Tag Archives: atrial fibrillation

Introduction The diagnosis of atrial fibrillation (AF) is made from an electrocardiogram (ECG) showing AF lasting for at least 30 seconds.1 The ECG characteristics of AF are irregularly irregular R–R intervals (where atrioventricular conduction is not impaired), absence of distinct repeating P-waves, and irregular atrial activations.1 AF is the most common sustained arrhythmia in the general population, with an estimated prevalence worldwide of 2% to 4%,2 and this is expected to increase two- to three-fold by 2030.3 In the UK, approximately 1.2 million individuals (1.8% of the populace) have been identified and diagnosed with AF.4,5 AF is a

The latter study enrolled 9,361 participants, of whom 4,683 were randomised to a goal SBP of <140 mmHg, and 4,678 were randomised to a goal SBP of <120 mmHg, the latter defined as intensive blood-pressure lowering. During 5.2 years of follow-up, intensive SBP lowering was associated with a 26% lower risk of developing new-onset AF (hazard ratio 0.74, 95% confidence interval 0.56 to 0.98, p<0.037). This effect was consistent among prespecified subgroups of participants stratified by age and sex.2 It is salutary to note that patients aged 60 years and older who have a life-expectancy of >3 years also benefit from intensive SBP lower

Introduction Following its discovery and introduction for clinical use in Birmingham, UK almost 250 years ago, digoxin has been used for the treatment of heart failure (HF). Indeed, until the advent of diuretics in the 1950s, it was the only available drug for this condition.1 Digoxin is an unusual drug in many respects. Derived from the foxglove plant, it increases intracellular Ca2+, and as an oral inotrope, is the only drug for chronic use in HF that addresses the primary problem, namely reduced cardiac pumping capacity (figure 1). All the other commonly used drugs for HF act indirectly to either inhibit the adverse neurohormonal response

Introduction Atrial fibrillation (AF) is a common arrhythmia responsible for significant patient morbidity, including stroke, heart failure and intrusive palpitations.1 Obesity is well recognised as a contributor to AF incidence and symptom burden.2 Weight loss has been shown to reduce occurrence of AF and increase the likelihood of maintaining sinus rhythm after cardioversion or catheter ablation for AF.3–5 Although it has been demonstrated that weight loss can reduce AF burden in a trial setting, it is well recognised that motivation for sustained weight loss is low in a real-world population, and often any weight loss achieved is tempora

Introduction Anticoagulant therapy is an essential component in the treatment and prevention of venous and arterial thromboembolic events. In recent years, direct-acting oral anticoagulants (DOACs) have replaced vitamin K antagonists (VKAs) for many of these indications, due to their more favourable risk-benefit profile.1 Despite this, bleeding remains a significant concern with DOACs, especially in patients at high risk, such as those with an indication for concurrent antiplatelet therapy, and may lead to poor adherence or undertreatment.2–4 Safer anticoagulation that spares haemostasis without compromising efficacy is, therefore, desirab

Introduction The optimal treatment for persistent atrial fibrillation (AF) in patients ≥65 years is unknown. There are several options including medical therapy for rate and rhythm control, direct current cardioversion (DCCV), permanent pacemaker (PPM) and atrioventricular node ablation (AVNA) and catheter ablation of AF.1 These treatment options have not been directly compared and each has its own advantages and disadvantages.2 In many patients, it is desirable to attempt to restore and maintain sinus rhythm to reduce symptoms and improve quality of life (QoL).3 DCCV has been reported to terminate AF in ≥90% of cases.4 However, recurrenc

What is the future of cardiovascular health? NHS Medical Director Professor Sir Stephen Powis opened the conference by outlining the growing need to provide high quality cardiovascular care. With a quarter of deaths in England attributable to cardiovascular disease and a wider cost to the economy of £15.8 billion per year,1 there is an urgent need for innovative care pathways and new technologies. He showcased virtual wards as one example of innovation, with over 100,000 patients having been managed remotely in 2022.2 In Liverpool, a Telehealth team has successfully utilised a medical monitoring app to manage patients at home, leading to a 1

Introduction Atrial fibrillation (AF) is a common arrhythmia with significant associated morbidity, mortality, and healthcare costs.1 N-3 fatty acids may influence the risk of AF, but previous studies show conflicting evidence on whether N-3 fatty acids are pro- or anti-arrhythmogenic. Given the significant cardiovascular disease risk reduction associated with N-3 fatty acids, there has been interest in delineating their risk profile. In 2004, Mozaffarian et al. noted that increased dietary fish intake was associated with lower incidence of AF.2 Two separate studies suggested that higher levels of circulating long-chain N-3 fatty acid and doc

Introduction There is an increasing prevalence of atrial fibrillation (AF) worldwide, with a one-in-three lifetime risk of developing AF over the age of 40 years.1 AF is a leading cause of stroke, and stroke risk is increased further in the presence of diabetes.2 Diabetes has been recognised as a risk factor for AF and, therefore, targeted screening for AF in such groups has been explored in combination with comorbid risk factors.2 There are yet to be universally accepted recommendations for AF screening. The European Society of Cardiology (ESC) recommend opportunistic screening in people >65 years and consideration of systematic screening

Introduction Heart failure (HF) is a common condition and the majority of patients have multiple co-morbidities. It is therefore essential that all healthcare professionals (HCPs) are familiar with the contemporary management of these patients. Whilst HF specialists are integral to the delivery of optimal patient care, it is important to ensure that therapies are optimised at every opportunity and enable the best care for patients in the context of acute or chronic non-cardiovascular illness. Current practice is often suboptimal; for example, in the latest national HF audit (England and Wales), the number of patients leaving hospital on thre