September 2014 Br J Cardiol 2014;21(suppl 1):S1–S11
Laurent Fauchier, Edouard Siméon, Christophe Saint-Etienne
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
September 2014 Br J Cardiol 2014;21:98
BJCardio Staff
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
September 2014 Br J Cardiol 2014;21:90
Professor Ivy Shiue; Dr Krasimira Hristova; Professor Jagdish Sharma
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
July 2014 Br J Cardiol 2014;21:89–90 doi:10.5837/bjc.2014.020
David Haslam
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
June 2014 Br J Cardiol 2014;21:64–8 doi:10.5837/bjc.2014.015
Wasim Javed, Matthew Fay, Mark Hashemi, Steven Lindsay, Melanie Thorpe, David Fitzmaurice
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
February 2014 Br J Cardiol 2014;21:29–32 doi:10.5837/bjc.2014.002 Online First
Wai Kah Choo, Shona Fraser, Gareth Padfield, Gordon F Rushworth, Charlie Bloe, Peter Forsyth, Stephen J Cross, Stephen J Leslie
Introduction Atrial fibrillation (AF) is a common arrhythmia affecting approximately 1% of the general population, this rises to 18% in those aged 85 years and above.1 The most effective method for correcting persistent AF is direct current cardioversion (DCCV). However, DCCV is associated with an increased risk of thromboembolic events.2 Anticoagulation with warfarin reduces the risk of thromboembolism from approximately 6% to less than 1%.3 The current recommendations advise therapeutic anticoagulation for at least three weeks prior to, and four weeks after cardioversion.4 A nurse-led elective DCCV service at Raigmore Hospital was establish
December 2013 Br J Cardiol 2013;20:160
Dr John Havard; Dr John Soong
National survey of patients with AF in the acute medical unit: a day in the life survey Dear Sirs, The first national survey examining the management of atrial fibrillation (AF) within acute medical units up and down the country has just been published in the British Journal of Cardiology.1 Essentially it seems to show that secondary care is just as bad as primary care in initiating warfarin for AF patients. This group of patients is five times more likely to have a thromboembolic cerebrovascular accident than matched populations in sinus rhythm and yet doctors are ineffective at influencing change. This study took place over a 24-hour period
August 2013 Br J Cardiol 2013;20:92-93 Online First
BJCardio Staff
With the number of patients with atrial fibrillation (AF) set to double by 2050, appropriate anticoagulation for this growing condition was highlighted in a special session at the meeting – a ‘State of The Art Lecture’. Professor Stefan H Hohnloser (JW Goethe University, Frankfurt, Germany) described how stroke in Europe costs an estimated €38 billion per year, with 20% attributable to AF. Yet a decade ago, around 40% of AF patients did not receive appropriate anticoagulation. Of those receiving therapy, only around 50% of time in therapeutic range (TTR) is seen. With this in mind, novel oral anticoagulants (NOACs) are non-inferior to
August 2013 Br J Cardiol 2013;20:92-93 Online First
BJCardio Staff
Patients with paroxysmal AF rate their heath-related quality of life (HRQoL) lower than their physicians do, according to results from the ANTIPAF (Angiotensin II Antagonist in Paroxysmal Atrial Fibrillation) trial. The study found these patients show signs of depression, sleeping disorders and low levels of physical activity even in the absence of significant concomitant cardiac disease. Researchers led by Professor Karl Ladwig (Helmholtz Centre, Munich, Germany) analysed data from patients enrolled in the ANTIPAF trial, which examined discordance between AF patients and their doctors. Between February 2004 and September 2008, 334 patients (
July 2013 Br J Cardiol 2013;20:106 doi:10.5837/bjc.2013.021 Online First
John Soong, Anjali Balasanthiran, Donald C MacLeod, Derek Bell
Introduction Atrial fibrillation (AF) is the most common cardiac dysrrhythmia, whose sequelae include stroke, heart failure and poor quality of life.1 In parallel with an ageing population, the prevalence of AF is increasing, with persistent or permanent forms affecting 10–15% of the population over the age of 75 years.2-6 The effective management of AF has been a source of recurring debate, leading to the publication of combined American College of Cardiology/American Heart Association/European Society of Cardiology (ACC/AHA/ESC), and National Institute for Health and Clinical Excellence (NICE) guidelines in 2006.7,8 In addition to evidenc
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