2,697 publications from this institution
Increased number of healthy lifestyle behaviors was significantly associated with lower MACE risk in patients with new-onset AF. These findings support the promotion of a healthy lifestyle to reduce the risk of adverse events in patients with AF.
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Affecting millions of people worldwide, heart failure (HF) is a complex clinical syndrome characterized by the insufficiency of the heart to pump and meet the metabolic demands of the body. HF is a significant public health issue that should be at the forefront of everyone's agenda. Recognized as an endpoint for a vast number of conditions of a cardiovascular and non-cardiovascular nature, the prevalence of HF is projected to increase significantly owing to an ageing population, an increase in risk factors and associated long-term conditions such as obesity, diabetes, chronic obstructive pulmonary disease (COPD), chronic kidney disease and hypertension. On the 9th of March 2023 at the 25in25 Summit, convened by the British Society for Heart Failure (BSH), stakeholders hailing from more than 48 health organizations and specialities from the UK, US, Canada and Europe, met, discussed and signed collaboratively a declaration to reduce HF mortality in the first year after diagnosis by 25% in the next 25 years. There is evidence that nearly 50% of patients exhibit symptoms and signs of HF in the 6 months preceding acute HF hospitalization, reflecting crucial missed opportunities for earlier intervention.2, 3 Despite a plethora of life-saving treatments for patients living with HF, the combination of a lack of awareness, late diagnosis, and delayed access to specialists results in 50% of patients dying within a year of admission to hospital, and 40% of newly diagnosed patients dying within a year (NICOR 2021). It is our aim as a Society to empower clinicians and patients with the skills for early detection of suspected HF and to improve prevention, as well as better management of the condition, to reach the afore-mentioned goal of 25in25. The BSH ‘Freedom from Failure – the F-word’ campaign, calling for (self) recognition of common symptoms of HF – fatigue, fighting for breath and fluid build-up (shown in the illustration) and seeking medical advice, is a means to raise awareness of the symptoms and signs of HF. Utilizing the BSH ‘F-word’ campaign, we have outlined some case studies to help recognize symptoms in our patients, ourselves and others. Each of these symptoms (and in combination) presenting in any health setting is an opportunity for early detection of HF. Detecting the undetected is crucial and implementing strategies for early detection can significantly reduce mortality rates and other adverse outcomes in HF. Achieving a 25% reduction in mortality within 25 years will require a concerted, collaborative effort, hence the establishment of the 25in25 Collaborative comprising all those involved in the initiative and the Summit. The theme across Europe for this year's Heart Failure Awareness Week (HFAW), 1–7 May, is ‘Detecting the Undetected’. HF is hidden in plain sight as illustrated in the cases above, it is our collective responsibility to seek it out earlier and treat optimally to give those with HF a better chance.
<b>Introduction</b>: The non-vitamin K antagonist oral anticoagulants (NOACs) are changing the landscape for stroke prevention in atrial fibrillation (AF) and prevention or treatment of venous thromboembolism (VTE). In patients with AF and concomitant acute coronary syndrome (ACS), the treatment regimen of combined NOACs and P2Y<sub>12</sub> inhibitors is gaining popularity.<b>Areas covered</b>: We conducted a review of safety evaluation and effectiveness of apixaban for AF and ACS treatment, both alone and in combination with different antiplatelet treatment regimens. The aim was to provide an overview of apixaban including mechanism of action, indications, adverse events and tolerability.<b>Expert opinion</b>: Apixaban is recommended as a safe, well tolerated and effective oral anticoagulant for reducing the risk of ischemic events among AF patients. It is of value in prevention and treatment of VTE and pulmonary embolism. Comparing to VKA, apixaban was superior in preventing stroke or systemic embolism with lower major bleeding events among AF patients. When combined with dual antiplatelet therapy apixaban may cause dose-related increase in bleeding which reduces the benefit of this treatment regimen among ACS patients but without AF. In those with ACS and concomitant AF, the combination of apixaban with P2Y<sub>12</sub> inhibitor appears to be safe and effective.
Among newly anticoagulated NVAF patients in the real-world setting, initiation with rivaroxaban or warfarin was associated with a significantly greater risk of major bleeding compared with initiation on apixaban. When compared with warfarin, initiation with apixaban was associated with significantly lower risk of major bleeding. Additional observational studies are required to confirm these findings.
People with chronic heart failure (HF) are at risk of thromboembolic events, including stroke, pulmonary embolism, and peripheral arterial embolism; coronary ischaemic events also contribute to the progression of HF. The use of long-term oral anticoagulation is established in certain populations, including people with HF and atrial fibrillation (AF), but there is wide variation in the indications and use of oral anticoagulation in the broader HF population.
