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Effectiveness Of Amiodarone, Propafenone And Synchronized Electrical Cardioversion For Conversion Of Atrial Fibrillation Paroxysm To Sinus Rhythm In Rigas Stradins University Hospital Department Of Emergency Medicine., Mihails Tracevskis

Digital Journal of Clinical Medicine

Abstract

Introduction: Atrial fibrillation remains a pervasive global health concern, contributing significantly to the incidence of stroke, heart failure, sudden death, and overall cardiovascular morbidity.

Materials and methods: The present study undertook a retrospective analysis involving a meticulous examination of 127 patients, representing a diverse cohort of individuals encompassing 73 men (with a median age of 62 and a range of 37-75) and 54 women (with a median age of 60 and a range of 42-78) duration of atrial fibrillation 48 hours or less.

Results: The results highlighted amiodarone's remarkable efficiency, as it successfully converted 81.2% of cases (56 …

Clinical Characteristics And Prognostic Factors Of Atrial Fibrillation At A Tertiary Center Of Pakistan – From A South-Asian Perspective – A Cross-Sectional Study, Intisar Ahmed, Aiysha Nasir, Pirbhat Shams, Hunaina Shahab, Muhammad Hassan, Faryal Subhani, Ghurfan Adnan, Awais Farhad, Aamir Hameed, Yawer Saeed

Section of Cardiology

Background: There is lack of large data from South-Asian region on atrial fibrillation and it is imperative that clinical presentation, prognostic factors, management pursued, and outcomes are known for this part of the world. Once collective evidence for the region is known, region-specific guidelines can be laid forward.
Objectives: To evaluate clinical characteristics and prognostic factors of atrial fibrillation at a tertiary care center of Pakistan.
Methods: This was a retrospective study conducted at a tertiary care center of Pakistan. Period of study ranged from July-December 2018. All hospitalized patients who were admitted with atrial fibrillation as a primary or …

Atrial Fibrillation That Required Cardioversion In The Post Anesthetic Recovery Unit In Ambulatory Surgery. A Case Report, Miryam Céspedes Morón, Ruiz Roque Rosina, Chipa Ccasani Fredy

Revista de la Facultad de Medicina Humana

In recent years, the profile of patients who can undergo ambulatory surgery procedures in independent ambulatory surgical centers has changed. It is very important to consider the availability, skills and experience of the care staff, as well as the integral study of the patient, the resolution capacity of these centers and evaluations with quality care indicators to obtain optimal results. The present case was of a 34-year-old male, first presentation of rapid and symptomatic atrial fibrillation documented in the immediate postoperative period. Patient care, diagnostic strategy and treatment were described, since the patient required electrical cardioversion.

Analysis Of Health Care Costs Over A One-Year Period Following Anticoagulant Therapy Among Ontario Patients Diagnosed With Atrial Fibrillation, Michael Situ

Electronic Thesis and Dissertation Repository

Atrial fibrillation patients are at high risk of ischemic strokes, which can be drastically reduced using oral anticoagulants (OACs). Warfarin has been the standard OAC for this population but its effectiveness rests on consistent monitoring with the potential for severe bleeding events. Newer OACs, like rivaroxaban and apixaban, address these drawbacks but have a comparatively higher upfront cost. Uncertainty remains over which OAC is cost-saving from a health care system perspective. Using a retrospective cohort study design and inverse probability weighting regression adjustment estimators, one-year health care costs among patients treated with warfarin, rivaroxaban, and apixaban were compared. Compared to …

Association Of Abdominal Obesity And Risk Of Atrial Fibrillation: Findings From The Reasons For Geographic And Racial Differences In Stroke (Regards) Study, Joonseok Kim

All ETDs from UAB

Background: Our knowledge of the association between abdominal obesity (AO) and the risk of atrial fibrillation (AF) after adjusting for body mass index (BMI) is limited. Methods: We included 11,617 black and white participants (mean age 63.0 + 8.4 years) from the REGARDS (REasons for Geographic and Racial Differences in Stroke) national cohort study who were free of AF at baseline between 2003 and 2007, and completed a follow-up exam between 2013 and 2016 with assessment of AF. A multivariable logistic regression model was used to estimate the odds ratio (OR) with 95% confidence interval of incident AF associated with …

