Publications

In the Danish universal healthcare system, patients with AF who had lower educational attainment, lower family income, or were living alone were less likely to undergo AF ablation.

DOACs with reduced doses are efficient and safe stroke prevention therapy in high-risk patients with AF when compared with warfarin therapy of sufficient TTR. In this comparison, warfarin therapy of excellent TTR-quality was associated with the lowest risk of bleeding and mortality.

International audience

Abstract Background The presence of cancer worsens the prognosis of patients with atrial fibrillation (AF). However, the association between cancer type and specific bleeding events has been scarcely investigated. Furthermore, the performance of bleeding risk scores, such HAS-BLED, ORBIT and ATRIA, in this high-risk subgroup of AF patients is unclear. Purpose To investigate the incidence rate (IR) of major, gastrointestinal (GI) bleeding and intracranial haemorrhage (ICH) according to cancer types. We also investigated the performance of HAS-BLED, ATRIA and ORBIT scores. HASBLED ≥3, ATRIA ≥5 and ORBIT ≥4 were defined as high-risk. Methods Observational retrospective cohort study including 399,344 patients with AF and cancer. Results Mean age was 77.9±10.2 years and 63.2% were men. During a mean follow-up of 2.0 years, the IR of major bleeding was as high as 8.41%/year, GI bleeding was 3.61%/year and ICH 1.33%/year. Major bleedings were more frequent in liver (12.68%/year), leukaemia (12.39%/year), pancreas (11.71%/year), bladder (11.67%/year) and myeloma (11.64%/year). GI bleeding were highest in liver (7.54%/year), pancreas (7.42%/year) and gastric (5.51%/year). The highest IR of ICH was found in leukaemia (1.89%/year), myeloma (1.52%/year), lymphoma and liver (1.45%/year) and pancreas cancer (1.41%/year). Figure 1 shows the hazard ratios and AUC values for the three scores against each endpoint. All the three scores were significantly associated with major, GI and ICH. The HAS-BLED score performed better than others for ICH prediction, while the ORBIT score showed the best predictivity for major and GI bleedings (p<0.0001 for all AUC comparisons) Conclusions Cancer increases the risk of bleeding in patients with cancer, with specific differences according to each cancer type. HAS-BLED score identified patients at highest risk for ICH and the ORBIT score for major and GI bleeding. Funding Acknowledgement Type of funding sources: None. Figure 1

INTRODUCTION: Acute failure is a critical condition, encompassed by the sudden or progressive onset of symptoms or signs of congestion. The treatment strategies available are mainly supportive and do not improve mortality or long-term outcomes. Therefore, there is a need for alternative novel treatment strategies. In this narrative review, we explore the role of relaxin agonist as a potential therapeutic strategy in acute heart failure. AREAS COVERED: We aim to provide an overview of the evidence of preclinical and clinical studies on relaxin as a treatment strategy for acute heart failure. Papers collected in this review are from original research and systematic reviews which have been filtered following Medline and Cochrane Library searches. EXPERT OPINION: Relaxin has shown great potential in both preclinical and clinical studies due to its antifibrotic, anti-inflammatory, and vasodilatory effect on the heart. However, there has been mixed evidence from clinical trials involving relaxin which could be due to patient groups, investigation sites, trial design, and chance. Further studies should focus on developing biomarkers to identify specific population groups who are most likely to benefit from relaxin.

The global health burden of chronic kidney disease is rapidly rising, and chronic kidney disease is an important risk factor for cerebrovascular disease. Proposed underlying mechanisms for this relationship include shared traditional risk factors such as hypertension and diabetes, uremia-related nontraditional risk factors, such as oxidative stress and abnormal calcium-phosphorus metabolism, and dialysis-specific factors such as cerebral hypoperfusion and changes in cardiac structure. Chronic kidney disease frequently complicates routine stroke risk prediction, diagnosis, management, and prevention. It is also associated with worse stroke severity, outcomes and a high burden of silent cerebrovascular disease, and vascular cognitive impairment. Here, we present a summary of the epidemiology, pathophysiology, diagnosis, and treatment of cerebrovascular disease in chronic kidney disease from the Kidney Disease: Improving Global Outcomes Controversies Conference on central and peripheral arterial disease with a focus on knowledge gaps, areas of controversy, and priorities for research.

