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1.
Zh Nevrol Psikhiatr Im S S Korsakova ; 120(8. Vyp. 2): 5-9, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33016670

RESUMO

OBJECTIVE: The timely diagnosis of atrial fibrillation (AF) in patients with cardiac embolism with implantable loop recorders (ILR). MATERIAL AND METHODS: Twenty-nine patients, hospitalized within 6 months after stroke (n=19) or transient ischemic attack (n=10), were included in the study. ILR were implanted in all cases. The mean time of follow-up was one year. RESULTS: Five hundred and thirteen transmissions were detected during the whole follow-up period. Symptomatic episodes were recorded in 165 cases. Such episodes as bradycardia, asystole, AF, atrial tachycardia and ventricular tachycardia were recorded in 98 cases out of 348 planned transmissions. All transmissions were analyzed by an operator. However, 70 cases were false-positive because of ILR over-sensing. In total, arrhythmias were detected in 5 patients, including sick sinus syndrome (1), supraventricular tachycardia (1), ventricular tachycardia (1) and atrial fibrillation (3). Anticoagulant therapy was started immediately after the diagnosis of AF. CONCLUSION: Loop recording monitoring is an effective strategy in patients with cardiac embolism for timely diagnosis and further treatment of arrhythmia.


Assuntos
Fibrilação Atrial , Ataque Isquêmico Transitório , Acidente Vascular Cerebral , Anticoagulantes , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/tratamento farmacológico , Eletrocardiografia Ambulatorial , Humanos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico
2.
Ther Umsch ; 77(8): 385-389, 2020.
Artigo em Alemão | MEDLINE | ID: mdl-33054647

RESUMO

Arrhythmia as an Incidental Finding Abstract. An arrhythmic pulse can be determined using clinical or technical examinations such as palpitation and ECG. Due to the rapid spread of wearables, more and more people have the opportunity to derive pulse curves or even ECGs themselves before seeking professional medical care, which increases the number of randomly detected arrhythmic pulse. Incidental findings naturally lead to relevant diagnoses in some of the people affected, but on the other hand they are also psychologically stressful for some individuals. Therefore, it is important to differentiate frequently found common benign causes from the causes with therapeutic consequence and to adequately inform patients about their rhythm. In particular bradyarrhythmias often have no therapeutic consequence as long as the patient remains asymptomatic. Pacemakers are usually only indicated for symptomatic bradycardia. Atrial fibrillation deserves special attention due to its frequency and the fact that, if undetected, this is associated with significantly increased morbidity and mortality. Supraventricular and ventricular extrasystoles increase with age. They are often "idiopathic", but they also can be an expression of still subclinical heart disease.


Assuntos
Fibrilação Atrial , Achados Incidentais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/terapia , Bradicardia/diagnóstico , Bradicardia/terapia , Eletrocardiografia , Humanos
3.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4071-4074, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018893

RESUMO

The aim of our work is to design an algorithm to detect premature atrial contraction (PAC), premature ventricular contraction (PVC), and atrial fibrillation (AF) among normal sinus rhythm (NSR) using smartwatch photoplethysmographic (PPG) data. Novel image processing features and two machine learning methods are used to enhance the PAC/PVC detection results of the Poincaré plot method. Compared with support vector machine (SVM) methods, the Random Forests (RF) method performs better. It yields a 10-fold cross validation (CV) averaged sensitivity, specificity, positive predicted value (PPV), negative predicted value (NPV), and accuracy for PAC/PVC labels of 63%, 98%, 83%, 94%, and 93%, respectively, and a 10-fold CV averaged sensitivity, specificity, PPV, NPV, and accuracy for AF subjects of 92%, 96%, 85%, 98%, and 95%, respectively. This is one of the first studies to derive image processing features from Poincaré plots to further enhance the accuracy of PAC/PVC detection using PPG recordings from a smartwatch.