Cost-Effectiveness Analysis Of Pharmacogenomics (Pgx) Based Warfarin, Apixaban And Rivaroxaban Compared To Standard Warfarin For Atrial Fibrillation Patients In Canada, Aneeka Hafeez

Electronic Thesis and Dissertation Repository

This study assessed cost-effectiveness of pharmacogenomics (PGx)-based warfarin, apixaban and rivaroxaban compared to standard warfarin therapy for atrial fibrillation (AF) patients in Canada. A decision-analytic Markov model was developed to compare lifetime costs and quality-adjusted life years (QALYs) from the public healthcare payer perspective. The parameters applied in the model were derived from published literature and some costs from the IC/ES databases. The results were summarized in terms of the incremental cost-effectiveness ratio (ICER). Compared to standard warfarin, PGx-based warfarin care had an ICER of 17,727/QALY and apixaban had an ICER of $64,853/QALY gained. Apixaban dominated rivaroxaban. The probabilistic sensitivity …

Ecg For All Patients In The Pacu: Some Say, Why? I Say, Why Not?, Paula Foran

Journal of Perioperative Nursing

Currently in many Australian hospitals, electrocardiogram (ECG) leads are removed after the operative process and, despite the machines being freely available in the Post Anaesthesia Care Unit (PACU), they are not connected to all patients.

There are many evidence-based reasons why an ECG would be advantageous for perioperative patient safety, including the detection of often asymptomatic conditions such as myocardial injury after non-cardiac surgery (MINS) and new-onset atrial fibrillation, which has been shown to increase the risk of stroke. Advantages may also be seen in saving precious minutes in a cardiac arrest, and the ability for nurses to constantly observe …

Changes In Anticoagulant Utilization Among United States Nursing Home Residents With Atrial Fibrillation From 2011 To 2016, Matthew Alcusky, David D. Mcmanus, Anne L. Hume, Marc Fisher, Jennifer Tjia, Kate L. Lapane

Jennifer Tjia

Background: Nursing home residents with atrial fibrillation are at high risk for ischemic stroke and bleeding events. The most recent national estimate (2004) indicated less than one third of this high-risk population was anticoagulated. Whether direct-acting oral anticoagulant ( DOAC ) use has disseminated into nursing homes and increased anticoagulant use is unknown.

Methods and Results: A repeated cross-sectional design was used to estimate the point prevalence of oral anticoagulant use on July 1 and December 31 of calendar years 2011 to 2016 among Medicare fee-for-service beneficiaries with atrial fibrillation residing in long-stay nursing homes. Nursing home residence was determined …

Developing A Community-Based Screening And Referral Mechanism For Atrial Fibrillation In Low Resource Settings: “Smartphone Monitoring For Atrial Fibrillation In Real-Time – India (Smart-India)”, Apurv Soni, Nisha Fahey, Harshil Patel, Kandarp Talati, Anna Handorf, John A. Bostrom, Shyamsundar Raihatha, Ravi Shah, Sunil Karna, Robert J. Goldberg, Jeroan J. Allison, Ki Chon, Somashekhar M. Nimbalkar, David D. Mcmanus

Apurv Soni

BACKGROUND: Atrial fibrillation (AF), the world’s most common arrhythmia, often goes undetected and untreated in low-resource communities, including India. Moreover, AF is an important risk factor for stroke, which plagues an estimated 1.6 million Indians annually. As such, early detection of AF and management of high-risk patients is critically important to decrease stroke burden in individuals with AF.

OBJECTIVE: The objectives of this study are to evaluate the age- and sex-stratified epidemiology of AF in Anand District, Gujarat India; characterize the profile of individuals who are diagnosed with AF; and determine the performance of two mobile technologies for community-based AF …

High Burden Of Unrecognized Atrial Fibrillation In Rural India: An Innovative Community-Based Cross-Sectional Screening Program, Apurv Soni, Allison Earon, Anna Handorf, Nisha Fahey, Kandarp Talati, John Bostrom, Ki Chon, Craig Napolitano, Michael S. Chin, John Stephen Sullivan, Shyamsundar Raithatha, Robert J. Goldberg, Somashekhar Nimbalkar, Jeroan J. Allison, Sunil Thanvi, David D. Mcmanus

Apurv Soni

BACKGROUND: Atrial fibrillation, the world's most common arrhythmia, is a leading risk factor for stroke, a disease striking nearly 1.6 million Indians annually. Early detection and management of atrial fibrillation is a promising opportunity to prevent stroke but widespread screening programs in limited resource settings using conventional methods is difficult and costly.

