scholarly journals Poor Time in Therapeutic Range Control is Associated with Adverse Clinical Outcomes in Patients with Non-Valvular Atrial Fibrillation: A Report from the Nationwide COOL-AF Registry

2020 ◽  
Vol 9 (6) ◽  
pp. 1698 ◽  
Author(s):  
Rungroj Krittayaphong ◽  
Thoranis Chantrarat ◽  
Roj Rojjarekampai ◽  
Pongpun Jittham ◽  
Poom Sairat ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Clinical Outcomes ◽  
Therapeutic Range ◽  
Major Bleeding ◽  
Stroke Prevention ◽  
International Normalized Ratio ◽  
Time In Therapeutic Range ◽  
Hazard Ratios ◽  
The Relationship

Background: Warfarin remains the most commonly used oral anticoagulant (OAC) in Thailand for stroke prevention among patients with non-valvular atrial fibrillation (NVAF). The aim of this study was to investigate the relationship between time in therapeutic range (TTR) after warfarin initiation and clinical outcomes of NVAF. Methods: TTR was calculated by the Rosendaal method from international normalized ratio (INR) data acquired from a nationwide NVAF registry in Thailand. Patients were followed-up every six months. The association between TTR and clinical outcomes was analyzed. Results: There was a total of 2233 patients from 27 hospitals. The average age was 68.4 ± 10.6 years. The average TTR was 53.56 ± 26.37%. Rates of ischemic stroke/TIA, major bleeding, ICH, and death were 1.33, 2.48, 0.76, and 3.3 per 100 person-years, respectively. When patients with a TTR < 65% were compared with those with TTR ≥ 65%, the adjusted hazard ratios (aHR) for the increased risks of ischemic stroke/TIA, major bleeding, ICH, and death were 3.07, 1.90, 2.34, and 2.11, respectively. Conclusion: Poor TTR control is associated with adverse clinical outcomes in patients with NVAF who were on warfarin. Efforts to ensure good TTR (≥65%) after initiation of warfarin are mandatory to minimize the risk of adverse clinical outcomes.

scholarly journals Anticoagulation Control in Different Ethnic Groups Receiving Vitamin K Antagonist for Stroke Prevention in Atrial Fibrillation

2021 ◽  
Vol 8 ◽  
Author(s):  
Nur Azyyati Zawawi ◽  
Izzati Abdul Halim Zaki ◽  
Long Chiau Ming ◽  
Hui Poh Goh ◽  
Hanis Hanum Zulkifly
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Outcome ◽  
Ethnic Groups ◽  
Therapeutic Range ◽  
Stroke Prevention ◽  
Warfarin Therapy ◽  
Adverse Clinical Outcome ◽  
Time In Therapeutic Range ◽  
Anticoagulation Control

Vitamin K antagonist such as warfarin reduces the risk of stroke in atrial fibrillation (AF) patients. Since warfarin has a narrow therapeutic index, its administration needs to be regularly monitored to avoid any adverse clinical outcomes such as stroke and bleeding. The quality of anticoagulation control with warfarin therapy can be measured by using time in therapeutic range (TTR). This review focuses on the prevalence of AF, quality of anticoagulation control (TTR) and adverse clinical outcome in AF patients within different ethnic groups receiving warfarin therapy for stroke prevention. A literature search was conducted in Embase and PubMed using keywords of “prevalence,” “atrial fibrillation,” “stroke prevention,” “oral anticoagulants,” “warfarin,” “ethnicities,” “race” “time in therapeutic range,” “adverse clinical outcome,” “stroke, bleeding.” Articles published by 1st February 2020 were included. Forty-one studies were included in the final review consisting of AF prevalence (n = 14 studies), time in therapeutic range (n = 18 studies), adverse clinical outcome (n = 9 studies) within different ethnic groups. Findings indicate that higher prevalence of AF but better anticoagulation control among the Whites as compared to other ethnicities. Of note, non-whites had higher risk of strokes and bleeding outcomes while on warfarin therapy. Addressing disparities in prevention and healthcare resource allocation could potentially improve AF-related outcomes in minorities.

