Tag Archives: stroke

Introduction Atrial fibrillation (AF) is the most common cardiac arrhythmia with an estimated prevalence in the UK of 3%.1 Epidemiological studies have shown a 12–20% reduction in the risk of AF in individuals who engage in guideline-recommended physical activity levels.2,3 However, the reduction in AF risk appears to diminish with increasing doses of exercise, with contemporary data proposing a paradoxical rise in the risk of AF with the highest doses of exercise; suggesting a U-shaped dose-response relationship (figure 1).4 Figure 1. The extreme exercise hypothesis4 whereby the benefits of exercise are reduced in extreme training volumes

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 Stroke is defined as an acute neurological deficit of cerebrovascular origin lasting longer than 24 hours. In the UK each year, stroke affects approximately 100,000 people, is a leading cause of mortality, causing over 30,000 deaths in 2020, and is a significant contributor to severe disability.1 Caring for patients with stroke in the UK costs approximately £2.5 million each year and leads to significant production losses. Clearly, preventing stroke has many benefits. Strokes can be ischaemic (85%), where tissue damage is due to occlusion of blood supply, or haemorrhagic (15%), due to a ruptured vessel.2 Ischaemic stroke can be

Introduction Cerebrovascular disease is a major cause of disability and mortality in adults worldwide.1 Patients can present with a stroke or transient ischaemic attack (TIA). Due to the risk of recurrent events, early investigation and treatment of risk factors is advised.2,3 One of the major risk factors for stroke is atrial fibrillation (AF). AF is a common cardiac arrhythmia, which is estimated to affect 2.5% of the adult population in Scotland, with a large proportion undiagnosed and consequently untreated. Cardioembolism accounts for around a quarter of all ischaemic strokes, which is most commonly caused by AF.4 Current evidence shows

Introduction Atrial fibrillation (AF) more than doubles the five-year risk of stroke in middle-aged men and women.1 Prior cerebrovascular disease markedly amplifies the risk of recurrent stroke in patients with or without AF.1,2 Figure 1 shows the influence of AF and prior cerebrovascular disease (stroke or transient ischaemic attack [TIA]) on the estimated five-year risk of a composite of stroke, systemic thromboembolism, or TIA (most events were ischaemic strokes) for a 60-year-old individual, from a large cohort study conducted in the UK.1 These observations demonstrate the need for long-term treatment to reduce the risk of stroke in thes

Stat tests loaded into the VITROS XT 7600 Moderate alcohol consumption does not protect against stroke Blood pressure and stroke risk increase steadily with increasing alcohol intake, and previous claims that one to two alcoholic drinks a day might protect against stroke are not borne out by new evidence from a genetic study involving 160,000 adults. Studies of East Asian genes, where two common genetic variants strongly affect what people choose to drink, show that alcohol itself directly increases blood pressure and the chances of having a stroke, according to a new study published in The Lancet (doi: 10.1016/S0140-6736(18)31772-0). Researc

Introduction Atrial fibrillation (AF) increases an individual’s risk of stroke fivefold.1 Oral anticoagulation (OAC) with warfarin reduces the risk of stroke by 64%.2 Novel or direct oral anticoagulants are non-inferior to warfarin in preventing stroke in non-valvular AF and have a similar bleeding profile, but with a lower risk of fatal intracranial haemorrhage and several practical advantages.3-7 While several antiplatelet agents have been shown to reduce the risk of recurrent stroke, they are considerably less effective than OAC, with a similar risk of major bleeding, and, therefore, are no longer recommended in national guidelines for

New practical NOACs guide A new version of EHRA Practical Guide on the use of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation (AF) was launched at the congress. ESC guidelines state that NOACs should be preferred over vitamin K antagonists, such as warfarin, for stroke prevention in AF patients, except those with a mechanical heart valve or rheumatic mitral valve stenosis, and their use in clinical practice is increasing. The guide gives concrete, practical advice on how to use NOACs in specific clinical situations. The guide is published in European Heart Journal (doi: 10.1093/eurheartj/ehy136). Anti

Large-scale studies examining these key aspects of work have been carried out in the US, but not within the UK and there is a significant data gap. The survey will take only 15–20 minutes to complete and will provide valuable insight in to the professional life of the UK cardiologist. Visit: https://bbk.onlinesurveys.ac.uk/the-organisation-life-work-balance-and-gender-perceptions CASTLE-AF: AF ablation first-line therapy in HF? Results from CASTLE-AF “indicate heart failure patients with co-existing AF should be treated with catheter ablation as a first-line therapy,” says the study’s co-lead investigator Dr Johannes Brachmann, (Cobur