Medicine and Health Sciences Commons^™

Postoperative Atrial Fibrillation Prevention: A Quality Improvement Project, Emily O. Schneiderman

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Postoperative atrial fibrillation remains one of the most common complications after cardiac surgery despite surgical and medical advances in the field. While generally transient, postoperative atrial fibrillation increases long-term morbidity and mortality, hospital length of stay, and financial obligation. The postoperative heart's unique chemical and physical properties make tactics for preventing and treating postoperative atrial fibrillation differ from classic atrial fibrillation management. This quality improvement project utilizes a care bundle for non-pharmacologic measures and early beta-blockade administration to reduce the incidence of postoperative atrial fibrillation. Implementation of this care bundle establishes a standard of care, increases clinician knowledge and accountability, …

Sociodemographic Determinants Of Oral Anticoagulant Prescription In Patients With Atrial Fibrillations: Findings From The Pinnacle Registry Using Machine Learning, Zahra Azizi, Andrew T. Ward, Donghyun J. Lee, Sanchit S. Gad, Kanchan Bhasin, Robert J. Beetel, Tiago Ferreira, Sushant Shankar, John S. Rumsfeld, Salim S. Virani

Office of the Provost

Background: Current risk scores that are solely based on clinical factors have shown modest predictive ability for understanding of factors associated with gaps in real-world prescription of oral anticoagulation (OAC) in patients with atrial fibrillation (AF).
Objective: In this study, we sought to identify the role of social and geographic determinants, beyond clinical factors associated with variation in OAC prescriptions using a large national registry of ambulatory patients with AF.
Methods: Between January 2017 and June 2018, we identified patients with AF from the American College of Cardiology PINNACLE (Practice Innovation and Clinical Excellence) Registry. We examined associations between patient …

Dysnatremia Is Associated With Increased Risk Of All-Cause Mortality Within 365 Days Post-Discharge In Patients With Atrial Fibrillation Without Heart Failure: A Prospective Cohort Study, Yan Zhou, Dong Lin, Shiwan Wu, Jiaxin Xiao, Min Yu, Zhongbo Xiao, Muli Wu, Zhisheng Chen, Cuihong Tian, Rongbing Chen, Yequn Chen, Xuerui Tan

Research outputs 2022 to 2026

Aim: The aim of this study is to evaluate the association between serum sodium concentrations at hospital admission and all-cause mortality within 365 days post-discharge in patients with atrial fibrillation (AF) without heart failure (HF). Methods: The prospective cohort study enrolled 1,446 patients with AF without HF between November 2018 and October 2020. A follow-up was performed 30, 90, 180, and 365 days after enrollment through outpatient visits or telephone interviews. All-cause mortality was estimated in three groups according to serum sodium concentrations: hyponatremia ( < 135 mmol/L), normonatremia (135 – 145 mmol/L), and hypernatremia ( > 145 mmol/L). We estimated the risk of all-cause mortalities using univariable and multivariable Cox proportional …

Retrospective Comparison Of Patients ≥ 80 Years With Atrial Fibrillation Prescribed Either An Fda-Approved Reduced Or Full Dose Direct-Acting Oral Anticoagulant, Roy Taoutel, Michael D. Ezekowitz, Usman A. Chaudhry, Carly Weber, Dana Hassan, Ed J. Gracely, Mohammed H. Kamareddine, Benjamin I. Horn, Glenn R. Harper

Department of Medicine Faculty Papers

Direct-acting oral anticoagulants (DOACs) represent the standard for preventing stroke and systemic embolization (SSE) in patients with atrial fibrillation (AF). There is limited information for patients ≥ 80 years. We report a retrospective analysis of AF patients ≥ 80 years prescribed either a US Food and Drug Administration (FDA)-approved reduced (n = 514) or full dose (n = 199) DOAC (Dabigatran, Rivaroxaban, or Apixaban) between January 1st, 2011 (first DOAC commercially available) and May 31st, 2017. The following multivariable differences in baseline characteristics were identified: patients prescribed a reduced dose DOAC were older (p < 0.001), had worse renal function (p = 0.001), were more often prescribed aspirin (p = 0.004) or aspirin and clopidogrel (p < 0.001), and more often had new-onset AF (p = 0.001). SSE and central nervous system (CNS) bleed rates were low and not different (1.02 vs 0 %/yr and 1.45 vs 0.44 %/yr) for the reduced and full dose groups, respectively. For non-CNS bleeds, rates were 10.89 vs 4.15 %/yr (p < 0.001, univariable) for the reduced and full doses, respectively. The mortality rate was 6.24 vs 1.75 %/yr (p = 0.001, univariable) for the reduced and full doses. Unlike the non-CNS bleed rate, mortality rate differences remained significant when adjusted for baseline characteristics. Thus, DOACs in patients ≥ 80 with AF effectively reduce SSE with a low risk of CNS bleeding, independent of DOAC dose. The higher non-CNS bleed rate and not the mortality rate is explained by the higher risk baseline characteristics in the reduced DOAC dose group. Further investigation of the etiology of non-CNS bleeds and mortality is warranted.