Relationship between Chronic Kidney Disease, Time-in-Therapeutic Range, and Adverse Outcomes in Atrial Fibrillation: A post hoc Analysis from the AMADEUS Trial

2021 ◽  
pp. 1-7
Author(s):  
Wern Yew Ding ◽  
Gregory Y.H. Lip ◽  
Alena Shantsila
Keyword(s):  
Atrial Fibrillation ◽  
Renal Function ◽  
Therapeutic Range ◽  
Major Bleeding ◽  
Post Hoc Analysis ◽  
Time In Therapeutic Range ◽  
All Cause Mortality ◽  
Post Hoc ◽  
Moderate Renal Failure

<b><i>Background:</i></b> The benefit of anticoagulation therapy in atrial fibrillation (AF) and chronic kidney disease (CKD) remains controversial. We aimed to evaluate the impact of renal function on the quality of anticoagulation control, and the effects of both these factors on outcomes in AF. <b><i>Methods:</i></b> Post hoc analysis of the AMADEUS trial. Trial-related outcomes were adjudicated and we studied the composite of first stroke/major bleeding/all-cause mortality, ischaemic stroke, major bleeding, all-cause mortality, and cardiovascular mortality. <b><i>Results:</i></b> We included 2,282 vitamin K antagonist (VKA)-treated patients {<i>n</i> = 787 (34.5%) females; median age 72 (interquartile ranges [IQR] 64–77) years}. Median follow-up was 365 (IQR 189–460) days. There were 1,922 (84.2%) non-CKD and 360 (15.8%) CKD patients. Renal function was inversely correlated with time-in-therapeutic range (<i>r</i> = −0.047, <i>p</i> = 0.025). There was no statistical difference in terms of crude study outcomes based on renal function. Multivariable regression analysis demonstrated that moderate renal failure with estimated glomerular filtration rate of less than 60 mL/min/1.73 m<sup>2</sup> (<i>p</i> = 0.032) and percentage of time-in-therapeutic range (<i>p</i> = 0.011) were independent predictors for the composite outcome of stroke, major bleeding, and all-cause mortality. <b><i>Conclusion:</i></b> Deteriorated renal function has a small negative impact on the quality of anticoagulation control with VKA which is linked to poor outcomes in AF. However, moderate renal failure itself was an independent risk factor for increased risk of stroke, major bleeding, and all-cause mortality amongst patients with AF.

scholarly journals Outcome Disparities by Insurance Plan and Educational Attainment in Patients with Atrial Fibrillation

2021 ◽  
Author(s):  
Sirin Apiyasawat ◽  
Tomon Thongsri ◽  
Kulyot Jongpiputvanich ◽  
Rungroj Krittayaphong ◽  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Health Insurance ◽  
Educational Attainment ◽  
Clinical Outcomes ◽  
Major Bleeding ◽  
List Type ◽  
Health Coverage ◽  
Insurance Plan ◽  
Clinical Trial Registration

AbstractObjectivesDespite efforts to cut poverty, improve public health, and raise educational attainment, countries still suffer from disparities. Since 2002, Thailand has successfully implemented the Universal Health Coverage Scheme (UCS) to eradicate health care access inequity. Here, we explored the interlink between insurance plan, educational attainment, and adverse clinical outcomes in the national registry of patients with atrial fibrillation (AF) in Thailand.DesignA nationwide prospective multicenter cohort of non-valvular 3402 AF.Primary OutcomesPatients were followed for 36 months for primary outcomes of all-cause mortality, ischemic stroke, and major bleeding. Survival analysis was performed using restricted mean survival time (RMST) and adjusted with multiple covariates.ResultsData from 3026 AF patients (mean age 67, 59% male) were analyzed. The mean CHA2DS2VASc and HASBLED scores were 3.0 (SD 1.7) and 1.5 (SD 1.0) respectively. Most of the patients attained the elementary level of education (N=1739, 57.4%). The major health insurance plans were Civil Servant Medical Benefit Scheme (CSMBS; N=1397, 46.2%) and UCS (N=1333, 44.1%). After 36 months of follow-up, 248 patients died (8.2%), 95 suffered from ischemic stroke (3.1%), and 136 suffered from major bleeding (4.5%). AF patients with no formal education lost 1.78 months before they died (adjusted RMST difference -1.78; 95% CI, -3.25 to -0.30; P =.02) and 1.04 months before they developed ischemic stroke (adjusted RMST difference -1.04; 95% CI, -2.03 to -0.04; P =.04) compared to those with higher education. Educational attainment level was not associated with major bleeding. Across all types of insurance plan, RMSTs to all three clinical outcomes were essentially similar.ConclusionEducation attainment level was independently associated with all-cause mortality and ischemic stroke in AF patients.Health insurance plans were not associated with adverse clinical outcomes.Clinical Trial RegistrationThai Clinical Trial Registration; Study ID: TCTR20160113002Strengths and limitations of this studyThe study links two of the most important of sociodemographic factors, education and health insurance plan, and clinical outcomes of atrial fibrillation (AF), one of the most common cardiovascular conditions.Data is derived from a large prospective and nationwide cohort.The study evaluates healthcare quality in universal health coverage system.Causal relationship cannot be assumed from a cohort trial.Enrollment took place in the medical center, thus, excluding patients who could not access the healthcare facilities.

