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Iwata H, Miyauchi K, Nojiri S, Nishizaki Y, Chikata Y, Daida H. Real-world antithrombotic strategies in patients with atrial fibrillation and recently developed acute coronary syndrome. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2025; 24:200339. [PMID: 39760131 PMCID: PMC11699624 DOI: 10.1016/j.ijcrp.2024.200339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 09/21/2024] [Accepted: 10/03/2024] [Indexed: 01/07/2025]
Abstract
Background The antithrombotic strategy for patients with atrial fibrillation (AF) and coronary artery disease following percutaneous coronary intervention is shifting towards less intensive. Nevertheless, for patients with AF and acute coronary syndrome (ACS), an optimal antithrombotic strategy is yet to be established. Methods and results We conducted a multi-center cohort study involving 146 Japanese centers that had prospectively registered 460 patients with AF and ACS followed for 2 years. Primary endpoint was the composite of thrombotic and bleeding events, and secondary endpoints included heart failure hospitalization. At the time of study registration, 86 % of participants had received direct oral anticoagulants (DOACs) and 75 % had received aspirin-based triple antithrombotic therapy (TAT) between March 2017 and August 2019. Apixaban was the most frequently used DOAC (29 %). While the proportion of anticoagulants did not change according to the time course, the intensity of antiplatelets significantly attenuated over time (dual antiplatelet at baseline: 75 %, and at 2-years: 7 %). The cumulative incidence of the primary outcome measure was similar in patients with warfarin and DOACs. However, the risk of heart failure hospitalization was significantly higher in those with warfarin compared to DOACs (Hazard ratio: 2.8, 95 % confidence interval: 1.1-5.8, p = 0.022). Conclusions The present findings suggest the appropriate optimization of antithrombotic medication balancing in patients with AF and ACS in Japan by reducing the intensity of antiplatelets during the study period.
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Affiliation(s)
- Hiroshi Iwata
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Katsumi Miyauchi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan
| | - Yuji Nishizaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Clinical Translational Science, Juntendo University, Tokyo, Japan
| | - Yuichi Chikata
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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2
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Huang X, Xie D, Huang J, Li R, Zheng Q, Liu X, Dai H, Lin X, Liu Y, Su J, Dong X, Lan Y, You C, Jiang S, Zhang J. Risk of Bleeding, Thrombosis and Death among Atrial Fibrillation Patients Treated with Oral Anticoagulants Across Estimated Glomerular Filtration Rates. Am J Cardiol 2025; 238:55-64. [PMID: 39631491 DOI: 10.1016/j.amjcard.2024.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Revised: 11/11/2024] [Accepted: 11/18/2024] [Indexed: 12/07/2024]
Abstract
There are limited data about the clinical benefits and harm of oral anticoagulants (OACs) for stroke prevention in patients with atrial fibrillation (AF) and chronic kidney disease using CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) creatinine equation for glomerular filtration rate (GFR) estimation in nuanced GFR stratification. We conducted a retrospective study in 12 centers in China and included 9,510 patients with AF. We grouped patients into the following estimated GFR (eGFR) categories: ≥60 (n = 7,616), 45 to 59 (n = 1,139), 30 to 44 (n = 474), and <30 (n = 281) ml/min/1.73 m2. Logistic regression was used to the compare risks of major bleeding, minor bleeding, total bleeding, thrombosis, and all-cause deaths in patients with AF with eGFR 45 to 59, 30 to 44, <30 ml/min/1.73 m2, and ≥60 ml/min/1.73 m2 after taking OACs. Patients with AF treated with OACs with eGFR 45 to 59, 30 to 44, and <30 ml/min/1.73 m2 had a significantly increased risk of all-cause deaths compared with eGFR ≥60 ml/min/1.73 m2 (adjusted odds ratio [aOR] 1.326, 95% confidence interval [CI] 1.049 to 1.665, p = 0.016; aOR 1.634, 95% CI 1.197 to 2.200, p = 0.002; aOR 2.492, 95% CI 1.766 to 3.471, p <0.001; respectively). Higher eGFR was associated with a significantly lower risk of all-cause deaths (aOR 0.990, 95% CI 0.986 to 0.994, p <0.001) and major bleeding (aOR 0.988, 95% CI 0.979 to 0.998, p = 0.018). Direct OACs remarkably reduced risk of major bleeding in those with eGFR 30 to 44 ml/min/1.73 m2 compared with warfarin. In conclusion, in patients with AF treated with OACs, patients with eGFR 45 to 59, 30 to 44, and <30 ml/min/1.73 m2 had a significantly increased risk of all-cause deaths compared with eGFR ≥60 ml/min/1.73 m2, and the risk of all-cause deaths increased with decreasing eGFR. Direct OACs are at least safe alternatives to warfarin in patients with AF with eGFR 30 to 44 ml/min/1.73 m2.
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Affiliation(s)
- Xinhai Huang
- School of Pharmacy, Fujian Medical University, Fuzhou, China; Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Donglin Xie
- School of Pharmacy, Fujian Medical University, Fuzhou, China; Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Jie Huang
- School of Pharmacy, Fujian Medical University, Fuzhou, China; Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Ruijuan Li
- Department of Pharmacy, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Qiaowei Zheng
- Department of Pharmacy, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiumei Liu
- Department of Pharmacy, People's Hospital of He'nan University of Chinese Medicine (People's Hospital of Zhengzhou), Zhengzhou, China
| | - Hengfen Dai
- Department of Pharmacy, Affiliated Fuzhou First Hospital of Fujian Medical University, Fuzhou, China
| | - Xiangsheng Lin
- Department of Pharmacy, Pingtan County General Laboratory Area Hospital, Fujian, China
| | - Yuxin Liu
- Department of Pharmacy, Huaihe Hospital of Henan University, Kaifeng, China
| | - Jun Su
- Department of Pharmacy, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui Province, China
| | - Xiaomin Dong
- Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Yanxian Lan
- Minzu Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Cuifang You
- Ningde Municipal Hospital Affiliated to Ningde Normal University, Ningde, China
| | - Shuzheng Jiang
- Traditional Chinese and Western Medicine Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinhua Zhang
- Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.
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3
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Gorostiza I, Bilbao-Gonzalez A, Mar J. Cost-effectiveness of direct oral anticoagulants in non-valvular atrial fibrillation. GACETA SANITARIA 2025:102451. [PMID: 39971633 DOI: 10.1016/j.gaceta.2025.102451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Revised: 12/20/2024] [Accepted: 12/24/2024] [Indexed: 02/21/2025]
Abstract
OBJECTIVE There is evidence on the efficiency of new direct oral anticoagulants (DOAC), mostly based on experimental efficacy data, but there is also a need to assess their cost-effectiveness in routine clinical practice using patient-level data. We designed a retrospective cohort study to assess the cost-effectiveness of DOAC compared to acenocoumarol in patients with non-valvular atrial fibrillation (NVAF) with a follow-up of up to 7 years. METHOD Basque Health Service-registered patients who started oral anticoagulant treatment between 2013 and 2016 were included in the study and followed up until the end of 2019. Data were extracted from an electronic medical record management system. Effectiveness was expressed in terms of life years gained and adjusted for health-related quality of life (i.e., quality-adjusted life years [QALY]). Propensity score techniques were used to adjust the estimates for differences between groups in baseline characteristics. RESULTS A total of 10,843 new users of oral anticoagulants with a mean follow-up of 4.1 years were included. The incremental cost-effectiveness ratio of DOAC compared to acenocoumarol ranged from €1,732 to €2,556/QALY, while the incremental net benefit for different willingness-to-pay thresholds was only negative for values below €3,000/QALY. CONCLUSIONS Based on the analysis of data from clinical practice and the similarity of results using several different techniques to adjust for bias associated with observational studies, we conclude that DOAC would be an efficient alternative for the treatment of patients with NVAF.
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Affiliation(s)
- Inigo Gorostiza
- Osakidetza Basque Health Service, Basurto University Hospital, Research and Innovation Unit, Bilbao, Spain; Institute for Health Services Research (Kronikgune), Barakaldo, Bizkaia, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain.
| | - Amaia Bilbao-Gonzalez
- Osakidetza Basque Health Service, Basurto University Hospital, Research and Innovation Unit, Bilbao, Spain; Institute for Health Services Research (Kronikgune), Barakaldo, Bizkaia, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - Javier Mar
- Institute for Health Services Research (Kronikgune), Barakaldo, Bizkaia, Spain; Osakidetza Basque Health Service, Debagoiena Integrated Healthcare Organisation, Research Unit, Arrasate-Mondragon, Gipuzkoa, Spain; Biogipuzkoa Health Research Institute, Donostia-San Sebastian, Gipuzkoa, Spain
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4
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Camm CF, Virdone S, Jerjes-Sánchez C, Oh S, Eikelboom JW, Oto A, Fox KAA, Camm AJ, Pieper KS, Goto S, Ragy H, Kakkar AK. Association of care specialty with anticoagulant prescription and clinical outcomes in newly diagnosed atrial fibrillation: Results from the GARFIELD-AF registry. Int J Cardiol 2025; 421:132866. [PMID: 39631531 DOI: 10.1016/j.ijcard.2024.132866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Revised: 11/06/2024] [Accepted: 11/27/2024] [Indexed: 12/07/2024]
Abstract
OBJECTIVE To determine whether stroke prevention strategy, comorbidity management, and clinical outcome risks differ across atrial fibrillation (AF) care specialties. METHODS Newly diagnosed non-valvular AF patients enrolled in the international, prospective GARFIELD-AF registry (enrolment: 2010-2016) were analysed. Prescription of oral anticoagulation (OAC) therapy and select comorbidities was assessed by baseline care specialty: cardiology, primary care, or other specialties (internist/neurologist/geriatrician). Associations between care specialty and 2-year clinical outcomes were evaluated using multivariable Cox frailty models to account for within-country homogeneity. RESULTS In 52,011 patients, 34,172 (65.7 %) were diagnosed and initially managed in cardiology care, 7396 (14.2 %) in primary care, and 10,443 (20.1 %) in other specialties. The inter-country care specialty distribution varied considerably. Non-vitamin K OAC (NOAC) therapy among CHA2DS2-VASc ≥2 patients was more common in cardiology care (31.0 %) than primary care (19.8 %) and other specialty care (24.9 %), but comorbidity management was similar across specialties. Compared to cardiology care, primary care was associated with greater non-cardiovascular mortality (1.21 [1.01-1.45]), major bleeding (1.31 [1.05-1.62]), and new/worsening heart failure risk (2.09 [1.69-2.59]). Care in other specialties was associated with greater all-cause (adjusted hazard ratio, 1.19 [95 % CI, 1.09-1.29]), cardiovascular (1.15 [1.01-1.31]), and non-cardiovascular mortality (1.29 [1.13-1.47]), as well as non-haemorrhagic stroke/systemic embolism (1.48 [1.26-1.73]), major bleeding (1.21 [1.02-1.43]), and new/worsening heart failure risk (1.45 [1.21-1.75]) than cardiology care. CONCLUSION Comorbidity management was similar across AF care specialties, but patients outside of cardiology care had fewer NOAC prescriptions and greater risk for most clinical endpoints. Cardiology expertise may have important implications for AF prognosis. CLINICAL TRIAL REGISTRATION URL: http://www. CLINICALTRIALS gov. Unique identifier for GARFIELD-AF: NCT01090362.
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Affiliation(s)
| | | | - Carlos Jerjes-Sánchez
- Tecnologico de Monterrey, Escuela de Medicine y Ciencias de la Salud, Monterrey, Mexico
| | - Seil Oh
- Seoul National University, Seoul, Republic of Korea
| | | | - Ali Oto
- Memorial Ankara Hospital, Ankara, Turkey
| | | | - A John Camm
- Cardiology Clinical Academic Group Molecular & Clinical Sciences Research Institute, St. George's University of London, London, UK
| | | | - Shinya Goto
- Tokai University School of Medicine, Kanagawa, Japan
| | - Hany Ragy
- National Heart Institute, Cairo, Egypt
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5
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Iwasaki YK, Noda T, Akao M, Fujino T, Hirano T, Inoue K, Kusano K, Nagai T, Satomi K, Shinohara T, Soejima K, Sotomi Y, Suzuki S, Yamane T, Kamakura T, Kato H, Katsume A, Kondo Y, Kuroki K, Makimoto H, Murata H, Oka T, Tanaka N, Ueda N, Yamasaki H, Yamashita S, Yasuoka R, Yodogawa K, Aonuma K, Ikeda T, Minamino T, Mitamura H, Nogami A, Okumura K, Tada H, Kurita T, Shimizu W. JCS/JHRS 2024 Guideline Focused Update on Management of Cardiac Arrhythmias. Circ J 2025:CJ-24-0073. [PMID: 39956587 DOI: 10.1253/circj.cj-24-0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2025]
Affiliation(s)
- Yu-Ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Takashi Noda
- Department of Cardiology, Tohoku University Hospital
| | - Masaharu Akao
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
| | - Tadashi Fujino
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | - Teruyuki Hirano
- Department of Stroke Medicine, Kyorin University School of Medicine
| | - Koichi Inoue
- Department of Cardiology, National Hospital Organization Osaka National Hospital
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | | | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Kyoko Soejima
- Department of Cardiovascular Medicine, Kyorin University School of Medicine
| | - Yohei Sotomi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Shinya Suzuki
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Teiichi Yamane
- Department of Cardiology, The Jikei University School of Medicine
| | - Tsukasa Kamakura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hiroyuki Kato
- Department of Cardiology, Japan Community Healthcare Organization Chukyo Hospital
| | - Arimi Katsume
- Department of Cardiovascular Medicine, Kyorin University School of Medicine
| | - Yusuke Kondo
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
| | - Kenji Kuroki
- Department of Cardiology, Faculty of Medicine, University of Yamanashi
| | - Hisaki Makimoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Data Science Center, Jichi Medical University
| | | | - Takafumi Oka
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Nobuaki Tanaka
- Department of Cardiology, Cardiovascular Center, Sakurabashi Watanabe Hospital
| | - Nobuhiko Ueda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hiro Yamasaki
- Department of Cardiology, Institute of Medicine, University of Tsukuba
| | - Seigo Yamashita
- Department of Cardiology, The Jikei University School of Medicine
| | - Ryobun Yasuoka
- Department of Cardiology, Kindai University School of Medicine
| | - Kenji Yodogawa
- Department of Cardiology, Nippon Medical School Hospital
| | | | - Takanori Ikeda
- Department of Cardiology, Toho University Medical Center Omori Hospital
| | - Toru Minamino
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Hideo Mitamura
- National Public Service Mutual Aid Federation Tachikawa Hospital
| | | | - Ken Okumura
- Department of Cardiology, Cardiovascular Center, Saiseikai Kumamoto Hospital
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | - Takashi Kurita
- Division of Cardiovascular Center, Kindai University School of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
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6
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Holsinger FC, Ismaila N, Adkins DR, Barber BR, Burnette G, Fakhry C, Galloway TJ, Goepfert RP, Miles BA, Paleri V, Patel AA, Roof SA, Starmer HM, Yom SS, Saba NF, Li R, Ku JA. Transoral Robotic Surgery in the Multidisciplinary Care of Patients With Oropharyngeal Squamous Cell Carcinoma: ASCO Guideline. J Clin Oncol 2025:JCO2402755. [PMID: 39933131 DOI: 10.1200/jco-24-02755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2024] [Accepted: 12/23/2024] [Indexed: 02/13/2025] Open
Abstract
PURPOSE To provide evidence-based recommendations for the use of transoral robotic surgery (TORS) in the multidisciplinary management of oropharyngeal squamous cell cancer (OPC). METHODS ASCO convened a multidisciplinary Expert Panel to evaluate the evidence and formulate recommendations. The literature search included studies published between January 1, 2002, and August 31, 2024, and comprised systematic reviews, meta-analyses, randomized controlled trials, and observational studies. Outcomes of interest include overall and disease-free survival, functional outcomes, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS A total of 58 publications were identified to inform the evidence base for this guideline. RECOMMENDATIONS Evidence-based recommendations address the evaluation and workup of patients with human papillomavirus (HPV)-positive OPC, the role of TORS, patient selection, adjuvant therapy, HPV-negative OPC, and use of TORS in salvage or recurrent setting.Additional information is available at www.asco.org/head-neck-cancer-guidelines.
