Explore the vast range of titles available.

The Atrial fibrillation Better Care (ABC) pathway for integrated management provides a simple strategy (Avoid stroke, Better symptom management, and Cardiovascular and comorbidity risk reduction) that helps to improve awareness and detection, and reminds clinicians of the simple decision-making steps for management of patients with atrial fibrillation in a holistic approach. The Atrial fibrillation Better Care (ABC) pathway for integrated management provides a simple strategy (Avoid stroke, Better symptom management, and Cardiovascular and comorbidity risk reduction) that helps to improve awareness and detection, and reminds clinicians of the simple decision-making steps for management of patients with atrial fibrillation in a holistic approach.

Background Cardiac arrhythmias are associated with poorer outcomes in patients with heart failure (HF), diabetes mellitus (DM), and chronic kidney disease (CKD). Previous studies have shown inconsistent conclusions regarding the association between sodium-glucose cotransporter 2 inhibitors (SGLT2i) and the risk of developing arrhythmias. This study aims to investigate the association of SGLT2i treatment with arrhythmia outcomes in clinical trials of patients with HF, DM, or CKD. Methods MEDLINE, EMBASE, and ClinicalTrials.gov were searched from inception up to 27 August 2020. Randomized controlled trials that randomized patients with DM, CKD, or HF to SGLT2i or placebo were included. The outcomes of interest include atrial fibrillation (AF), embolic stroke, atrial flutter (AFL), AF/AFL, ventricular tachycardia (VT), and cardiac arrest. Relative risks (RRs) and 95% confidence intervals (CI) were pooled using a random-effects model. Results Out of 4,532 citations, 22 trials with altogether 52,115 patients were included (mean age 63.2 years; 33,747 [64.8%] of participants were men). SGLT2i were associated with a lower risk of AF (RR 0.82, 95% CI 0.70–0.96), embolic stroke (RR 0.32, 95% CI 0.12–0.85), AF/AFL (RR 0.82, 95% CI 0.71–0.95), and VT (RR 0.73, 95% CI 0.53–0.99), while the risk reductions in AFL (RR 0.83, 95% CI 0.58–1.17) and cardiac arrest (RR 0.83, 95% CI 0.61–1.14) did not reach statistical significance. The associations appeared to be consistent across different baseline conditions (DM vs CKD vs HF; atherosclerotic cardiovascular disease [ASCVD] vs no ASCVD) and the SGLT2i used. Conclusions SGLT2i reduced the risk of cardiac arrhythmias. Our study provides further evidence for recommending the use of SGLT2i in patients with DM, CKD, and HF. Further research is needed to fully elucidate the mechanism by which SGLT2i protect against arrhythmias.

Chronic Kidney Disease in Atrial Fibrillation In a study of data from Danish national registries, CKD was associated with an increased risk of stroke and bleeding among patients with atrial fibrillation. Warfarin decreased the risk of stroke among such patients. Both warfarin and aspirin increased the risk of bleeding. The prevalence of both atrial fibrillation and chronic kidney disease increases with age. 1 , 2 The prevalence of atrial fibrillation is 2.3% among persons 40 years of age or older and 5.9% among those 65 years of age or older, 2 and the prevalence of end-stage renal disease increases from approximately 3.5% among persons 45 to 64 years of age to nearly 6% among those 75 years of age or older. 1 Many patients have both disorders, 3 – 6 and the number of such patients is increasing, owing in part to the aging population and the improved survival in both diseases. Atrial fibrillation increases . . .