Assuntos
Fibrilação Atrial , Complexos Ventriculares Prematuros , Fibrilação Atrial/diagnóstico , Complexos Atriais Prematuros , Eletrocardiografia , Humanos , Fotopletismografia , Complexos Ventriculares Prematuros/diagnóstico
4.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 316-319, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33017992

RESUMO

Atrial fibrillation (AF) is a common heart rhythm which occurs when the upper chambers of the heart beat irregularly. With the rapid development of the deep learning algorithm, the Convolutional Neural Networks (CNN) is widely investigated for the ECG classification task. However, for AF detection, the performance of CNN is greatly limited due to the lack of consideration for temporal characteristic of the ECG signal. In order to improve the discriminative ability of CNN, we introduce the attention mechanism to help the network concentrate on the informative parts and obtain the temporal features of the signals. Inspired by this idea, we propose a temporal attention block (TA-block) and a temporal attention convolutional neural network (TACNN) for the AF detection tasks. The TA-block can adaptively learn the temporal features of the signal and generate the attention weights to enhance informative features. With a stack architecture of TA-blocks, the TA-CNN obtains better performance as a result of paying more attention to the informative parts of the signal. We validate our approach on the single lead ECG classification dataset of The PhysioNet Computing in Cardiology Challenge 2017. The experimental results indicate that the proposed framework outperform state-of-the-arts classification networks.Clinical Relevance-The proposed algorithm can be potentially applied to the portable cardiovascular monitoring devices reducing the danger of AF.


Assuntos
Fibrilação Atrial , Algoritmos , Fibrilação Atrial/diagnóstico , Eletrocardiografia , Frequência Cardíaca , Humanos , Redes Neurais de Computação
5.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 410-413, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018015

RESUMO

Atrial fibrillation (AF) is an irregular heart rhythm due to disorganized atrial electrical activity, often sustained by rotational drivers called rotors. In the present work, we sought to characterize and discriminate whether simulated single stable rotors are located in the pulmonary veins (PVs) or not, only by using non-invasive signals (i.e., the 12-lead ECG). Several features have been extracted from the signals, such as Hjort descriptors, recurrence quantification analysis (RQA), and principal component analysis. All the extracted features have shown significant discriminatory power, with particular emphasis to the RQA parameters. A decision tree classifier achieved 98.48% accuracy, 83.33% sensitivity, and 100% specificity on simulated data.Clinical Relevance-This study might guide ablation procedures, suggesting doctors to proceed directly in some patients with a pulmonary veins isolation, and avoiding the prior use of an invasive atrial mapping system.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Veias Pulmonares , Fibrilação Atrial/diagnóstico , Eletrocardiografia , Humanos , Veias Pulmonares/cirurgia , Resultado do Tratamento
6.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 906-909, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018131

RESUMO

A correct and early diagnosis of cardiac arrhythmias could improve patients' quality of life. The aim of this study is to classify the cardiac rhythm (atrial fibrillation, AF, or normal sinus rhythm NSR) from the photoplethysmographic (PPG) signal and assess the effect of the observation window length. Simulated signals are generated with a PPG simulator previously proposed. The different window lengths taken into account are 20, 30, 40, 50, 100, 150, 200, 250 and 300 beats. After systolic peak detection algorithm, 10 features are computed on the inter-systolic interval series, assessing variability and irregularity of the series. Then, feature selection was performed (using the sequential forward floating search algorithm) which identified two variability parameters (Mean and rMSSD) as the best selection. Finally, the classification by linear support vector machine was performed. Using only two features, accuracy was very high for all the analyzed observation window lengths, going from 0.913±0.055 for length equal to 20 to 0.995±0.011 for length equal to 300 beats.Clinical relevance These preliminary results show that short PPG signals (20 beats) can be used to correctly detect AF.


Assuntos
Fibrilação Atrial , Algoritmos , Fibrilação Atrial/diagnóstico , Humanos , Fotopletismografia , Qualidade de Vida , Máquina de Vetores de Suporte
7.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2594-2597, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018537

