Publications

The Impact of COVID-19 on the Management of Heart Failure -A United Kingdom Patient Questionnaire Study

Abstract Aim The coronavirus disease 2019 (COVID-19) pandemic has created significant challenges to healthcare globally, necessitating rapid restructuring of service provision. This questionnaire survey was conducted amongst adult heart failure (HF) patients in the United Kingdom (UK), to understand the impact of COVID-19 upon HF services. Methods and Results The survey was conducted by the Pumping Marvellous Foundation (PMF), a UK HF patient charity. “Survey Monkey” was used to disseminate the questionnaire in the PMF’s online patient group and in 10 UK hospitals (out-patient hospital and community HF clinics). 1050 responses were collected (693/1050-66% women); 55% (579/1050) were aged over 60 years. Anxiety level was significantly higher regarding COVID19 (mean 7±2.5 on anxiety scale of 0 to 10) compared to anxiety regarding HF (6.1±2.4; p<0.001). Anxiety was higher amongst patients aged ≤60 years about HF (6.3±2.2 versus 5.9±2.5 in those aged >60 years; p=0.005) and COVID-19 (7.3±2.3 versus 6.7±2.6 those aged >60 years; p<0.001). 65% respondents (686/1050) reported disruption to HF appointments (cancellation or postponement) during the lockdown period. 37% reported disruption to medication prescription services and 34% reported inability to access their HF teams promptly. 32% expressed reluctance to attend hospital (25% stated they would only attend hospital if there was no alternative and 7% stated that they would not attend hospital at all). Conclusions The COVID-19 pandemic has caused significant anxiety amongst HF patients regarding COVID-19 and HF. Cancellation or postponement of scheduled clinic appointments, investigations, procedures, prescription and monitoring services were implicated as sources of anxiety.

2016 European Guidelines on cardiovascular disease prevention in clinical practice

Abstract 13225: Which Oral Anti-Coagulant Do Patients Prefer for Stroke Prevention in Non-Valvular Atrial Fibrillation?

Introduction: There are various oral anticoagulants available for stroke prevention in patients suffering from non-valvular atrial fibrillation (NVAF) with some drug-related variations in clinical profile and non-clinical attributes. Patient preferences should be taken into account in anticoagulant prescription decisions. Hypothesis: Patient valuation of different anticoagulant characteristics in stroke prevention allows for meaningful comparison of the non-VKA oral anticoagulants (NOACs; apixaban, dabigatran, edoxaban, rivaroxaban) and Vitamin K Antagonist (VKA, ie. warfarin). Methods: Multi-criteria decision analysis was developed with 5 clinical and 3 non-clinical criteria. Criteria weights were defined using results from two discrete choice experiments (DCEs). The evaluation model contained more fine-grained events than the DCEs, and therefore preference weights from DCEs needed to be distributed to the evaluation criteria. The weights were distributed according to event fatality rates, which were obtained from the RE-LY trial that compared dabigatran to warfarin. An additive model was used to combine treatment performance with the weights to estimate the overall value of each oral anticoagulant. Probabilistic and structural sensitivity analyses were performed. Results: Dabigatran obtained the highest overall value (see Figure: weighted contribution of different evaluation criteria to the overall value of five oral anticoagulants) and the highest first rank probability (88%) in the probabilistic sensitivity analysis. Rivaroxaban performed worse than the other NOACs, but better than VKA (both with 0% first rank probability). The results were insensitive to removing availability of reversal agent from the model. Conclusions: Patient preferences on treatment characteristics allows to discriminate oral anticoagulants for stroke prevention in NVAF, with dabigatran ranking highest and warfarin lowest.

2018 ESC/ESH Guidelines for the Management of Arterial Hypertension

Guidelines summarize and evaluate available evidence with the aim of assisting health professionals in selecting the best management strategies for an individual patient with a given condition. Guidelines and their recommendations should facilitate decision making of health professionals in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate.

Cerebral microbleeds and stroke risk after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies

British Heart Foundation and UK Stroke Association.

