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5. Prognosis, disease progression, and treatment of atrial fibrillation patients during 1 year: follow-up of the Euro Heart Survey on Atrial Fibrillation

Author

Nieuwlaat R., Prins M. H., Le Heuzey J. -Y., Vardas P. E., Aliot E., Santini M., Cobbe S. M., Widdershoven J. W. M. G., Baur L. H., Levy S., Crijns H. J. G. M., Olsson B., Breithardt G., Manini M., Bramley C., Laforest V., Taylor C., Del Gaiso S., Huber K., De Backer G., Sirakova V., Cerbak R., Thayssen P., Lehto S., Blanc J. -J., Delahaye F., Kobulia B., Zeymer U., Cokkinos D., Karlocai K., Graham I., Shelley E., Behar S., Maggioni A., Goncalves L., Grabauskiene V., Asmussen I., Deckers J., Stepinska J., Mareev V., Vasiljevic Z., Riecansky I., Kenda M. F., Alonso A., Lopez-Sendon J. L., Rosengren A., Buser P., Okay T., Sychov O., Fox K., Schofield P., Simoons M., Wood D., Battler A., Boersma E., Komajda M., Andresen D., McGregor K., Mulder B., Priori S., Ryden L., Vahanian A., Wijns W., Sanofi-Aventis, Grigoryan S. V., Apetyan I., Aroyan S., Camm A. J., Azarapetyan L., Anvari A., Gottsauner-Wolf M., Pfaffenberger S., Aydinkoc K., Kalla K., Penka M., Drexel H., Langer P., Pierard L. A., Davies W., Legrand V., Blommaert D., Schroeder E., Mancini I., Geelen P., Brugada P., De Zutter M., Vrints C., Vercammen M., Morissens M., Capucci A., Borisov B., Petrov V. A., Marinova M., Assen A., Goudev R., Peychev Y., Stoyanovsky V., Stoynev E., Kranjcevic S., Moutiris J., Ioannides M., Evequoz D., Spacilova J., Novak M., Eisenberger M., Mullerova J., Kautzner J., Riedlbauchova L., Petru` J., Taborsky M., Cappelen H., Sharaf Y. A., Ibrahim B. S. S., Tammam K., Saad A., Elghawaby H., Sherif H. Z., Farouk H., Mielke A., Engelen M., Kirchhof P., Zimmermann P., Aviles F. F., Rubio J., Malpartida F., Corona M., Sanchez L. T., Miguel J., Herrera L., Quesada A., Garcia A. J. M., Gonzalez C. S., Juango M. S. A., Berjon-Reyero J., Alegret J. M., Fernandez J. M. C., Carrascosa C., Romero R. A. F., Lara M. G., Sendon J. L. L., de Diego J. J. G., Martin L. S., Irurita M., Guttierez N. H., Rubio J. R. S., Antorrena I., Paves A. B., Salvador A., Orriach M. D., Garcia A. A., Epelde F., Martinez V. B., Sanchez A. B., Galvez C. P., Rivero R. F., Madrid A. H., Baron-Esquivias G., Peinado R., Guindal J. A. G., Vera T. R., Fernandez E. L., Gayan R., Garcia J., Bodegas A., Lopez J. T., Florez J. M., Cabezas C. L., de Castroviejo E. V. R., Bellido J. M., Ruiz M. E., Savolainen K., Nieminen M., Toivonen L., Syvanne M., Pietila M., Galley D., Beltra C., Gay A., Daubert J. C., Lecocq G., Poulain C., Cleland J. G. F. C., Shelton R., Choudhury A., Abuladze G., Jashi I., Tsiavou A., Giamouzis G., Dagres N., Kostopoulou A., Tsoutsanis D., Stefanadis C., Latsios G., Vogiatzis I., Gotsis A., Bozia P., Karakiriou M., Koulouris S., Parissis J., Kostakis G., Kouris N., Kontogianni D., Athanasios K., Douras A., Tsanakis T., Marketou M., Patsourakos N., Czopf L., Halmosi R., Preda I., Csoti E., Badics A., Strasberg B., Freedberg N. A., Katz A., Zalzstein E., Grosbard A., Goldhammer E., Nahir M., Epstein M., Vider I., Luria D., Mandelzweig L., Aloisi B., Cavallaro A., Antonielli E., Doronzo B., Pancaldo D., Mazzola