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Affiliation(s)
| | - Nofisat Ismaila
- American Society of Clinical Oncology (ASCO), Alexandria, VA
| | | | | | | | | | | | - Ryan P Goepfert
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Vinidh Paleri
- The Royal Marsden Hospitals NHS Foundation Trust, The Institute of Cancer Research London, United Kingdom
| | | | | | | | - Sue S Yom
- University of California San Francisco, San Francisco, CA
| | - Nabil F Saba
- Emory University School of Medicine, Atlanta, GA
| | - Ryan Li
- Oregon Health & Science University, Portland, OR
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7
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Gragnano F, van Klaveren D, Heg D, Räber L, Krucoff MW, Raposeiras-Roubín S, Ten Berg JM, Leonardi S, Kimura T, Corpataux N, Spirito A, Hermiller JB, Abu-Assi E, Chan Pin Yin D, Azzahhafi J, Montalto C, Galazzi M, Bär S, Kavaliauskaite R, D'Ascenzo F, De Ferrari GM, Watanabe H, Steg PG, Bhatt DL, Calabrò P, Mehran R, Urban P, Pocock S, Windecker S, Valgimigli M. Derivation and Validation of the PRECISE-HBR Score to Predict Bleeding After Percutaneous Coronary Intervention. Circulation 2025; 151:343-355. [PMID: 39462482 DOI: 10.1161/circulationaha.124.072009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2024] [Accepted: 10/14/2024] [Indexed: 10/29/2024]
Abstract
BACKGROUND Accurate bleeding risk stratification after percutaneous coronary intervention is important for treatment individualization. However, there is still an unmet need for a more precise and standardized identification of patients at high bleeding risk. We derived and validated a novel bleeding risk score by augmenting the Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE-DAPT) score with the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria. METHODS The derivation cohort comprised 29 188 patients undergoing percutaneous coronary intervention, of whom 1136 (3.9%) had Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding at 1 year, from 4 contemporary real-world registries and the XIENCE V USA trial. The PRECISE-DAPT score was refitted with a Fine-Gray model in the derivation cohort and extended with the ARC-HBR criteria. The primary outcome was BARC 3 or 5 bleeding within 1 year. Independent predictors of BARC 3 or 5 bleeding were selected at multivariable analysis (P<0.01). The discrimination of the score was internally assessed with apparent validation and cross-validation. The score was externally validated in 4578 patients from the MASTER DAPT trial (Management of High Bleeding Risk Patients Post Bioresorbable Polymer Coated Stent Implantation With an Abbreviated Versus Prolonged DAPT Regimen) and 5970 patients from the STOPDAPT-2 (Short and Optimal Duration of Dual Antiplatelet Therapy-2) total cohort. RESULTS The PRECISE-HBR score (age, estimated glomerular filtration rate, hemoglobin, white blood cell count, previous bleeding, oral anticoagulation, and ARC-HBR criteria) showed an area under the curve (AUC) for 1-year BARC 3 or 5 bleeding of 0.73 (95% CI, 0.71-0.74) at apparent validation, 0.72 (95% CI, 0.70-0.73) at cross-validation, 0.74 (95% CI, 0.68-0.80) in MASTER DAPT, and 0.73 (95% CI, 0.66-0.79) in STOPDAPT-2, with superior discrimination compared with PRECISE-DAPT (cross-validation: ΔAUC, 0.01; P=0.02; MASTER DAPT: ΔAUC, 0.05; P=0.004; STOPDAPT-2: ΔAUC, 0.02; P=0.20) and other risk scores. In the derivation cohort, a cutoff of 23 points identified 11 414 patients (39.1%) with a 1-year BARC 3 or 5 bleeding risk ≥4%. An alternative version of the score, including acute myocardial infarction on admission instead of white blood cell count, showed similar predictive ability. CONCLUSIONS The PRECISE-HBR score is a contemporary, simple 7-item risk score to predict bleeding after percutaneous coronary intervention, offering a moderate improvement in discrimination over multiple existing scores. Further evaluation is required to assess its impact on clinical practice.
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Affiliation(s)
- Felice Gragnano
- Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Caserta, Italy (F.G., P.C.)
- Division of Cardiology, Sant'Anna and San Sebastiano Hospital, Caserta, Italy (F.G., P.C.)
| | - David van Klaveren
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands (D.v.K.)
| | - Dik Heg
- Department of Clinical Research (D.H.), University of Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital (L.R., N.C., A.S., S.B., R.K., S.W., M.V.), University of Bern, Switzerland
| | - Mitchell W Krucoff
- Duke University Medical Center-Duke Clinical Research Institute, Durham, NC (M.W.K.)
| | | | - Jurriën M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (J.M.t.B., D.C.P.Y., J.A.)
| | - Sergio Leonardi
- Department of Molecular Medicine, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Italy (S.L., M.G.)
| | - Takeshi Kimura
- Department of Cardiology, Hirakata Kohsai Hospital, Japan (T.K., H.W.)
| | - Noé Corpataux
- Department of Cardiology, Bern University Hospital (L.R., N.C., A.S., S.B., R.K., S.W., M.V.), University of Bern, Switzerland
| | - Alessandro Spirito
- Department of Cardiology, Bern University Hospital (L.R., N.C., A.S., S.B., R.K., S.W., M.V.), University of Bern, Switzerland
| | - James B Hermiller
- Department of Cardiology, Ascension St. Vincent's Heart Center of Indiana, Indianapolis (J.B.H.)
| | - Emad Abu-Assi
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain (S.R.-R., E.A.-A.)
| | - Dean Chan Pin Yin
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (J.M.t.B., D.C.P.Y., J.A.)
| | - Jaouad Azzahhafi
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (J.M.t.B., D.C.P.Y., J.A.)
| | - Claudio Montalto
- Interventional Cardiology, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy (C.M.)
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (C.M.)
| | - Marco Galazzi
- Department of Molecular Medicine, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Italy (S.L., M.G.)
| | - Sarah Bär
- Department of Cardiology, Bern University Hospital (L.R., N.C., A.S., S.B., R.K., S.W., M.V.), University of Bern, Switzerland
| | - Raminta Kavaliauskaite
- Department of Cardiology, Bern University Hospital (L.R., N.C., A.S., S.B., R.K., S.W., M.V.), University of Bern, Switzerland
| | - Fabrizio D'Ascenzo
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy (F.D., G.M.D.F.)
| | - Gaetano M De Ferrari
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy (F.D., G.M.D.F.)
| | | | - Philippe Gabriel Steg
- Université Paris-Cité, French Alliance for Cardiovascular Trials, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, France (P.G.S.)
| | - Deepak L Bhatt
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY (D.L.B., R.M.)
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Caserta, Italy (F.G., P.C.)
- Division of Cardiology, Sant'Anna and San Sebastiano Hospital, Caserta, Italy (F.G., P.C.)
| | - Roxana Mehran
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY (D.L.B., R.M.)
| | | | - Stuart Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, UK (S.P.)
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital (L.R., N.C., A.S., S.B., R.K., S.W., M.V.), University of Bern, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital (L.R., N.C., A.S., S.B., R.K., S.W., M.V.), University of Bern, Switzerland
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland (M.V.)
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8
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Anker MS, Bullinger L, Keller U, Khan MS. Growth Differentiation Factor-15: A Promising Biomarker and Target in Cancer Patients. JACC CardioOncol 2025; 7:153-156. [PMID: 39967201 DOI: 10.1016/j.jaccao.2025.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2024] [Accepted: 01/02/2025] [Indexed: 02/20/2025] Open
Affiliation(s)
- Markus S Anker
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine CBF, Berlin, Germany; Charité - University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany; Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.
| | - Lars Bullinger
- Department of Hematology, Oncology, and Cancer Immunology, Charité - University Medicine Berlin, corporate member of Free University Berlin and Humboldt University Berlin, Berlin, Germany; German Cancer Consortium (DKTK), partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany; Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Ulrich Keller
- Department of Hematology, Oncology, and Cancer Immunology, Charité - University Medicine Berlin, corporate member of Free University Berlin and Humboldt University Berlin, Berlin, Germany; German Cancer Consortium (DKTK), partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany; Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Muhammad Shahzeb Khan
- Baylor College of Medicine, Temple, Texas, USA; The Heart Hospital Plano, Plano, Texas, USA; Baylor Scott and White Research Institute, Dallas, Texas, USA. https://twitter.com/ShahzebKhanMD
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9
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Choi J, Lee SR, Kim TH, Yu HT, Park J, Park JK, Kang KW, Shim J, Uhm JS, Kim J, Park HW, Kim JB, Lee YS, Joung B, Choi EK. Clinical outcomes of Asian patients with newly diagnosed atrial fibrillation and previously diagnosed atrial fibrillation: Insights from the CODE-AF Registry. Heart Rhythm 2025; 22:424-431. [PMID: 39461683 DOI: 10.1016/j.hrthm.2024.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 10/06/2024] [Accepted: 10/18/2024] [Indexed: 10/29/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) may have different clinical features in its early phase. OBJECTIVE The purpose of this study was to compare the characteristics and clinical outcomes of early-phase AF with later-phase AF using a large multicenter prospective registry (CODE-AF [COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation]). METHODS Patients enrolled between June 2016 and March 2021 were divided into 2 groups based on AF duration: (1) newly diagnosed (AF duration ≤90 days); and (2) previously diagnosed (AF duration >90 days). Baseline characteristics and clinical outcomes were compared. RESULTS Among the 10,001 study participants (mean age 67.0 ± 14.5 years; 64% men), 22% were defined as newly diagnosed and 78% as previously diagnosed. Newly diagnosed patients had fewer comorbidities and more unhealthy social behaviors. Despite lower prescription rates of oral anticoagulant, direct oral anticoagulants were more frequently used. The newly diagnosed group also had a higher composite clinical outcome risk within 90 days (adjusted hazard ratio 1.81, 95% confidence interval 1.30-2.53, P <.001) and revealed a higher risk of all bleeding and heart failure admission within 90 days. No significant differences remained between the groups over 36-month follow-up. CONCLUSION Patients with early-stage AF were younger and had fewer comorbidities. Although there was a higher risk of heart failure admissions and minor bleeding, the risks of death, stroke, and major bleeding were not significantly increased. Structured monitoring and management during the initial months are essential to address these risks.
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Affiliation(s)
- JungMin Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Junbeom Park
- Department of Cardiology, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Jin-Kyu Park
- Department of Cardiology, Hanyang University Seoul Hospital, Seoul, Republic of Korea
| | - Ki-Woon Kang
- Division of Cardiology, Eulji University Hospital, Daejeon, Republic of Korea
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Republic of Korea
| | - Jae-Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jun Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyung Wook Park
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Republic of Korea
| | - Jin-Bae Kim
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Republic of Korea
| | - Young Soo Lee
- Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Republic of Korea.
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
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10
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Cohoon KP, Henkin S, Tomihama RT, Thomas SE, Porres-Aguilar M, Brunton NE, Hornacek D, Secemsky EA. Implementing the 2024 ACC/AHA Multisocietal PAD guidelines into clinical practice: Key changes from the 2016 guidelines. Vasc Med 2025; 30:110-113. [PMID: 39713878 DOI: 10.1177/1358863x241306354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2024]
Affiliation(s)
- Kevin P Cohoon
- Department of Internal Medicine, Division of Cardiovascular Diseases, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Roger T Tomihama
- Department of Radiological Sciences, VA Long Beach Healthcare System, University of California, Irvine, CA, USA
| | - Sneha E Thomas
- Department of Vascular Medicine, Riverside University Health System, Moreno Valley, CA, USA
| | - Mateo Porres-Aguilar
- Department of Medicine, Divisions of Adult Thrombosis and Hospital Medicine, Texas Tech University Health Sciences Center and Paul L Foster School of Medicine, El Paso, TX, USA
| | - Nichole E Brunton
- Cardiovascular Medicine Fellow, Virginia Commonwealth University, Richmond, VA, USA
| | - Deborah Hornacek
- Department of Cardiovascular Medicine, Section of Vascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Eric A Secemsky
- Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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11
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Chang DR, Chiang HY, Hsiao YL, Le UM, Hong YC, Chang SS, Chen KW, Lin CC, Yeh HC, Ting IW, Chen PC, Chen HL, Chang KC, Kuo CC. Interaction between chronic kidney disease and atrial fibrillation on incident stroke and all-cause mortality: Matched cohort study of 49,594 patients. Atherosclerosis 2025; 401:119055. [PMID: 39647253 DOI: 10.1016/j.atherosclerosis.2024.119055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 11/05/2024] [Accepted: 11/12/2024] [Indexed: 12/10/2024]
Abstract
BACKGROUND AND AIMS The interaction between full-spectrum chronic kidney disease (CKD) and atrial fibrillation (AF) on ischemic stroke and all-cause mortality risk, particularly in stage 4 and 5 CKD, remains undetermined. METHODS This matched cohort study identified incident AF patients using the International Classification of Disease codes and electrocardiograms from the Clinical Research Data Repository of China Medical University Hospital between 2003 and 2020. For each AF patient, we selected four controls without AF and matched them by age, sex, eGFR within 10 mL/min/1.73 m2, end-stage kidney disease (ESKD) vintage, and diagnosis year. Multivariable Cox proportional hazard models were utilized to assess the interaction between AF and CKD on three-year ischemic stroke and all-cause mortality outcomes. RESULTS Within a total of 10,155 patients and 39,439 controls, incidence rates were 3.03 % and 1.48 % for ischemic stroke and 15.6 % and 9.53 % for overall mortality, respectively. In AF, the stroke risk was the highest among patients with stage 4 and 5-ND (non-dialysis) CKD with adjusted hazard ratio (aHR) of 3.31 (95 % CI, 2.46-4.45) and 2.73 (1.88-3.96), respectively. The mortality risk difference varied between 45% and 177 % with the highest difference noted in ESKD (aHR 3.36 [95 % CI, 2.84-3.98] in AF vs. 1.59 [95 % CI, 1.28-1.96] in non-AF; interaction p < 0.001). Anticoagulation therapy significantly lowered the mortality risk among patients with AF and advanced CKD (3-way interaction p < 0.001). CONCLUSIONS The risk of ischemic stroke and overall mortality was particularly high among patients with concurrent AF and stage 4 and 5-ND CKD, underscoring the urgent evidence to optimize prognosis.
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Affiliation(s)
- David Ray Chang
- AKI-CARE (Clinical Advancement, Research and Education) Center, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan; Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan; Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Ya-Luan Hsiao
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Uyen-Minh Le
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Yu-Cuyan Hong
- AKI-CARE (Clinical Advancement, Research and Education) Center, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan; Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Shih-Sheng Chang
- Division of Cardiology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Ke-Wei Chen
- Division of Cardiology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Che-Chen Lin
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Hung-Chieh Yeh
- AKI-CARE (Clinical Advancement, Research and Education) Center, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan; Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan; Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - I-Wen Ting
- AKI-CARE (Clinical Advancement, Research and Education) Center, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan; Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan; Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Pei-Chun Chen
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Hung-Lin Chen
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Kuan-Cheng Chang
- Division of Cardiology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Chin-Chi Kuo
- AKI-CARE (Clinical Advancement, Research and Education) Center, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan; Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan; Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan.