At the beginning of June 2020, there were nearly 7 million reported cases of coronavirus disease 2019 (COVID-19) worldwide and over 400,000 deaths in people with COVID-19. The objective of this study was to determine associations between comorbidities listed in the Charlson comorbidity index and mortality among patients in the United States with COVID-19. A retrospective cohort study of adults with COVID-19 from 24 healthcare organizations in the US was conducted. The study included adults aged 18-90 years with COVID-19 coded in their electronic medical records between January 20, 2020, and May 26, 2020. Results were also stratified by age groups (<50 years, 50-69 years, or 70-90 years). A total of 31,461 patients were included. Median age was 50 years (interquartile range [IQR], 35-63) and 54.5% (n = 17,155) were female. The most common comorbidities listed in the Charlson comorbidity index were chronic pulmonary disease (17.5%, n = 5,513) and diabetes mellitus (15.0%, n = 4,710). Multivariate logistic regression analyses showed older age (odds ratio [OR] per year 1.06; 95% confidence interval [CI] 1.06-1.07; p < 0.001), male sex (OR 1.75; 95% CI 1.55-1.98; p < 0.001), being black or African American compared to white (OR 1.50; 95% CI 1.31-1.71; p < 0.001), myocardial infarction (OR 1.97; 95% CI 1.64-2.35; p < 0.001), congestive heart failure (OR 1.42; 95% CI 1.21-1.67; p < 0.001), dementia (OR 1.29; 95% CI 1.07-1.56; p = 0.008), chronic pulmonary disease (OR 1.24; 95% CI 1.08-1.43; p = 0.003), mild liver disease (OR 1.26; 95% CI 1.00-1.59; p = 0.046), moderate/severe liver disease (OR 2.62; 95% CI 1.53-4.47; p < 0.001), renal disease (OR 2.13; 95% CI 1.84-2.46; p < 0.001), and metastatic solid tumor (OR 1.70; 95% CI 1.19-2.43; p = 0.004) were associated with higher odds of mortality with COVID-19. Older age, male sex, and being black or African American (compared to being white) remained significantly associated with higher odds of death in age-stratified analyses. There were differences in which comorbidities were significantly associated with mortality between age groups. Limitations include that the data were collected from the healthcare organization electronic medical record databases and some comorbidities may be underreported and ethnicity was unknown for 24% of participants. Deaths during an inpatient or outpatient visit at the participating healthcare organizations were recorded; however, deaths occurring outside of the hospital setting are not well captured. Identifying patient characteristics and conditions associated with mortality with COVID-19 is important for hypothesis generating for clinical trials and to develop targeted intervention strategies.

Elderly patients with atrial fibrillation who were not appropriate candidates for standard doses of oral anticoagulants because of a high risk of bleeding were assigned to receive 15 mg of edoxaban or placebo once daily. Edoxaban was superior to placebo in preventing stroke or systemic embolism.

In this trial, dabigatran plus a P2Y 12 inhibitor was compared with warfarin plus a P2Y 12 inhibitor and aspirin after PCI in patients with atrial fibrillation. The risk of bleeding was lower with dabigatran therapy; prevention of thromboembolic events was similar with the two strategies.

This trial compared standard therapy (dual antiplatelet therapy plus a vitamin K antagonist) with two regimens containing rivaroxaban plus antiplatelet therapy. The rivaroxaban groups had reduced rates of bleeding and similar efficacy in preventing cardiovascular events. Approximately 5 to 8% of patients who undergo percutaneous coronary intervention (PCI) have atrial fibrillation. 1 – 3 Dual antiplatelet therapy (DAPT) with a P2Y 12 inhibitor and aspirin is superior to oral anticoagulation with a vitamin K antagonist in reducing the risk of thrombosis in patients undergoing placement of a first-generation stent, 4 but oral anticoagulation is superior to DAPT in reducing the risk of ischemic stroke in patients with atrial fibrillation. 5 The treatment strategy for patients with atrial fibrillation who have received stents must balance the risk of stent thrombosis and ischemic stroke with the risk of bleeding. A common guideline-supported . . .

