Biotricity: Deep Data and AI Bring Enhanced Value to Medical Wearables

MedicalResearch.com Interview with:

Waqaas Al-Siddiq

Waqaas Al-Siddiq

Waqaas Al-Siddiq
Founder and CEO of Biotricity Inc

MedicalResearch.com: In light of Apple’s announcement that it will incorporate an EKG monitoring device into Apple watches in the near future, would you discuss your vision of the growing medical wearables market? 

Response: First of all, the public is still largely confused as to what constitutes a medical wearable device. Apple’s new watch, with its EKG monitoring service, is not a medical wearable because it will not produce clinical-grade data needed for diagnosis or treatment. This is not to say that Apple’s watch isn’t helpful. Many people are not even aware that they have a heart problem, but if their Apple watch consistently tells them that they have an irregular heart rhythm, or arrhythmia, they could take that as a sign to go to a physician and get a professional diagnosis. A physician will then prescribe a medical wearable device, such as our Bioflux, to monitor the patient’s heart rhythm. Medical-grade wearable devices produce clinical-grade data that is accurate to within 90-95 percent or higher and are prescribed by physicians to make diagnoses and treatment plans.

That being said, I envision that the medical wearables market will expand considerably with the advent of consumer-based wearables that facilitate health tracking. One of the biggest problems we have today is a lack of awareness. Anywhere between 2.7 and 6.1 million people in the U.S. suffer from atrial fibrillation – a condition that makes the heart beat irregularly – and many aren’t aware that they have the condition. Consumer-based health trackers like the Fitbit and the Apple Watch can help raise awareness and alert consumers to possible health issues, which will encourage them to see a physician for a thorough and professional examination and diagnosis. This, in turn, gives the medical wearable market a boost as more people will be diagnosed with the aid of a medical wearable. Another factor that is playing into this adoption trend is that next-generation medical wearables are increasingly becoming smaller and easier to use for both patients and physicians. So, I think that the future of medical wearables will see them firmly entrenched in mainstream practice and eventually become tools within the home for individuals with chronic issues.  Continue reading

USPSTF: Unclear If Benefits of Screening for Atrial Fibrillation Outweigh Harms

MedicalResearch.com Interview with:

Seth Landefeld, M.D.  Dr. Landefeld is chairman of the department of medicine and the Spencer chair in medical science leadership at the University of Alabama at Birmingham (UAB) School of Medicine. Dr. Landefeld also serves on the board of directors of the American Board of Internal Medicine, the UAB Health System, and the University of Alabama Health Services Foundation

Dr. Landefeld

Seth Landefeld, M.D. 
Dr. Landefeld is chairman of the department of medicine and the Spencer chair in medical science leadership at the University of Alabama at Birmingham (UAB) School of Medicine.
Dr. Landefeld also serves on the board of directors of the American Board of Internal Medicine, the UAB Health System, and the University of Alabama Health Services Foundation.

MedicalResearch.com: What is the background for this study? Would you briefly explain what is meant by atrial fibrillation and whom it primarily affects?

Response: Atrial fibrillation—or AF—is an irregular heartbeat. AF affects nearly 3 million Americans and is a leading cause of stroke. Older age and obesity increase the risk of AF, and the condition also occurs more in men than in women. With an aging society and the growing prevalence of obesity in the U.S., this was an important topic for the U.S. Preventive Services Task Force to review.

The Task Force looked at the latest research to see if screening for atrial fibrillation using electrocardiography—or ECG, which is a test that records the activity of someone’s heart—to supplement traditional care is an effective way to diagnose AF and prevent stroke.