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12
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Krittayaphong R, Pumprueg S, Yindeengam A, Lip GYH. Number needed to treat for net clinical benefit of oral anticoagulants in Asian patients with atrial fibrillation. J Arrhythm 2025; 41:e70023. [PMID: 39963658 PMCID: PMC11831184 DOI: 10.1002/joa3.70023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2024] [Revised: 01/12/2025] [Accepted: 01/31/2025] [Indexed: 02/20/2025] Open
Abstract
Background Oral anticoagulants (OAC) can reduce ischemic stroke/systemic embolism (SSE) in patients with non-valvular atrial fibrillation (AF) while increasing the risk of major bleeding. We aimed to analyze the number needed to treat for the net benefit (NNTnet) of warfarin and non-vitamin K antagonist oral anticoagulants (NOACs). Methods We analyzed the results from multicenter national AF registry from 27 hospitals in Thailand. Follow-up data were collected every 6 months until 3 years. Main outcomes were SSE, major bleeding, and intracranial hemorrhage (ICH). NNT was calculated from the absolute risk reduction (ARR) of SSE or absolute risk increase (ARI) of major bleeding or ICH. We compared NNTnet of warfarin versus no OAC, NOACs versus no OAC, and NOACs versus warfarin. Warfarin was also categorized into time in therapeutic range (TTR) < and ≥65%. Results We studied a total of 3405 patients (mean age 67.8 ± 11.3 years, 1424 (41.8%) were female). The incidence rates of SSE, major bleeding, and ICH were 1.51, 2.25, and 0.78 per 100 person-years, respectively. Warfarin had negative NNTnet -37 compared to no OAC. NOACs had positive NNTnet 101 and 27 compared to no OACs and warfarin. Warfarin with TTR 65% had positive NNTnet 42 compared to no OAC. NOACs had comparable NNTnet as warfarin with TTR ≥65%. Conclusion Warfarin had a negative NNTnet compared to no OAC. Only warfarin with TTR 65% has positive NNTnet. NOACs had positive NNTnet compared to no OAC and when compared to warfarin.
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Affiliation(s)
- Rungroj Krittayaphong
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
| | - Satchana Pumprueg
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
| | - Ahthit Yindeengam
- Her Majesty Cardiac Center, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science at University of LiverpoolLiverpool John Moores University and Liverpool Heart & Chest HospitalLiverpoolUK
- Danish Center for Health Services Research, Department of Clinical MedicineAalborg UniversityAalborgDenmark
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13
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Wulbrand C, Müller F, Weber M, Füchtmeier B, Hanke A. Time to surgery and other risk factors for mortality and complication rates in patients with periprosthetic femoral fractures at the knee. Injury 2025; 56:112071. [PMID: 39642603 DOI: 10.1016/j.injury.2024.112071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 10/17/2024] [Accepted: 11/26/2024] [Indexed: 12/09/2024]
Abstract
BACKGROUND There is a high level of evidence that a short time to surgery (TTS) improves the outcome for patients with hip fractures. Accordingly, recommendations for timely treatment have been included in national guidelines. As patient characteristics appear to be similar, it seems reasonable that these guidelines are applicable to other fracture entities, such as knee periprosthetic femoral fracture (PPF). This monocentric retrospective study aimed to investigate outcome-related risk factors, particularly TTS, for knee PPF. METHODS In total, 141 consecutive patients with knee PPF in a maximum-care arthroplasty and trauma centre, treated between 2006 and 2020, were retrospectively evaluated. Primary outcome variables were operative and general complications as well as mortalities within 1 year. Outcome-related risk factors were identified based on regression analysis using SPSS. For analysis of TTS, the cases were divided into two groups using a TTS of 24 h as the cutoff value. RESULTS The 1-year mortality was 8.3 %. Associated risk factors were age (HR 1.2; p = 0.010) and Charlson score (HR 2.1; p = 0.001). Both, surgical and general complications occurred in 20.6 % of the cases. Age (OR 1.07, p = 0.025) and a TTS > 24 h (OR 3.06, p = 0.020) were identified as risk factors for general complications. The TTS ≤ 24 h (n = 75) and TTS > 24 h (n = 66) groups were comparable in terms of baseline characteristics. Revision arthroplasty was performed more frequently in the TTS > 24 h group (p < 0.001). CONCLUSION 1-year mortality after knee PPF was 8.3 %. With a high complication rate in the treatment of knee PPF, TTS was identified as a risk factor for general complications. Early treatment appears to be beneficial for patients with knee PPF.
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Affiliation(s)
- Christian Wulbrand
- Department for Trauma, Orthopaedics and Sports Medicine, Hospital Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049, Regensburg, Germany.
| | - Franz Müller
- Department for Trauma, Orthopaedics and Sports Medicine, Hospital Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049, Regensburg, Germany.
| | - Markus Weber
- Department for Trauma, Orthopaedics and Sports Medicine, Hospital Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049, Regensburg, Germany.
| | - Bernd Füchtmeier
- Department for Trauma, Orthopaedics and Sports Medicine, Hospital Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049, Regensburg, Germany.
| | - Alexander Hanke
- Department for Trauma, Orthopaedics and Sports Medicine, Hospital Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049, Regensburg, Germany.
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14
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Krittayaphong R. How to Apply Predictive Model in Real-World Practice: The Standard of Model Validation. Clin Cardiol 2025; 48:e70096. [PMID: 39950516 PMCID: PMC11826316 DOI: 10.1002/clc.70096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2025] [Accepted: 02/04/2025] [Indexed: 02/17/2025] Open
Affiliation(s)
- Rungroj Krittayaphong
- Department of MedicineFaculty of Medicine Siriraj Hospital, Division of Cardiology, Mahidol UniversityBangkokThailand
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15
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Owen GD, Terry CJ, Neal EB, Nelson SD, Omar M, Pettapiece-Phillips MJ, Kripalani S. Personalizing Quality Improvement: Addressing Anticoagulation Gaps in Atrial Fibrillation. J Healthc Qual 2025; 47:e0460. [PMID: 39670955 DOI: 10.1097/jhq.0000000000000460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2024]
Abstract
INTRODUCTION Risk of stroke is greater in patients with atrial fibrillation. Anticoagulation is effective at decreasing risk, yet 40-50% of eligible patients are not prescribed anticoagulation and seem to have a concerning gap in care quality. This quality improvement initiative implemented a pharmacist-led approach to identify, verify, and close apparent anticoagulation treatment gaps. METHODS We included adult primary care patients with diagnosis of atrial fibrillation; congestive heart failure, hypertension, age ≥75 years (doubled), diabetes, stroke/transient ischemic attack (doubled), vascular disease, age 65-74 years, and sex (female) (CHA 2 DS 2 -VASc) score of at least 2, and no current anticoagulant use. We identified patients using claims and electronic health record data and evaluated explanations through chart review and provider contact. A provider outreach protocol was developed and implemented to address opportunities for anticoagulation. RESULTS Of 242 patients with an apparent gap, 84% had a verified treatment gap. However, 86% of verified treatment gaps were explained through pharmacist chart review and outreach to providers, and they did not require further action. Explanations included spontaneous resolution of atrial fibrillation, patient declining treatment, completion of a procedure to correct atrial fibrillation or mitigate stroke risk, and high bleeding risk. CONCLUSIONS Relying solely on claims- and electronic health record-based algorithms may substantially overestimate gaps in care quality.
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16
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Winkelmayer WC, Hu A, Khairallah P, Airy M, Erickson KF, Chang TI, Niu J. Oral Anticoagulant Initiation in Patients With Kidney Failure on Hemodialysis Newly Diagnosed With Atrial Fibrillation (2007-2020): An Observational Study of Trends and Disparities. Kidney Med 2025; 7:100926. [PMID: 39844893 PMCID: PMC11750526 DOI: 10.1016/j.xkme.2024.100926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2025] Open
Abstract
Rationale & Objective Atrial fibrillation (AF) is common in patients with kidney failure on hemodialysis (HD), but few patients receive oral anticoagulant (OAC) treatment. Availability of direct-target OACs starting in 2010 may have induced greater OAC initiation, but this has not been systematically studied. Study Design Retrospective cohort study. Setting & Participants Using Medicare fee-for-service billing claims (2006-2020), we identified previously OAC-naïve HD patients newly-diagnosed with AF between January 1, 2007, and October 1, 2020. Exposures Calendar year; race/ethnicity. Outcomes OAC initiation within 90 days from AF diagnosis (any; specific agent). Analytical Approach We estimated initiation risk ratios for each calendar year compared with the referent cohort, 2007, using unadjusted and multivariable-adjusted modified Poisson regression. We also determined differences by racial/ethnic group in OAC initiation, as well as any changes in these disparities over time. Results Among 82,389 HD patients newly-diagnosed with AF, 20,002 (24.3%) initiated new OAC treatment within 90 days: 20.5% in 2007 and 34.1% in 2020. Direct-target OACs accounted for 81.0% of OAC initiations in 2020. Adjusted regression models estimated that OAC initiation remained essentially unchanged between 2007 and 2013, but thereafter increased toward a demographics-adjusted risk ratio of 1.61 (95% CI: 1.50-1.73) in 2020. Compared with non-Hispanic Whites, the rates of OAC initiation were 15% (95% CI, 12%-17%) lower among Black patients, 29% (95% CI, 24%-34%) lower among Asian patients, and 22% (95% CI, 19%-25%) lower among Hispanic patients. These disparities were not found to have differed across time (P interaction = 0.75). Limitations Lack of clinical detail to firmly establish contraindications to OAC initiation. Conclusions While rates of OAC initiation among patients on HD with newly-diagnosed AF increased in recent years, predominantly driven by increased use of apixaban, OAC initiation rates remained low, at 34% of patients in 2020. Compared with non-Hispanic White patients, OAC initiation remained consistently lower in patients of other race and ethnic groups.
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Affiliation(s)
| | - Austin Hu
- Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Pascale Khairallah
- Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Medha Airy
- Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Kevin F. Erickson
- Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Tara I. Chang
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Jingbo Niu
- Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX
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Englisch C, Nopp S, Moik F, Steiner D, Starzer AM, Fritzer-Szekeres M, Preusser M, Berghoff AS, Pabinger I, Ay C. Growth Differentiation Factor-15 Predicts Major Bleeding in Cancer Patients: Results From the Vienna CAT-BLED Study. JACC CardioOncol 2025; 7:141-152. [PMID: 39967200 DOI: 10.1016/j.jaccao.2024.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Revised: 11/19/2024] [Accepted: 11/22/2024] [Indexed: 02/20/2025] Open
Abstract
BACKGROUND The hemostatic system is tightly interconnected with cancer. Research has focused predominantly on thrombotic complications, but less is known about bleeding and bleeding risk prediction. Growth differentiation factor (GDF)-15 has previously emerged as a prognostic biomarker for bleeding. OBJECTIVES The aim of this study was to investigate the association and predictive ability of GDF-15 for bleeding risk in patients with cancer. METHODS The CAT-BLED (Vienna Cancer, Thrombosis, and Bleeding) study is a prospective, observational cohort study including cancer patients initiating systemic anticancer therapies. Patients were followed for up to 2 years for thrombotic and bleeding events. The primary outcome was major bleeding. GDF-15 was measured at inclusion and at 3 and 6 months of follow-up. RESULTS A total of 779 patients (48% women, median age 62 years, 15% on therapeutic anticoagulation) were included. During a median follow-up period of 18 months, 79 patients (10.1%) experienced major bleeding (12-month cumulative incidence 8.8%; 95% CI: 6.7-10.9). Higher GDF-15 levels were independently associated with increased major bleeding risk (adjusted subdistribution HR per doubling: 1.29; 95% CI: 1.04-1.59), and patients with levels greater than the cohort median (1,864 ng/L) had a significantly higher 12-month cumulative incidence (13.1% vs 4.6%; P < 0.001). This association remained robust in follow-up measurements at 3 and 6 months. GDF-15 showed moderate to good discrimination for predicting 6-month major bleeding risk (C statistic = 0.69; 95% CI: 0.60-0.77). GDF-15 was not associated with venous thromboembolism but was strongly associated with mortality (adjusted HR: 1.37; 95% CI: 1.25-1.50). CONCLUSIONS GDF-15 levels predict major bleeding risk in cancer patients and are not associated with venous thromboembolism, making GDF-15 a particularly promising biomarker for bleeding risk prediction.
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Affiliation(s)
- Cornelia Englisch
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Stephan Nopp
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Florian Moik
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria; Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Daniel Steiner
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Angelika M Starzer
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | | | - Matthias Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Anna S Berghoff
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Ingrid Pabinger
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Cihan Ay
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
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18
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Smetana GW, Gelfand EV, Tung P, Burns RB. How Would You Manage This Patient With Recent-Onset Atrial Fibrillation? Grand Rounds Discussion From Beth Israel Deaconess Medical Center. Ann Intern Med 2025; 178:269-278. [PMID: 39928945 DOI: 10.7326/annals-24-03490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2025] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia. Risk factors for AF include obstructive sleep apnea, physical inactivity, obesity, cigarette use, and alcohol misuse. Atrial fibrillation substantially increases the risk for stroke and is associated with higher rates of mortality than for individuals without AF. Strategies to prevent these risk factors and to optimize those that already exist reduce the risk for subsequent AF. Physicians play an important role in proposing strategies to reduce the risk for AF among patients. Decision making regarding management of AF is often complex and requires consideration of symptoms, burden of AF (the percentage of time in AF), comorbid conditions that increase stroke risk, and the risk for bleeding. In particular, novel risk scoring systems to predict stroke risk, and consideration of factors beyond those in these tools, refine the ability to identify patients with AF who are most likely to benefit from anticoagulation to reduce stroke risk. Early use of catheter ablation of AF in selected patients improves symptoms and reduces the potential for progression from intermittent to persistent AF. A 2023 collaborative guideline from the American College of Cardiology, American Heart Association, American College of Chest Physicians, and the Heart Rhythm Society addressed multiple aspects of care of patients with AF. Here, a general cardiologist and a cardiac electrophysiologist discuss recommendations derived from this guideline and how to apply them to the care of a particular patient.
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Affiliation(s)
- Gerald W Smetana
- Beth Israel Deaconess Medical Center, Boston, Massachusetts (G.W.S., E.V.G., P.T., R.B.B.)
| | - Eli V Gelfand
- Beth Israel Deaconess Medical Center, Boston, Massachusetts (G.W.S., E.V.G., P.T., R.B.B.)
| | - Patricia Tung
- Beth Israel Deaconess Medical Center, Boston, Massachusetts (G.W.S., E.V.G., P.T., R.B.B.)
| | - Risa B Burns
- Beth Israel Deaconess Medical Center, Boston, Massachusetts (G.W.S., E.V.G., P.T., R.B.B.)
