Publications

Data on the management of atrial fibrillation (AF) in the Balkan Region are limited. The Serbian AF Association (SAFA) prospectively investigated contemporary 'real-world' AF management in clinical practice in Albania, Bosnia&Herzegovina, Bulgaria, Croatia, Montenegro, Romania and Serbia through a 14-week (December 2014-February 2015) prospective, multicentre survey of consecutive AF patients. We report the results pertinent to stroke prevention strategies. Of 2712 enrolled patients, 2663 (98.2%) with complete data were included in this analysis (mean age 69.1 ± 10.9 years, female 44.6%). Overall, 1960 patients (73.6%) received oral anticoagulants (OAC) and 762 (28.6%) received antiplatelet drugs. Of patients given OAC, 17.2% received non-vitamin K antagonist oral anticoagulants (NOACs). CHA2DS2-VASc score was not significantly associated with OAC use. Of the 'truly low-risk' patients (CHA2DS2-VASc = 0 [males], or 1 [females]) 56.5% received OAC. Time in Therapeutic Range (TTR) was available in only 18.7% of patients (mean TTR: 49.5% ± 22.3%). Age ≥ 80 years, prior myocardial infarction and paroxysmal AF were independent predictors of OAC non-use. Our survey shows a relatively high overall use of OAC in AF patients, but with low quality of vitamin K antagonist therapy and insufficient adherence to AF guidelines. Additional efforts are needed to improve AF-related thromboprophylaxis in clinical practice in the Balkan Region.

An official journal of the European Society of Cardiology. Publishes top quality European and international original scientific work and reviews in the fields of Arrhythmias, Pacing and Cellular Electrophysiology.

NCT00041938.

Birth in spring or summer is associated with a higher risk of cardiovascular mortality in male AF patients, but not in females. This could be related to the underlying differences in rates of major adverse clinical events between genders. Further studies should aim at clarifying the mechanisms behind this association, which may help us understand the higher level of risk in female patients with AF.

Appendix: Towards Assigning Diagnosis Codes using Medication History

This study-based meta-analysis shows that it may be both safer and more effective to use NOACs compared with VKAs to treat patients with nonvalvular atrial fibrillation and concomitant aspirin therapy.

Measurement of BNP, CRP, and eGFR were incrementally additive to clinical risk factors in a cumulative manner to improve prediction of arrhythmia recurrence post-CA of AF. The implications of poor arrhythmia outcome in AF patients with multiple abnormal biomarkers pre-CA procedure may help with patient selection and inform the likelihood of success or the need of more complicated CA procedure(s).

Diagnosis assignment is the process of assigning disease codes to patients. Automatic diagnosis assignment has the potential to validate code assignments, correct erroneous codes, and register completion. Previous methods build on text-based techniques utilizing medical notes but are inapplicable in the absence of these notes. We propose using patients' medication data to assign diagnosis codes. We present a proof-of-concept study using medical data from an American dataset (MIMIC-III) and Danish nationwide registers to train a machine-learning-based model that predicts an extensive collection of diagnosis codes for multiple levels of aggregation over a disease hierarchy. We further suggest a specialized loss function designed to utilize the innate hierarchical nature of the disease hierarchy. We evaluate the proposed method on a subset of 567 disease codes. Moreover, we investigate the technique's generalizability and transferability by (1) training and testing models on the same subsets of disease codes over the two medical datasets and (2) training models on the American dataset while evaluating them on the Danish dataset, respectively. Results demonstrate the proposed method can correctly assign diagnosis codes on multiple levels of aggregation from the disease hierarchy over the American dataset with recall 70.0% and precision 69.48% for top-10 assigned codes; thereby being comparable to text-based techniques. Furthermore, the specialized loss function performs consistently better than the non-hierarchical state-of-the-art version. Moreover, results suggest the proposed method is language and dataset-agnostic, with initial indications of transferability over subsets of disease codes.

On the basis of data from this large-scale prospective cohort study, elevated RC was associated with a lower risk of incident AF.

The first international guidance on antithrombotic therapy in the elderly came from the European Society of Cardiology Working Group on Thrombosis in 2015. This same group has updated its previous report on antiplatelet and anticoagulant drugs for older patients with acute or chronic coronary syndromes, atrial fibrillation, or undergoing surgery or procedures typical of the elderly (transcatheter aortic valve implantation and left atrial appendage closure). The aim is to provide a succinct but comprehensive tool for readers to understand the bases of antithrombotic therapy in older patients, despite the complexities of comorbidities, comedications and uncertain ischaemic- vs. bleeding-risk balance. Fourteen updated consensus statements integrate recent trial data and other evidence, with a focus on high bleeding risk. Guideline recommendations, when present, are highlighted, as well as gaps in evidence. Key consensus points include efforts to improve medical adherence through deprescribing and polypill use; adoption of universal risk definitions for bleeding, myocardial infarction, stroke and cause-specific death; multiple bleeding-avoidance strategies, ranging from gastroprotection with aspirin use to selection of antithrombotic-drug composition, dosing and duration tailored to multiple variables (setting, history, overall risk, age, weight, renal function, comedications, procedures) that need special consideration when managing older adults.