We found that more research is needed to determine if screening with ECG can help to identify AF and prevent stroke in adults who are 65 and older and do not have signs or symptoms of the disease.  Continue reading

New Biomarkers Predictive of Atrial Fibrillation Outcome

MedicalResearch.com Interview with:

John D Horowitz, MBBS, PhD. Director of Cardiology/Clinical Pharmacology Queen Elizabeth Hospital University of Adelaide Australia

Dr. Horowitz

John D Horowitz, MBBS, PhD.
Director of Cardiology/Clinical Pharmacology
Queen Elizabeth Hospital
University of Adelaide
Australia 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response:  Atrial fibrillation (AF) describes intermittent or permanent episodes of irregular pulse, due to rapid electrical activity within the atria (filling chambers) of the heart. During AF, the atria quiver, rather than contract, and the response of the ventricles is often rapid, resulting in palpitations and an increased risk of development of heart failure. AF may occur at any age, but is most common in ageing patients (typically over 75 years). The primary importance of AF is that it markedly increases the risk of thrombus formation in the atrium, with the resultant problem that these thrombi may dislodge (embolise), and commonly block arteries in the brain, causing strokes. Hence patients with AF are usually treated with anticoagulants.

Although AF often occurs in patients with prior damage to their hearts and atrial distension, there has been evidence for about the past 8 years that AF also is caused, at least in part, by inflammatory changes: two components have been identified as possible causes for this inflammation: lack of nitric oxide (NO) effect[ NO is  an anti-inflammatory chemical formed by all tissues in the body],  and excess activity of the pro-inflammatory enzyme myeloperoxidase (MPO).  High concentrations of ADMA, which inhibits NO formation, may result from effects of MPO on tissues. SDMA, which is closely related to ADMA, also exerts pro-inflammatory effects and tends to suppress NO formation.

The currently reported study began with the design of the ARISTOTLE trial, an investigation of the (then) novel anticoagulant apixaban as an alternative to warfarin therapy, as a means of preventing strokes in patients with AF. It was elected to perform a substudy to investigate the potential role of ADMA and SDMA as modulators of risk in patients with atrial fibrillation.

This substudy, performed in just over 5000 patients from the ARISTOTLE trial, essentially asked two questions:

(1) There are several indices of stroke risk in patients with atrial fibrillation, such as the CHADS2 score. These all rely on patient characteristics (eg age, presence of diabetes) rather than chemical changes. We postulated that there would be a direct relationship between clinically based risk scores and ADMA/SDMA concentrations.

(2) More ambitiously, we postulated that ADMA and SDMA concentrations would represent INDEPENDENT risk markers for major adverse effects in atrial fibrillation patients on anticoagulant treatment, namely stroke, major bleeding and risk of mortality. 

ADMA/SDMA concentrations were determined in Adelaide, Australia, while statistical analyses were performed in Uppsala, Sweden.

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Asthma Linked to Increased Risk of Atrial Fibrillation

MedicalResearch.com Interview with:

Aivaras Cepelis, MSci Department of Public Health and Nursing, Faculty of Medicine and Health Science, NTNU, Norwegian University of Science and Technology Trondheim, Norway

Aivaras Cepelis

Aivaras Cepelis, MSci
Department of Public Health and Nursing, Faculty of Medicine and Health Science
NTNU, Norwegian University of Science and Technology
Trondheim, Norway

MedicalResearch.com: What is the background for this study?

Response: Atrial fibrillation is the most common sustained, irregular and often rapid heart rate with a lifetime risk of 26%. The number of adults with atrial fibrillation is projected to double by 2050. Atrial fibrillation is also linked to adverse cardiovascular outcomes such as doubled risk of stroke and cardiovascular mortality. Therefore, we believe that research into the novel risk factors of the disease is highly warranted.

One of the potential condition that could play a role in the growing prevalence of atrial fibrillation is asthma. Asthma is a chronic inflammatory airway disease, affecting as many as 30 million children and adults in Europe. High levels of systemic inflammation biomarkers have been reported in both uncontrolled asthmatics and patients with atrial fibrillation. Furthermore, beta-agonists, the most common prescribed asthma control medication, has been shown to influence heart rate and increase the risk of irregular heartbeat.

