 1], there are some inconvenient factors which make their conventional use difficult to implement and follow. There is a consistent suboptimal utilization of oral anticoagulation therapy. Warfarin is prescribed to only two thirds of appropriate candidates despite guidelines recommendations. 18 The narrow therapeutic window in the anticoagulation process makes it neccessary to monitor closely the prothrombin time. Insufficient

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Newly Detected Atrial Fibrillation and Compliance With Antithrombotic Guidelines

Cited by 156 publications

References 27 publications

Incident Stroke and Mortality Associated With New-Onset Atrial Fibrillation in Patients Hospitalized With Severe Sepsis

Incident Stroke and Mortality Associated With New-Onset Atrial Fibrillation in Patients Hospitalized With Severe Sepsis

Untreated atrial fibrillation in the United Kingdom: Understanding the barriers and treatment options

Dabigatran, a direct thrombin inhibitor, in atrial fibrillation: Is it already time for a change in oral anticoagulation therapy?

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