1,138 research outputs found
ESC and EHRA lead a path towards integrated care for multimorbid atrial fibrillation patients:the Horizon 2020 EHRA-PATHS project
Maxillary and Mandibular Dental-Arch Dimensions and Occlusion in Bilateral Cleft Lip and Palate Patients from 3 to 17 Years of Age
Knowledge gaps in patients with venous thromboembolism : usefulness of a new questionnaire
The current awareness of venous thromboembolism (VTE) and knowledge of thromboprophylaxis
among patients receiving oral anticoagulation therapy (OAC) are insufficient. We sought to develop and evaluate the usefulness of the Jessa AF Knowledge Questionnaire
(JAKQ), modified for VTE patients. Consecutive patients at least 1 month since the VTE event (n = 273, mean
[SD] age, 51 [17] years; 52.7%, women; 55.9%, unprovoked event) were enrolled to the study. The median percentage of correct responses was 64.2% (interquartile range, 53%-73%; minimum,
12%; maximum, 100%). Younger patients had better knowledge about VTE in general, including a higher
proportion of correct responses to the question about the definition of PE (71.4% vs 57.7%, P = 0.03),
about the possible consequence of DVT, including PE (81.1% vs 62%, P = 0.001) and VTE risk related to
long travels (78.1% vs 59.2%, P = 0.002). There was no difference in overall scoring between patients
taking new oral anticoagulants and those taking vitamin K antagonists (mean [SD], 64.1% [16.3%] vs
63.9% [13.8%], respectively, P = 0.7). Regardless of the type of anticoagulants, 39.3% of patients knew
that VTE is not always symptomatic, 33.6% knew what to do when they missed an OAC dose, and 50%
did not know which painkillers are the safest in combination with anticoagulants. Education applied
in 27 patients resulted in an increase in the median percentage of correct responses from 60% to 80%
(P = 0.0001). Knowledge on VTE and anticoagulation is suboptimal among patients on VKA and NOACs.
Education of VTE patients should be improved especially in older individuals on NOACs
The U.S. Law of Client Confidentiality: Framework for an International Perspective
In this Article, I will consider two general areas of the U.S. law of confidentiality. In Part I, I will reflect briefly upon what I call “the U.S. culture of lawyer-client confidentiality.” I say “culture” rather than “cult,” and one must guard against temptations to confuse those concepts. Those reflections will serve as background—by way of both match and contrast—to my sketch of the U.S. law of confidentiality in Part II
COMPUTED TOMOGRAPHY AND MAGNITEC RESONANCE FINDINGS IN ATHLETES AT RISK FOR SUDDEN CARDIAC DEATH
EuroEco (European Health Economic Trial on Home Monitoring in ICD Patients): a provider perspective in five European countries on costs and net financial impact of follow-up with or without remote monitoring
Aim: Remote follow-up (FU) of implantable cardiac defibrillators (ICDs) allows for fewer in-office visits in combination with earlier detection of relevant findings. Its implementation requires investment and reorganization of care. Providers (physicians or hospitals) are unsure about the financial impact. The primary end-point of this randomized prospective multicentre health economic trial was the total FU-related cost for providers, comparing Home Monitoring facilitated FU (HM ON) to regular in-office FU (HM OFF) during the first 2 years after ICD implantation. Also the net financial impact on providers (taking national reimbursement into account) and costs from a healthcare payer perspective were evaluated.
