"Information on comorbidities was generated from ICD-9-CM codes in the clinical database with coding algorithms as described by Quan et al. . The CHA 2 DS 2 -VASc score and Charlson comorbidity index were also calculated for each patient for risk stratification   . The initiation date and discontinuation date of AADs as well as information on other medications were ascertained via review of the institutional pharmacologic database and clinical notes and orders in the electronic medical record. "
[Show abstract][Hide abstract] ABSTRACT: Introduction
Although there are many different antiarrhythmic drugs (AADs) approved for rhythm management of atrial fibrillation (AF), little comparative effectiveness data exist to guide drug selection.
We followed 5952 consecutive AF patients who were prescribed amiodarone (N = 2266), dronedarone (N = 488), dofetilide (N = 539), sotalol (N = 1718), or class 1C agents (N = 941) to the primary end point of AF recurrence.
Median follow-up time was 18.2 months (range 0.1–101.6 months). Patients who were prescribed amiodarone had the highest, while patients on class 1C agents had the lowest baseline CHA2DS2-VASc score, Charlson comorbidity index, and burden of comorbid illnesses including coronary artery disease, congestive heart failure, diabetes mellitus, hyperlipidemia, chronic obstructive lung disease, chronic kidney disease, or cancer (p < 0.05 for all comparisons). After adjusting for baseline characteristics, using dronedarone as benchmark, amiodarone [hazard ratio (HR) 0.58, p < 0.001], class 1C agents (HR 0.70, p < 0.001), and sotalol (HR 0.79, p = 0.008), but not dofetilide (HR 0.87, p = 0.178) were associated with less AF recurrence. In addition, compared to dronedarone, amiodarone and class 1C agents were associated with lower rates of admissions for AF (HR 0.55, p < 0.001 for amiodarone; HR 0.71, p = 0.021 for class 1C agents) and all-cause mortality was lowest in patients treated with class 1C agents (HR 0.42, p = 0.018). The risk of stroke was similar among all groups.
Compared with dronedarone, amiodarone, class 1C agents, and sotalol are more effective for rhythm control, while dofetilide had similar efficacy. These findings have important implications for clinical practice.
Journal of Cardiology 07/2015; DOI:10.1016/j.jjcc.2015.07.001 · 2.78 Impact Factor
"Other predictors of ICH may include the predictors of major bleeding (extra- and intracranial) that comprise the HAS-BLED score (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or pre-disposition, Labile INR, Elderly (>65), Drugs/alcohol concomitantly). A HAS-BLED score of >3 is considered ‘high risk’, although it should be noted that because this scoring system was developed for use in AF, its applicability to other patient groups is unclear (65,66). The risk of recurrent stroke and systemic embolism is likely to be greater in patients with AF and a high CHADS2 or CHA2DS2-VASc score, and transesophageal echocardiographic evidence of left ventricular dysfunction, left atrial enlargement, or left atrial thrombus (67,68). "
[Show abstract][Hide abstract] ABSTRACT: Each year, 1·0–2·0% of individuals with atrial fibrillation and 0·1–0·2% of those with venous thromboembolism who are receiving one of the novel oral anticoagulants (dabigatran, rivaroxaban, or apixaban) can be expected to experience an acute ischemic stroke. Additionally, 0·2–0·5% of individuals with atrial fibrillation who are receiving one of the novel oral anticoagulants can be expected to experience an intracranial hemorrhage. This opinion piece addresses the current literature and offers practical approaches to the management of patients receiving novel oral anticoagulants who present with an ischemic or hemorrhagic stroke. Specifically, we discuss the role of thrombolysis in anticoagulated patients with acute ischemic stroke and factors to consider concerning restarting anticoagulation after acute ischemic and hemorrhagic stroke.
International Journal of Stroke 06/2014; 9(5). DOI:10.1111/ijs.12295 · 3.83 Impact Factor
"To stratify the subjects, comorbid conditions and other risk factors such as congestive heart failure, hypertension, age ≥75, diabetes, history of stroke, vascular disease, age 65–74, and sex category were taken into account according to the CHA2DS2-VASc or CHADS2 scheme criteria [5,11]. In both CHA2DS2-VASc or CHADS2 scheme systems, a score of 0 was categorized into low risk, a score of 1 was moderate risk , and score ≥2 was high risk . "
[Show abstract][Hide abstract] ABSTRACT: The CHADS2/CHA2DS2-VASc scores are used to predict thrombo-embolic/stroke in patients with nonvalvular atrial fibrillation (AF). Nevertheless, limited data are available regarding the association between these risk stratification for stroke and left atrial (LA) remodeling status of AF patients. The purpose of this study was to explore the association between these scores and LA remodeling status assessed quantificationally by echocardiography in AF patients.
One hundred AF patients were divided into 3 groups based on the CHA2DS2-VASc/CHADS2 score: the score of 0 (low stroke risk), the score of 1 (moderate stroke risk) and the score of ≥2 (high stroke risk). All patients were performed through conventional and velocity vector imaging echocardiography. Echocardiographic parameters: maximum LA volume index (LAVImax), LA total emptying fraction (LAEFt) and LA mean strain were obtained to assess quantificationally LA remodeling status.
On categorizing with CHA2DS2-VASc, the score of 1 group showed augment in LAVImax and attenuation in LA mean strain derived from VVI, compared with the score of 0 group (LAVImax: 40.27±21.91 vs. 26.79±7.87, p=0.002; LA mean strain: 15.18±6.36 vs. 22±8.54, p=0.001). On categorizing with the CHADS2 score, similar trends were seen between the score of ≥2 and 1 groups (LAVImax: 43.72±13.77 vs. 31.41±9.50, p<0.001; LA mean strain: 11.01±5.31 vs. 18.63±7.00, p<0.001). With multivariate logistic regression, LAVImax (odds ratio: 0.92 , 95% C=I: 0.85 to 0.98, p= 0.01) and LA mean strain reflecting LA remodeling (odds ratio: 1.10, 95% CI: 1.02 to 1.19, p=0.01) were strongly predictive of the CHA2DS2-VASc score of 0.
The superiority of the CHADS2 score may lay in identifying LA remodeling of AF patients with high stroke risk. Whereas, the CHA2DS2-VASc score was better than the CHADS2 score at identifying LA remodeling of AF patients presenting low stroke risk.
PLoS ONE 10/2013; 8(10):e77653. DOI:10.1371/journal.pone.0077653 · 3.23 Impact Factor
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