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19
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Atreja N, Dubey A, Kang A, Jiang J, Hagan M, Michael-Asalu A, Cheng D, Deitelzweig S. Effectiveness and Safety in Patients with Non-Valvular Atrial Fibrillation Who Switched from Warfarin to Direct Oral Anticoagulants in Medicare Population. Adv Ther 2025:10.1007/s12325-024-03099-y. [PMID: 39883308 DOI: 10.1007/s12325-024-03099-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Accepted: 12/17/2024] [Indexed: 01/31/2025]
Abstract
INTRODUCTION Atrial fibrillation (AF), a common heart rhythm abnormality, is linked to a higher risk of stroke. Traditionally, warfarin has been the primary anticoagulation treatment for reducing the stroke risk. The new standard of treatment by direct oral anticoagulants (DOACs) offers greater benefits including improved efficacy and fewer adverse effects with reduced monitoring. This study aims to evaluate the risk of stroke/systemic embolism (SE) and major bleeding (MB) among patients with AF who switched from warfarin to DOACs. METHODS This study utilized Medicare data to conduct a retrospective analysis of patients with non-valvular atrial fibrillation (NVAF) who switched from warfarin to DOACs between January 1, 2012, and December 31, 2019. Patients with NVAF aged 65 and older who switched from warfarin and had continuous health plan enrollment were included. Descriptive statistics, propensity score matching (PSM), and Cox proportional hazard (PH) models were utilized to compare the outcomes and assess risks of SE and MB across the DOAC cohorts. RESULTS Among 1,843,495 patients with NVAF on warfarin, 171,700 switched to DOACs within 90 days of discontinuation (apixaban: 90,850; rivaroxaban: 67,698; dabigatran: 12,900). The mean follow-up period across DOAC cohorts ranged from 552 to 628 days. After PSM, apixaban showed significantly lower rates of stroke/SE compared to dabigatran (2.99% vs. 3.98%, p < 0.0001) and rivaroxaban (3.08% vs. 3.80%, p < 0.0001). MB rates were also lower with apixaban versus dabigatran (4.29% vs. 5.57%, p < 0.0001) and rivaroxaban (4.07% vs. 6.35%, p < 0.0001). Cox PH models confirmed these findings, with apixaban demonstrating lower risks of stroke/SE [hazard ratio (HR) 0.83, 95% confidence interval (CI) 0.72-0.96 vs. dabigatran; HR 0.91, 95% CI 0.85-0.96 vs. rivaroxaban] and MB (HR 0.79, 95% CI 0.71-0.89 vs. dabigatran; HR 0.68, 95% CI 0.65-0.72 vs. rivaroxaban). CONCLUSION The risk of stroke/SE and MB varies significantly among patients with NVAF switching from warfarin to different DOACs, with apixaban presenting the lowest risk compared to dabigatran and rivaroxaban.
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Affiliation(s)
| | | | - Amiee Kang
- Bristol Myers Squibb, Lawrenceville, NJ, USA
| | - Jenny Jiang
- Bristol Myers Squibb, Lawrenceville, NJ, USA
| | | | | | - Dong Cheng
- Bristol Myers Squibb, Lawrenceville, NJ, USA.
| | - Steven Deitelzweig
- Department of Hospital Medicine, Ochsner Health System, New Orleans, LA, 70121, USA
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20
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Masunaga N, Ishii M, Oka K, Okamoto K, Yoshida Y, Minami K, Ishigami K, Doi K, Hamatani Y, Yoshizawa T, Ide Y, Fujino A, Iguchi M, Wada H, Hasegawa K, Tsuji H, Esato M, Abe M, Akao M. 10-Year Trends of Antithrombotic Therapy Status and Clinical Outcomes in Patients With Atrial Fibrillation and Renal Dysfunction - The Fushimi AF Registry. Circ J 2025; 89:174-183. [PMID: 39477486 DOI: 10.1253/circj.cj-24-0614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2025]
Abstract
BACKGROUND Anticoagulation therapy for atrial fibrillation (AF) has undergone major changes following the introduction of direct oral anticoagulants (DOAC) in 2011. However, the transition of anticoagulation therapy for AF patients with severe renal dysfunction remains to be elucidated. METHODS AND RESULTS Follow-up data, including creatinine clearance (CrCl), were available for 3,706 patients in the Fushimi AF Registry. We divided patients into 3 groups based on CrCl as follows: (1) CrCl ≥50 mL/min; (2) 50 mL/min>CrCl≥30 mL/min; and (3) CrCl <30 mL/min. In patients with CrCl ≥50 mL/min and 50>CrCl≥30 mL/min, prescription of oral anticoagulants increased year-by-year from 2011 to 2021 with a growing proportion of DOAC; however, the prescription of oral anticoagulants remained almost unchanged in those with CrCl <30 mL/min. In patients with CrCl ≥50 mL/min and 50 mL/min>CrCl≥30 mL/min, the incidence of adverse events, including stroke/systemic embolism and major bleeding, was lower among patients enrolled after 2014 than before 2013. However, these trends were not seen in patients with CrCl <30 mL/min. CONCLUSIONS Despite the increased use of DOAC in patients with AF since 2011, anticoagulation therapy for AF patients with severe renal dysfunction has largely remained unchanged, and a reduction in adverse events in those patients has not been observed.
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Affiliation(s)
- Nobutoyo Masunaga
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
| | - Mitsuru Ishii
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
| | - Kouhei Oka
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
| | - Keita Okamoto
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
| | - Yusuke Yoshida
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
| | - Kimihito Minami
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
| | - Kenjiro Ishigami
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
| | - Kosuke Doi
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
| | - Yasuhiro Hamatani
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
| | - Takashi Yoshizawa
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
| | - Yuya Ide
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
| | - Akiko Fujino
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
| | - Moritake Iguchi
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
| | - Hiromichi Wada
- Division of Translational Research, National Hospital Organization Kyoto Medical Center
| | - Koji Hasegawa
- Division of Translational Research, National Hospital Organization Kyoto Medical Center
| | | | - Masahiro Esato
- Department of Cardiology, Heart Rhythm Section, Ogaki Tokushukai Hospital
| | - Mitsuru Abe
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
| | - Masaharu Akao
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
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21
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Tsuda T, Hayashi K, Kato T, Kusayama T, Nakagawa Y, Nomura A, Tada H, Usui S, Sakata K, Kawashiri MA, Fujino N, Yamagishi M, Takamura M. Effects of Longitudinal Changes in Anemia Status on Clinical Outcomes in Patients With Non-Valvular Atrial Fibrillation - Analysis From the Hokuriku-Plus AF Registry. Circ J 2025; 89:164-173. [PMID: 39198193 DOI: 10.1253/circj.cj-24-0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2024]
Abstract
BACKGROUND Anemia, a common comorbidity in older patients with heart failure (HF) and atrial fibrillation (AF), is associated with an increased risk of adverse events. This study evaluated the prognostic effects of longitudinal changes in anemia status on clinical outcomes in patients with AF. METHODS AND RESULTS We prospectively evaluated data of 1,388 patients with AF from the Hokuriku-Plus AF Registry (1,010 men; mean [±SD] age 72.3±9.7 years) and recorded the incidence of death, HF, thromboembolism, and major bleeding. Of these patients, the 1,233 for whom hemoglobin levels were available at baseline and at the 1-year follow-up were further evaluated. Patients were categorized into 3 groups based on longitudinal changes in 1-year anemia status: Group 1, AF without anemia; Group 2, AF with improved anemia; and Group 3, AF with sustained or new-onset anemia. Over the 1-5 years of follow up, the incidences of death, HF, thromboembolism, and major bleeding were significantly higher among patients with than without anemia. In addition, the incidence of death or HF was significantly higher in Group 3 than in Groups 1 and 2. Multivariate analysis revealed no anemia or improvement in anemia in 1 year as an independent predictor for a favorable prognosis for cardiovascular death and HF. CONCLUSIONS Recovery from anemia may be associated with a favorable clinical course of AF.
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Affiliation(s)
- Toyonobu Tsuda
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences
| | - Kenshi Hayashi
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences
| | - Takeshi Kato
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences
| | - Takashi Kusayama
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences
| | - Yoichiro Nakagawa
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences
| | - Akihiro Nomura
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences
| | - Hayato Tada
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences
| | - Soichiro Usui
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences
| | - Kenji Sakata
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences
| | | | - Noboru Fujino
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences
| | | | - Masayuki Takamura
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences
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22
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Naito N, Takagi H. Comparative Efficacy of Antithrombotic Strategies in Bioprosthetic Aortic Valve Replacement: A Network Meta-Analysis. Angiology 2025:33197241313254. [PMID: 39840465 DOI: 10.1177/00033197241313254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2025]
Abstract
This meta-analysis evaluates outcomes in patients undergoing bioprosthetic aortic valve replacement (bAVR), comparing different antithrombotic strategies. We conducted a systematic search through May 2024. A standard meta-analysis compared outcomes between patients who received anticoagulation therapy (AC) and those who did not. Therapeutic categories were subdivided into four groups: AC alone, AC with antiplatelet therapy (AP), AP alone, and no antithrombotic therapy. A network meta-analysis was performed for these categories. The review included 16 studies, comprising a total of 59,054 patients. There was no significant difference in all-cause mortality rates (HR: hazard ratio [95% CI: confidence interval] = 0.98 [0.77-1.25], P = .88) or thromboembolic events (HR [95% CI] = 0.91 [0.65-1.28], P = .60) between patients with and without AC. However, bleeding events were significantly higher in patients receiving AC (HR [95% CI] = 1.55 [1.20-2.00], P < .01). Network meta-analysis showed that AP alone was associated with lower mortality rates compared with other therapeutic categories. Additionally, AP alone was associated with fewer bleeding events compared with AC alone and AC with AP. This meta-analysis suggests that AP alone in patients undergoing bAVR is associated with superior outcomes compared with other antithrombotic strategies.
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Affiliation(s)
- Noritsugu Naito
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
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23
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Lip GYH, Benamouzig R, Martin AC, Pesce G, Gusto G, Quignot N, Khachatryan A, Dai F, Sedjelmaci F, Chaves J, Subash R, Mokgokong R. Comparative safety and effectiveness of oral anticoagulants in key subgroups of patients with non-valvular atrial fibrillation and at high risk of gastrointestinal bleeding: A cohort study based on the French National Health Data System (SNDS). PLoS One 2025; 20:e0317895. [PMID: 39841678 PMCID: PMC11753696 DOI: 10.1371/journal.pone.0317895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 01/04/2025] [Indexed: 01/24/2025] Open
Abstract
BACKGROUND Risk factors and comorbidities can complicate management of non-valvular atrial fibrillation. We describe and compare real-world safety and effectiveness of direct oral anticoagulants (DOACs; apixaban, rivaroxaban, dabigatran) and vitamin K antagonists (VKAs) in subgroups of patients with non-valvular atrial fibrillation at high risk for gastrointestinal (GI) bleeding, utilizing data from a national quasi-exhaustive French database. METHODS Anticoagulant-naïve adults with non-valvular atrial fibrillation with ≥1 gastrointestinal bleeding risk factor, initiating anticoagulant treatment January 2016-December 2019, and covered by the French national health data system were eligible. The following subgroups were evaluated: patients age ≥75 years, receiving concomitant medications, HAS-BLED score ≥3, and chronic kidney disease stage 3-4. Outcomes included major bleeding and stroke/systemic embolism. Patient characteristics were balanced using propensity score matching. RESULTS A total of 314,184 patients were identified; characteristics were similar for propensity score-matched subgroups in VKA/DOAC and DOAC/DOAC comparisons. DOACs showed lower risk of major bleeding versus VKAs in all subgroups evaluated (p<0.0001 for all). Apixaban showed lower risk of major bleeding and gastrointestinal bleeding versus rivaroxaban in all subgroups (p≤0.05 for all) and versus dabigatran in elderly patients, patients with HAS-BLED score ≥3, and those receiving concomitant medications (p<0.05 for all). Stroke/systemic embolism risk was lower with apixaban versus rivaroxaban in elderly patients, those with HAS-BLED ≥3, and those receiving concomitant medications; risks were similar for other comparisons. CONCLUSIONS DOACs were associated with improved safety and effectiveness when compared to VKAs among subgroups of non-valvular atrial fibrillation patients at high risk of gastrointestinal bleeding. Apixaban was associated with lower risks of major bleeding, gastrointestinal bleeding, and stroke/systemic embolism versus rivaroxaban as well as lower risk of major bleeding, gastrointestinal bleeding bleed and similar risk of stroke/systemic embolism versus dabigatran among several of these patient subgroups.
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Affiliation(s)
- Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Anne-Céline Martin
- European Hospital Georges Pompidou, Paris, France
- INSERM UMRS_1140, University of Paris, Paris, France
| | | | | | | | | | - Feng Dai
- Pfizer Inc., Groton, New York, United States of America
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24
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Ma F, Zeng Z, Chen J, Guan C, Xu W, Wang C, Zhang J. A new score for predicting intracranial hemorrhage in patients using anticoagulant drugs. Front Neurol 2025; 16:1475956. [PMID: 39911456 PMCID: PMC11794049 DOI: 10.3389/fneur.2025.1475956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Accepted: 01/06/2025] [Indexed: 02/07/2025] Open
Abstract
Objectives The use of anticoagulants in patients increases the risk of intracranial hemorrhage (ICH). Our aim was to identify factors associated with cerebral hemorrhage in patients using anticoagulants and to develop a predictive model that would provide an effective tool for the clinical assessment of cerebral hemorrhage. Methods In our study, indications for patients receiving anticoagulation included AF, VTE, stroke/TIA, arteriosclerosis, peripheral vascular diseases (PVD), prosthetic mechanical valve replacement, etc. Data were obtained from the patient record hospitalization system. Logistic regression, area under the curve (AUC), and bar graphs were used to build predictive models in the development cohort. The models were internally validated, analytically characterized, and calibrated using AUC, calibration curves, and the Hosmer-Lemeshow test. Results This single-center retrospective study included 617 patients treated with anticoagulants. Multifactorial analysis showed that male, leukoaraiosis, high risk of falls, APTT ≥ 45.4 s, and FIB ≥ 4.2 g/L were independent risk factors for cerebral hemorrhage, and β-blockers were protective factors. The model was constructed using these six factors with an AUC value of 0.883. In the validation cohort, the model had good discriminatory power (AUC = 0.801) and calibration power. Five-fold cross-validation showed Kappa of 0.483. Conclusion Predictive models based on a patient's medical record hospitalization system can be used to identify patients at risk for cerebral hemorrhage. Identifying people at risk can provide proactive interventions for patients.
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Affiliation(s)
- Fuxin Ma
- Department of Pharmacy, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Zhiwei Zeng
- Department of Pharmacy, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Jiana Chen
- Department of Pharmacy, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Chengfu Guan
- Department of Pharmacy, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Wenlin Xu
- Department of Pharmacy, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Chunhua Wang
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jinhua Zhang
- Department of Pharmacy, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
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25
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Alberts M, He J, Kharat A, Pericone CD, Ashton V. Health Care Resource Use and Costs of Rivaroxaban Versus Warfarin Among Nonvalvular Atrial Fibrillation Polypharmacy Patients With Obesity. J Am Heart Assoc 2025; 14:e036401. [PMID: 39791405 DOI: 10.1161/jaha.124.036401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 11/13/2024] [Indexed: 01/12/2025]
Abstract
BACKGROUND The economic burden of nonvalvular atrial fibrillation (NVAF) is substantial. Many patients with NVAF are obese and manage other health conditions requiring multiple medications. This real-world study compared health care resource use (HRU) and costs for rivaroxaban and warfarin in patients with NVAF who had polypharmacy and obesity. METHODS AND RESULTS We used health care claims databases (Merative MarketScan commercial and Medicare supplemental claims) to identify patients initiating the direct oral anticoagulant rivaroxaban or warfarin with ≥1 diagnostic claim for atrial fibrillation, presence of polypharmacy (based on 3 categories for the number of concurrent medications: 1-4, 5-9, ≥10), and obesity. Cohorts were balanced for demographic and baseline characteristics using propensity score matching. All-cause and NVAF-related HRU rates and costs were compared between treatments using rate ratios and adjusted mean differences per patient per year. Eligible patients totaled 95 875, with 19 990 patients in each treatment cohort following propensity score matching. All-cause HRU rates were significantly lower with rivaroxaban versus warfarin, and hospital stays were reduced by 3.1 days with rivaroxaban. Mean (95% CI) all-cause total medical and total health care costs per patient per year were significantly reduced with rivaroxaban versus warfarin (-$4499 [-$5660 to -$3305] and -$1627 [-$2790 to -$438], respectively). NVAF-related HRU was reduced with rivaroxaban versus warfarin, but total NVAF-related medical costs were not significantly different between treatment groups ($144 [-$756 to $1079] per patient per year). Subgroup and sensitivity analysis results were generally consistent with the main analysis. CONCLUSIONS Among patients with NVAF, polypharmacy, and obesity, rivaroxaban was associated with a reduction in HRU and all-cause costs compared with warfarin.