RESUMO

Detection of Atrial fibrillation (AF) from premature atrial contraction (PAC) and premature ventricular contraction (PVC) is challenging as frequent occurrences of these ectopic beats can mimic the typical irregular patterns of AF. In this paper, we present a preliminary study of using density Poincare plot based machine learning method to detect AF from PAC/PVCs using electrocardiogram (ECG) recordings. First, we propose creation of this new density Poincare plot which is derived from the difference of the heart rate. Next, from this density Poincare plot, template correlation and discrete wavelet transform are used to extract suitable image-based features, which is followed by infinite latent feature selection algorithm to rank the features. Finally, classification of AF vs PAC/PVC is performed using K-Nearest Neighbor, discriminant analysis and support vector machine (SVM) classifiers. Our method is developed and validated using a subset of Medical Information Mart for Intensive Care (MIMIC) III database containing 8 AF and 8 PAC/PVC subjects. Both 10-fold and leave-one-subject-out cross validations are performed to show the robustness of our proposed method. During the 10-fold cross-validation, SVM achieved the best performance with 99.49% sensitivity, 94.51% specificity and 97.29% accuracy with the extracted features while for the leave-one-subject-out, the highest overall accuracy is 90.91%. Moreover, when compared with two state-of-the-art methods, the proposed algorithm achieves superior AF vs. PAC/PVC discrimination performance.Clinical Relevance-This preliminary study shows that with the help of density Poincare plot, AF can be separated from PAC/PVC with better accuracy.


Assuntos
Fibrilação Atrial , Complexos Ventriculares Prematuros , Fibrilação Atrial/diagnóstico , Complexos Atriais Prematuros/diagnóstico , Átrios do Coração , Ventrículos do Coração , Humanos , Complexos Ventriculares Prematuros/diagnóstico
8.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2679-2682, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018558

RESUMO

Pulse transit time (PTT) based continuous cuff-less blood pressure (BP) monitoring has attracted wide interests owing to its potential in improving the control and early prevention for cardiovascular diseases. However, it is still impractical in large-scale clinical application due to the concern of BP measurement accuracy. Since such approach strongly relies on the PTT-BP model under certain theoretical assumptions, the accuracy would be affected by the vessel properties alterations induced by cardiovascular disorders. Atrial fibrillation (AF) is one of the most common cardiac diseases which often coexist with hypertension. The present study sought to examine the Impact of AF on the PTT and BP, validate the capability of PTT based cuff-less methods on AF patients. By investigating the PTT and BP on 74 critically ill patients with AF, we found that parameters including PTT, R-R interval and diastolic BP (DBP) were significantly changed when AF occurs, while the systolic BP (SBP) value and photoplethysmography intensity ratio (PIR) changed little. Further, by performing two cuff-less BP estimation method, we found that the estimated accuracy is decreased on PTT based method when AF occurs, but there is little change on PIR based method. The findings demonstrated that the impact of AF on PTT is significant, which would also influence the PTT-BP relationship. But the PIR would still be a predictive factor for BP estimation for AF patients.


Assuntos
Fibrilação Atrial , Fibrilação Atrial/diagnóstico , Pressão Sanguínea , Determinação da Pressão Arterial , Humanos , Fotopletismografia , Análise de Onda de Pulso
9.
BMJ ; 370: m3208, 2020 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-32938633

RESUMO

OBJECTIVE: To investigate whether opportunistic screening in primary care increases the detection of atrial fibrillation compared with usual care. DESIGN: Cluster randomised controlled trial. SETTING: 47 intention-to-screen and 49 usual care primary care practices in the Netherlands, not blinded for allocation; the study was carried out from September 2015 to August 2018. PARTICIPANTS: In each practice, a fixed sample of 200 eligible patients, aged 65 or older, with no known history of atrial fibrillation in the electronic medical record system, were randomly selected. In the intention-to-screen group, 9218 patients eligible for screening were included, 55.0% women, mean age 75.2 years. In the usual care group, 9526 patients were eligible for screening, 54.3% women, mean age 75.0 years. INTERVENTIONS: Opportunistic screening (that is, screening in patients visiting their general practice) consisted of three index tests: pulse palpation, electronic blood pressure measurement with an atrial fibrillation algorithm, and electrocardiography (ECG) with a handheld single lead electrocardiographic device. The reference standard was 12 lead ECG, performed in patients with at least one positive index test and in a sample of patients (10%) with three negative tests. If 12 lead ECG showed no atrial fibrillation, patients were invited for more screening by continuous monitoring with a Holter electrocardiograph for two weeks. MAIN OUTCOME MEASURES: Difference in the detection rate of newly diagnosed atrial fibrillation over one year in intention-to-screen versus usual care practices. RESULTS: Follow-up was complete for 8874 patients in the intention-to-screen practices and for 9102 patients in the usual care practices. 144 (1.62%) new diagnoses of atrial fibrillation in the intention-to-screen group versus 139 (1.53%) in the usual care group were found (adjusted odds ratio 1.06 (95% confidence interval 0.84 to 1.35)). Of 9218 eligible patients in the intention-to-screen group, 4106 (44.5%) participated in the screening protocol. In these patients, 12 lead ECG detected newly diagnosed atrial fibrillation in 26 patients (0.63%). In the 266 patients who continued with Holter monitoring, four more diagnoses of atrial fibrillation were found. CONCLUSIONS: Opportunistic screening for atrial fibrillation in primary care patients, aged 65 and over, did not increase the detection rate of atrial fibrillation, which implies that opportunistic screening for atrial fibrillation is not useful in this setting. TRIAL REGISTRATION: Netherlands Trial Register No NL4776 (old NTR4914).