Bridging Thrombolysis In Atrial Fibrillation Stroke Is Associated With Increased Hemorrhagic Complications Without Improved Outcomes, Feras Akbik, Ali Alawieh, Laurie Dimisko, Brian M. Howard, C Michael Cawley, Frank C. Tong, Fadi Nahab, Owen B. Samuels, Ilko Maier, Wuwei Feng, Nitin Goyal, Robert M. Starke, Ansaar Rai, Kyle M. Fargen, Marios N. Psychogios, Pascal Jabbour, Reade De Leacy, Saleh G. Keyrouz, Travis M. Dumont, Peter Kan, Jan Liman, Adam S. Arthur, Stacey Q. Wolfe, J. Mocco, Roberto Javier Crosa, W Christopher Fox, Benjamin Gory, Alejandro M. Spiotta, Jonathan A. Grossberg

Department of Neurosurgery Faculty Papers

BACKGROUND: Atrial fibrillation (AF) associated ischemic stroke is associated with worse functional outcomes, less effective recanalization, and increased rates of hemorrhagic complications after intravenous thrombolysis (IVT). Conversely, AF is not associated with hemorrhagic complications or functional outcomes in patients undergoing mechanical thrombectomy (MT). This differential effect of MT and IVT in AF associated stroke raises the question of whether bridging thrombolysis increases hemorrhagic complications in AF patients undergoing MT.

METHODS: This international cohort study of 22 comprehensive stroke centers analyzed patients with large vessel occlusion (LVO) undergoing MT between June 1, 2015 and December 31, 2020. Patients were divided into …

Atrial Fibrillation And Cognitive Decline: A Computational Hemodynamics Investigation, Timothy J. Hunter

Electronic Thesis and Dissertation Repository

Background: Atrial fibrillation (AF) is a prevalent cardiac disease which has been associated with increased risk of dementia and cognitive decline. We hypothesize that atrial fibrillation leads to regional transient hypoperfusion events in the brain, and that geometric variations in the arterial structure called the Circle of Willis (CoW) play a role in these events.

Methods: A computational model was developed to simulate cerebral blood flow in six common variations of the CoW. Risk was assessed based on frequency of beat-wise regional hypoperfusion events during AF, and sensitivity analysis was performed with respect to this model output.

Results …

The Utility Of Has-Bled Score In Predicting The Bleeding Risk Of Atrial Fibrillation Patients Undergoing Percutaneous Coronary Intervention Receiving Anticoagulation And Dual Anti-Platelet Therapy: A Single Center Retrospective Cohort Study, Luk Yin Cheung Adrian, Chan Chi Lin Jaclyn

Journal of the Hong Kong College of Cardiology

Background The Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly and Drugs/alcohol (HAS-BLED) score is a validated bleeding risk prediction tool in patients with atrial fibrillation taking oral anticoagulation. Its predictive value in patients with atrial fibrillation undergoing percutaneous coronary intervention receiving combination of anticoagulation and antiplatelet therapy is unknown. This retrospective cohort study sought to validate the accuracy of HAS-BLED score in predicting the bleeding risk in patients with atrial fibrillation who underwent percutaneous coronary intervention receiving both anticoagulation and dual antiplatelet therapy. Method We calculated HAS-BLED score in 186 patients with AF …

No Mental Illness Impact On Post-Aortic Valve Replacement Patients’ New-Onset Atrial Fibrillation, Natalie Kolba, Julia Dokko, Samantha Novotny, Sohaib Agha, Ashutosh Yaligar, Puja Parikh, Aurora Pryor, Henry Tannous, Laurie Shroyer, Thomas Bilfinger

Department of Surgery Faculty Publications

No abstract provided.

