Tag Archives: atrial fibrillation

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Introduction Atrial fibrillation is the most common arrhythmia, affecting 1–2% of the population.1 It is associated with an increased risk of stroke and death, heart failure, reduction in quality of life, mental health problems and cognitive impairment.2 Hospitalisation is common and costly.3 Dronedarone was first approved by the National Institute for Health and Care Excellence (NICE) in April 20104 for atrial fibrillation rhythm control, but following two fatal cases of liver toxicity it is contraindicated in patients with liver dysfunction, a creatinine clearance (CrCl) ≤30 ml/min, in permanent atrial fibrillation or congestive heart f

Introduction Atrial fibrillation (AF) is a supraventricular tachyarrhythmia characterised by uncoordinated activation of the atria. AF is a progressive disease and represents the most common serious disorder of cardiac rhythm. The incidence and prevalence of the disease increase progressively with age and is more common among men.1–5 AF is associated with higher mortality and cardiovascular (CV) morbidity.6–13 Specifically, AF is a recognised risk factor for stroke, with the proportion of strokes attributable to AF increasing exponentially with age.1,2,7,14–17 Although clinicians are most concerned about stroke risk among AF patients, c

When the NOACs (novel oral anticoagulants) were introduced over three years ago, they promised to revitalise the management of conditions such as atrial fibrillation (AF), venous thromboembolism (VTE) and thromboprophylaxis after major joint replacement surgery. Rivaroxaban is currently available in multiple indications, including (but not limited to): prevention of stroke and systemic embolism in adult patients with non-valvular AF, treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and the prevention of recurrent DVT and PE in adults. For decades anticoagulant therapy in these conditions had relied on the vitamin K antagon

ESC guidelines and differences between NOACs Following the roll-out of the novel oral anticoagulants (NOACs), the European Society of Cardiology (ESC) published in 2012 a focused update of its guidelines for the management of atrial fibrillation (AF). Since the NOACs tested in clinical trials all showed at least non-inferiority when compared with vitamin K antagonists (VKAs), with a better safety profile, particularly with reduction in intracranial haemorrhage (ICH), the ESC 2012 guideline recommended NOACs as broadly preferable to VKAs in the vast majority of patients with non-valvular AF (NVAF).1 In 2013, the European Heart Rhythm Associati

Introduction Vitamin K antagonists (VKAs) reduce the risk of stroke in patients with atrial fibrillation (AF). For more than five decades, they were the only available treatment. Novel oral anticoagulants (NOACs) have recently been approved for the prevention of non-valvular AF-related stroke. Dose-adjusted VKA therapy and NOACs are highly effective in AF patients. However, dabigatran, rivaroxaban and apixaban are more convenient, while at least equally effective and with a comparable safety profile (regarding bleeding complications) for stroke prevention compared with VKAs.1-3 Recent guidelines prefer treatment with NOACs over VKAs for most

The National Institute for Health and Care Excellence (NICE) has said that thousands of people with atrial fibrillation (AF) could be prevented from having strokes, disability or death if its new guidance is followed. It says many patients with AF are not being appropriately anticoagulated and highlights how there has not been widespread uptake of novel oral anticoagulant drugs (NOACs) which were approved by NICE in 2012. Clinical guideline 180 published in June 2014 updates and replaces the 2006 NICE clinical guideline 36. The full guidance can be found at http://www.nice.org.uk/guidance/CG180 NICE Chair, Professor David Haslam writes on the

Dear Sirs, Research on sex difference in mortality after myocardial infarction (MI) since the 1990s has been debated and increased. Several observational studies have shown that younger women, in particular, seemed to have higher mortality rates than men of similar age during the two-year or longer follow-up, although these studies were mainly from the USA.1-3 Recent American studies have also found that, even after full adjustment for potential risk factors, excess risk for in-hospital mortality for women was still noted, particularly among those <50 years old with acute ST-segment elevation MI, leading to 98% (odds ratio [OR] 1.98, 95% c

Yet, not all today’s physicians are keeping step with this new world. All too often adopting new ways of talking to patients or prescribing new technologies and medicines is left by the wayside in favour of keeping to tried and tested habits. Treating a common heart disorder Take the case with atrial fibrillation (AF), which affects around 800,000 people in the UK. Anticoagulation to reduce the risk of stroke is an essential part of AF management but according to the Department of Health many patients are not always appropriately anticoagulated.1 Since 2012, the National Institute for Health and Care Excellence (NICE) has approved a number

Introduction Screening has been proposed as a method to detect patients with undiagnosed atrial fibrillation (AF) as it is a dangerous, prevalent condition that may be easily diagnosed with a simple low-cost test, an electrocardiogram (ECG), and the risk of serious sequelae such as ischaemic stroke can be effectively reduced with anticoagulation.1 Hence, it fulfils the Wilson Jungner criteria for a screening programme.2 The potential benefits of AF screening are far reaching, as reducing stroke prevalence has massive implications for both patients and health services in the UK, where stroke consumes approximately 5% of total National Health S