However, research looking at asthma and atrial fibrillation link are lacking and no previous studies have assessed the dose-response relationship between levels of asthma control and atrial fibrillation. We utilized over 54 000 adults from a large well-defined Norwegian population cohort The Nord-Trøndelag Health Study (HUNT) to explore this association.

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Work Stress Associated With Increase Risk of Atrial Fibrillation

MedicalResearch.com Interview with:

atrial-fibrillation

Atrial Fibrillation-
Wikipedia

Eleonor Fransson, PhD
Associate Professor in Epidemiology
Department of Natural Sciences and Biomedicine
School of Health and Welfare
JÖNKÖPING UNIVERSITY

MedicalResearch.com: What is the background for this study?

Response: Atrial fibrillation is a very common heart rhythm disorder affecting a large number of people in the population, but there is limited knowledge about risk factors for the disease. This is especially true when it comes to the role of occupational factors.

MedicalResearch.com: What are the main findings?

Response: We found that work stress measured as job strain, that is, a combination of having high psychological job demands and low control over the work situation, was associated with almost 50% increased risk of atrial fibrillation. When we combined the results from our study with two previously published studies on the same topic, we found that work stress was associated with 37% increased risk.

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Oral Anticoagulants Still Underused in AFib Patients

MedicalResearch.com Interview with:
Anna Gundlund, MD, PhD

Herlev-Gentofte Hospital, Department of Cardiology
Denmark 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Atrial fibrillation increases a person’s risk of ischemic strokes up to 5-fold. Oral anticoagulation therapy lowers this risk effectively (>60%) and is therefore recommended for patients with atrial fibrillation and at least 1-2 other risk factors for stroke.

Our study show, that oral anticoagulation therapy is still underused in patients with atrial fibrillation – even after a stroke event. In stroke survivors with atrial fibrillation, oral anticoagulation therapy were associated with better outcomes than no oral anticoagulation therapy.  Continue reading

Should Digoxin Still Be Used in Patients With Atrial Fibrillation?

MedicalResearch.com Interview with:

Renato D. Lopes MD, MHS, PhD Duke University Medical Center Duke Clinical Research Institute Durham, NC 27705

Dr. Renato Lopes

Renato D. Lopes MD, MHS, PhD
Professor of Medicine, Division of Cardiology
Duke University Medical Center
Duke Clinical Research Institute
Terrace Level, Durham, NC 27705

MedicalResearch.com: What is the background for this study?

1-      Digoxin is used in ≈ 30% of patients with atrial fibrillation (AF) worldwide, despite the lack of randomized clinical trials to assess its efficacy and safety in this setting.
2-      Current AF guidelines recommend digoxin for rate control in patients with AF with and without heart failure (HF).
3-      There are no specific recommendations about serum digoxin concentration monitoring in the atrial fibrillation guidelines.

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Some Heart Attack Patients Without AFib Still at Increased Risk of Stroke

MedicalResearch.com Interview with:

Normal rhythm tracing (top) Atrial fibrillation (bottom) Wikipedia image

Normal rhythm tracing (top) Atrial fibrillation (bottom)
Wikipedia image

João Pedro Ferreira, MD, PhD &
Faiez Zannad, MD, PhD
National Institute of Health and Medical Research (INSERM)Center for Clinical Multidisciplinary Research 1433INSERM U1116University of LorraineRegional University Hospital of NancyFrench Clinical Research Infrastructure Network (F-CRIN) Investigation Network Initiative–Cardiovascular and Renal Clinical Trialists, Nancy, France
Department of Physiology and Cardiothoracic SurgeryCardiovascular Research and Development UnitFaculty of MedicineUniversity of Porto, Porto, Portugal

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: It is uncertain whether patients with a myocardial infarction with systolic dysfunction but without atrial fibrillation have increased risk for stroke.