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Affiliation(s)
| | - Jinghua He
- Janssen Scientific Affairs LLC, a Johnson & Johnson company Titusville NJ USA
| | - Akshay Kharat
- Janssen Scientific Affairs LLC, a Johnson & Johnson company Titusville NJ USA
| | | | - Veronica Ashton
- Janssen Scientific Affairs LLC, a Johnson & Johnson company Titusville NJ USA
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26
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Himmelreich JCL, Virdone S, Camm AJ, Pieper K, Harskamp RE, Verheugt FWA, Bassand JP, Misselwitz F, Pereira-Barretto AC, Cools F, Gibbs H, Kakkar AK. Emulation of ARISTOTLE and ROCKET AF trials in real-world atrial fibrillation patients results in similar efficacy and safety as original landmark trials: insights from the GARFIELD-AF registry. Open Heart 2025; 12:e002966. [PMID: 39832940 PMCID: PMC11751782 DOI: 10.1136/openhrt-2024-002966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Accepted: 11/20/2024] [Indexed: 01/22/2025] Open
Abstract
AIMS This study aimed to determine the robustness, reproducibility and representativeness of the landmark Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (AF) (ARISTOTLE) and Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in AF (ROCKET AF) randomised trials through replication in an observational AF patient registry. METHODS AND RESULTS Patients from the Global Anticoagulant Registry in the FIELD (GARFIELD)-AF registry treated with apixaban, rivaroxaban or vitamin K antagonist (VKA) were assessed for eligibility for the ARISTOTLE and ROCKET AF trials. HRs of apixaban and rivaroxaban versus comparator for stroke/systemic embolism, major bleeding and all-cause mortality within 2 years follow-up were calculated using propensity score overlap-weighted Cox models. Among GARFIELD-AF patients on apixaban, 2570/3615 (71%) would have been eligible for ARISTOTLE. Among patients using rivaroxaban, 2005/4914 (41%) would have been eligible for ROCKET AF. Eligibility rates were steady over time, with minor differences across medical specialties. Real-world AF patients selected according to trial criteria had lower cardiovascular burden than the original trial participants, especially compared with ROCKET AF. HRs (95% CI) for apixaban versus VKA among ARISTOTLE-eligible users were 0.57 (0.34 to 0.94) for stroke/systemic embolism, 0.76 (0.48 to 1.20) for major bleeding and 0.89 (0.70 to 1.12) for all-cause mortality. Among ROCKET AF-eligible rivaroxaban users, HRs for rivaroxaban versus VKA were 0.90 (0.57 to 1.43), 0.92 (0.59 to 1.43) and 0.86 (0.69 to 1.08), respectively. All safety and efficacy estimates were similar to those in the original trials. CONCLUSION Real-world representativeness of the selection criteria was greater for ARISTOTLE than ROCKET AF. The pivotal randomised trials of apixaban and rivaroxaban versus warfarin can be successfully emulated in real-world AF patients by applying trial-specific selection criteria and appropriate methodology for non-randomised treatment allocation. TRIAL REGISTRATION NUMBER NCT01090362.
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Affiliation(s)
- Jelle C L Himmelreich
- Thrombosis Research Institute, London, UK
- Department of General Practice, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Amsterdam Public Health, Peronalized Medicine, Amsterdam, The Netherlands
| | | | - A John Camm
- Cardiology Clinical Academic Group Molecular & Clinical Sciences Research Institute, St. George's University of London, London, UK
| | | | - Ralf E Harskamp
- Department of General Practice, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Amsterdam Public Health, Peronalized Medicine, Amsterdam, The Netherlands
| | | | | | | | | | - Frank Cools
- AZ Klina, General Hospital Klina, Brasschaat, Belgium
| | - Harry Gibbs
- General Medicine, Alfred Hospital, Monash University, Melbourne, Victoria, Australia
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27
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Wang BX. Bridging the Gaps in Atrial Fibrillation Management in the Emergency Department. J Cardiovasc Dev Dis 2025; 12:20. [PMID: 39852298 PMCID: PMC11766356 DOI: 10.3390/jcdd12010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2024] [Revised: 12/13/2024] [Accepted: 01/07/2025] [Indexed: 01/26/2025] Open
Abstract
Atrial fibrillation (AF) frequently presents in emergency departments (EDs), contributing significantly to adverse cardiovascular outcomes. Despite established guidelines, ED management of AF often varies, revealing important gaps in care. This review addresses specific challenges in AF management for patients in the ED, including the nuances of rate versus rhythm control, the timing of anticoagulation initiation, and patient disposition. The updated 2024 European Society of Cardiology (ESC) guidelines advocate early rhythm control for select patients while recommending rate control for others; however, uncertainties persist, particularly regarding these strategies' long-term impact on outcomes. Stroke prevention through timely anticoagulation remains crucial, though the ideal timing, especially for new-onset AF, needs further research. Additionally, ED discharge protocols and follow-up care for AF patients are often inconsistent, leaving many without proper long-term management. Integration of emerging therapies, including direct oral anticoagulants and advanced antiarrhythmic drugs, shows potential but remains uneven across EDs. Innovative multidisciplinary models, such as "AF Heart Teams" and observation units, could enhance care but face practical challenges in implementation. This review underscores the need for targeted research to refine AF management, optimize discharge protocols, and incorporate novel therapies effectively. Standardizing ED care for AF could significantly reduce stroke risk, lower readmission rates, and improve overall patient outcomes.
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Affiliation(s)
- Brian Xiangzhi Wang
- Department of Cardiology, Jersey General Hospital, Gloucester Street, St. Helier, Jersey JE1 3QS, UK
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Bonini N, Proietti M, Romiti GF, Vitolo M, Fawzy AM, Ding WY, Imberti JF, Fauchier L, Marin F, Nabauer M, Dan GA, Potpara TS, Boriani G, Lip GYH. Optimal Medical Therapy for Heart Failure and Integrated Care in Patients With Atrial Fibrillation: A Report From the ESC-EHRA EORP Atrial Fibrillation Long-Term General Registry. J Am Heart Assoc 2025; 14:e030499. [PMID: 39704238 DOI: 10.1161/jaha.123.030499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 11/08/2024] [Indexed: 12/21/2024]
Abstract
BACKGROUND Heart failure (HF) often occurs in patients with atrial fibrillation (AF), with a major impact on prognosis. Few data are available on the effect of integrated treatment strategies to improve prognosis in patients with AF. We aimed to evaluate the association between HF (according to left ventricular ejection fraction [LVEF]), HF optimal medical therapy and adherence to the Atrial Fibrillation Better Care pathway, and major outcomes in patients with AF. METHODS AND RESULTS From the ESC-EHRA EORP-AF (European Society of Cardiology-European Heart Rhythm Association EURObservational Research Programme in Atrial Fibrillation) General Long-Term Registry, we evaluated patients with HF, categorized according to LVEF (HF with reduced ejection fraction, HF with mildly reduced ejection fraction, HF with preserved ejection fraction). Optimal medical therapy for HF was guidelines-defined. The primary end point was the composite of all-cause death and major adverse cardiovascular events. From the original cohort, 9373 (84.5%) patients were included in this analysis (median age, 71 [interquartile range, 62-77] years; 39.9% women). Compared with no HF, all HF categories were associated with an increased risk of the primary composite outcome, with highest figures observed for HF with reduced ejection fraction (hazard ratio [HR], 2.36 [95% CI, 2.00-2.78]). The risk was reduced in patients with AF and HF adherent to optimal medical therapy (HR, 0.83 [95% CI, 0.70-0.98]), as well as in those adherents to the Atrial Fibrillation Better Care pathway (HR, 0.65 [95% CI, 0.48-0.88]). The effect of Atrial Fibrillation Better Care pathway was consistent across the spectrum of LVEF. CONCLUSIONS Patients with AF and HF have a high risk of major adverse events, and this risk is inversely associated with LVEF. Atrial Fibrillation Better Care pathway adherent management is associated with improved clinical outcomes in patients with HF, across the spectrum of LVEF.
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Affiliation(s)
- Niccolò Bonini
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital Liverpool United Kingdom
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences University of Modena and Reggio Emilia, Policlinico di Modena Modena Italy
| | - Marco Proietti
- Department of Clinical Sciences and Community Health University of Milan Milan Italy
- Division of Subacute Care IRCCS Istituti Clinici Scientifici Maugeri Milan Italy
| | - Giulio Francesco Romiti
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital Liverpool United Kingdom
- Department of Translational and Precision Medicine Sapienza-University of Rome Italy
| | - Marco Vitolo
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital Liverpool United Kingdom
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences University of Modena and Reggio Emilia, Policlinico di Modena Modena Italy
- Clinical and Experimental Medicine PhD Program University of Modena and Reggio Emilia Modena Italy
| | - Ameenathul Mazaya Fawzy
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital Liverpool United Kingdom
| | - Wern Yew Ding
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital Liverpool United Kingdom
| | - Jacopo Francesco Imberti
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital Liverpool United Kingdom
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences University of Modena and Reggio Emilia, Policlinico di Modena Modena Italy
- Clinical and Experimental Medicine PhD Program University of Modena and Reggio Emilia Modena Italy
| | - Laurent Fauchier
- Service de Cardiologie Centre Hospitalier Universitaire Trousseau Tours France
| | - Francisco Marin
- Department of Cardiology Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, CIBER-CV Murcia Spain
| | - Michael Nabauer
- Department of Cardiology Ludwig-Maximilians-University Munich Germany
| | - Gheorghe Andrei Dan
- University of Medicine, 'Carol Davila' Colentina University Hospital Bucharest Romania
| | - Tatjana S Potpara
- School of Medicine University of Belgrade Serbia
- Intensive Arrhythmia Care, Cardiology Clinic Clinical Center of Serbia Belgrade Serbia
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences University of Modena and Reggio Emilia, Policlinico di Modena Modena Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital Liverpool United Kingdom
- Danish Center for Health Services Research, Department of Clinical Medicine Aalborg University Aalborg Denmark
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Kino T, Nogami A, Soejima K, Uno K, Kumagai K, Kurita T, Fukuzawa M, Takita A, Ishizu T, Aonuma K. Current Real-World Status of Off-Label Under- and Over-Dose of Direct Oral Anticoagulants After Atrial Fibrillation Ablation. J Cardiovasc Electrophysiol 2025. [PMID: 39777770 DOI: 10.1111/jce.16560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2024] [Revised: 11/29/2024] [Accepted: 12/13/2024] [Indexed: 01/11/2025]
Abstract
BACKGROUND Off-label under- and overdosing of direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) is not uncommon in real-world practice. OBJECTIVE This study aimed to identify efficacy and safety of off-label DOACs dose after AF ablation. METHODS The RYOUMA registry was a prospective multicenter study of Japanese patients who underwent AF ablation between 2017 and 2018. DOAC prescriptions were categorized into on-label standard dose, on-label reduced dose, off-label underdose, and off-label overdose. RESULTS The proportion of off-label doses among patients after AF ablation varied depending on the type of DOAC, ranging from 13.5% to 34.9%. Of 2821 patients, 366 (13.0%) were prescribed an off-label underdose and exhibited significantly higher CHADS2, CHA2DS2-VASc, CHA2DS2-VA, HELT-E2S2, and HAS-BLED scores, age, concomitant use of antiplatelets, and lower weight when compared to the on-label standard dose (n = 1809). While the incidence of ischemic stroke after 1 year of off-label underdose was notably low (0.28%), the rate of major bleeding was relatively high (1.7%). Off-label overdose was prescribed to 134 patients (4.8%), who showed a significantly higher incidence of major bleeding (3.0%) compared to on-label standard dose (0.91%; p = 0.02). The off-label overdose group did not have any particular background and its thromboembolic risk was, conversely, low. The most likely cause of off-label overdose was clinicians potentially overlooking dose criteria, including advanced age, low body weight, and low creatinine clearance. CONCLUSIONS In patients after AF ablation, off-label DOAC overdose was infrequent, but significantly associated with higher incidence of major bleeding during the remote period after AF ablation. TRIAL REGISTRATION The study was registered as UMIN000026092 (University Hospital Medical Information Network-Clinical Trial Registry).
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Affiliation(s)
- Tabito Kino
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kyoko Soejima
- Department of Cardiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Kikuya Uno
- Heart Rhythm Center, Tokyo Heart Rhythm Hospital, Tokyo, Japan
| | | | - Takashi Kurita
- Division of Cardiovascular Center, Kindai University School of Medicine, Osaka, Japan
| | - Masayuki Fukuzawa
- Primary Medical Science Department, Daiichi Sankyo Co. Ltd., Chuo-ku, Japan
| | - Atsushi Takita
- Data Intelligence Department, Daiichi Sankyo Co. Ltd., Chuo-ku, Japan
| | - Tomoko Ishizu
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kazutaka Aonuma
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Palareti G, Legnani C, Testa S, Paoletti O, Cini M, Antonucci E, Pengo V, Poli D, Ageno W, Prandoni P, Prisco D, Tosetto A. Can the Charlson comorbidity index help to guide DOAC dosing in patients with atrial fibrillation and improve the efficacy and safety of treatment? A subanalysis of the MAS study. Curr Probl Cardiol 2025; 50:102913. [PMID: 39481583 DOI: 10.1016/j.cpcardiol.2024.102913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Accepted: 10/27/2024] [Indexed: 11/02/2024]
Abstract
BACKGROUND Frailty influences the effectiveness and safety of anticoagulant therapy in patients with atrial fibrillation (AF). The age-weighted Charlson comorbidity index may offer a valuable tool to assess the risk of adverse events in AF patients treated with direct oral anticoagulants (DOACs). This sub-analysis of MAS trial data aimed to assess whether using the Charlson index, instead of the standard criteria, would have led to different dosing and improved adverse event occurrence during treatment. METHODS The MAS study looked for a relationship between DOAC levels assessed at baseline and adverse events during follow-up. The study is described in detail elsewhere. RESULTS Among the 1,657 patients studied, 832 (50.2 %) had a relatively low Charlson index (up to 6, general median class), of whom 132 (15.9 %) were treated with reduced doses. Conversely, among the 825 patients with a high Charlson index (≥7), 257 (31.1 %) received standard doses. A weak but statistically significant positive correlation (r = 0.1413, p < 0.0001 by ANOVA) was observed between increasing Charlson classes and DOAC levels standardized to allow comparability among drug results. However, no significant differences were found in the incidence or number of adverse events during follow-up, or in other parameters, between patients with low and high Charlson's scores. CONCLUSIONS Utilizing the Charlson index would have led to notable differences in DOAC dosing compared to standard criteria. However, we found no evidence that its use would have improved the prediction of adverse events in AF patients enrolled in the MAS study.