C., Buontempi L., Calvi V., Giuffrida G., Figlia A., Ippolito F., Gelmini G. -P., Gaibazzi N., Ziacchi V., De Tommasi F., Lombardi F., Fiorentini C., Terranova P., Maiolino P., Albunni M., Pinna-Pintor P., Fumagalli S., Masotti G., Boncinelli L., Rossi D., Santoro G. M., Fioranelli M., Naccarella F., Maranga S. S., Lepera G., Bresciani B., Seragnoli E., Forti M. C., Cortina V., Baciarello G., Cicconetti P., Lax A., Vitali F., Igidbashian D., Scarpino L., Terrazzino S., Tavazzi L., Cantu F., Pentimalli F., Novo S., Coppola G., Zingarini G., Ambrozio G., Moruzzi P., Callegari S., Saccomanno G., Russo P., Carbonieri E., Paino A., Zanetta M., Barducci E., Cemin R., Rauhe W., Pitscheider W., Meloni M., Marchi S. M., Di Gennaro M., Calcagno S., Squaratti P., Quartili F., Bertocchi P., De Martini M., Mantovani G., Komorovsky R., Desideri A., Celegon L., Tarantini L., Catania G., Lucci D., Bianchini F., Puodziukynas A., Kavoliuniene A., Barauskiene V., Aidietis A., Barysiene J., Vysniauskas V., Zukauskiene I., Kazakeviciene N., Georgievska-Ismail L., Poposka L., Vataman E., Grosu A. A., op Reimer W. S., de Swart E., Lenzen M., Jansen C., Brons R., Tebbe H., van Hoogenhuyze D. C. A., Veerhoek M. J., Kamps M., Haan D., van Rijn N., Bootsma A., van den A., Fransen H., Eurlings L., Meeder J., De Boer M. J., Winter J., Broers H., Werter C., Bijl M., Versluis S., Milkowska M., Wozakowska-Kaplon B., Janion M., Lepska L., Swiatecka G., Kokowicz P., Cybulski J., Gorecki A., Szulc M., Rekosz J., Manczak R., Wnuk-Wojnar A. -M., Trusz-Gluza M., Rybicka-Musialik A., Myszor J., Szpajer M., Cymerman K., Sadowski J., Sniezek-Maciejewska M., Ciesla-Dul M., Gorkiewicz-Kot I., Grodzicki T., Rewiuk K., Kubik L., Lewit J., de Sousa J. M. F. R., Ferreira R., Freitas A., Morais J. C. A., Pires R., Gomes M. J. V., Gago P., Candeias R. A. C., Nunes L., Sa J. V. M., Ventura M., de Oliveira M., Alves L. B., Bostaca I., Olariu C. T., Dan G. A., Dan A., Podoleanu C., Frigy A., Georgescu G. I. M., Arsenescu C., Statescu C., Sascau R., Dimitrascu D. L., Rancea R., Shubik Y. V., Duplyakov D., Shalak M., Danielyan M., Galyavich A., Zakirova V., Hatala R., Kaliska G., Kmec J., Zupan I., Tasie` J., Vokac D., Edvardsson N., Poci D., Gamra H., Denguir H., Sepetoglu A., Arat-Ozkan A., Orynchak M., Paliy E., Vakalyuk I., Malidze D., Prog R., Yabluchansky M. I., Makienko N. V., Potpara T., Knezevic S., Randjelovic M., Nieuwlaat R., Prins M.H., Le Heuzey J.-Y., Vardas P.E., Aliot E., Santini M., Cobbe S.M., Widdershoven J.W.M.G., Baur L.H., Levy S., Crijns H.J.G.M., Olsson B., Breithardt G., Manini M., Bramley C., Laforest V., Taylor C., Del Gaiso S., Huber K., De Backer G., Sirakova V., Cerbak R., Thayssen P., Lehto S., Blanc J.-J., Delahaye F., Kobulia B., Zeymer U., Cokkinos D., Karlocai K., Graham I., Shelley E., Behar S., Maggioni A., Goncalves L., Grabauskiene V., Asmussen I., Deckers J., Stepinska J., Mareev V., Vasiljevic Z., Riecansky I., Kenda M.F., Alonso A., Lopez-Sendon J.L., Rosengren A., Buser P., Okay T., Sychov O., Fox K., Schofield P., Simoons M., Wood D., Battler A., Boersma E., Komajda M., Andresen D., McGregor K., Mulder B., Priori S., Ryden L., Vahanian A., Wijns W., Sanofi-Aventi, Grigoryan S.V., Apetyan I., Aroyan