Assuntos
Fibrilação Atrial/diagnóstico , Seleção de Pacientes , Atenção Primária à Saúde , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Análise por Conglomerados , Eletrocardiografia , Feminino , Humanos , Análise de Intenção de Tratamento , Masculino , Programas de Rastreamento , Fatores de Risco
10.
Medicine (Baltimore) ; 99(30): e21388, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791751

RESUMO

BACKGROUND: Increasing prevalence of atrial fibrillation has a significant impact on health, society, and healthcare resource utilization, due to increased morbidity, mortality, risk of stroke, and reduction in quality of life. Early diagnosis allows for treatment initiation, a reduction in complications and associated costs, and so innovation to improve screening and enable easy access are needed Developments in digital technology have significantly contributed to the availability of screening tools. The single-lead electrocardiogram AliveCor (Mountainview, CA) device offers the opportunity to provide heart rhythm screening and has been used extensively in clinical practice and research studies. METHODS: This review investigates the feasibility, validity, and utility of the AliveCor device as a tool for atrial fibrillation detection in clinical practice and in wider research. Databases searched included PUBMED, CINAHL, MEDLINE, and World of Science, plus grey literature search. Search terms related to atrial fibrillation, screening, and AliveCor with adults >18 years. Feasibility metrics were applied including process, resource, management, and scientific outcomes. Studies not written in the English language were excluded. Validity of AliveCor was explored by extracting sensitivity and specificity data from eligible studies and overall effectiveness analyzed by incorporating the above, with wider issues surrounding screening approaches, cost effectiveness and appropriateness of AliveCor as a screening tool. RESULTS: The AliveCor device screening was reviewed in 11 studies matching inclusion criteria. Atrial fibrillation detection rates ranged from 0.8% to 36% and this largely correlated to the study population, where wider age inclusion and mass/population screening represented lower atrial fibrillation detection. Recruitment from higher-risk groups (older age, targeted localities, chronic disease) identified higher numbers with atrial fibrillation. Feasibility metrics demonstrated AliveCor as an effective tool of choice in terms of process, resources, and management. Duration of screening time had an impact on rates of atrial fibrillation detection. There was however significant heterogeneity between studies reviewed. CONCLUSION: The AliveCor device offers a convenient, valid, and feasible means of monitoring for atrial fibrillation. Further analysis of electrocardiograms produced by AliveCor may be necessary in some circumstances. The AliveCor electrocardiogram device can be successfully implemented into both opportunistic and systematic screening strategies for atrial fibrillation.


Assuntos
Fibrilação Atrial/diagnóstico , Eletrocardiografia/instrumentação , Humanos
11.
Asian Cardiovasc Thorac Ann ; 28(7): 416-420, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32854515

RESUMO

Atrial fibrillation is a common clinical arrhythmia with high morbidity and a risk of stroke. The Cox-maze IV procedure that uses radiofrequency energy for ablation is established as an effective way to eliminate atrial fibrillation. Compared to the Cox-maze IV procedure, the video-assisted Wolf mini-maze procedure is associated with reduced surgical trauma, but still requires bilateral thoracotomies, and the ablation line connecting the right and left pulmonary vein isolations cannot be created with a bipolar ablation clamp. We have developed a novel video-assisted mini-maze technique that uses a unilateral (left chest) thoracoscopic approach (the Mei mini-maze procedure).