Stroke prevention in atrial fibrillation: re-defining ‘real-world data’ within the broader data universe

Real-world data (RWD) has been defined as data generated outside of traditional randomized clinical trials (RCTs). Though RWD has received increasing attention from regulatory authorities and professional societies, dividing evidence into that derived from 'real-world' vs. 'non-real-world' sources provides only one element of a much larger framework for evidence evaluation. Evidence should be evaluated on the source of the data, the method of treatment allocation (whether any intervention being evaluated was assigned or simply observed as used in practice) and the context in which the evidence was generated (overall study design). Under this framework, RWD refers only to data source, and a study incorporates RWD when it primarily uses data collected for non-research purposes, such as insurance claims data or the electronic health record, regardless of study design. Separation of study design, data source, and context enables parallel evaluation of two critical elements: (i) whether a study can support claims of causal inference, which can be assured with a high degree of confidence only in studies where patients are assigned treatments by protocol; and (ii) whether the study population and clinical context mirror clinical practice, a strength of observational studies using data from clinical practice or administrative claims. In this review, we describe the strengths and weaknesses of observational and non-observational studies, and studies involving RWD and non-RWD, through the lens of anticoagulation for atrial fibrillation (AF). Observational studies employing RWD are useful for describing how oral anticoagulants are used in clinical practice, but generally cannot be used to make claims regarding comparative treatment effects. Questions regarding treatment effect generally are best answered through an RCT, and additional pragmatic RCTs are needed to compare different antithrombotic agents for the prevention of thrombotic events in AF.

Patients’ views on stroke prevention for atrial fibrillation after an intracerebral haemorrhage: a qualitative study

Patients' decision-making for stroke prevention for AF post-ICH was influenced by individual, medical, and social factors. At the heart of patients', decision-making were concerns with maintaining an acceptable QoL. The study findings help nurses and other healthcare professionals to better understand what matters to patients who are eligible for stroke prevention for AF post-ICH, thus promoting more effective shared decision making.

Excessive Supraventricular Ectopic Activity and Adverse Cardiovascular Outcomes: a Systematic Review and Meta-analysis

Effect of Digoxin vs Bisoprolol for Heart Rate Control in Atrial Fibrillation on Patient-Reported Quality of Life

ClinicalTrials.gov Identifier: NCT02391337 and clinicaltrialsregister.eu Identifier: 2015-005043-13.

Age-Dependent Prognostic Impact of Paroxysmal Versus Sustained Atrial Fibrillation on the Incidence of Cardiac Death and Heart Failure Hospitalization (the Fushimi AF Registry)

P3180The effect of PCI complexity on the efficacy and safety of dabigatran dual therapy vs warfarin triple therapy in atrial fibrillation: a subgroup analysis from the RE-DUAL PCI trial

Background: Dual antiplatelet therapy (DAPT) prevents ischemic events after coronary stenting, but increases bleeding. Complex percutaneous coronary intervention (PCI) carries an intrinsic higher risk for ischemic recurrences, and while guidelines support the use of dedicated clinical risk scores prior to the selection of DAPT duration, validation of these tools in the setting of complex coronary intervention has not been yet provided. Purpose: We aimed to test the value of the PRECISE-DAPT score, a standardized tool for DAPT duration decision-making, among patients undergoing complex PCI. Methods: Complex PCI was defined as 3 stents implanted and/or 3 lesions treated and/or bifurcation with 2 stents implanted and/or total stent length >60 mm and/or chronic total occlusion as target lesion. Ischemic and bleeding outcomes for patients with high (25) or non-high (<25) PRECISE-DAPT score were evaluated according to the presence or the absence of complex PCI. Results: Among 14,963 patients from the PRECISE-DAPT study population, a total of 3,118 patients underwent complex PCI. Consistent to the PRECISE-DAPT decision-making algorhythm, TIMI Bleeding were significantly increased by a longer DAPT treatment only in patients with a high PRECISE-DAPT score, with no heterogeneity among the group with or without complex PCI (Pint 0.89). Irrespective of PCI complexity, the composite ischemic endpoint was reduced with a longer DAPT treatment exclusively among patients with non-high score (noncomplex PCI: ARD -1.14%, 95% CI -2.26% to -0.02; complex PCI: ARD -3.86%, 95% CI -7.71% to +0.06) (Pint 0.19), whereas no advantage was observed in patients with high score (Pint 0.97). Net adverse clinical events (composite of ischemia and bleeding) in patients with complex PCI were significantly reduced by a longer DAPT treatment only in case of non-high score (ARD -4.05%, 95% CI -7.96% to -0.07), whereas no benefit was observed among patients at high score irrespective of PCI complexity (Pint 0.83).