Methods and results: Atotal of 312 patients with VVI-or DDD-ICD implants from 17 centres in six EU countries were randomised to HMON or OFF, of which 303 were eligible for data analysis. For all contacts (in-office, calendar-or alert-triggered web-based review, discussions, calls) time-expenditure was tracked. Country-specific cost parameters were used to convert resource use into monetary values. Remote FU equipment itself was not included in the cost calculations. Given only two patients from Finland (one in each group) a monetary valuation analysis was not performed for Finland. Average age was 62.4 +/- 13.1 years, 81% were male, 39% received a DDD system, and 51% had a prophylactic ICD. Resource use with HM ON was clearly different: less FU visits (3.79 +/- 1.67 vs. 5.53 +/- 2.32; P < 0.001) despite a small increase of unscheduled visits (0.95 +/- 1.50 vs. 0.62 +/- 1.25; P < 0.005), more non-office-based contacts (1.95+3.29 vs. 1.01 +/- 2.64; P < 0.001), more Internet sessions (11.02 +/- 15.28 vs. 0.06 +/- 0.31; P < 0.001) and more in-clinic discussions (1.84 +/- 4.20 vs. 1.28 +/- 2.92; P < 0.03), but with numerically fewer hospitalizations (0.67 +/- 1.18 vs. 0.85 +/- 1.43, P = 0.23) and shorter length-of-stay (6.31 +/- 15.5 vs. 8.26 +/- 18.6; P = 0.27), although not significant. For the whole study population, the total FU cost for providers was not different for HM ON vs. OFF [mean (95% CI): (sic)204 169-238) vs. (sic)213 (182-243); range for difference ((sic)-36 to 54), NS]. From a payer perspective, FU-related costs were similar while the total cost per patient (including other physician visits, examinations, and hospitalizations) was numerically (but not significantly) lower. There was no difference in the net financial impact on providers [profit of (sic)408 (327-489) vs. (sic)400 (345-455); range for difference ((sic)-104 to 88), NS], but there was heterogeneity among countries, with less profit for providers in the absence of specific remote FU reimbursement (Belgium, Spain, and the Netherlands) and maintained or increased profit in cases where such reimbursement exists (Germany and UK). Quality of life (SF-36) was not different.
Conclusion: For all the patients as a whole, FU-related costs for providers are not different for remote FU vs. purely in-office FU, despite reorganized care. However, disparity in the impact on provider budget among different countries illustrates the need for proper reimbursement to ensure effective remote FU implementation
Edoxaban vs. warfarin in patients with atrial fibrillation on amiodarone: a subgroup analysis of the ENGAGE AF-TIMI 48 trial
Background In the ENGAGE AF-TIMI 48 trial, the higher-dose edoxaban (HDE) regimen had a similar incidence of ischaemic stroke compared with warfarin, whereas a higher incidence was observed with the lower-dose regimen (LDE). Amiodarone increases edoxaban plasma levels via P-glycoprotein inhibition. The current pre-specified exploratory analysis was performed to determine the effect of amiodarone on the relative efficacy and safety profile of edoxaban. Methods and results At randomization, 2492 patients (11.8%) were receiving amiodarone. The primary efficacy endpoint of stroke or systemic embolic event was significantly lower with LDE compared with warfarin in amiodarone treated patients vs. patients not on amiodarone (hazard ratio [HR] 0.60, 95% confidence intervals [CIs] 0.36-0.99 and HR 1.20, 95% CI 1.03-1.40, respectively; P interaction <0.01). In patients randomized to HDE, no such interaction for efficacy was observed (HR 0.73, 95% CI 0.46-1.17 vs. HR 0.89, 95% CI 0.75-1.05, P interaction = 0.446). Major bleeding was similar in patients on LDE (HR 0.35, 95% CI 0.21-0.59 vs. HR 0.53, 95% CI 0.46-0.61, P interaction = 0.131) and HDE (HR 0.94, 95% CI 0.65-1.38 vs. HR 0.79, 95% CI 0.69-0.90, P interaction = 0.392) when compared with warfarin, independent of amiodarone use. Conclusions Patients randomized to the LDE treated with amiodarone at the time of randomization demonstrated a significant reduction in ischaemic events vs. warfarin when compared with those not on amiodarone, while preserving a favourable bleeding profile. In contrast, amiodarone had no effect on the relative efficacy and safety of HD
Physical activity and incidence of atrial fibrillation: A systematic review and meta-analysis
