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COVID-19 patients taking prior DOACs were associated with lower long-term mortality risk and ICH/gastrointestinal bleeding than patients not taking OAC. Compared to patients on DOACs, VKA users were associated with higher risks of mortality, ischaemic stroke/TIA/SE and ICH/gastrointestinal bleeding.

There has been an increase in OAC prescribing in older people newly admitted to care homes with AF. This study provides an insight into the factors influencing OAC prescribing in this population.

NCT00911508.

Anticoagulants prevent thrombosis and death in patients with atrial fibrillation and venous thromboembolism (VTE) but also increase bleeding risk. The benefit/risk ratio favors anticoagulation in most of these patients. However, some will have a bleeding complication, such as the common trip-and-fall brain injury in elderly patients that results in traumatic intracranial hemorrhage. Clinicians must then make the difficult decision about when to restart the anticoagulant. Restarting too early risks making the bleeding worse. Restarting too late risks thrombotic events such as ischemic stroke and VTE, the indications for anticoagulation in the first place. There are more data on restarting patients with spontaneous intracranial hemorrhage, which is very different than traumatic intracranial hemorrhage. Spontaneous intracranial hemorrhage increases the risk of rebleeding because intrinsic vascular changes are widespread and irreversible. In contrast, traumatic cases are caused by a blow to the head, usually an isolated event portending less future risk. Clinicians generally agree that anticoagulation should be restarted but disagree about when. This uncertainty leads to long restart delays causing a large, potentially preventable burden of strokes and VTE, which has been unaddressed because of the absence of high quality evidence. Restart Traumatic Intracranial Hemorrhage (the "r" distinguished intracranial from intracerebral) (TICrH) is a prospective randomized open label blinded end-point response-adaptive clinical trial that will evaluate the impact of delays to restarting direct oral anticoagulation (1, 2, or 4 weeks) on the composite of thrombotic events and bleeding in patients presenting after traumatic intracranial hemorrhage.

In patients with newly diagnosed T2DM, alcohol abstinence was associated with a low risk of AF development. Lifestyle modifications, such as alcohol abstinence, in patients newly diagnosed with T2DM should be recommended to reduce the risk of AF.

The optimal antithrombotic regimen for patients with atrial fibrillation and ischemic heart disease remains unclear. Therefore, we aimed to compare the efficacy and safety of triple therapy (TT [an anticoagulant and 2 antiplatelet drugs]) with dual therapy (DAPT [2 antiplatelet drugs] or DT [an anticoagulant and a single antiplatelet drug]) in patients with atrial fibrillation and ischemic heart disease. We systematically searched the Cochrane Library, PubMed and Embase databases for all relevant studies up to August 2017. The overall risk estimates were calculated using the random-effects model. A total of 17 observational studies were included. Regarding the efficacy outcomes, no differences were observed between the triple therapy and the dual therapy for all-cause death, cardiovascular death, or thrombotic complications (i.e., acute coronary syndrome, stent thrombosis, thromboembolism/stroke, and major adverse cardiac and cerebrovascular events). Regarding the safety outcomes, compared with DAPT, TT was associated with increased risks of major bleeding (a relative risk of 1.96 [1.40-2.74]), minor bleeding (1.69 [1.06-2.71]) and overall bleeding (1.80 [1.23-2.64]). Compared wtih DT, TT was associated with a greater risk of major bleeding (1.65 [1.23-2.21]), but rates of minor bleeding (0.99 [0.56-1.77]) and overall bleeding (1.14 [0.76-1.71]) were similar. Overall, TT confers an increased hazard of major bleeding with no thromboembolic protection compared with dual therapy in patients with atrial fibrillation and ischemic heart disease.

These findings at a nationwide scale confirm the relevance of the subgroups in the EHRA algorithm for identifying a higher risk of AF incidence, showing that older patients (>75 years, regardless of comorbidities) have a higher incidence of AF than those with prior ischaemic stroke. Further studies are needed to evaluate the usefulness of algorithm-based risk stratification strategies for AF screening and the impact of screening on major cardiovascular event rates.

Abstract Funding Acknowledgements Type of funding sources: None. Background There is limited evidence of long-term impact of exercise-based CR on clinical endpoints for patients with AF. We therefore compared 18-month all-cause mortality, hospitalisation, stroke, and heart failure in patients with AF and an electronic medical record (EMR) of exercise-based CR to matched controls. Methods and Results This retrospective cohort study included patient data obtained on 11 December 2020, from a global federated health research network. AF patients undergoing exercise-based CR were propensity score matched to AF patients without exercise-based CR by age, sex, race, medication, and co-morbidities. We ascertained 18-month incidence of all-cause mortality, hospitalisation, stroke, and heart failure. Of 1,350,886 patients with AF, 10,625 patients had an EMR of exercise-based CR within 6-months of incident AF. The propensity score matched cohort of 21,250 patients with AF demonstrated that exercise-based CR was associated with 64% lower odds of all-cause mortality (odds ratio 0.36, 95% confidence interval (CI) 0.33-0.40), 41% lower odds of hospitalisation (0.59, 95% CI 0.56-0.63), and 17% lower odds of incident stroke (0.83, 95% CI 0.71-0.98) compared to propensity score matched controls. No significant associations were shown for heart failure at 18-months (0.92, 95% CI 0.81-1.02). The beneficial association of exercise-based CR on all-cause mortality was independent of sex, older age, comorbidities, and AF subtype. CONCLUSIONS Exercise-based CR among patients with incident AF was associated with lower odds of all-cause mortality, hospitalisation, and stroke at 18-months follow-up. The longitudinal nature of this retrospective follow-up study strongly supports the provision of exercise programmes for patients with incident AF.

