Arrhythmias in Pregnancy
Afshan B. Hameed, Diana S. Wolfe in Cardio-Obstetrics, 2020
There is an increasing incidence of atrial fibrillation in pregnancy, with recent literature citing it as being the leading cause of hospital admissions among sustained arrhythmias in pregnancy [21]. Risk factors include older age, obstructive sleep apnea, underlying congenital heart disease, and hypertension [21]. Pregnancy-associated atrial fibrillation is also known as lone atrial fibrillation, that is, without a prior history of atrial fibrillation outside of pregnancy and no structural heart disease. These episodes of atrial fibrillation are usually self-limited with low risk of embolic events. There appears to be a high variability in the interventions and care in this group [22]. The general basis of treatment of atrial fibrillation is heart rate/rhythm control, and prevention of stroke.
Risks and Rates
Peter Cummings in Analysis of Incidence Rates, 2019
In a closed population we can often estimate both risks and rates. Sometimes risks may have clearer or more useful interpretations. Atrial fibrillation is an irregular heart rhythm which is often fast and uncomfortable. Five hypothetical patients come to your emergency department with new atrial fibrillation and to fix this you administer Drug A intravenously for up to 30 minutes (Figure 2.5). All patients reverted to normal rhythm within 30 minutes, an incidence proportion of 1. The rate of conversion to normal rhythm for Drug A was 60 × 5/(22 + 27 + 21 + 24 + 25) = 2.5 conversion events per person-hour. For the next five patients who present with this problem you decide to use newer Drug B. The rate for Drug B was superior, 60 × 3/(3 + 4 + 2 + 30 + 30) = 2.6 conversions to normal rhythm per person-hour, but the incidence proportion for conversion was only .6. If Drug B works, it does so quickly, but Drug A yielded a greater overall proportion with normal rhythm after 30 minutes. For the average patient, all other things being equal (cost, side effects) Drug A produced a better result. In this example, a comparison based upon risks (incidence proportion), rather than rates, may be preferred.
Making evidence-based practice happen in ‘real world’ contexts
Martin Lipscomb in Exploring Evidence-based Practice, 2015
Here, we examine the role of partnerships in EBP with a particular focus upon collaborative research teams. We address how partnerships are initiated and developed and examine some of the practical considerations associated with these partnerships. We draw upon our experiences of developing a collaborative research team exploring the management of atrial fibrillation in rural and northern Canada. Atrial fibrillation is a type of irregular heartbeat that is associated with very high increases in death and disability, including a 500% increase in stroke risk (Heart and Stroke Foundation of Canada, 2014). The management of atrial fibrillation and its associated risks requires input from a wide range of healthcare providers across many community and specialist settings. There is very little literature that has examined the management of atrial fibrillation in rural settings and our team has been working to undertake exploratory studies to examine patient, provider and health service issues. Our research team comprises a broad range of researchers and knowledge users, including decision makers, interdisciplinary healthcare providers from a range of community and specialty contexts, policy makers and a patient expert. The team has developed over the past three years, initially for a qualitative study to explore the experiences of healthcare providers managing atrial fibrillation in rural communities but, more recently, has expanded into a tri-provincial Canadian partnership to collaborate on a wider range of research and clinical initiatives. In this chapter, we present some examples of our ‘living partnership’ and will reflect on some of the lessons learned to date.
Predictors of cognitive dysfunction in hereditary transthyretin amyloidosis with liver transplant
Published in Amyloid, 2023
Sara Cavaco, Ana Martins da Silva, Joana Fernandes, Ana Paula Sousa, Cristina Alves, Márcio Cardoso, Armando Teixeira-Pinto, Teresa Coelho
A total of 269 patients were included in the study (Table 1). Fifty-five percent were male and the median (minimum–maximum): age was 45 years old (28–75), education was 7 years (4–21), age at disease onset was 30 years old (19–57), disease duration was 14 years (4–30), disease duration post-LT duration was 10 years (0–40) and mPND score was 2 (0–4). Atrial flutter or atrial fibrillation was identified in 13 patients (5.2%). Thirty-five patients (13%) had cognitive dysfunction and the remaining 234 patients (87%) had normal cognition. The cognitive dysfunction group was divided into two subgroups according to the level of dysfunction: 14 (5%) had mild cognitive dysfunction and 21 (8%) had moderate cognitive dysfunction. The frequency of deficits on each measure per each cognitive status group is presented in Supplementary Table S1.
Motivation of overweight patients with atrial fibrillation to lose weight or to follow a weight loss management program: a cross-sectional study
Published in Acta Cardiologica, 2021
Michiel Delesie, Lien Desteghe, Marianne Bertels, Noor Gerets, Florence Van Belleghem, Jasper Meyvis, Ivan Elegeert, Paul Dendale, Hein Heidbuchel
Recent data showed that lifestyle and cardiovascular risk factor management is becoming an increasingly important aspect to optimise outcomes in atrial fibrillation (AF) patients and especially in obese AF patients [1]. It is shown that an increased body mass index (BMI) is independently associated with the progression from paroxysmal to permanent AF [2]. Risk factor management, weight reduction and more exercise can improve AF burden, symptoms, success rates of rhythm restoring procedures and the quality of life in these patients [3–5]. A recent meta-analysis in AF patients with overweight or obesity, evidenced that already modest (≥10%) weight loss is associated with less recurrent AF, improvement in AF burden and lower AF symptom severity [6]. Despite this evidence, it is very hard in daily practice to convince and motivate overweight/obese AF patients to take care of their weight and to improve their cardiorespiratory fitness. Although some hospitals offer rehabilitation programs for these patients, only a minority of the AF patients is included in these programs. Moreover, in many countries, reimbursement for rehabilitation of AF patients is non-existent, or as in Belgium, is restricted to patients who underwent an invasive cardiac procedure or who were recently admitted to the hospital with heart failure.
Reducing treatment toxicity in Waldenström macroglobulinemia
Published in Expert Opinion on Drug Safety, 2021
Shayna Sarosiek, Steven P. Treon, Jorge J. Castillo
Atrial fibrillation, one of the most concerning side effects with ibrutinib, has a time to onset that ranges from a few months to more than a year. Although atrial fibrillation risk persists throughout treatment, the variation in time of onset is likely related to the individual patient’s preexisting cardiac conditions [46,47]. As previously reported, the median time of onset was 4 months in patients with a history of atrial fibrillation but 33 months in those with no history of atrial fibrillation [47]. If atrial fibrillation develops, the patient’s stroke risk should be determined. If anticoagulation is required, a thorough assessment of bleeding risk should be completed before starting anticoagulation due to the increased risk of bleeding associated with BTK inhibitors. If it is deemed safe to initiate anticoagulation or if the patient is already on anticoagulation at the time of ibrutinib initiation, direct oral anticoagulants should be preferentially chosen. Concurrent use of vitamin K antagonists was an exclusion criterion in prior trials, so safety data are not available. Despite the paucity of evidence, warfarin may potentially be used in combination with ibrutinib if other treatment options do not exist, a discussion of risks and benefits is performed, and the patient is very closely monitored. Although new atrial fibrillation does not necessitate cessation of therapy, a dose reduction or temporary hold in therapy may occur, while initial treatment of the arrhythmia is facilitated. If clinically indicated, cardiac amyloidosis should be exonerated.
Related Knowledge Centers
- Angina
- Arrhythmia
- Atrial Flutter
- Cardiac Cycle
- Fibrillation
- Lightheadedness
- Palpitations
- Shortness of Breath
- Syncope
- Atrium
- Shortness of Breath