In this study including >22,000 patients and 600 stroke events we found a subgroup of patients at high risk for stroke despite not having atrial fibrillation. These patients are older, have worse renal function, frank signs of pulmonary congestion, hypertension and previous stroke history. We created a simple and “ready to use” score that allows the identification of these patients in routine clinical practice.  Continue reading

NOACs For Atrial Fib Anticoagulation May Have Lower Risk of Kidney Side Effects

Atrial Fibrillation - Wikipedia image

Normal rhythm tracing (top) Atrial fibrillation (bottom) Wikipedia

Interview with:
Dr Xiaoxi Yao PhD
Assistant Professor
Researcher
Mayo Clinic

What is the background for this study? What are the main findings?

Response: Lifelong oral anticoagulation, either with warfarin or a non-vitamin K antagonist oral anticoagulant (NOAC), is indicated for stroke prevention in most patients with atrial fibrillation (AF). Emerging evidence suggests that NOACs may be associated with better renal outcomes than warfarin.

The study found renal function decline is common among patients with atrial fibrillation treated with oral anticoagulants. NOACs, particularly dabigatran and rivaroxaban, may be associated with lower risks of adverse renal outcomes than warfarin.

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Dementia Incidence Lower For Atrial Fibrillation Patients Treated With Anticoagulation

MedicalResearch.com Interview with:

Dr. Leif Friberg MD, PhD Associate professor in cardiology Karolinska Institute Friberg Resarch Stockholm, Sweden 

Dr. Leif Friberg

Dr. Leif Friberg MD, PhD
Associate professor in cardiology
Karolinska Institute
Friberg Resarch
Stockholm, Sweden 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: I have been doing research on atrial fibrillation and stroke risk for many years and knew that the very common heart arrhythmia is associated with a 40% increased risk of dementia. Considering that that 12-15% of 75 years olds have this arrhythmia, and even more at higher ages, the problem is significant to say the least.

The mechanism behind stroke in atrial fibrillation is that blood clots are formed in the heart. When these are dislodged they travel with the blood stream and may get stuck in the narrow vessels of the brain where they stop blood flow causing brain infarction or stroke. Oral anticoagulant drugs like warfarin or the newer so called NOAC (new oral anticoagulant) drugs are highly efficient in preventing formation of these large blood clots and offer at least 70% risk reduction. Now, blood clots come in different sizes. There are also microscopic clots that do not cause symptoms of stroke but all the same eat away at the brain at a slow but steady pace. Imaging studies shows this after only a few months or even weeks of atrial fibrillation. Our hypothesis was therefore: If anticoagulants are so effective in protecting against large clots, will they not help against the small ones too?

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In Euthyroid Individuals, Higher Free Thyroid Levels Linked To Greater Risk of Atrial Fibrillation

MedicalResearch.com Interview with:
Christine Baumgartner MD
Inselspital
Universitätsspital Bern
Bern, Switzerland
Research Fellow, Division of Hospital Medicine
UCSF

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Overt and subclinical hyperthyroidism increase the risk of atrial fibrillation, but it is unclear whether subclinical hypothyroidism, which is known to increase cardiovascular events, or thyroid function in the normal range are also associated with incident atrial fibrillation. Given the high prevalence of atrial fibrillation and its associated morbidity and mortality, identifying potentially modifiable risk factors is important. Therefore, we aimed to assess the risk of atrial fibrillation in individuals with subclinical hypothyroidism or variations of thyroid function within the normal range.

Our main findings are that higher free thyroxine levels are associated with an increased risk of atrial fibrillation in euthyroid individuals, but thyroid-stimulating hormone levels within the euthyroid or subclinical hypothyroid range was not related to atrial fibrillation risk.