Urinary Biomarkers of Oxidative Stress in Atrial Fibrillation

There is increasing evidence from molecular studies to support the role of inflammation and increased oxidative stress that produce structural and electrical atrial remodeling to produce Atrial Fbrillation (AF). Oxidative damage to cardiomyocytes yields chemical substances that are secreted in urine. These substances can serve as biomarkers that can be measured, potentially allowing clinicians to quantify oxidative damage to the heart.

Antithrombotic Therapy in Arterial Thrombosis and Thromboembolism in COVID-19

Antidiabetic drugs and hypoglycaemia risk in patients with atrial fibrillation treated with non-vitamin K antagonist oral anticoagulants

Journal Article Antidiabetic drugs and hypoglycaemia risk in patients with atrial fibrillation treated with non-vitamin K antagonist oral anticoagulants Get access Katarzyna Nabrdalik, Katarzyna Nabrdalik Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UKDepartment of Internal Medicine, Diabetology and Nephrology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland Search for other works by this author on: Oxford Academic Google Scholar Hanna Kwiendacz, Hanna Kwiendacz Department of Internal Medicine, Diabetology and Nephrology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland Search for other works by this author on: Oxford Academic Google Scholar Gregory Y H Lip Gregory Y H Lip Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UKDanish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark Corresponding author. Email: gregory.lip@liverpool.ac.uk Search for other works by this author on: Oxford Academic Google Scholar European Heart Journal - Cardiovascular Pharmacotherapy, Volume 9, Issue 5, August 2023, Pages 435–436, https://doi.org/10.1093/ehjcvp/pvad042 Published: 24 June 2023 Article history Received: 06 June 2023 Accepted: 12 June 2023 Corrected and typeset: 24 June 2023 Published: 24 June 2023

Prediction of electro-anatomical substrate and arrhythmia recurrences using APPLE, DR-FLASH and MB-LATER scores in patients with atrial fibrillation undergoing catheter ablation

Arrhythmia recurrences after catheter ablation of atrial fibrillation (AF) cause intensive treatment costs. Left atrial electro-anatomical remodeling measured as low voltage areas (LVA) during catheter ablation indicates advanced disease stage and is associated with poor ablation success. The aim of this study was to analyze the prediction of LVA and arrhythmia recurrences using APPLE, DR-FLASH and MB-LATER scores. APPLE, DR-FLASH scores were calculated at baseline and MB-LATER at 3 months post-ablation in AF patients undergoing first catheter ablation. LVA was determined using high-density maps and defined as <0.5 mV. Early (ERAF, <3 months) and late (LRAF, 3-12 months) were analyzed during follow-up. The study population included 241 patients (age 64 ± 11 years, 59% males, 59% persistent AF, 27% LVA, 27% LRAF). LVA were significantly associated with recurrences (OR 2.081, p = 0.026). While on univariable analysis, all scores were significantly associated with LVA, on multivariable analysis only APPLE (OR 1.789, p < 0.001) and DR-FLASH (OR 2.144, p < 0.001) remained significant predictors. However, MB-LATER (OR 1.445, p = 0.034) and ERAF (OR 5.078, p < 0.001) remained associated with LRAF on the multivariable analysis. These results were validated in a subgroup of 873 patients (age 61 ± 10, 63% males, 39% persistent AF, 34% LRAF, 27% LVA) from The Leipzig Heart Center AF Ablation Registry. All scores were significantly associated with recurrences. However, ERAF was the most powerful predictor for later rhythm outcomes. Summarizing, a clinical score useful for prediction for both LVA and rhythm outcomes in AF patients remains a clinical unmet need.

Oral anticoagulation in device-detected atrial fibrillation: effects of age, sex, cardiovascular comorbidities, and kidney function on outcomes in the NOAH-AFNET 6 trial

Meta-Analysis of Oral Anticoagulant Monotherapy as an Antithrombotic Strategy in Patients With Stable Coronary Artery Disease and Nonvalvular Atrial Fibrillation

Author response for "Revisiting “Intensive” Blood Glucose Control: A Causal Directed Acyclic Graph‐guided Systematic Review of Randomized Controlled Trials"