OBJECTIVE: The objective of this study is to screen people for atrial fibrillation in rural western India using a US Food and Drug Administration-approved single-lead electrocardiography device, Alivecor.

METHODS: Residents from 6 villages in Anand District, Gujarat, India, comprised the base population. After obtaining informed consent, a team …

Family Medicine Resident Education On Perioperative Management Of Patients On Anticoagulation, Hanna Mathers

Family Medicine Clerkship Student Projects

Family Medicine residents at CMMC in Lewiston, Maine manage patients in an outpatient clinic as well as on an inpatient family medicine teaching service. Many patients in the community are anticoagulated for native valve atrial fibrillation and undergo surgical procedures both in the inpatient and outpatient setting. Residents are often asked on to determine the necessity and timing of anticoagulation discontinuation for patients that they see. With patients on newer oral anticoagulants and various degrees of risk, it can be a challenge to make an informed choice. Residents have found that they would feel more confident in perioperative management of …

Cost-Effectiveness Of Genomic-Based Warfarin Therapy, John Weissert, Kourosh Ravvaz

Journal of Patient-Centered Research and Reviews

Background: With over 40 years of demonstrated clinical efficacy, warfarin remains the world’s most used pharmaceutical to prevent ischemic stroke in patients with atrial fibrillation (AF). However, warfarin has many challenges. Thus, despite known effectiveness, warfarin is a leading cause to drug-induced morbidity and mortality. Over 50 different warfarin therapy protocols, including a number of pharmacogenomic-based (PG) protocols, with as many as 14 independent variables, have been developed to improve safety and efficacy, thereby reducing ischemic strokes and intracranial hemorrhages (ICH).

Purpose: To conduct a preliminary cost-effectiveness study to determine the price point at which using warfarin PG dosing to …

Catheter Ablation For Atrial Fibrillation: Predicting Recurrence, Kendra Thomas

Electronic Thesis and Dissertation Repository

Background

Catheter ablation has emerged as treatment for atrial fibrillation (AF). Health care-related variables have not been explored as predictors of first ablation outcome. Determining factors associated with arrhythmia recurrence may help select patients likely to benefit. The objective was to identify variables associated with recurrence following AF ablation.

Methods

Retrospective cohort design of 314 AF patients who had undergone first ablation. Follow-up visits occurred at 3, 6 and 12 months. Variables and the outcome of recurrence were modeled with Cox proportional hazards analysis.

Results/Conclusions

After mean follow-up of 239+/-125 days, 110/314 patients (35.0%) experienced recurrence. Adjusted Cox proportional hazards …

Dabigatran And Warfarin For Stroke Prevention In Atrial Fibrillation: Use, Switching, And Clinical Effects Following New Market Entry In Real-World Patients, Julie C. Lauffenburger '03

Doctoral Dissertations

Patients with atrial fibrillation frequently benefit from anticoagulation to prevent stroke and systemic embolism. For decades, warfarin was the primary oral anticoagulant option despite its narrow therapeutic index requiring monitoring and drug-drug interactions. Dabigatran’s recent availability provides practical advantages including no monitoring and fewer interactions; however, it lacks a convenient reversal agent for bleeding events. Currently, it is unclear what factors have driven anticoagulant utilization since dabigatran’s introduction, and little real-world evidence on the agents’ comparative effectiveness and safety is available. The objectives were to describe dabigatran and warfarin’s utilization and switching patterns and assess their comparative effectiveness and safety. …

Is Pulse Palpation Helpful In Detecting Atrial Fibrillation? A Systematic Review, Georga Cooke, Jenny Doust, Sharon Sanders

Jenny Doust

Background: Atrial fibrillation in the elderly is common and potentially life threatening. The classical sign of atrial fibrillation is an irregularly irregular pulse. Objective: The objective of this research was to determine the accuracy of pulse palpation to detect atrial fibrillation. Methods: We searched Medline, EMBASE, and the reference lists of review articles for studies that compared pulse palpation with the electrocardiogram (ECG) diagnosis of atrial fibrillation. Two reviewers independently assessed the search results to determine the eligibility of studies, extracted data, and assessed the quality of the studies. Results: We identified 3 studies (2385 patients) that compared pulse palpation …