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Life Simple 7 Score Closely Link To Risk of Atrial Fibrillation

MedicalResearch.com Interview with:

Parveen K. Garg, MD, MPH Assistant Professor of Clinical Medicine Keck Hospital of USC 

Dr. Garg

Parveen K. Garg, MD, MPH
Assistant Professor of Clinical Medicine
Keck Hospital of USC 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Atrial fibrillation is the most commonly presenting cardiac arrhythmia in clinical practice, affecting over 2 million people in the United States. This arrhythmia accounts for up to 15% of all strokes and annual costs for AF treatment are estimated at over 6.5 billion dollars. Despite the growing public health challenge that AF poses, effective prevention strategies are lacking. In 2010, the American Heart Association identified metrics of ideal cardiovascular health known as Life’s Simple 7 to target for the primary prevention of cardiovascular disease. We wanted to determine whether adherence to these health metrics helps prevent atrial fibrillation as well.

Therefore, we examined the association between the Life’s Simple 7 (LS7) and incident atrial fibrillation in the REasons for Geographic And Ethnic Differences in Stroke (REGARDS) study. We found that individuals in this study with optimal cardiovascular health (high adherence to LS7 metrics) had an over 30% lower risk of developing atrial fibrillation compared to those with inadequate cardiovascular health (low adherence to LS7 metrics). We also observed that even minor improvements in adherence to the LS7 (increase in total score by 1-point) were associated with a 5% lower risk of atrial fibrillation.

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Study Finds Ablation To Be Superior For Atrial Fibrillation In Patients With Heart Failure

MedicalResearch.com Interview with:

Nassir F. Marrouche, MD Professor, Internal Medicine Cardiology University of Utah

Dr. Marrouche

Nassir F. Marrouche, MD
Professor, Internal Medicine
Cardiology
University of Utah 

MedicalResearch.com: What is the background for this study?

Response: Study the effectiveness of catheter ablation of Atrial Fibrillation in patients with heart failure in improving hard primary endpoints of mortality and heart failure progression when compared to conventional standard treatment

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Morbidity and Financial Costs of Atrial Fibrillation High and Likely to Grow

MedicalResearch.com Interview with:

Sandra L. Jackson, PhD National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention Chamblee GA

Dr. Sandra  Jackson

Sandra L. Jackson, PhD
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
Chamblee GA

MedicalResearch.com: What is the background for this study?

Response: People who have atrial fibrillation are at increased risk for having a heart attack or stroke. While we know that the percentage of the population with atrial fibrillation is increasing in the US, there is no national surveillance system to track the burden of emergency department visits, hospitalizations and deaths related to atrial fibrillation across all ages and health insurance provider types. This study combined data from the Healthcare Cost and Utilization Project and the National Vital Statistics System to provide national estimates for atrial fibrillation-related healthcare service use and deaths from 2006-2014.

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Insertable Cardiac Monitors Detect Previously Undiagnosed Atrial Fibrillation

MedicalResearch.com Interview with:
James A. Reiffel, M.D
Professor Emeritus of Medicine
Special Lecturer in Medicine
Dept of Medicine Cardiology
Columbia University Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Atrial fibrillation is a common arrhythmia (multi-millions of Americans) and carries with it a risk of stroke and of heart failure (among others) if not treated preventively. In many people, atrial fibrillation comes to attention because of symptoms, but not in all. The chances of developing Atrial fibrillation are substantially increased in certain populations of patients, such as the ones we enrolled in our study.  Continuous monitoring of such patients, as we did, and as others have also done recently, though in smaller numbers of patients, can detect otherwise unsuspected atrial fibrillation, which can lead to treatment before complications arise.

We found that using such monitoring, when monitored for 18 months, almost 1 in 3 patients had atrial fibrillation detected, as did 40% by 30 months. Intermittent monitoring, including by cell phones, may detect some atrial fibrillation but it is not nearly as effective as the type of monitoring we did and so many patients will be missed by lesser monitoring methods.

