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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