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Affiliation(s)
| | | | - Sophie Testa
- Centro Emostasi e Trombosi, Laboratorio Analisi Chimico-Cliniche e Microbiologiche, ASST Cremona, Cremona, Italy
| | - Oriana Paoletti
- Centro Emostasi e Trombosi, Laboratorio Analisi Chimico-Cliniche e Microbiologiche, ASST Cremona, Cremona, Italy
| | - Michela Cini
- Fondazione Arianna Anticoagulazione, Bologna, Italy
| | | | - Vittorio Pengo
- Clinica Cardiologica, Centro Trombosi, Dipartimento di Scienze Cardio-Toraco-Vascolare, Università di Padova, Italy
| | - Daniela Poli
- Malattie Aterotrombotiche, AOU Careggi, Firenze, Italy
| | - Walter Ageno
- Ospedale Regionale di Bellinzona e Valli, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | | | - Domenico Prisco
- Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze, Italy
| | - Alberto Tosetto
- UOC Ematologia, Centro Malattie Emorragiche e Trombotiche (CMET), AULSS 8 Berica Ospedale S. Bortolo, Vicenza, Italy
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Kim JY, Kim BJ, Kang J, Kim DY, Han MK, Kim SE, Lee H, Park JM, Kang K, Lee SJ, Kim JG, Cha JK, Kim DH, Park TH, Lee K, Park HK, Cho YJ, Hong KS, Choi KH, Kim JT, Kim DE, Choi JC, Oh MS, Yu KH, Lee BC, Park KY, Lee JS, Jang S, Chae JE, Lee J, Kye MS, Gorelick PB, Bae HJ. Long-Term Incidence of Gastrointestinal Bleeding Following Ischemic Stroke. J Stroke 2025; 27:102-112. [PMID: 39916459 PMCID: PMC11834334 DOI: 10.5853/jos.2024.00661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 07/04/2024] [Accepted: 09/13/2024] [Indexed: 02/20/2025] Open
Abstract
BACKGROUND AND PURPOSE Previous research on patients with acute ischemic stroke (AIS) has shown a 0.5% incidence of major gastrointestinal bleeding (GIB) requiring blood transfusion during hospitalization. The existing literature has insufficiently explored the long-term incidence in this population despite the decremental impact of GIB on stroke outcomes. METHODS We analyzed the data from a cohort of patients with AIS admitted to 14 hospitals as part of a nationwide multicenter prospective stroke registry between 2011 and 2013. These patients were followed up for up to 6 years. The occurrence of major GIB events, defined as GIB necessitating at least two units of blood transfusion, was tracked using the National Health Insurance Service claims data. RESULTS Among 10,818 patients with AIS (male, 59%; mean age, 68±13 years), 947 (8.8%) experienced 1,224 episodes of major GIB over a median follow-up duration of 3.1 years. Remarkably, 20% of 947 patients experienced multiple episodes of major GIB. The incidence peaked in the first month after AIS, reaching 19.2 per 100 person-years, and gradually decreased to approximately one-sixth of this rate by the 2nd year with subsequent stabilization. Multivariable analysis identified the following predictors of major GIB: anemia, estimated glomerular filtration rate <60 mL/min/1.73 m2 , and a 3-month modified Rankin Scale score of ≥4. CONCLUSION Patients with AIS are susceptible to major GIB, particularly in the first month after the onset of AIS, with the risk decreasing thereafter. Implementing preventive strategies may be important, especially for patients with anemia and impaired renal function at stroke onset and those with a disabling stroke.
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Affiliation(s)
- Jun Yup Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Beom Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jihoon Kang
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Do Yeon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Moon-Ku Han
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seong-Eun Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Heeyoung Lee
- Department of Clinical Preventive Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jong-Moo Park
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University, Uijenongbu, Korea
| | - Kyusik Kang
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Soo Joo Lee
- Department of Neurology, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
| | - Jae Guk Kim
- Department of Neurology, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Dae-Hyun Kim
- Department of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Kyungbok Lee
- Department of Neurology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hong-Kyun Park
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Yong-Jin Cho
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Keun-Sik Hong
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Chonnam National University College of Medicine, Gwangju, Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam National University College of Medicine, Gwangju, Korea
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Mi-Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Byung-Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Sujung Jang
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Jae Eun Chae
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Min-Surk Kye
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Philip B. Gorelick
- Davee Department of Neurology, Division of Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - on Behalf of the CRCS-K Investigators
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Department of Clinical Preventive Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University, Uijenongbu, Korea
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
- Department of Neurology, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
- Department of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
- Department of Neurology, Seoul Medical Center, Seoul, Korea
- Department of Neurology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea
- Department of Neurology, Chonnam National University Hospital, Chonnam National University College of Medicine, Gwangju, Korea
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
- Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
- Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
- Davee Department of Neurology, Division of Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Kuo LY, Lim ZLT, Letch C, Silverman J, Kim JJY, McClintock S. Evaluating the utility of the HAS-BLED bleeding-estimator tool for transurethral resection of prostate. BJUI COMPASS 2025; 6:e480. [PMID: 39877584 PMCID: PMC11771491 DOI: 10.1002/bco2.480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2024] [Revised: 11/05/2024] [Accepted: 11/09/2024] [Indexed: 01/31/2025] Open
Abstract
Objectives To evaluate the utility of the HAS-BLED bleeding risk-estimation tool to predict for clinically significant postoperative haematuria in patients receiving transurethral resection of prostate (TURP). Patients and Methods A single-centre, retrospective cohort analysis of patients underwent TURP from April 2019 to December 2023 for treatment of symptomatic benign prostate hyperplasia. The primary objective was to evaluate reliability of HAS-BLED score in predicting postoperative bleeding event. A focus sub-analysis was performed on anticoagulated patient cohort. Each patient was categorised in to HASBLED low-, moderate- and high-risk group according to the preestablished estimator tool. Patients' demographics, clinical, pathological and operative details were collected. Events of clinically significant haematuria within 3 months postoperatively were captured. Cohort characteristics and outcome were analysed with two-sided t test and ANOVA test. Further weight-adjusted multivariable analysis and ROC curve was performed to evaluate the predictive value of HAS-BLED score. Results Our analysis showed that patients assigned as high-risk by HAS-BLED were at 2.17-times higher chance of developing clinically significant haematuria compared to the low-risk patients. The risk for high-risk patient was 18.5% (95%CI 11.7-25.3%) and 8.5% (95%CI 4.6-12.4%) for low-risk patients. Moderate-risk did not demonstrate any significant difference relative to the low-risk group. Sub-analysis of 113 patients receiving long-term anticoagulation accentuates the utility of the tool. The risk of haematuria for high-risk patient was 32.7% (95%CI 20.7-44.7%), moderate-risk patient was 28.7% (95%CI 17.0-40.3%), and low-risk patient was 9.7% (95%CI 4.2-15.2%). In this cohort, the risk of haematuria was 3.37 and 2.96 times higher in the high and moderate-risk compared to the low-risk group, respectively. Conclusion This is the first study to validate a bleeding estimator tool for TURP patients. High HAS-BLED score positively predicts clinically significant post-TURP haematuria, particularly for patients receiving anticoagulation therapy.
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Affiliation(s)
- Lu Yu Kuo
- Department of UrologyGold Coast University HostpialSouthportQueenslandAustralia
| | - Zhong Li Titus Lim
- Department of UrologyPrincess Alexandra HospitalWoolloongabbaQueenslandAustralia
| | - Caitlin Letch
- School of Medicine and DentistryGriffith UniversitySouthportQueenslandAustralia
| | - Joshua Silverman
- Department of UrologyGold Coast University HostpialSouthportQueenslandAustralia
| | - Jason Jae Yeun Kim
- Department of UrologyGold Coast University HostpialSouthportQueenslandAustralia
| | - Scott McClintock
- Department of UrologyGold Coast University HostpialSouthportQueenslandAustralia
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Tae CH, Shim KN. Do all antithrombotic agents have a similar impact on small bowel bleeding? Clin Endosc 2025; 58:80-81. [PMID: 39895271 DOI: 10.5946/ce.2024.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Accepted: 01/01/2025] [Indexed: 02/04/2025] Open
Affiliation(s)
- Chung Hyun Tae
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ki-Nam Shim
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
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Eisman AS, Chen ES, Wu WC, Crowley KM, Aluthge DP, Brown K, Sarkar IN. Learning health system linchpins: information exchange and a common data model. J Am Med Inform Assoc 2025; 32:9-19. [PMID: 39538369 DOI: 10.1093/jamia/ocae277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 10/17/2024] [Accepted: 10/22/2024] [Indexed: 11/16/2024] Open
Abstract
OBJECTIVE To demonstrate the potential for a centrally managed health information exchange standardized to a common data model (HIE-CDM) to facilitate semantic data flow needed to support a learning health system (LHS). MATERIALS AND METHODS The Rhode Island Quality Institute operates the Rhode Island (RI) statewide HIE, which aggregates RI health data for more than half of the state's population from 47 data partners. We standardized HIE data to the Observational Medical Outcomes Partnership (OMOP) CDM. Atherosclerotic cardiovascular disease (ASCVD) risk and primary prevention practices were selected to demonstrate LHS semantic data flow from 2013 to 2023. RESULTS We calculated longitudinal 10-year ASCVD risk on 62,999 individuals. Nearly two-thirds had ASCVD risk factors from more than one data partner. This enabled granular tracking of individual ASCVD risk, primary prevention (ie, statin therapy), and incident disease. The population was on statins for fewer than half of the guideline-recommended days. We also found that individuals receiving care at Federally Qualified Health Centers were more likely to have unfavorable ASCVD risk profiles and more likely to be on statins. CDM transformation reduced data heterogeneity through a unified health record that adheres to defined terminologies per OMOP domain. DISCUSSION We demonstrated the potential for an HIE-CDM to enable observational population health research. We also showed how to leverage existing health information technology infrastructure and health data best practices to break down LHS barriers. CONCLUSION HIE-CDM facilitates knowledge curation and health system intervention development at the individual, health system, and population levels.
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Affiliation(s)
- Aaron S Eisman
- Center for Biomedical Informatics, Brown University, Providence, RI 02912, United States
- The Warren Alpert Medical School, Brown University, Providence, RI 02912, United States
- Yale School of Medicine, New Haven, CT 06510, United States
| | - Elizabeth S Chen
- Center for Biomedical Informatics, Brown University, Providence, RI 02912, United States
- The Warren Alpert Medical School, Brown University, Providence, RI 02912, United States
- School of Public Health, Brown University, Providence, RI 02912, United States
| | - Wen-Chih Wu
- The Warren Alpert Medical School, Brown University, Providence, RI 02912, United States
- School of Public Health, Brown University, Providence, RI 02912, United States
- Division of Cardiology, VA Providence Health Care, Providence, RI 02912, United States
| | - Karen M Crowley
- Center for Biomedical Informatics, Brown University, Providence, RI 02912, United States
| | - Dilum P Aluthge
- Center for Biomedical Informatics, Brown University, Providence, RI 02912, United States
- The Warren Alpert Medical School, Brown University, Providence, RI 02912, United States
| | - Katherine Brown
- Center for Biomedical Informatics, Brown University, Providence, RI 02912, United States
- The Warren Alpert Medical School, Brown University, Providence, RI 02912, United States
| | - Indra Neil Sarkar
- Center for Biomedical Informatics, Brown University, Providence, RI 02912, United States
- The Warren Alpert Medical School, Brown University, Providence, RI 02912, United States
- School of Public Health, Brown University, Providence, RI 02912, United States
- Rhode Island Quality Institute, Providence, RI 02912, United States
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Pelicon K, Petek K, Boc A, Kejžar N, Blinc A, Boc V. External validation of the OAC 3-PAD risk score after endovascular revascularisation. VASA 2025; 54:43-49. [PMID: 39565726 DOI: 10.1024/0301-1526/a001159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2024]
Abstract
Background: The OAC3-PAD bleeding risk score was developed to assess the bleeding risk in patients with peripheral arterial disease (PAD), however its performance in patients treated exclusively with endovascular revascularisation has not yet been tested. We aimed to externally validate the bleeding risk score for this patient cohort. Patients and methods: A retrospective observational study, analysing the data of all PAD patients successfully treated with endovascular revascularisation in a single centre within a five-year period. The performance of the Cox proportional hazards (CPH) model, upon which the OAC3-PAD bleeding risk score is based, was tested using calibration methods, discrimination, and a scaled Brier score for overall performance. The OAC3-PAD bleeding risk score was calculated for all patients, classifying them into the four respective risk groups. Kaplan-Meier curves were plotted for all risk groups and discrimination was tested using log-rank tests. Results: While discrimination of the CPH model was adequate, calibration of the model was poor and the scaled Brier score was 3.27% (95% CI 0.65%-4.40%). Of the 1,434 patients, 33 (2.3%) experienced a major bleeding event. The frequency of bleeding was 0.4% in the low risk group (3/736 patients), 0.8% in the low-to-moderate risk group (2/243 patients), 5.8% in the moderate-to-high risk group (15/258 patients), and 6.6% in the high risk group (13/197 patients). The OAC3-PAD score successfully discriminated each of the two lower bleeding risk groups from one of the two higher risk groups, but failed to discriminate among the two lower risk groups and the two higher risk groups, respectively. Conclusions: Although the OAC3-PAD score did not stratify patients into the four respective risk groups, it allowed discrimination between the low risk patients and the high risk patients. It could therefore become a useful tool for predicting major bleeding events in patients with PAD after endovascular revascularisation.
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Affiliation(s)
- Kevin Pelicon
- Department of Vascular Diseases, University Medical Centre Ljubljana, Slovenia
| | - Klemen Petek
- Department of Vascular Diseases, University Medical Centre Ljubljana, Slovenia
| | - Anja Boc
- Department of Vascular Diseases, University Medical Centre Ljubljana, Slovenia
- Institute of Anatomy, Faculty of Medicine, University of Ljubljana, Slovenia
| | - Nataša Kejžar
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Slovenia
| | - Aleš Blinc
- Department of Vascular Diseases, University Medical Centre Ljubljana, Slovenia
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Slovenia
| | - Vinko Boc
- Department of Vascular Diseases, University Medical Centre Ljubljana, Slovenia
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Slovenia
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Chapa JJ, Bhakta D. Editorial commentary: Subclinical atrial fibrillation: What are its implications and what are best practices? Trends Cardiovasc Med 2025; 35:8-9. [PMID: 38663525 DOI: 10.1016/j.tcm.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 04/14/2024] [Indexed: 05/07/2024]
Affiliation(s)
- Jeffrey J Chapa
- Division of Cardiovascular Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Deepak Bhakta
- Division of Cardiovascular Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States; Indiana University Health Physicians, Indianapolis, IN, United States.
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Verso M, Maraziti G, Vinci A, Castellani D, Bassotti G, Morelli O. Clinical and endoscopic findings in patients with acute gastrointestinal bleeding associated with direct oral anticoagulants: Results from a single-center prospective cohort study. Thromb Res 2025; 245:109227. [PMID: 39581066 DOI: 10.1016/j.thromres.2024.109227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 09/10/2024] [Accepted: 11/18/2024] [Indexed: 11/26/2024]
Affiliation(s)
- Melina Verso
- Internal, Vascular and Emergency Medicine Stroke Unit, Department of Medicine & Surgery University of Perugia, 06123 Perugia, Italy
| | - Giorgio Maraziti
- Internal, Vascular and Emergency Medicine Stroke Unit, Department of Medicine & Surgery University of Perugia, 06123 Perugia, Italy.
| | - Alessandra Vinci
- Internal, Vascular and Emergency Medicine Stroke Unit, Department of Medicine & Surgery University of Perugia, 06123 Perugia, Italy
| | - Danilo Castellani
- Gastroenterology, Hepatology & Digestive Endoscopy Section, Department of Medicine & Surgery, University of Perugia, 06123 Perugia, Italy
| | - Gabrio Bassotti
- Gastroenterology, Hepatology & Digestive Endoscopy Section, Department of Medicine & Surgery, University of Perugia, 06123 Perugia, Italy
| | - Olivia Morelli
- Gastroenterology, Hepatology & Digestive Endoscopy Section, Department of Medicine & Surgery, University of Perugia, 06123 Perugia, Italy
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Wennberg E, Abualsaud AO, Eisenberg MJ. Patient Management Following Percutaneous Coronary Intervention. JACC. ADVANCES 2025; 4:101453. [PMID: 39801818 PMCID: PMC11717659 DOI: 10.1016/j.jacadv.2024.101453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 10/23/2024] [Accepted: 11/05/2024] [Indexed: 01/16/2025]
Abstract
Percutaneous coronary intervention (PCI) is a mainstay procedure for the treatment of coronary artery disease. PCI techniques have evolved considerably since the advent of PCI in 1978, and with this evolution in techniques has come changes in the best practices for patient management following PCI. The objective of this review is to provide a comprehensive overview of key considerations in patient management following PCI. The long-term management of patients post-PCI should follow 3 main principles: 1) lifestyle modification and reduction of risk factors; 2) implementation of secondary prevention therapies; and 3) timely detection of restenosis. Best practices in achieving these principles include promotion of smoking cessation, regular physical activity, and a healthy diet, as well as blood pressure, diabetes mellitus, lipid, and weight management; prescription of secondary prevention therapies balancing ischemic and bleeding risk; and avoidance of routine surveillance for restenosis.