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Contraindications Not The Reason Atrial Fibrillation Patients Not Prescribed Anticoagulants

MedicalResearch.com Interview with:

Tom Marshall, MSc, PhD, MRGP, FFPH Professor of public health and primary care Institute of Applied Health Research University of Birmingham Birmingham UK

Prof. Marshall

Tom Marshall, MSc, PhD, MRGP, FFPH
Professor of public health and primary care
Institute of Applied Health Research
University of Birmingham
Birmingham UK 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: It is widely recognised that anticoagulants are underused in patients with atrial fibrillation (AF) although they are effective in reducing risk of stroke. We investigated whether this could be explained by the fact that many AF patients have conditions which are considered relative contraindications to their use.

We analysed electronic medical records from 645 general practices from 2004 to 2015 and included over 1 million patients with AF. We found that about 6% of AF patients had are relative contraindications such as recent history of major bleeding. In each of the 12 years, similar numbers of patients with and without contraindications were prescribed anticoagulants.

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Patients With Paroxysmal Atrial Fibrillation Less Likely To Receive Anticoagulants

MedicalResearch.com Interview with:

Dr Nicola Adderley BA, MSci (Cantab), MA, MPhil, PhD Institute of Applied Health Research Research Fellow University of Birmingham

Dr. Adderley

Dr Nicola Adderley BA, MSci (Cantab), MA, MPhil, PhD
Institute of Applied Health Research
Research Fellow
University of Birmingham

MedicalResearch.com: What is the background for this study?

Response: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a major global public health problem. It is associated with a five-fold increase in risk of stroke.

There are three types of AF – paroxysmal, persistent or permanent. In paroxysmal AF, episodes come and go, and usually stop without any treatment. With persistent AF episodes can last for periods of more than seven days and are treated with medication or a medical procedure called cardioversion. In permanent AF, the irregular heartbeat is present all the time and cardioversion has failed to restore a normal heart rhythm.

All patients with AF, including paroxysmal AF, are at an increased risk of stroke. UK guidelines recommend anticoagulant treatment, such as the blood-thinning drug warfarin, for patients with all types of AF in order to reduce the risk of stroke.

Our study aimed to determine whether patients with paroxysmal AF are less likely to be treated with anticoagulants than patients with persistent or permanent AF and to investigate trends in treatment between 2000 and 2015.

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Normalizing Testosterone With Replacement Therapy Reduced Atrial Fibrillation Risk

MedicalResearch.com Interview with:

Rajat S. Barua, MD; PhD; FACC; FSCAI Associate Professor of Medicine (Cardiology), University of Kansas School of Medicine Director, Cardiovascular Research, Dept. of Cardiology, Kansas City VA Medical Center Director, Interventional Cardiology & Cardiac Catheterization Laboratory Kansas City VA Medical Center

Dr. Barua

Rajat S. Barua, MD; PhD; FACC; FSCAI
Associate Professor of Medicine (Cardiology), University of Kansas School of Medicine
Director, Cardiovascular Research, Dept. of Cardiology, Kansas City VA Medical Center
Director, Interventional Cardiology & Cardiac Catheterization Laboratory
Kansas City VA Medical Center

MedicalResearch.com: What is the background for this study?

Response: Atrial fibrillation is the most common cardiac arrhythmia worldwide, with significant morbidity, mortality and financial burden. Atrial fibrillation is known to increase with age and is higher in men than in women. Although the underlying mechanisms of this sex difference are still unclear, one preclinical and several small clinical studies have suggested that testosterone deficiency may play a role in the development of atrial fibrillation. To date, no studies have investigated the effect of testosterone-level normalization on incidence of new atrial fibrillation in men after testosterone replacement therapy.

In this study, we investigated the incidence of atrial fibrillation in hypogonadal men with documented low testosterone levels. We compared the incidence of atrial fibrillation among patients who did not receive any testosterone replacement therapy, those who received testosterone replacement therapy that resulted in normalization of total testosterone, and those who received testosterone replacement therapy but that did not result in normal total testosterone levels.