The Undesirable Communication: A Case Of Cerebral Air Emboli In The Setting Of Atrio-Esophageal Fistula Following Atrial Fibrillation Catheter Ablation, Momin Islam, Hussam Al Hennawi, Anwar Khedr, Khaled Harmouch, Mohammad F. Mathbout

Abington Jefferson Health Papers

Atrial-esophageal fistula is an extremely rare condition but is often a deleterious complication following catheter ablation for atrial fibrillation. The associated iatrogenic communication acts as a conduit for air and bacterial translocation, which may lead to cerebral air embolism and polymicrobial sepsis, respectively. Coupled with a history of invasive procedures, the diagnosis is largely based on the accompanying neurological symptoms. In this report, we present the case of a 73-year-old female who presented with neurological deficits attributed to cerebral vascular emboli three weeks after catheter ablation for the treatment of chronic atrial fibrillation.

Cardiology Implications Of Ed Covid-19 Patients In An Underserved Rural Health Care Environment, Pedro Colio

Dissertations

Background/Purpose: Positive COVID-19 patients with chronic comorbidities have been associated with severe cardiac complications (e.g., STEMI, NSTEMI, myocarditis, pericarditis, AF) specifically among underserved communities. Acute STEMI and NSTEMI are cardiac conditions associated with ruptured atherosclerotic plaque leading to significant myocardial injury. AF, the most common arrhythmia leading to cerebrovascular accidents, is also common in hospitalized patients with severe illnesses. Myocarditis and pericarditis are inflammatory heart conditions associated with acute viral infections. According to the literature, these cardiac issues have been linked as complications of COVID-19. COVID 19 is an emerging, complex, and costly public health challenge globally with potential lifelong …

Evidence-Based Intervention To Improve Health Literacy Among Older Adults With Newly Diagnosed Atrial Fibrillation, Johana Rowe

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background and Significance: Atrial fibrillation (AFib) is the most common arrhythmia encountered in the healthcare setting. As of 2018, approximately 6.1 million people in the United States were living with AFib which is projected to increase to 12.1 million by 2030. Older adults are at higher risk of developing AFib and its complications. AFib is a chronic condition that requires targeted patient education by healthcare providers in different healthcare settings. Patient’s low health literacy regarding the condition is a significant barrier to therapy adherence. Given the high rate of poor health literacy among individuals newly diagnosed with AFib and the …

Dronedarone For Atrial Fibrillation Prophylaxis In Patients Undergoing Open Heart Surgical Interventions: A Case Series, Jay D. Patel, Mrhaf Alsamman, Dewansh Goel, Sai Gudduru, Rakesh Prashad

Journal of Community Hospital Internal Medicine Perspectives

Atrial fibrillation (a-fib) is one of the most frequently encountered and studied arrhythmias in medicine. The presence of A-fib in the post-operative period of coronary artery bypass graft (CABG) surgery is of particular concern for clinicians as this presents risks of post-operative stroke, hospital readmission, or anticoagulation dilemmas depending on the patient’s comorbidities. In this case study, we present 5 patients who were treated with dronedarone prior to undergoing open heart procedures. We subsequently followed each patients clinical course paying close attention for any evidence of post-operative a-fib.

Causal Associations Between Covid-19 And Atrial Fibrillation: A Bidirectional Mendelian Randomization Study, Xiaoyu Zhang, Biyan Wang, Tao Geng, Di Liu, Qiuyue Tian, Xiaoni Meng, Qiaoyun Zhang, Mengyang Jiang, Yiqiang Zhang, Manshu Song, Wei Wang, Youxin Wang, Baoguo Wang

Research outputs 2022 to 2026

Background and aims: Observational studies showed that coronavirus disease (2019) (COVID-19) attacks universally and its most menacing progression uniquely endangers the elderly with cardiovascular disease (CVD). The causal association between COVID-19 infection or its severity and susceptibility of atrial fibrillation (AF) remains unknown. Methods and results: The bidirectional causal relationship between COVID-19 (including COVID-19, hospitalized COVID-19 compared with not hospitalized COVID-19, hospitalized COVID-19 compared with the general population, and severe COVID-19) and AF are determined by using two-sample Mendelian randomization (MR) analysis. Genetically predicted severe COVID-19 was not significantly associated with the risk of AF [odds ratio (OR), 1.037; 95% …

Cardiology And The Brain: How An Individual's Cardiovascular Health Relates To Their Mental Health, Megan Shea Kopicko