S., Camm A.J., Azarapetyan L., Anvari A., Gottsauner-Wolf M., Pfaffenberger S., Aydinkoc K., Kalla K., Penka M., Drexel H., Langer P., Pierard L.A., Davies W., Legrand V., Blommaert D., Schroeder E., Mancini I., Geelen P., Brugada P., De Zutter M., Vrints C., Vercammen M., Morissens M., Capucci A., Borisov B., Petrov V.A., Marinova M., Assen A., Goudev R., Peychev Y., Stoyanovsky V., Stoynev E., Kranjcevic S., Moutiris J., Ioannides M., Evequoz D., Spacilova J., Novak M., Eisenberger M., Mullerova J., Kautzner J., Riedlbauchova L., Petru` J., Taborsky M., Cappelen H., Sharaf Y.A., Ibrahim B.S.S., Tammam K., Saad A., Elghawaby H., Sherif H.Z., Farouk H., Mielke A., Engelen M., Kirchhof P., Zimmermann P., Aviles F.F., Rubio J., Malpartida F., Corona M., Sanchez L.T., Miguel J., Herrera L., Quesada A., Garcia A.J.M., Gonzalez C.S., Juango M.S.A., Berjon-Reyero J., Alegret J.M., Fernandez J.M.C., Carrascosa C., Romero R.A.F., Lara M.G., Sendon J.L.L., de Diego J.J.G., Martin L.S., Irurita M., Guttierez N.H., Rubio J.R.S., Antorrena I., Paves A.B., Salvador A., Orriach M.D., Garcia A.A., Epelde F., Martinez V.B., Sanchez A.B., Galvez C.P., Rivero R.F., Madrid A.H., Baron-Esquivias G., Peinado R., Guindal J.A.G., Vera T.R., Fernandez E.L., Gayan R., Garcia J., Bodegas A., Lopez J.T., Florez J.M., Cabezas C.L., de Castroviejo E.V.R., Bellido J.M., Ruiz M.E., Savolainen K., Nieminen M., Toivonen L., Syvanne M., Pietila M., Galley D., Beltra C., Gay A., Daubert J.C., Lecocq G., Poulain C., Cleland J.G.F.C., Shelton R., Choudhury A., Abuladze G., Jashi I., Tsiavou A., Giamouzis G., Dagres N., Kostopoulou A., Tsoutsanis D., Stefanadis C., Latsios G., Vogiatzis I., Gotsis A., Bozia P., Karakiriou M., Koulouris S., Parissis J., Kostakis G., Kouris N., Kontogianni D., Athanasios K., Douras A., Tsanakis T., Marketou M., Patsourakos N., Czopf L., Halmosi R., Preda I., Csoti E., Badics A., Strasberg B., Freedberg N.A., Katz A., Zalzstein E., Grosbard A., Goldhammer E., Nahir M., Epstein M., Vider I., Luria D., Mandelzweig L., Aloisi B., Cavallaro A., Antonielli E., Doronzo B., Pancaldo D., Mazzola C., Buontempi L., Calvi V., Giuffrida G., Figlia A., Ippolito F., Gelmini G.-P., Gaibazzi N., Ziacchi V., De Tommasi F., Lombardi F., Fiorentini C., Terranova P., Maiolino P., Albunni M., Pinna-Pintor P., Fumagalli S., Masotti G., Boncinelli L., Rossi D., Santoro G.M., Fioranelli M., Naccarella F., Maranga S.S., Lepera G., Bresciani B., Seragnoli E., Forti M.C., Cortina V., Baciarello G., Cicconetti P., Lax A., Vitali F., Igidbashian D., Scarpino L., Terrazzino S., Tavazzi L., Cantu F., Pentimalli F., Novo S., Coppola G., Zingarini G., Ambrozio G., Moruzzi P., Callegari S., Saccomanno G., Russo P., Carbonieri E., Paino A., Zanetta M., Barducci E., Cemin R., Rauhe W., Pitscheider W., Meloni M., Marchi S.M., Di Gennaro M., Calcagno S., Squaratti P., Quartili F., Bertocchi P., De Martini M., Mantovani G., Komorovsky R., Desideri A., Celegon L., Tarantini L., Catania G., Lucci D., Bianchini F., Puodziukynas A., Kavoliuniene A., Barauskiene V., Aidietis A., Barysiene J., Vysniauskas V., Zukauskiene I., Kazakeviciene N., Georgievska-Ismail L., Poposka L., Vataman E., Grosu A.A., op Reimer W.S., de Swart E., Lenzen M., Jansen C., Brons R., Tebbe H., van Hoogenhuyze D.C.A., Veerhoek M.J., Kamps M., Haan D., van Rijn N., Bootsma A., van den A., Fransen H., Eurlings L., Meeder J., De Boer M.J., Winter J., Broers H., Werter C., Bijl M., Versluis S., Milkowska M., Wozakowska-Kaplon B., Janion M., Lepska L., Swiatecka G., Kokowicz P., Cybulski J., Gorecki A., Szulc M., Rekosz J., Manczak R., Wnuk-Wojnar A.