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter , Veias Pulmonares/cirurgia , Cirurgia Torácica Vídeoassistida , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Ablação por Cateter/efeitos adversos , Frequência Cardíaca , Humanos , Veias Pulmonares/fisiopatologia , Cirurgia Torácica Vídeoassistida/efeitos adversos , Resultado do Tratamento
12.
BMJ ; 370: m2724, 2020 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-32784208

RESUMO

OBJECTIVE: To assess temporal trends in the association between newly diagnosed atrial fibrillation and death. DESIGN: Community based cohort study. SETTING: Framingham Heart Study cohort, in 1972-85, 1986-2000, and 2001-15 (periods 1-3, respectively), in Framingham, MA, USA. PARTICIPANTS: Participants with no atrial fibrillation, aged 45-95 in each time period, and identified with newly diagnosed atrial fibrillation (or atrial flutter) during each time period. MAIN OUTCOME MEASURES: The main outcome was all cause mortality. Hazard ratios for the association between time varying atrial fibrillation and all cause mortality were calculated with adjustment for time varying confounding factors. The difference in restricted mean survival times, adjusted for confounders, between participants with atrial fibrillation and matched referents at 10 years after a diagnosis of atrial fibrillation was estimated. Meta-regression was used to test for linear trends in hazard ratios and restricted mean survival times over the different time periods. RESULTS: 5671 participants were selected in time period 1, 6177 in period 2, and 6174 in period 3. Adjusted hazard ratios for all cause mortality between participants with and without atrial fibrillation were 1.9 (95% confidence interval 1.7 to 2.2) in time period 1, 1.4 (1.3 to 1.6) in period 2, and 1.7 (1.5 to 2.0) in period 3 (Ptrend=0.70). Ten years after diagnosis of atrial fibrillation, the adjusted difference in restricted mean survival times between participants with atrial fibrillation and matched referents decreased by 31%, from -2.9 years (95% confidence interval -3.2 to -2.5) in period 1, to -2.1 years (-2.4 to -1.8) in period 2, to -2.0 years (-2.3 to -1.7) in period 3 (Ptrend=0.03). CONCLUSIONS: No evidence of a temporal trend in hazard ratios for the association between atrial fibrillation and all cause mortality was found. The mean number of life years lost to atrial fibrillation at 10 years had improved significantly, but a two year gap compared with individuals without atrial fibrillation still remained.


Assuntos
Fibrilação Atrial/mortalidade , Eletrocardiografia , Medição de Risco/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Causas de Morte , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Massachusetts/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , Taxa de Sobrevida/tendências
13.
Arch Cardiovasc Dis ; 113(8-9): 551-563, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32753124

RESUMO

Obesity is a major risk factor for atrial fibrillation. It also influences the natural history of the disease, leading to more persistent forms and poorer ablation outcomes. This article reviews atrial fibrillation ablation in the obese population, focusing on outcomes, complications and periprocedural management. Through an analysis of the possible pathophysiological mechanism linking obesity and atrial fibrillation, we identify potential strategies to improve post-ablation outcomes in this challenging population.


Assuntos
Técnicas de Ablação , Fibrilação Atrial/cirurgia , Obesidade/fisiopatologia , Técnicas de Ablação/efeitos adversos , Adiposidade , Animais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/fisiopatologia , Índice de Massa Corporal , Frequência Cardíaca , Humanos , Obesidade/diagnóstico , Obesidade/epidemiologia , Fatores de Risco , Resultado do Tratamento , Ganho de Peso
15.
Ther Adv Cardiovasc Dis ; 14: 1753944720926824, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32633682

RESUMO

INTRODUCTION: Current atrial fibrillation (AF) guidelines recommend flecainide as a first-line rhythm control option in patients without structural heart disease. While there is proven efficacy in clinical trials and guideline support, it is hypothesized that flecainide may be underutilized due to negative outcomes in the CAST trial and that adverse effects are less common than previously perceived. METHODS: This retrospective chart review evaluated patients ⩾18 years initiated on flecainide for AF from August 2011 to October 2016 by a cardiology provider at the study site. Exclusion criteria included: <5 days of flecainide therapy, AF due to a reversible cause, and inadequate documentation. The primary outcome was efficacy of flecainide at maintaining symptomatic control at 6 and 12 months. Secondary outcomes included characterization of alterations in rhythm control strategies and documented normal sinus rhythm per electrocardiogram at 6 and 12 months. RESULTS: Of the 326 patients identified, 144 patients were included. After 6 and 12 months, 102 patients (70.8%) and 89 patients (61.8%) of the 144 were symptomatically controlled. Atenolol use (p = 0.024), female sex (p = 0.006), hypertension (p = 0.040), and dronedarone failure (p = 0.012) were associated with flecainide discontinuation at 6 months. At 12 months, only previous propafenone failure (p = 0.032) was significant. Of the 144 patients, 16 (11.1%) reported adverse effects with dizziness, hot flashes, bradycardia, and headache (1.4% each) being the most common. CONCLUSION: Flecainide is a well-tolerated medication, even at 12 months, with very minor adverse effects. These results support the utility of flecainide in guideline recommended patient populations.