Background Cachexia, defined as the combination of weight loss, weakness, fatigue, anorexia and abnormal biochemical markers based on Evans' criteria, is known to exacerbate the prognosis of heart failure (HF) patients. This systematic review and meta‐analysis investigates the prognostic impact and prevalence of cachexia, as defined by Evans' criteria, in patients with HF. Methods PubMed, Cochrane Library, Scopus and Web of Science were searched from inception until December 2023, including HF patients for whom the Evans' criteria were applied to explore the prevalence and prognostic impact of cachexia. This study employed a meta‐analyses using the random‐effects model and inverse‐variance method that was adhered to the revised 2020 PRISMA guidelines for systematic reviews and meta‐analyses (CRD42023446443). Results Six prospective or retrospective studies of 2252 patients with HF were included, whereby all‐cause mortality was significantly greater in patients with cachexia with low heterogeneity among studies (HR: 1.60, 95% CI 1.31–1.95, p < 0.001; I2 = 0%). For the studies that used full, uniformly defined Evans' criteria, among 1844 patients, mortality remained greater in patients with cachexia (HR: 1.58, 95% CI 1.27–1.97, p < 0.001; I2 = 0%). In a subgroup analysis among 1714 of HF with reduced ejection fraction, the results were consistent (HR: 1.57, 95% CI 1.28–1.92, p < 0.001; I2 = 0%). Additionally, 10 studies comprising 2862 patients indicated a 31% risk of cachexia in HF (95% CI 21–43%, I2 = 94%). Conclusions Cachexia is an independent predictor for increased all‐cause mortality among patients with HF with a notable prevalence of 31%. Interventions aiding in improving fatigue, anorexia and exercise capacity could help improve the quality of life of this clinical population.

Abstract Aims Atrial fibrillation (AF) is the most common sustained heart arrhythmia and a major preventable cause of stroke, heart failure, and dementia. Atrial fibrillation already accounts for a significant amount of National Health Service (NHS) funding, and over the coming years is highly likely to impose a growing cost on NHS budgets and the wider UK healthcare system. We, therefore, need greater understanding of the main cost drivers (e.g. hospitalizations) of this increasingly prevalent arrhythmia. Such data would help with NHS resource planning over the next decades. Methods and results Based on prior published data, we initially calculated the cost of AF for 1995, and then again for 2000 which was calculated from a combination of contemporary and extrapolated data from that time. These data have been used as the basis for forecasting AF costs in the UK and as a share of total NHS expenditure. Atrial fibrillation direct costs were split between cost driver categories; general practitioner (GP) consultations, GP referred OPD (outpatient department) visits, prescriptions and monitoring visits, primary admissions, and post-discharge OPD visits. Forecast assumptions used: (i) NHS expenditure from 2020 onwards assumed to increase at annual rate of 3%/year; and (ii) the UK inflation rate to increase by 2% annually. Sensitivity modelling of 3%, 4%, and 6% projected annual increase in AF prevalence amongst the population was applied. The estimated direct and proportion of NHS expenditure of AF in 2020 for each of the assumed increases of 3%, 4%, and 6% would be £1435 m (0.91%), £1741 m (1.11%), and £2548 m (1.62%), respectively. For 2030, the modelling would mean that the direct costs of AF and proportion of NHS expenditure would be £2351 m (1.11%), £3141 m (1.48%), and £5562 m (2.63%), respectively. For 2040, the modelling shows that the direct costs of AF and proportion of NHS expenditure would be £3851 m (1.35%), £5668 m (1.99%), and £12 143 m (4.27%), respectively. By far the largest contributor to the total direct AF costs in 2020 was for primary admissions (nearly 60%), with a further 7% with post-discharge outpatient clinic visits. Taken together the total for these two categories in 2020 would cost the NHS between £949 and £1685 m, depending on the projected increase in annual rate of AF prevalence. The full cost of AF related hospitalizations may be underestimated, due to the other admissions associated with a secondary coding of AF, which in 2020 are forecast to cost between £2269 and £4030 m, depending on the annual population increase of AF prevalence. There will be an increasing number of patients discharged to a nursing home after a hospital admission associated with a principal AF diagnosis, with cost estimates for this in 2000 being £111 m, and predicted to rise to between £346 and £614 m by 2020. Conclusion Focusing on 2020, AF is predicted to directly cost the NHS a total of a minimum of £1435 m and a maximum of £2548 m (depending on AF prevalence); hence, between 0.9% and 1.6% of NHS expenditure, mostly from primary admissions. The total direct costs of AF would increase to 1.35–4.27% of NHS expenditure, over the next two decades. If hospitalizations can be avoided or reduced, we would substantially reduce the healthcare costs of AF to the NHS.