| 1. |
- Camm, A. J., et al.
(författare)
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The changing circumstance of atrial fibrillation : progress towards precision medicine
- 2016
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Ingår i: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 279:5, s. 412-427
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Forskningsöversikt (refereegranskat)abstract
- The prevalence of atrial fibrillation (AF) in the general population is between 1% and 2% in the developed world and is higher in men than in women. The arrhythmia occurs much more commonly in the elderly, and the estimated lifetime risk of developing AF is one in four for men and women aged 40 years and above. Projected data from multiple population-based studies in the USA and Europe predict a two- to threefold increase in the number of AF patients by 2060. The high lifetime risk of AF and increased longevity underscore the important public health burden posed by this arrhythmia worldwide. AF has multiple aetiologies and a broad variety of presentations. The primary pathologies underlying or promoting the occurrence of AF vary more than for any other cardiac arrhythmia, ranging from autonomic imbalance to organic heart disease and metabolic disorders, such as diabetes mellitus, metabolic syndrome, hyperthyroidism and kidney disease, and lifestyle factors such as smoking, alcohol consumption and participation in endurance sports. Biomarkers are increasingly being investigated and, together with clinical and genetic factors, will eventually lead to a clinically valuable detailed classification of AF which will also incorporate pathophysiological determinants and mechanisms of the arrhythmia. In turn, this will allow the development and application of precision medicine to this troublesome arrhythmia.
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| 3. |
- Lip, G. Y. H., et al.
(författare)
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A tailored treatment strategy : a modern approach for stroke prevention in patients with atrial fibrillation
- 2016
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Ingår i: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 279:5, s. 467-476
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Forskningsöversikt (refereegranskat)abstract
- The main priority in atrial fibrillation (AF) management is stroke prevention, following which decisions about rate or rhythm control are focused on the patient, being primarily for management of symptoms. Given that AF is commonly associated with various comorbidities, risk factors such as hypertension, heart failure, diabetes mellitus and sleep apnoea should be actively looked for and managed in a holistic approach to AF management. The objective of this review is to provide an overview of modern AF stroke prevention with a focus on tailored treatment strategies. Biomarkers and genetic factors have been proposed to help identify high-risk' patients to be targeted for oral anticoagulation, but ultimately their use must be balanced against that of more simple and practical considerations for everyday use. Current guidelines have directed focus on initial identification of truly low-risk' patients with AF, that is those patients with a CHA(2)DS(2)-VASc [congestive heart failure, hypertension, age 75years (two points), diabetes mellitus, stroke (two points), vascular disease, age 65-74years, sex category] score of 0 (male) or 1 (female), who do not need any antithrombotic therapy. Subsequently, patients with 1 stroke risk factors can be offered effective stroke prevention, that is oral anticoagulation. The SAMe-TT2R2 [sex female, age <60years, medical history (>2 comorbidities), treatment (interacting drugs), tobacco use (two points), race non-Caucasian (two points)] score can help physicians make informed decisions on those patients likely to do well on warfarin (SAMe-TT2R2 score 0-2) or those who are likely to have a poor time in therapeutic range (SAMe-TT2R2 score >2). A clinically focused tailored approach to assessment and stroke prevention in AF with the use of the CHA(2)DS(2)VASc, HAS-BLED [hypertension, abnormal renal/liver function (one or two points), stroke, bleeding history or predisposition, labile international normalized ratio, elderly (>65years) drugs/alcohol concomitantly (one or two points)] and SAMeTT(2)R(2) scores to evaluate stroke risk, bleeding risk and likelihood of successful warfarin therapy, respectively, is discussed.
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