-M., Trusz-Gluza M., Rybicka-Musialik A., Myszor J., Szpajer M., Cymerman K., Sadowski J., Sniezek-Maciejewska M., Ciesla-Dul M., Gorkiewicz-Kot I., Grodzicki T., Rewiuk K., Kubik L., Lewit J., de Sousa J.M.F.R., Ferreira R., Freitas A., Morais J.C.A., Pires R., Gomes M.J.V., Gago P., Candeias R.A.C., Nunes L., Sa J.V.M., Ventura M., de Oliveira M., Alves L.B., Bostaca I., Olariu C.T., Dan G.A., Dan A., Podoleanu C., Frigy A., Georgescu G.I.M., Arsenescu C., Statescu C., Sascau R., Dimitrascu D.L., Rancea R., Shubik Y.V., Duplyakov D., Shalak M., Danielyan M., Galyavich A., Zakirova V., Hatala R., Kaliska G., Kmec J., Zupan I., Tasie` J., Vokac D., Edvardsson N., Poci D., Gamra H., Denguir H., Sepetoglu A., Arat-Ozkan A., Orynchak M., Paliy E., Vakalyuk I., Malidze D., Prog R., Yabluchansky M.I., Makienko N.V., Potpara T., Knezevic S., and Randjelovic M.

Subjects
Male, medicine.medical_specialty, Rate control, Heart Diseases, Heart disease, Prognosi, Hemorrhage, Risk Assessment, Anticoagulation, Electrocardiography, Internal medicine, Atrial Fibrillation, Humans, Medicine, Sinus rhythm, Prospective Studies, Mortality, Prospective cohort study, Stroke, Survival rate, Aged, Progression, medicine.diagnostic_test, business.industry, Anticoagulant, Anticoagulants, Atrial fibrillation, Prognosis, medicine.disease, Management, Survival Rate, Prospective Studie, Heart Disease, Treatment Outcome, Heart failure, Disease Progression, Cardiology, Rhythm control, Female, Cardiology and Cardiovascular Medicine, business, Human
Abstract

Aims: To gain insight in the prognosis and treatment of atrial fibrillation (AF) patients during 1-year follow-up in the Euro Heart Survey (EHS) on AF. Methods and results: The EHS enrolled 5333 AF patients in 2003-2004. One-year follow-up data were available for 80%. Of first detected AF patients, 46% did not have a recurrence during 1 year, paroxysmal AF largely remained paroxysmal AF (80%), and 30% of persistent AF progressed to permanent AF. Many treatment changes occurred since baseline. Oral anticoagulation was started in 19% and discontinued in 16% of all patients. Of patients initially on rhythm control 27% did not receive rhythm control during follow-up, whereas 15% of patients initially on rate control received rhythm control. Mortality was highest in permanent AF (8.2%), but also substantial in first detected AF (5.7%). In multivariable analysis, sinus rhythm at baseline was associated with lower mortality, but no significant effect was observed regarding the application of either rhythm or rate control. Conclusion: The EHS on AF provides unique prospective observational data on AF progression, long-term treatment, prognosis, and determinants of adverse outcome of the total clinical spectrum of AF in a European cardiology-based patient cohort. © The Author 2008.