Assuntos
Antiarrítmicos/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Flecainida/uso terapêutico , Frequência Cardíaca/efeitos dos fármacos , Idoso , Antiarrítmicos/efeitos adversos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Feminino , Flecainida/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
16.
PLoS Med ; 17(7): e1003146, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32673305

RESUMO

BACKGROUND: Atrial fibrillation (AF) is underdiagnosed and especially undertreated in China. We aimed to investigate the prevalence of unknown and untreated AF in community residents (≥65 years old) and to determine whether an education intervention could improve oral anticoagulant (OAC) prescription. METHODS AND FINDINGS: We performed a single-time point screening for AF with a handheld single-lead electrocardiography (ECG) in Chinese residents (≥65 years old) in 5 community health centers in Shanghai from April to September 2017. Disease education and advice on referral to specialist clinics for OAC treatment were provided to all patients with actionable AF (newly detected or undertreated known AF) at the time of screening, and education was reinforced at 1 month. Follow-up occurred at 12 months. In total, 4,531 participants were screened (response rate 94.7%, mean age 71.6 ± 6.3 years, 44% male). Overall AF prevalence was 4.0% (known AF 3.5% [n = 161], new AF 0.5% [n = 22]). The 183 patients with AF were older (p < 0.001), taller (p = 0.02), and more likely to be male (p = 0.01), and they had a higher prevalence of cardiovascular disease than those without AF (p < 0.001). In total, 85% (155/183) of patients were recommended for OAC treatment by the established guidelines (CHA2DS2-VASc ≥ 2 for men; ≥ 3 for women). OAC prescription rate for known AF was 20% (28/138), and actionable AF constituted 2.8% of all those screened. At the 12-month follow-up in 103 patients (81% complete), despite disease education and advice on specialist referral, only 17 attended specialist clinics, and 4 were prescribed OAC. Of those not attending specialist clinics, 71 chose instead to attend community health centers or secondary hospital clinics, with none prescribed OAC, and 15 had no review. Of the 17 patients with new AF and a class 1 recommendation for OAC, only 3 attended a specialist clinic, and none were prescribed OAC. Of the 28 AF patients taking OAC at baseline, OAC was no longer taken in 4. Ischemic stroke (n = 2) or death (n = 3) occurred in 5/126 (4%), with none receiving OAC. As screening was performed at a single time point, some paroxysmal AF cases may have been missed; thus, the rate of new AF may be underestimated. CONCLUSIONS: We demonstrated a noticeable gap in AF detection and treatment in community-based elderly Chinese: actionable AF constituted a high proportion of those screened. Disease education and advice on specialist referral are insufficient to close the gap. Before more frequent or intensive screening for unknown AF could be recommended in China, greater efforts must be made to increase appropriate OAC therapy in known AF to prevent AF-related stroke.


Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/terapia , Administração Oral , Idoso , Anticoagulantes/administração & dosagem , Fibrilação Atrial/epidemiologia , China/epidemiologia , Centros Comunitários de Saúde , Estudos Transversais , Eletrocardiografia , Feminino , Seguimentos , Humanos , Masculino , Programas de Rastreamento , Prevalência , Estudos Prospectivos , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidade , Varfarina/administração & dosagem , Varfarina/uso terapêutico
17.
PLoS Med ; 17(7): e1003197, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32678820