Journal Article Accepted manuscript Association between cumulative uric acid exposure and the risk of incident cardiac conduction block Get access Na Li, MD, Na Li, MD Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, ChinaDepartment of Rheumatology and Immunology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Liufu Cui, MD, Liufu Cui, MD Department of Rheumatology and Immunology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Panagiotis Korantzopoulos, MD, PhD, Panagiotis Korantzopoulos, MD, PhD First Department of Cardiology, University of Ioannina Medical School, Ioannina, Greece Search for other works by this author on: Oxford Academic PubMed Google Scholar Nan Zhang, BS, Nan Zhang, BS Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Rong Shu, MD, Rong Shu, MD Department of Rheumatology and Immunology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Haicheng Song, MD, Haicheng Song, MD Department of Rheumatology and Immunology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Jierui Wang, MD, Jierui Wang, MD Department of Rheumatology and Immunology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Shuohua Chen, MD, Shuohua Chen, MD Department of Cardiology, Kailuan General Hospital, Tangshan, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Gregory Y H Lip, MD, FESC, Gregory Y H Lip, MD, FESC Liverpool Centre for Cardiovascular Sciences at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United KingdomDanish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark Search for other works by this author on: Oxford Academic PubMed Google Scholar Gary Tse, MD, PhD, Gary Tse, MD, PhD Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, ChinaSchool of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China Search for other works by this author on: Oxford Academic PubMed Google Scholar ... Show more Konstantinos P Letsas, MD, PhD, Konstantinos P Letsas, MD, PhD Arrhythmia Unit, Laboratory of Cardiac Pacing and Electrophysiology, Onassis Cardiac Surgery Center, Athens, Greece Search for other works by this author on: Oxford Academic PubMed Google Scholar George Bazoukis, MD, PhD, George Bazoukis, MD, PhD Department of Cardiology, Larnaca General Hospital, Larnaca, CyprusEuropean University Cyprus, Medical School, Nicosia, Cyprus https://orcid.org/0000-0003-1009-9772 Search for other works by this author on: Oxford Academic PubMed Google Scholar Gan-Xin Yan, MD, PhD, Gan-Xin Yan, MD, PhD Lankenau Medical Center and Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USAFuwai Huazhong Hospital, Zhengzhou, Henan, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Xuemei Yang, BS, Xuemei Yang, BS School of Clinical Medicine, North China University of Science and Technology, Tangshan, Hebei, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Shouling Wu, MD, Shouling Wu, MD Department of Cardiology, Kailuan General Hospital, Tangshan, China Corresponding authors: Prof. Tong Liu, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, No. 23, Pingjiang Road, Hexi District, Tianjin 300211, People's Republic of China. E-mail: liutong@tmu.edu.cn or liutongdoc@126.com; Prof. Shouling Wu, Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, China. E-mail: drwusl@163.com Search for other works by this author on: Oxford Academic PubMed Google Scholar Tong Liu, MD, PhD, FESC Tong Liu, MD, PhD, FESC Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China Corresponding authors: Prof. Tong Liu, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, No. 23, Pingjiang Road, Hexi District, Tianjin 300211, People's Republic of China. E-mail: liutong@tmu.edu.cn or liutongdoc@126.com; Prof. Shouling Wu, Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, Tangshan, China. E-mail: drwusl@163.com https://orcid.org/0000-0003-0482-0738 Search for other works by this author on: Oxford Academic PubMed Google Scholar Cardiovascular Research, cvae115, https://doi.org/10.1093/cvr/cvae115 Published: 04 June 2024 Article history Received: 22 November 2023 Revision received: 25 December 2023 Accepted: 05 January 2024 Published: 04 June 2024

Based on this ecological epidemiological study, racial differences in stroke incidence were robust to a variety of statistical analyses, regardless of the subtype. This suggests the need for region-specific approaches to stroke prevention.

COPD is common in AF, being found in 13% of patients, and is associated with increased burden of comorbidities, differential management, and worse outcomes, with more than a two-fold higher risk of all-cause death and increased risk of CV death and major bleeding. Therapy with BBs does not increase the risk of adverse outcomes in patients with AF and COPD.