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Biomarker VCAM-1 Associated With New Onset Atrial Fibrillation

MedicalResearch.com Interview with:
Stefan Kiechl, MD and
Karin Willeit, MD
Department of Neurology
Medical University Innsbruck
Innsbruck, Austria 

MedicalResearch.com: What is the background for this study?

Response: Atrial fibrillation (AF) is the most common cardiac arrhythmia and a major contributor to thromboembolic stroke and population morbidity and mortality. Aside from well-established risk factors such as age, heart failure, and hypertension, inflammation has been suggested to play a significant role in the pathogenesis of AF. This is evidenced by histologic studies that found marked inflammatory infiltrates in atrial biopsies of AF patients and by epidemiological studies demonstrating an association of circulatory inflammation markers with incident AF. Of note, an increased endocardial expression of vascular intercellular adhesion molecule 1 (VCAM-1), a mediator of leukocyte trafficking, during rapid atrial pacing was demonstrated which was shown to contribute to an inflammatory and prothrombotic environment within atrial tissue.

Because it is still unclear whether inflammation related to AF is primarily a systemic or localized phenomenon, we sought to examine the association of 13 baseline inflammation markers with incident atrial fibrillation in the prospective population-based Bruneck Study and to replicate key findings in a second cohort, the SAPHIR Study.

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Valvular Heart Disease: Edoxaban vs Warfarin in the ENGAGE AF-TIMI 48 Trial

MedicalResearch.com Interview with:
Raffaele De Caterina MD, PhD

Professor of Cardiology and Director of the University Cardiology Division
‘G d’Annunzio’ University in Chieti

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The widely used term “valvular atrial fibrillation” encompasses a variety of conditions in which atrial fibrillation and valvular heart disease coexist. Since most trials of the non-vitamin K antagonist oral anticoagulants (NOACs) have variably excluded “valvular atrial fibrillation”, in more or less restrictive terms, there has been uncertainty whether NOACs can be used in such varied conditions. While atrial fibrillation in the presence of a mechanical valve or rheumatic mitral stenosis has to be a true contraindication (unfavorable data with one NOAC in the former setting; no data in the latter setting), patients with valvular diseases such as mitral insufficiency, aortic stenosis, aortic insufficiency, or with the presence of a bioprosthesis, have been variably included in the phase III trials of NOACs, but had not been extensively and conclusively studied before.

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Does Stress Raise Risk of Atrial Fibrillation?

MedicalResearch.com Interview with:

Simon Graff MD Department of Public Health Research Unit for General Practice Aarhus University Aarhus C, Denmark

Dr. Simon Graff

Simon Graff MD
Department of Public Health
Research Unit for General Practice
Aarhus University
Aarhus C, Denmark 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The presented study is a continuation of our interest in the role of stress and the possible causes of atrial fibrillation.  We published a study that showed that spousal bereavement were followed by a transiently increased risk of new onset of atrial fibrillation. With spousal bereavement being one of the most stressful life-event, we wanted to know whether minor and differentiated stress exposures had an effect as well. Therefore we used register based data on perceived stress as a new measure of exposure.

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Appropriate Anticoagulation Underutilized in Atrial fibrillation

MedicalResearch.com Interview with:
Dr. Ying Xian
 MD PhD
Department of Neurology,
Duke Clinical Research Institute
Duke University Medical Center
Durham, North Carolina

MedicalResearch.com: What is the background for this study?

Response: Atrial fibrillation (AF) is the most common arrhythmia. AF increases the risk for stroke and accounts for 10% to 15% of all ischemic strokes. While the burden of AF-related stroke is high, AF is a potentially treatable risk factor. Numerous studies have demonstrated that vitamin K antagonists, such as warfarin, or non-vitamin K antagonist oral anticoagulants (NOACs), reduce the risk of ischemic stroke. Based on these data, current guidelines recommend adjusted-dose warfarin or NOACs over aspirin for stroke prevention in high-risk patients with Atrial fibrillation.