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Affiliation(s)
- Erica Wennberg
- Lady Davis Institute for Medical Research, Jewish General Hospital/McGill University, Montreal, Quebec, Canada
- MD/PhD Program, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ali O. Abualsaud
- Division of Cardiology, Jewish General Hospital/McGill University, Montreal, Quebec, Canada
| | - Mark J. Eisenberg
- Lady Davis Institute for Medical Research, Jewish General Hospital/McGill University, Montreal, Quebec, Canada
- Division of Cardiology, Jewish General Hospital/McGill University, Montreal, Quebec, Canada
- Departments of Medicine and of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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Haj AK, Ryu J, Jurgens SJ, Chaudhry S, Koyama S, Wang X, Choi SH, Hou C, Sanna-Cherchi S, Anderson CD, Ellinor PT, Bendapudi PK. Loss of function in protein Z (PROZ) is associated with increased risk of ischemic stroke in the UK Biobank. J Thromb Haemost 2025; 23:171-180. [PMID: 39383998 PMCID: PMC11725435 DOI: 10.1016/j.jtha.2024.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 08/20/2024] [Accepted: 09/12/2024] [Indexed: 10/11/2024]
Abstract
BACKGROUND The vitamin K-dependent coagulation factor protein Z (PZ), encoded by the PROZ gene, is canonically considered to have anticoagulant effects through negative regulation of factor Xa. Paradoxically, higher circulating PZ concentrations have repeatedly been associated with an elevated risk of acute ischemic stroke. OBJECTIVES We performed a large-scale genetic association study to examine the relationship between germline genetic variants in PROZ and the risk of ischemic stroke. METHODS Using whole-exome sequencing and clinical data for 416 711 participants in the UK Biobank (UKB), we identified individuals with rare (minor allele frequency ≤0.1%) putatively function-altering variants in PROZ. Using Firth's logistic regression and controlling for known stroke risk factors, we evaluated the association between variant carrier status and noncardioembolic ischemic stroke (NCEIS). Additionally, we evaluated differences in the plasma levels of 1472 proteins between PROZ variant carriers and noncarriers in a subset of 48 893 UKB participants. RESULTS After accounting for missing data, qualifying variants in PROZ were identified in 414 UKB participants (99.0% heterozygous). Variant carriers had a significantly increased risk of NCEIS (odds ratio, 2.34; 95% CI, 1.15-4.13; P = .02) but not of venous thromboembolism, myocardial infarction, or peripheral artery disease. Plasma proteomics analysis revealed that PROZ variant carriers had significantly elevated levels of 2 proteins related to the response to cerebral ischemia, peroxiredoxins 1 and 6 (PRDX1: fold change, 1.83; P = 1.3 × 10-5; PRDX6: fold change, 1.78; P = 9.6 × 10-10). CONCLUSION Lifelong exposure to decreased PZ levels confers a significantly increased risk of NCEIS, consistent with the role of PZ as an anticoagulant factor.
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Affiliation(s)
- Amelia K Haj
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Justine Ryu
- Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA; Section of Hematology, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sean J Jurgens
- Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA; Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Experimental Cardiology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Sharjeel Chaudhry
- Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Division of Hemostasis and Thrombosis, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Satoshi Koyama
- Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Xin Wang
- Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Seung Hoan Choi
- Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Cody Hou
- Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Simone Sanna-Cherchi
- Division of Nephrology, Columbia University Irving Medical Center, New York, New York, USA
| | - Christopher D Anderson
- Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Patrick T Ellinor
- Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Pavan K Bendapudi
- Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Division of Hemostasis and Thrombosis, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Division of Hematology and Blood Transfusion Service, Massachusetts General Hospital, Boston, Massachusetts, USA.
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Garg J, Kabra R, Gopinathannair R, Di Biase L, Wang DD, Saw J, Hahn R, Freeman JV, Ellis CR, Lakkireddy D. State of the Art in Left Atrial Appendage Occlusion. JACC Clin Electrophysiol 2024:S2405-500X(24)00932-0. [PMID: 39797854 DOI: 10.1016/j.jacep.2024.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Accepted: 10/21/2024] [Indexed: 01/13/2025]
Abstract
Left atrial appendage occlusion (LAAO) has become an important therapeutic target for stroke prevention in patients with nonvalvular atrial fibrillation. Over the past 2 decades, several advancements in LAAO devices (percutaneous and surgical) have been made for stroke prevention and arrhythmia therapy. However, there are several unanswered questions regarding optimal patient selection, the preferred LAAO approach and device, the management of periprocedural and postprocedural complications, including pericardial effusion, device-related thrombus, and device leaks. This review focuses on fundamental foundational concepts in various aspects of the left atrial appendage and management strategies as they relate to current clinical needs.
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Affiliation(s)
- Jalaj Garg
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California, USA
| | - Rajesh Kabra
- Kansas City Heart Rhythm Institute and Research Foundation, Kansas City, Kansas, USA
| | - Rakesh Gopinathannair
- Kansas City Heart Rhythm Institute and Research Foundation, Kansas City, Kansas, USA
| | - Luigi Di Biase
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Dee Dee Wang
- Center for Structural Heart Disease, Henry Ford Health, Detroit, Michigan, USA
| | - Jacqueline Saw
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rebecca Hahn
- Department of Cardiology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - James V Freeman
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA; Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation, New Haven, Connecticut, USA
| | - Christopher R Ellis
- Department of Medicine, Section of Cardiac Electrophysiology, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Dhanunjaya Lakkireddy
- Kansas City Heart Rhythm Institute and Research Foundation, Kansas City, Kansas, USA.
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Vanderstuyft E, Hias J, Hellemans L, Van Aelst L, Tournoy J, Van der Linden LR. Appropriateness of antithrombotics in geriatric inpatients with atrial fibrillation: a retrospective, cross-sectional study. Eur J Hosp Pharm 2024:ejhpharm-2023-004033. [PMID: 38580430 DOI: 10.1136/ejhpharm-2023-004033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/19/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Atrial fibrillation occurs in nearly half of geriatric inpatients and is a major cause of morbidity and mortality. Suboptimal anticoagulation use is an important concern in this population. This study aimed to evaluate the appropriateness of antithrombotic therapies in this patient cohort. METHODS A retrospective analysis was conducted on the geriatric wards of a teaching hospital in Belgium, on a background of clinical pharmacy services. The first 90 atrial fibrillation patients from 2020 to 2022 were included if they received an oral anticoagulant. We assessed utilisation and appropriateness of antithrombotics at discharge, examined reasons for guideline deviations, and explored factors associated with underdosing. Temporal associations for appropriateness and type of anticoagulant (vitamin K antagonist (VKA) vs direct oral anticoagulant (DOAC)) were assessed. RESULTS The mean age of patients was 86.5 (±5.3) years and the median CHA2DS2-VASc score was 5 (interquartile range (IQR) 4-6). At discharge, 256 (94.8%) patients used a DOAC; nine (3.3%) used a VKA; one (0.4%) a DOAC-antiplatelet combination, and in four patients (1.5%) all antithrombotics were discontinued. The majority (64.4%) of patients received reduced DOAC doses with apixaban prescribed in 40.7%. In 39 (14.4%) patients, antithrombotic use was considered inappropriate, mostly without a rationale (23/39). Year 2022 (odds ratio (OR) 0.104; 95% confidence interval (CI), 0.012-0.878) was the sole determinant for underdosing. No significant differences were found with respect to appropriateness (p=0.533) or anticoagulant class (p=0.479) over time. CONCLUSION Most geriatric inpatients received a justified reduced DOAC dose. A significant proportion was managed inappropriately with underdosing (= unjustified reduced dose) being most common. Frequently no rationale was provided for deviating from trial-tested doses.
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Affiliation(s)
- Esther Vanderstuyft
- Pharmacy Department, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Julie Hias
- Pharmacy Department, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Laura Hellemans
- Pharmacy Department, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven Biomedical Sciences Group, Leuven, Belgium
| | - Lucas Van Aelst
- Department of Cardiovascular Sciences, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
- Department of Cardiology, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Jos Tournoy
- Department of Geriatric Medicine, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
- Department of Chronic Diseases, Metabolism and Ageing, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
| | - Lorenz Roger Van der Linden
- Pharmacy Department, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
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Omura A, Mori H, Sasai M, Tezuka T, Wada D, Sone H, Takei Y, Tashiro K, Sato T, Ebato M, Suzuki H. Use of Direct Oral Anticoagulation for Isolated Distal Deep Vein Thrombosis in Japanese Orthopedic Patients. Ann Vasc Dis 2024; 17:371-377. [PMID: 39726555 PMCID: PMC11669022 DOI: 10.3400/avd.oa.24-00061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 09/01/2024] [Indexed: 12/28/2024] Open
Abstract
Objectives: Although direct oral anticoagulants (DOAC) have become widely used, little is known about the efficacy of DOAC for isolated distal deep vein thrombosis (DVT). Methods: In-hospitalized orthopedic patients with isolated distal DVT who were diagnosed from 2016 to 2018 were enrolled and were followed for 1 year. Embolic events included symptomatic pulmonary embolism (PE) and DVT extension above the knee. Bleeding events were determined in the presence of bleeding academic research consortium (BARC) 2, 3 or 5 bleeding. Results: Of 196 orthopedic patients, 84% of patients (n = 164) received DOAC (DOAC+ group), whereas 16% of patients (n = 32) did not (DOAC- group). Cumulative incidence of embolic events was observed in 1.5% of the DOAC+ group and none of the DOAC- group (p = 0.443). Cumulative incidence of bleeding events was observed in 5.1% of the DOAC+ group and none of the DOAC- group (p = 0.157). The majority of bleeding events (80%) occurred in patients with HAS-BLED scores of 3 or greater. Conclusions: There were no significant differences in embolic events and bleeding events in retrospective data. Balancing thrombotic risk and bleeding risk remains to be key for isolated distal DVT.
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Affiliation(s)
- Ayumi Omura
- Division of Cardiology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Hiroyoshi Mori
- Division of Cardiology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Masahiro Sasai
- Division of Cardiology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Takahiro Tezuka
- Division of Cardiology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Daisuke Wada
- Division of Cardiology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Hiromoto Sone
- Division of Cardiology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Yosuke Takei
- Division of Cardiology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Kazuma Tashiro
- Division of Cardiology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Tokutada Sato
- Division of Cardiology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Mio Ebato
- Division of Cardiology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Hiroshi Suzuki
- Division of Cardiology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
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Kim I, Kim JS, Cheung DY, Kim BW, Hou JU. Comparison of Risk-Scoring Models to Predict Gastrointestinal Bleeding in Patients With Direct Oral Anticoagulants. J Gastroenterol Hepatol 2024. [PMID: 39686912 DOI: 10.1111/jgh.16853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Revised: 10/21/2024] [Accepted: 12/05/2024] [Indexed: 12/18/2024]
Abstract
BACKGROUND AND AIM The risk of gastrointestinal bleeding (GIB) remains a concern with the use of direct oral anticoagulants (DOAC). We evaluated the efficacy of four risk-scoring models (HAS-BLED, ATRIA, VTE-BLEED, and ORBIT) in predicting GIB according to the concomitant use of antiplatelet therapy in DOAC users. METHODS Patients prescribed DOAC between December 2014 and October 2020 were enrolled in two university-affiliated hospitals. The performance of the four models was compared based on the concomitant use of antiplatelet therapy. The primary outcomes were likelihood ratios and the area under the receiver operating characteristic (AUROC) curve to predict GIB. RESULTS A total of 4494 patients were included in the study. The AUROC values for the entire cohort were 0.643 (95% CI: 0.601-0.686) for HAS-BLED, 0.693 (95% CI: 0.649-0.737) for ATRIA, 0.708 (95% CI: 0.665-0.750) for VTE-BLEED, and 0.709 (95% CI: 0.667-0.751) for ORBIT. The AUROC for all scoring models increased in patients without antiplatelet therapy compared to the entire cohort and patients with antiplatelet therapy. The specificity and diagnostic accuracy for all scoring models increased in patients without antiplatelet therapy compared to patients with antiplatelet. CONCLUSIONS Our results confirmed that current risk-scoring models for predicting GIB perform better in patients without antiplatelet therapy than in those on concomitant antiplatelet therapy. This suggests that future risk prediction models should consider the concomitant use of antiplatelet therapy for diagnostic accuracy.
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Affiliation(s)
- Ilsoo Kim
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Joon Sung Kim
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Dae Young Cheung
- Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Byung-Wook Kim
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jong-Uk Hou
- Division of Software, Department of Information Science, Hallym University, Chuncheon, South Korea
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Jackson LR, Kang A, Noxon V, Atreja N, Hines DM, Hagan M, Jiang J, Atwater BD. Racial differences and geographic variations in oral anticoagulation treatment among Medicare patients with non-valvular atrial fibrillation. PLoS One 2024; 19:e0314345. [PMID: 39666755 PMCID: PMC11637370 DOI: 10.1371/journal.pone.0314345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 11/09/2024] [Indexed: 12/14/2024] Open
Abstract
INTRODUCTION Use of oral anticoagulants (OACs) for stroke reduction in atrial fibrillation (AF) varies by race and geography within the United States. We seek to better understand the relationship between OAC underutilization, race, and US geography. METHODS Patients with AF were selected from the US Centers for Medicare & Medicaid Services claims database from January 1, 2013, to December 31, 2016. The final population consisted of patients with 12 months of health plan enrollment before and after their index AF diagnosis, with a baseline CHAD2S2-VASc ≥2 and of either Black or White race (other races are underrepresented in the data). Among those with AF that met the inclusion criteria, patients who were prescribed warfarin or DOACs within 12 months after the index date were extracted. Each patient was assigned to a US county based on their 5-digit zip code and OAC use was stratified by race. Statistically significant differences were determined by student's t-test and chi-square. RESULTS Of the 2,390,830 final patients, 94.1% were White and 5.9% were Black patients. Mean (SD) age and HASBLED scores were 78 (9) and 3.9 (1.2) respectively, for Black patients and 80 (9) and 3.3 (1.2), respectively, for White patients (p<0.0001). The mean (SD) CHAD2S2-VASc scores were 4.5 (1.9) for White patients, and 5.3 (1.9) for Black patients with p<0.0001, respectively. Black patients (vs White patients) had a higher non-treatment (no DOAC or warfarin) rate (56.1% vs 47.4%, p<0.0001) across the US which was particularly notable in the southeast. In addition, treatment rates were highly variable within each US state. Counties with dense population more frequently demonstrated significant differences by race than counties with sparse population. CONCLUSION Our study showed differences in the use of OACs across US counties and among various racial groups. These disparities highlighted the areas of unmet need for both Black and White patients.