RESUMO

BACKGROUND: Growing prevalence of atrial fibrillation (AF) in the ageing population and its associated life-changing health and resource implications have led to a need to improve its early detection. Primary care is an ideal place to screen for AF; however, this is limited by shortages in general practitioner (GP) resources. Recent increases in the number of clinical pharmacists within primary care makes them ideally placed to conduct AF screening. This study aimed to determine the feasibility of GP practice-based clinical pharmacists to screen the over-65s for AF, using digital technology and pulse palpation during the influenza vaccination season. METHODS AND FINDINGS: Screening was conducted over two influenza vaccination seasons, 2017-2018 and 2018-2019, in four GP practices in Kent, United Kingdom. Pharmacists were trained by a cardiologist to pulse palpate, record, and interpret a single-lead ECG (SLECG). Eligible persons aged ≥65 years (y) attending an influenza vaccination clinic were offered a free heart rhythm check. Six hundred four participants were screened (median age 73 y, 42.7% male). Total prevalence of AF was 4.3%. All participants with AF qualified for anticoagulation and were more likely to be male (57.7%); be older; have an increased body mass index (BMI); and have a CHA2DS2-VASc (Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes, previous Stroke, Vascular disease, Age 65-74 years, Sex category) score ≥ 3. The sensitivity and specificity of clinical pharmacists diagnosing AF using pulse palpation was 76.9% (95% confidence interval [CI] 56.4-91.0) and 92.2% (95% CI 89.7-94.3), respectively. This rose to 88.5% (95% CI 69.9-97.6) and 97.2% (95% CI 95.5-98.4) with an SLECG. At follow-up, four participants (0.7%) were diagnosed with new AF and three (0.5%) were initiated on anticoagulation. Screening with SLECG also helped identify new non-AF cardiovascular diagnoses, such as left ventricular hypertrophy, in 28 participants (4.6%). The screening strategy was cost-effective in 71.8% and 64.3% of the estimates for SLECG or pulse palpation, respectively. Feedback from participants (422/604) was generally positive. Key limitations of the study were that the intervention did not reach individuals who did not attend the practice for an influenza vaccination and there was a limited representation of UK ethnic minority groups in the study cohort. CONCLUSIONS: This study demonstrates that AF screening performed by GP practice-based pharmacists was feasible, economically viable, and positively endorsed by participants. Furthermore, diagnosis of AF by the clinical pharmacist using an SLECG was more sensitive and more specific than the use of pulse palpation alone. Future research should explore the key barriers preventing the adoption of national screening programmes.


Assuntos
Fibrilação Atrial/diagnóstico , Assistência à Saúde/organização & administração , Farmacêuticos , Assistência ao Convalescente , Idoso , Algoritmos , Fibrilação Atrial/epidemiologia , Cardiologistas , Análise Custo-Benefício , Assistência à Saúde/economia , Eletrocardiografia/economia , Estudos de Viabilidade , Feminino , Determinação da Frequência Cardíaca/métodos , Humanos , Influenza Humana/prevenção & controle , Masculino , Prevalência , Inquéritos e Questionários , Reino Unido/epidemiologia , Vacinação
18.
Asian Cardiovasc Thorac Ann ; 28(7): 421-426, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32611195

RESUMO

The term atrial functional mitral regurgitation refers to a newly recognized disease entity in which mitral regurgitation occurs secondary to left atrial disease, without left ventricular dilatation and intrinsic mitral valve disease, typically in the setting of long-standing atrial fibrillation. Recent evidence suggests that atrial functional mitral regurgitation is associated with increased risk of death and heart failure re-hospitalization. The etiology, pathophysiology, and mechanism of atrial functional mitral regurgitation is not completely understood but they should not be regarded as the same as for the conventional type of functional mitral regurgitation secondary to left ventricular dilatation and dysfunction. Mitral annular dilatation, atriogenic leaflet distortion, insufficient leaflet remodeling, and subtle left ventricular dysfunction may play a role in the pathogenesis of atrial functional mitral regurgitation. The therapeutic and surgical considerations of atrial functional mitral regurgitation are different from those of ventricular functional mitral regurgitation. In this review, we assess current evidence regarding this new disease entity and propose a new surgical approach based on up-to-date understanding and experience of this condition.