Since the introduction of NOACs, the patterns of periprocedural antithrombotic regimens have changed rapidly toward more use of TAT, specifically with NOAC-based regimen. Appropriate stroke prevention with oral anticoagulants is still underutilized in patients with AF undergoing PCI in Korea.

This study received no funding.

Aim. To analyze clinical specifics of the Russian population of non-valvular atrial fibrillation patients participating in the 2nd phase of international registry Gloria AF. Material and methods. The data on clinical characteristics presented, of the Russian population of atrial fibrillation patients, gathered in the second phase of Gloria AF study. The study is an international prospective observational program representing the registry of patients with the first time diagnosed atrial fibrillation. Results. Most patients included into Russian population of the Gloria AF registry had one or several comorbidities: 93,6% had arterial hypertension, 37,4% — coronary heart disease, 14,4% — myocardial infarction in anamnesis. Nineteen and three percent of patients had diabetes, 56,4% — chronic heart failure, 8,7% had stroke in anamnesis. Stroke risk assessment showed that the average score by CHA2 DS2 -VASc was 3,2 points, and 14,4% had the risk as 1 pt, 86,6% — two and more points. Such profile of risk was comparable with the data from general population of Gloria AF, and close to those from Garfield registry. Antithrombotic therapy profile analysis points on an intensive implementation of the Novel Oral Anticoagulants into real clinical practice of the investigative centers participating in the Gloria AF. Conclusion. The results witness on comparable with the international data risk profile in Russian Federation population of AF patients included into the second phase of Gloria AF registry, as on an intensive implementation of the new class Novel Oral Anticoagulants into routine clinical practice of research centers participating in the registry.

Perioperative stroke can be debilitating immediately long term. The involvement of specialist stroke teams plays a key role in reducing the long-term burden and mortality of this condition.

Abstract Funding Acknowledgements Type of funding sources: None. Background and Aims Adverse outcomes associated with atrial fibrillation (AF) in Asians have not been fully elucidated. In a patient-level comparative analysis of UK Biobank and Korean National Health Insurance Service-Health Screening data, we evaluated the race-specific associations of AF with stroke and mortality. Methods This study enrolled 425,805 Asians (mean [SD] age, 56.0 [9.3] years; 55.3% of men) and 372,851 Whites (mean [SD] age, 57.1 [8.0] years; 47.6% of men). The main outcomes were total, ischemic, and hemorrhagic strokes and all-cause death. Results During the follow-up period (mean [SD], 7.3 [1.4] years in Asians; 11.7 [1.5] years in Whites), the incident rates (IR) of AF per 1000 person-years were 2.6 (95% CI, 2.5–2.7) in Asians and 4.4 (95% CI, 4.3–4.5) in Whites. The IR of total, ischemic, and hemorrhagic strokes were greater in Asians with AF than in Whites with AF. The rate difference (IR of the outcome in those with AF minus IR of the outcome in those without AF) for total stroke was 15.2 (95% CI, 13.4–17.0) in Asians and 4.5 (95% CI, 4.0–5.0) in Whites. For ischemic and hemorrhagic strokes, the rate differences were 2.5- to 3.5-fold higher in Asians than in Whites. Asians had a rate difference of 26.3 (95% CI, 24.2–28.4) for all-cause death, whereas Whites had a rate difference of 20.7 (95% CI, 19.7–21.7). Conclusion Despite the higher incidence of AF in Whites, the outcomes of AF-related rates of total, ischemic, and hemorrhagic strokes and all-cause death was greater in Asians than Whites.