Relationship of particular matter and temperature on the risk of adverse events in atrial fibrillation patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.M Rivera-Caravaca ◽  
V Roldan ◽  
V Vicente ◽  
G.Y.H Lip ◽  
F Marin
Keyword(s):  
Atrial Fibrillation ◽  
Air Pollution ◽  
Ischemic Stroke ◽  
Clinical Outcomes ◽  
Major Bleeding ◽  
Cardiovascular Events ◽  
Air Pollutant ◽  
Aerodynamic Diameter ◽  
Increased Risk ◽  
The Impact

Abstract Background Ambient particulate matter (PM), is a principal component of air pollutant and the main culprit of the adverse effects of air pollution on humans' health. In particular, PM with aerodynamic diameter &lt;10 μm (PM10) has been shown to be associated with worse clinical outcomes. Similarly, cardiovascular risk increases during colder temperatures/seasons. Thus, both, air pollution and temperature fluctuations are examples confirming how the climate change is affecting our health. However, our knowledge about the impact of air pollution and temperature in anticoagulated atrial fibrillation (AF) patients is scarce. Purpose Herein, we investigated if PM10 and temperature are associated with an increased risk of adverse clinical outcomes in patients with AF taking vitamin K antagonists (VKAs). Methods We included AF patients who were stable on VKAs (INR 2.0–3.0) for 6 months in a tertiary hospital (Murcia, South-east Spain). During a median follow-up of 6.5 (IQR 4.3–7.9) years, ischemic strokes, major bleeds, adverse cardiovascular events, and mortality were recorded. From 2007–2016, data on average temperature and PM10 (PM with aerodynamic diameter &lt;10 μm) were obtained and related to clinical outcomes. Results 1361 patients (48.7% male; median age 76, IQR 71–81 years) were included. High PM10 and low temperatures were associated with higher risk of major bleeding (adjusted Hazard Ratio, aHR 1.44, 95% CI 1.22–1.70 and aHR 1.03, 95% CI 1.01–1.05) and mortality (aHR 1.50, 95% CI 1.34–1.69 and aHR 1.04, 95% CI 1.02–1.06) (Table 1). PM10 was also significantly associated with ischemic stroke and temperature with cardiovascular events. The relative risk for cardiovascular events and mortality increased in months in the lower quartile (Q1) of temperature (&lt;12.74°C) (RR 1.12, 95% CI 1.04–1.21 and RR 1.41, 95% CI 1.15–1.74; respectively). Comparing seasons, there were higher risks of cardiovascular events in spring, autumn, and winter than in summer, whereas the risk of mortality increased only in winter. Conclusions In AF patients taking VKAs highPM10 and low temperature were associated with an increased the risk of ischemic stroke and cardiovascular events, respectively. Both factors increased major bleeding and mortality risks, which were higher during colder months and seasons. Table 1. Univariate and Multivariate Cox Funding Acknowledgement Type of funding source: None

Sign in / Sign up

Export Citation Format

Share Document