Assuntos
Fibrilação Atrial/fisiopatologia , Função do Átrio Esquerdo , Implante de Prótese de Valva Cardíaca , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Remodelamento Atrial , Frequência Cardíaca , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Anuloplastia da Valva Mitral/efeitos adversos , Anuloplastia da Valva Mitral/instrumentação , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/epidemiologia , Insuficiência da Valva Mitral/fisiopatologia , Prevalência , Recuperação de Função Fisiológica , Resultado do Tratamento , Função Ventricular Esquerda
19.
J Stroke Cerebrovasc Dis ; 29(8): 104903, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32689580

RESUMO

PURPOSE: Evaluate reversal strategies in atrial fibrillation (AF) patients with warfarin-associated intracranial hemorrhage (ICH) in clinical care. MATERIALS AND METHODS: Observational cohort of AF patients with warfarin-associated ICH at two referral hospitals (2007-2010), with patient features, reversal agents, and outcomes collected from medical records. RESULTS: Among 498 ICH patients 403 received fresh frozen plasma (FFP) without 3-factor prothrombin complex concentrates (PCCs) or recombinant factor VIIa (rFVIIa), 65 received PCCs or rFVIIa, mostly with FFP, and 30 received no acute reversal agents. Median time from presentation to reversal agent administration was 3.4 h (IQR 2.3-5.3). INR was reversed to ≤1.4 by 6 h post-presentation in 46% of patients receiving PCCs/rFVIIa versus 15% receiving FFP alone (p<0.0001). Among PCCs/rFVIIa recipients, 31% died in-hospital vs. 24% receiving FFP alone (p=0.27). Adjusted OR for death accounting for age and Glasgow Coma Score was 0.78 (0.36-1.69) for PCCs/rFVIIa vs FFP only and 1.16 (0.59-2.27) comparing those reaching vs. not reaching INR ≤ 1.4 at 6 h. CONCLUSIONS: Treatment with PCCs/rFVIIa led to faster INR reversal than treatment with FFP alone. Neither treatment with PCCs/rFVIIa nor rapid INR reversal was associated with improved survival. Delays receiving PCCs may largely eliminate the benefit of treatment.


Assuntos
Anticoagulantes/efeitos adversos , Fibrilação Atrial/tratamento farmacológico , Fatores de Coagulação Sanguínea/uso terapêutico , Coagulação Sanguínea/efeitos dos fármacos , Coagulantes/uso terapêutico , Fator VIIa/uso terapêutico , Hemorragias Intracranianas/terapia , Plasma , Varfarina/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fatores de Coagulação Sanguínea/efeitos adversos , Boston , Coagulantes/efeitos adversos , Fator VIIa/efeitos adversos , Feminino , Humanos , Coeficiente Internacional Normatizado , Hemorragias Intracranianas/induzido quimicamente , Hemorragias Intracranianas/diagnóstico , Masculino , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
20.
Medicine (Baltimore) ; 99(27): e20881, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629677

RESUMO

Atrial fibrillation (AF) is a major independent risk factor of stroke and anticoagulation therapy is needed in patients with AF after ischemic stroke. However, the detection rate of AF is low after ischemic stroke. Developing a prediction model for newly diagnosed AF after ischemic stroke will help to assess the subclinical AF.We identified 98,103 patients with diabetes mellitus (DM) and 261,893 patients without DM, who were not AF history and admitted for newly ischemic stroke from the National Health Insurance Research Database in Taiwan. The prediction model for 3-year incidence of AF after ischemic stroke was derived from multivariate logistic regression and also the accuracy rate of the prediction model was compared with CHA2DS2-VASC and CHADS2 scores as a reference.Four thousand nine hundred seventy six patients in the DM cohort and 16,127 patients in the non-DM cohort developed AF during 3 years of follow-up. The variables in the point-based prediction model for non-DM patients (range: -3-28), included age, heart failure, coronary artery disease, gout, obstructive pulmonary disease, hypertension, female, and statin use, while those for DM patients (range: -2-30) included age, heart failure, coronary artery disease, chronic kidney disease, hypertension, obstructive pulmonary disease, and statin use. Compared to the CHADS2 and CHA2DS2-VASc scoring systems, this scoring system was better at predicting 3-year risk of AF after ischemic stroke in both cohorts.This model might be useful in evaluating the benefit of insertable cardiac monitor implantation and anticoagulation agents in individual patients after ischemic stroke.


Assuntos
Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Diabetes Mellitus/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Adulto , Fatores Etários , Doenças Cardiovasculares/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Taiwan/epidemiologia
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