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Affiliation(s)
- Larry R. Jackson
- Duke Clinical Research Institute, Durham, NC, United States of America
| | - Amiee Kang
- Bristol Myers Squibb, Lawrenceville, NJ, United States of America
| | | | - Nipun Atreja
- Bristol Myers Squibb, Lawrenceville, NJ, United States of America
| | | | - Melissa Hagan
- Bristol Myers Squibb, Lawrenceville, NJ, United States of America
| | - Jenny Jiang
- Bristol Myers Squibb, Lawrenceville, NJ, United States of America
| | - Brett D. Atwater
- Inova Schar Heart and Vascular, Falls Church, VA, United States of America
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Chen J, Wang L, Chen G, Peng W, Hu W, Guo H, Mao K. Oral anticoagulants-induced intracranial hemorrhage: a real-world pharmacovigilance study over 2008-2024. Expert Opin Drug Saf 2024:1-10. [PMID: 39655388 DOI: 10.1080/14740338.2024.2430320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 09/24/2024] [Indexed: 12/12/2024]
Abstract
BACKGROUND This study aims to review and describe the national post-market cases of oral anticoagulants (OACs)-induced intracranial hemorrhage (ICH) to enhance patient safety. RESEARCH DESIGN AND METHODS All ICH cases of OACs as primary suspected medicines were extracted from the FAERS. The disproportionality analysis was utilized for signal detection. Subgroup analyses and logistic regression were conducted according to age, sex, weight, hypertension status, concomitant antiplatelet drugs, and indications. Stratification analysis was performed according to the ICH locations. RESULTS In total 11,201 cases of OACs-induced ICH were identified from 2008Q1 to 2024Q1. The median time-to-onset (TTO) and median age for OAC-induced ICHs were 181 days and 75 years, respectively. Most potent positive signal was subdural hemorrhage in rivaroxaban and vitamin K antagonists (VKAs), spinal cord hemorrhage in apixaban, hemorrhagic cerebellar infarction in edoxaban and extra-axial hemorrhage in dabigatran (IC025: 4.04, 5.00, 3.45, 6.09 and 3.51, respectively). After adjusting for confounding factors, lower ICH risks were observed in direct oral anticoagulants (DOACs), compared to VKAs. CONCLUSION DOACs demonstrated a robust lower risk of ICH compared with VKAs. Different OACs exhibited distinct risk profiles at different ICH sites. The majority of DOACs-induced ICH occurred within 5 months and in elderly patients.
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Affiliation(s)
- Jiale Chen
- Department of Pharmacy, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Ling Wang
- Department of Pharmacy, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, China
| | - Guoquan Chen
- Department of Pharmacy, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Wenxing Peng
- Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wei Hu
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hejian Guo
- Department of Pharmacy, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - KaiLi Mao
- Department of Pharmacy, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, China
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Batko J, Litwinowicz R, Kapelak B, Bartuś K. First-in-Human Percutaneous Epicardial-Only Left Atrial Appendage Closure Using Sierra Left Atrial Appendage Ligation System. J Clin Med 2024; 13:7417. [PMID: 39685873 DOI: 10.3390/jcm13237417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2024] [Revised: 11/28/2024] [Accepted: 12/03/2024] [Indexed: 12/18/2024] Open
Abstract
Background: In patients with atrial fibrillation and contraindications for oral anticoagulation, in which an increased risk of stroke remains, a left atrial appendage exclusion should be considered for elimination, because the left atrial appendage is the most common site of thrombus. The aim of this study is to present the first-in-human study results of the Sierra Aegis Left Atrial Appendage Ligation System, a new epicardial-only left atrial appendage closure system. Methods: This study was a prospective, first-in-human, single-center study evaluating the effectiveness and safety of the Sierra Aegis Left Atrial Appendage Ligation System device for epicardial left atrial appendage closure. Seven patients (mean age: 57.3 ± 10.6 years, 71.4% male) were qualified for a left atrial appendage closure because of an increased risk of bleeding with the need for lifelong anticoagulation pharmacology due to an increased risk of stroke. The patients' preoperative and intraoperative characteristics were collected. Patients were observed during their 1-month, 3-month, 6-month, and 1-year follow-up. Results: The mean procedure time was 21.2 ± 8.2 min. All patients spent 3 days in the hospital including monitoring, the performance of preoperative CT scans, and anatomical evaluation. No tamponade, bleeding, thrombus, or left atrial appendage leakage were observed during the procedure or in-hospital stay. During the 1-month, 3-month, 6-month, and 1-year follow-up visits, none of the patients reported any complications. No tamponade, leakage, or left atrial appendage thrombus were observed. Conclusions: This first-in-human study regarding Sierra use for left atrial appendage closure shows promising results regarding the effectiveness and safety of the Sierra device for use in humans.
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Affiliation(s)
- Jakub Batko
- Department of Anatomy, Jagiellonian University Medical College, 31-008 Krakow, Poland
- CAROL-Cardiothoracic Anatomy Research Operative Lab, Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Radosław Litwinowicz
- Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, St. John Paul II Hospital, 31-202 Krakow, Poland
| | - Boguslaw Kapelak
- Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, St. John Paul II Hospital, 31-202 Krakow, Poland
| | - Krzysztof Bartuś
- Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, St. John Paul II Hospital, 31-202 Krakow, Poland
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Cho MS, Kang DY, Ahn JM, Yun SC, Oh YS, Lee CH, Choi EK, Lee JH, Kwon CH, Park GM, Choi HO, Park KH, Park KM, Hwang J, Yoo KD, Cho YR, Kim JH, Hwang KW, Jin ES, Kwon O, Kim KH, Park SJ, Park DW, Nam GB. Edoxaban Antithrombotic Therapy for Atrial Fibrillation and Stable Coronary Artery Disease. N Engl J Med 2024; 391:2075-2086. [PMID: 39225258 DOI: 10.1056/nejmoa2407362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
BACKGROUND Despite consistent recommendations from clinical guidelines, data from randomized trials on a long-term antithrombotic treatment strategy for patients with atrial fibrillation and stable coronary artery disease are still lacking. METHODS We conducted a multicenter, open-label, adjudicator-masked, randomized trial comparing edoxaban monotherapy with dual antithrombotic therapy (edoxaban plus a single antiplatelet agent) in patients with atrial fibrillation and stable coronary artery disease (defined as coronary artery disease previously treated with revascularization or managed medically). The risk of stroke was assessed on the basis of the CHA2DS2-VASc score (scores range from 0 to 9, with higher scores indicating a greater risk of stroke). The primary outcome was a composite of death from any cause, myocardial infarction, stroke, systemic embolism, unplanned urgent revascularization, and major bleeding or clinically relevant nonmajor bleeding at 12 months. Secondary outcomes included a composite of major ischemic events and the safety outcome of major bleeding or clinically relevant nonmajor bleeding. RESULTS We assigned 524 patients to the edoxaban monotherapy group and 516 patients to the dual antithrombotic therapy group at 18 sites in South Korea. The mean age of the patients was 72.1 years, 22.9% were women, and the mean CHA2DS2-VASc score was 4.3. At 12 months, a primary-outcome event had occurred in 34 patients (Kaplan-Meier estimate, 6.8%) assigned to edoxaban monotherapy and in 79 patients (16.2%) assigned to dual antithrombotic therapy (hazard ratio, 0.44; 95% confidence interval [CI], 0.30 to 0.65; P<0.001). The cumulative incidence of major ischemic events at 12 months appeared to be similar in the trial groups. Major bleeding or clinically relevant nonmajor bleeding occurred in 23 patients (Kaplan-Meier estimate, 4.7%) in the edoxaban monotherapy group and in 70 patients (14.2%) in the dual antithrombotic therapy group (hazard ratio, 0.34; 95% CI, 0.22 to 0.53). CONCLUSIONS In patients with atrial fibrillation and stable coronary artery disease, edoxaban monotherapy led to a lower risk of a composite of death from any cause, myocardial infarction, stroke, systemic embolism, unplanned urgent revascularization, or major bleeding or clinically relevant nonmajor bleeding at 12 months than dual antithrombotic therapy. (Funded by the CardioVascular Research Foundation and others; EPIC-CAD ClinicalTrials.gov number, NCT03718559.).
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Affiliation(s)
- Min Soo Cho
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Do-Yoon Kang
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Jung-Min Ahn
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Sung-Cheol Yun
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Yong-Seog Oh
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Chang Hoon Lee
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Eue-Keun Choi
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Ji Hyun Lee
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Chang Hee Kwon
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Gyung-Min Park
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Hyung Oh Choi
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Kyoung-Ha Park
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Kyoung-Min Park
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Jongmin Hwang
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Ki-Dong Yoo
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Young-Rak Cho
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Ji Hyun Kim
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Ki Won Hwang
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Eun-Sun Jin
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Osung Kwon
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Ki-Hun Kim
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Seung-Jung Park
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Duk-Woo Park
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Gi-Byoung Nam
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
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Ding Q, Xu W, Chen Y, Chang S, Zhang J. Correlation between thrombocytopenia and adverse outcomes in patients with atrial fibrillation: a systematic review and meta-analysis. Front Cardiovasc Med 2024; 11:1383470. [PMID: 39691493 PMCID: PMC11649656 DOI: 10.3389/fcvm.2024.1383470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 10/28/2024] [Indexed: 12/19/2024] Open
Abstract
Background Thrombocytopenia is often associated with adverse outcomes in patients with atrial fibrillation. Therefore, we conducted a meta-analysis to comprehensively assess the impact of thrombocytopenia on ischemic stroke/systemic embolism, major bleeding and all-cause mortality in patients with atrial fibrillation. Methods Two electronic databases, PubMed and Web of Science, were systematically searched from their inception to December 1, 2023, including the studies on the correlation between atrial fibrillation patients with thrombocytopenia and adverse outcomes. Relevant data was extracted, literature quality was evaluated, meta-analysis was performed by using REVMAN 5.4 software, and the results were reported with odds ratio (OR) of 95% confidence interval (CI). Results A total of 12 studies included 73,824 patients with atrial fibrillation (average age: 72.67, males: 42,275, 57.3%), among them, there were 7,673 patients combined with thrombocytopenia. The average follow-up time of these studies was 87 days to 55 months. Compared to no thrombocytopenia, atrial fibrillation patients combined with thrombocytopenia have a significant risk reduction of ischemic stroke/systemic embolism [OR: 0.79, 95% CI: (0.69, 0.91); P < 0.01]. Nevertheless, the risk of both major bleeding [OR: 1.51, 95% CI: (1.20, 1.79), P < 0.01] and all-cause mortality [OR: 1.40, 95% CI: (1.23, 1.61); P < 0.01] is significantly higher in thrombocytopenia group. Conclusions Thrombocytopenia has an important impact on the prognosis of patients with atrial fibrillation. Thrombocytopenia is significantly associated with a lower risk of ischemic stroke/systemic embolism but a higher risk of major bleeding and all-cause mortality. Attention to thrombocytopenia and optimization of treatment may be the effective way to improve the prognosis of atrial fibrillation with thrombocytopenia. Systematic Review Registration https://www.crd.york.ac.uk/, PROSPERO Registration Number: (CRD42023459916).
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Gaboreau Y, Frappé P, Vermorel C, Foote A, Bosson JL, Pernod G. Patients treated with vitamin K oral anticoagulants in family practice: a new approach to bleeding risk assessment. An ancillary study by the CACAO prospective general practice cohort. Fam Pract 2024; 41:932-940. [PMID: 39446561 DOI: 10.1093/fampra/cmae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2024] Open
Abstract
BACKGROUND The ability of bleeding risk scores to predict major bleeding (MB) or clinically relevant nonmajor bleeding (CRNMB) remains a topic of contention, particularly in nonselected patients in family practice. In addition, the capacity to predict bleeding risk using simple variables has yet to be established. OBJECTIVES The main objective was to confirm that severe anemia was the most predictive factor for the estimation of bleeding risk in patients treated with vitamin K antagonists (VKAs). Secondary objectives were to test the capacity of different bleeding scores to detect high-risk patients. Subsequently, the impact of functional decline on bleeding incidence was explored. METHODS The CACAO study was a multicenter prospective cohort study of patients who, due to nonvalvular atrial fibrillation (NVAF) and/or venous thromboembolism (VTE), had been prescribed an oral anticoagulant by their general practitioner (GP) as a prophylactic measure. Patient characteristics were collected at the time of inclusion by GPs, who then monitored them in accordance with standard practice for one year. MB and CRNMB were the main outcomes for one year. By applying this approach, a total of 13 scores were analyzed. RESULTS Aaemia was found to be strongly associated with MB (HR: 2.77, 95% CI: 1.2-6.36), with a particularly pronounced association observed in cases of severe anemia (HR: 12.9, 95% CI: 2.76-60.35). Twelve out of 27 MB cases were not identified by at least half of the scores. By contrast, functional decline was identified as a novel factor associated with MB (HR: 2.45, 95% CI: 1.13-5.31). CONCLUSIONS Preexisting anemia is a major prognostic factor associated with the occurrence of bleeding. It seems relevant to suggest that functional decline should be considered by GPs when assessing bleeding risk.
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Affiliation(s)
- Yoann Gaboreau
- Department of General Practice, Université Grenoble Alpes, 38000 Grenoble, France
- Université Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, UMR5525, 38000 Grenoble, France
| | - Paul Frappé
- Department of General Practice, University of Saint-Etienne, 42000 Saint-Etienne, France
- Inserm UMR 1059, Sainbiose DVH, University of Saint-Etienne, 42000 Saint-Etienne, France
- Inserm CIC-EC 1408, 42000 Saint-Etienne, France
| | - Celine Vermorel
- Université Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, UMR5525, 38000 Grenoble, France
| | - Alison Foote
- University Grenoble-Alpes, 38000 Grenoble, France
| | - Jean-Luc Bosson
- Université Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, UMR5525, 38000 Grenoble, France
| | - Gilles Pernod
- Université Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, UMR5525, 38000 Grenoble, France
- University Grenoble-Alpes, Vascular Medicine Unit, CHU de Grenoble, 38000 Grenoble, France
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50
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Kuo LY, Kuo J, Silverman J, Kim JJY, Letch C, McClintock S. Comparison of perioperative bleeding risk between direct oral anticoagulants in transurethral resection of prostate. BJU Int 2024; 134 Suppl 2:30-37. [PMID: 39210619 PMCID: PMC11603099 DOI: 10.1111/bju.16478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
OBJECTIVES To evaluate the perioperative morbidity and mortality associated with direct oral anticoagulants (DOACs) and warfarin for patients receiving transurethral resection of prostate (TURP). PATIENTS AND METHODS This was a single-centre, retrospective cohort analysis of patients who underwent TURP for benign prostate hyperplasia from April 2019 to December 2023. The primary objective was to evaluate the perioperative bleeding and thromboembolic risk between anticoagulated (AC) vs no-AC patients. The secondary objective was to evaluate perioperative bleeding and thromboembolic risk between different formulations of DOACs. Patient demographics, prior treatment, prostate size, baseline bleeding risk, and operative details were collected. Bleeding and thromboembolic-related morbidity were captured within a 3-month postoperative period. Perioperative management of AC therapy was recorded, and all patients had their AC therapy withheld. Cohort characteristic between the AC vs no-AC, and DOAC groups were analysed with two-sided t-test, and chi-square test. Further logistic regression analyses were carried out to identified significant variables between the groups. These significant variables were used for adjustment in inverse probability-weighted treatment effect analysis to evaluate bleeding risk. RESULTS There were 629 patients in the cohort, and 113 (18%) patients were receiving AC therapy. The AC patients were at 1.6 times statistically significant increased risk of acute bleeding, and 11 times increased risk of prolonged haematuria for >14 days. When compared to apixaban, patients on rivaroxaban conferred a statistically significant increased risk of acute bleeding by 2.21 times. Patients receiving AC therapy had a statistically significant increased risk of stroke in the perioperative setting (no-AC vs AC: 0.4% vs 2.7%, P = 0.01). CONCLUSION This is the first study to evaluate risk of bleeding for TURP patients receiving DOACs. The AC patients are more likely to experience haematuria and stroke in the perioperative period despite withholding therapy. Apixaban appears to cause less bleeding-related complications than rivaroxaban.
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Affiliation(s)
- Lu Yu Kuo
- Department of UrologyGold Coast University HospitalSouthportQueenslandAustralia
| | - Jenny Kuo
- Department of UrologyGold Coast University HospitalSouthportQueenslandAustralia
| | - Joshua Silverman
- Department of UrologyGold Coast University HospitalSouthportQueenslandAustralia
| | - Jason Jae Yeun Kim
- Department of UrologyGold Coast University HospitalSouthportQueenslandAustralia
| | - Caitlin Letch
- School of Medicine and DentistryGriffith UniversitySouthportQueenslandAustralia
| | - Scott McClintock
- Department of UrologyGold Coast University HospitalSouthportQueenslandAustralia
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