Senior Honors Theses and Projects

A scoping review was conducted to explore the relationship between the cardiovascular system and neurological system to determine if there is a connection between certain mental illnesses and heart health. This study was guided through implementation of Arksey and O’Malley’s (2005) framework for scoping reviews. A literature search was conducted using PubMed, CINAHL, Cochrane Library, and Google Scholar databases. Of the 934,251 sources found, only 21 studies met the study criteria and were ultimately selected for this study. Upon review, three themes were identified: (a) anxiety and cardiovascular disease; (b) schizophrenia and cardiovascular disease; and (c) depression and cardiovascular disease. …

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 …

Rivaroxaban And Apixaban In Patients With Atrial Fibrillation; A Real-World Data, Onur Aslan, Si̇nan Yildirim

Turkish Journal of Medical Sciences

Background/aim: This study aims to analyze the real-life data of patients who were prescribed rivaroxaban and apixaban and to emphasize the points that we think will make a difference compared to randomized controlled studies. Materials and methods: The patients who accepted to participate in the study in whom rivaroxaban (15-20 mg) and apixaban (2.5-5 mg) were started with the diagnosis of atrial fibrillation between 01 January 2018 and 31 December 2019 and whose records were fully accessed through the hospital automation system were included in the study. Results: One hundred and ninety-four (48.5%) of a total of 400 patients using …

Cha2ds2-Vasc Score As A Prognostic Indicator In Patients With Atrial Fibrillation Undergoing Coronary Stenting, Jian-Yong Zheng, Dong-Tao Li, Yi-Gang Qiu, Yi-Xiong Huang, Zheng-Ming Xu, Li Zhao, Yu Chen, Yi Cao, Yi-Da Tang, Cheng-Jun Guo, Zhi-Min Ma, Yong-Quan Wu, Yan Jiao, Tian-Chang Li

Turkish Journal of Medical Sciences

Background/aim: Patients with atrial fibrillation (AF) and coronary stenting had a poor prognosis. This study aimed to assess the accuracy of CHA2 DS2 -VASc score for predicting and grading adverse clinical outcomes in this population. Materials and methods: We reviewed the clinical data of all patients with previously documented nonvalvular AF who underwent coronary stenting between January 2010 and June 2015 in 12 hospitals of Beijing, China. The study population was divided into three groups: 1) Low CHA2 DS2 -VASc score, ≦ 2 points, 2) Intermediate score, 3-4 points, and 3) High score, ≧ 5 points. Major adverse cardiac/cerebrovascular events …

The Relationship Between Morning Blood Pressure Surge And Asymptomatic Episodes Of Paroxysmal Atrial Fibrillation In Patients With Systemic Arterial Hypertension, Ümmü Taş, Sedat Taş, İdi̇l Yavuz

Turkish Journal of Medical Sciences

Background/aim: Hypertension is a known risk factor for developing atrial fibrillation. However, there is limited data to investigate the association between morning blood pressure surge (MBPS) and paroxysmal atrial fibrillation (PAF). We conducted the present study to determine whether there is a relationship between asymptomatic PAF and MBPS and whether MBPS may be a predictor of asymptomatic PAF episodes. Materials and methods: This prospective study comprised 264 adult patients who were newly diagnosed with essential hypertension or were previously diagnosed but not receiving regular antihypertensive therapy. We evaluated the patients in 2 groups according to their 24-h electrocardiography monitoring results: …

Evaluation Of Atrial Fibrosis In Atrial Fibrillation Patients With Three Different Methods, Cem Çöteli̇, Tuncay Hazirolan, Kudret Aytemi̇r, Ahmet Gürkan Erdemi̇r, Emi̇ne Ni̇lay Bakir, Uğur Canpolat, Hi̇kmet Yorgun, Ahmet Hakan Ateş, Ergün Bariş Kaya, Zeli̇ha Günnur Di̇kmen, Necla Özer

Turkish Journal of Medical Sciences

Background/aim: The presence of atrial fibrosis has already been known as a risk factor for atrial fibrillation (AF) development. We aimed to evaluate atrial fibrosis with previously defined three different methods, which were cardiac magnetic resonance imaging (C-MRI), echocardiographic strain imaging, and biomarkers and show the relationship between these methods in patients with AF scheduled for cryoballoon ablation. Materials and methods: A total of 30 patients were enrolled. Atrial T1 relaxation durations were measured using C-MRI before the procedure of atrial fibrillation catheter ablation. Fibroblast growth factor-21 (FGF-21) and fibroblast growth factor-23 (FGF-23) levels were measured at serum derived from …