Whether physical activity increases or decreases the risk of atrial fibrillation (AF) remains controversial. We conducted a systematic review and meta-analysis to evaluate the relationship between AF and extent of physical activity. We searched Medline and EMBASE in June 2014 for studies that reported on the associated risk of AF according to history of physical activity. Pooled risk ratios for AF were calculated using inverse variance random effects model, and heterogeneity assessed using I2. Subgroup analysis was performed according to the nature of the physical activity, and the quality of the studies. We identified 19 relevant studies with a total of over half a million participants (n = 511,503). The pooled analysis showed no association between intensive physical activity and AF (RR 1.00 95% CI 0.82–1.22, I2 = 73%, 8 studies, 152,925 participants) with no difference considering low and moderate to high risk of bias studies. Pooled analysis of studies reporting on increasing amount of time spent on physical activities did not show a significant association with AF (RR 0.95 95% CI 0.72–1.26, I2 = 84%, 4 studies, 112,784 participants). Studies of athletes or participants with a history of sports activity which were of poor methodology quality showed a borderline significant association with AF (pooled RR 1.98 95% CI 1.00–3.94, I2 = 59%, 6 studies, 1973 participants). In conclusion, we found no significant increase in AF with a higher level of physical activity. These findings support clinical guidelines encouraging patients to exercise as there is no evidence for harm associated with increased physical activity
Baseline demographics of a contemporary Belgian atrial fibrillation cohort included in a large randomised clinical trial on targeted education and integrated care (AF-EduCare/AF-EduApp study)
BackgroundAs the prevalence of atrial fibrillation (AF) increases worldwide and AF management becomes ever more diversified and personalised, insights into (regional) AF patient demographics and contemporary AF management are needed. This paper reports the current AF management and baseline demographics of a Belgian AF population recruited for a large multicenter integrated AF study (AF-EduCare/AF-EduApp study).MethodsWe analyzed data from 1,979 AF patients, assessed between 2018 and 2021 for the AF-EduCare/AF-EduApp study. The trial randomised consecutive patients with AF (irrespective of AF history duration) into three educational intervention groups (in person-, online-, and application-based), compared with standard care. Baseline demographics of both the included and excluded/refused patients are reported.ResultsThe mean age of the trial population was 71.2 ± 9.1 years, with a mean CHA2DS2-VASc score of 3.4 ± 1.8. Of all screened patients, 42.4% were asymptomatic at presentation. Being overweight was the most common comorbidty, present in 68.9%, while 65.0% were diagnosed with hypertension. Anticoagulation therapy was prescribed in 90.9% of the total population and in 94.0% of the patients with an indication for thromboembolic prophylaxis. Of the 1,979 assessed AF patients, 1,232 (62.3%) were enrolled in the AF-EduCare/AF-EduApp study, with transportation problems (33.4%) as the main reason for refusal/non-inclusion. About half of the included patients were recruited at the cardiology ward (53.8%). AF was first diagnosed, paroxysmal, persistent and permanent in 13.9%, 47.4%, 22.8% and 11.3%, respectively. Patients who refused or were excluded were older (73.3 ± 9.2 vs. 69.8 ± 8.9 years, p < 0.001) and had more comorbidities (CHA2DS2-VASc 3.8 ± 1.8 vs. 3.1 ± 1.7, p < 0.001). The four AF-EduCare/AF-EduApp study groups were comparable across the vast majority of parameters.ConclusionsThe population showed high use of anticoagulation therapy, in line with current guidelines. In contrast to other AF trials about integrated care, the AF-EduCare/AF-EduApp study managed to incorporate all types of AF patients, both out-patient and hospitalised, with very comparable patient demographics across all subgroups. The trial will analyze whether different approaches to patient education and integrated AF care have an impact on clinical outcomes.Clinical Trial Registrationhttps://clinicaltrials.gov/ct2/show/NCT03707873?term=af-educare&draw=2&rank=1, identifier: NCT03707873; https://clinicaltrials.gov/ct2/show/NCT03788044?term=af-eduapp&draw=2&rank=1, identifier: NCT03788044
- …