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Stopping Warfarin in Dementia Patients with Atrial Fib Associated With Increased Risk of Stroke and Death

MedicalResearch.com Interview with:

Ariela Orkaby, MD, MPH Geriatrics & Preventive Cardiology Associate Epidemiologist Division of Aging, Brigham and Women's Hospital Instructor in Medicine, Harvard Medical School

Dr. Ariela Orkaby

Ariela Orkaby, MD, MPH
Geriatrics & Preventive Cardiology
Associate Epidemiologist
Division of Aging, Brigham and Women’s Hospital
Instructor in Medicine, Harvard Medical School

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Atrial Fibrillation is a common heart rhythm that affects 1 in 25 adults over age 60 and 1 in 10 adults over age 80. The feared consequence of atrial fibrillation is stroke, leading to the prescription of blood thinning medications (anticoagulants such as warfarin) to prevent strokes. However, there is an underutilization of these life-saving medications in older adults, and particularly in those who have dementia. In part, this is due to a lack of research and inclusion of older adults with dementia in prior studies.

In this study, we used clinical Veterans Administration data, linked to Medicare, to follow 2,572 individuals over age 65 who had atrial fibrillation and until a diagnosis of dementia. The average age was 80 years, and 99% were male. We found that only 16% remained on warfarin. We used statistical methods to account for reasons why a patient would or would not be treated with warfarin and found that those who continued to take warfarin had a significantly lower risk of stroke (HR 0.74, 95% Confidence interval 0.54- 0.99, p=0.47) and death (HR 0.72, 95% CI 0.60-0.87, p<0.01) compared to those who did not continue to take warfarin, without an increased risk of bleeding.

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Increase In Subdural Hematomas Associated With Increase Use of Antithrombotic Drugs


MedicalResearch.com Interview with:

David Gaist, MD, PhD</strong> Department of Neurology Odense University Hospital University of Southern Denmark Odense, Denmark

Dr. David Gaist

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The incidence of subdural hematoma (SDH; a bleed located within the skull, but outside the brain) has been reported to be on the increase. Previous studies have shown an association between use of antithrombotic drugs and SDH. However, studies with updated estimates of this risk and with focus on current more complex and aggressive regimens of antithrombotic treatment are scarce.

We therefore performed this study, where we identified 10,010 patients aged 20-89 years that were admitted with SDH in Denmark in 2000 through 2015. Preadmission use of antithrombotic drugs (low-dose aspirin, clopidogrel, vitamin K antagonist, e.g. warfarin, and direct oral anticoagulants) of these cases was compared to that of 400,380 individuals from the general population with no history of SDH (controls).

We found that use of antithrombotic drugs was associated with an increased risk of subdural hematoma . The magnitude of this risk varied by type of antithrombotic, and was, e.g., low for use of low-dose aspirin, and highest for warfarin. Further, with a single exception (low-dose aspirin and dipyridamole), concurrent use of more than one antithrombotic drug was associated with higher risk of SDH, particularly if warfarin was taken along with an antiplatelet drug, e.g., low-dose aspirin or clopidogrel. Increasing use of antithrombotic drugs was observed in the study period. The incidence of subdural hematomas in the Danish population also increased markedly in the years 2000-2015, particularly among those aged 75+ years. Our study indicates that this increased incidence, can, at least partly, be explained by increased use of antithrombotic drugs.

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Which AFib Patients Should Resume Warfarin After Intracranial Hemorrhage?

MedicalResearch.com Interview with:
Peter Brønnum Nielsen MD PhD
Aalborg Thrombosis Research Unit
Department of Clinical Medicine
Faculty of Health
Department of Cardiology, Atrial Fibrillation Study Group
Aalborg University Hospital
Aalborg, Denmark
 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response:   Patients who sustain an intracranial hemorrhage (ICH) event are often excluded from randomized trials investigating stroke prevention in atrial fibrillation (AF) by use of oral anticoagulant treatment.

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