Published
2008

6. Antithrombotic treatment in real-life atrial fibrillation patients: a report from the Euro Heart Survey on Atrial Fibrillation

Author

Nieuwlaat R., Capucci A., Lip G. Y. H., Olsson S. B., Prins M. H., Nieman F. H., Lopez-Sendon J., Vardas P. E., Aliot E., Santini M., Crijns H. J. G. M., Andresen D., Camm A. J., Davies W., Levy S., Breithardt G., Cobbe S., Le Heuzey J. -Y., Manini M., Bramley C., Laforest V., Taylor C., Del Gaiso S., Huber K., De Backer G., Sirakova V., Cerbak R., Thayssen P., Lehto S., Blanc J. -J., Delahaye F., Kobulia B., Zeymer U., Cokkinos D., Karlocai K., Graham I., Shelley E., Behar S., Maggioni A., Goncalves L., Grabauskiene V., Asmussen I., Deckers J., Stepinska J., Mareev V., Vasiljevic Z., Riecansky I., Kenda M. F., Alonso A., Rosengren A., Buser P., Okay T., Sychov O., Fox K., Schofield P., Simoons M., Wood D., Battler A., Boersma E., Komajda M., McGregor K., Mulder B., Priori S., Ryden L., Vahanian A., Wijns W., Sanofi-Aventis, Grigoryan S. V., Apetyan I., Aroyan S., Azarapetyan L., Anvari A., Gottsauner-Wolf M., Pfaffenberger S., Aydinkoc K., Kalla K., Penka M., Drexel H., Langer P., Pierard L. A., Legrand V., Blommaert D., Schroeder E., Mancini I., Geelen P., Brugada P., De Zutter M., Vrints C., Vercammen M., Morissens M., Borisov B., Petrov V. A., Marinova M., Assen A., Goudev R., Peychev Y., Stoyanovsky V., Stoynev E., Kranjcevic S., Moutiris J., Ioannides M., Evequoz D., Spacilova J., Novak M., Eisenberger M., Mullerova J., Kautzner J., Riedlbauchova L., Petru` J., Taborsky M., Cappelen H., Sharaf Y. A., Ibrahim B. S. S., Tammam K., Saad A., Elghawaby H., Sherif H. Z., Farouk H., Mielke A., Engelen M., Kirchhof P., Zimmermann P., Aviles F. F., Rubio J., Malpartida F., Corona M., Sanchez L. T., Miguel J., Herrera L., Quesada A., Garcia A. J. M., Gonzalez C. S., Juango M. S. A., Berjon-Reyero J., Alegret J. M., Fernandez J. M. C., Carrascosa C., Romero R. A. F., Lara M. G., Sendon J. L. L., de Diego J. J. G., Martin L. S., Irurita M., Guttierez N. H., Rubio J. R. S., Antorrena I., Paves A. B., Salvador A., Orriach M. D., Garcia A. A., Epelde F., Martinez V. B., Sanchez A. B., Galvez C. P., Rivero R. F., Madrid A. H., Baron-Esquivias G., Peinado R., Guindal J. A. G., Vera T. R., Fernandez E. L., Gayan R., Garcia J., Bodegas A., Lopez J. T., Florez J. M., Cabezas C. L., de Castroviejo E. V. R., Bellido J. M., Ruiz M. E., Savolainen K., Nieminen M., Toivonen L., Syvanne M., Pietila M., Galley D., Beltra C., Gay A., Daubert J. C., Lecocq G., Poulain C., Cleland J. G. F. C., Shelton R., Choudhury A., Abuladze G., Jashi I., Tsiavou A., Giamouzis G., Dagres N., Kostopoulou A., Tsoutsanis D., Stefanadis C., Latsios G., Vogiatzis I., Gotsis A., Bozia P., Karakiriou M., Koulouris S., Parissis J., Kostakis G., Kouris N., Kontogianni D., Athanasios K., Douras A., Tsanakis T., Marketou M., Patsourakos N., Czopf L., Halmosi R., Preda I., Csoti E., Badics A., Strasberg B., Freedberg N. A., Katz A., Zalzstein E., Grosbard A., Goldhammer E., Nahir M., Epstein M., Vider I., Luria D., Mandelzweig L., Aloisi B., Cavallaro A., Antonielli E., Doronzo B., Pancaldo D., Mazzola C., Buontempi L., Calvi V., Giuffrida G., Figlia A., Ippolito F., Gelmini G. -P., Gaibazzi N., Ziacchi V., De Tommasi F., Lombardi F., Fiorentini C., Terranova P., Maiolino P., Albunni M., Pinna-Pintor P., Fumagalli S., Masotti G., Boncinelli L., Rossi D., Santoro G. M., Fioranelli M., Naccarella F., Maranga S. S., Lepera G., Bresciani B., Seragnoli E., Forti M. C., Cortina V., Baciarello G., Cicconetti P., Lax A., Vitali F., Igidbashian D., Scarpino L., Terrazzino S., Tavazzi L., Cantu F., Pentimalli F., Novo S., Coppola G., Zingarini G., Ambrozio G., Moruzzi P., Callegari S., Saccomanno G., Russo P., Carbonieri E., Paino A., Zanetta M., Barducci E., Cemin R., Rauhe W., Pitscheider W., Meloni M., Marchi S. M., Di Gennaro M., Calcagno S., Squaratti P., Quartili F., Bertocchi P., De Martini M., Mantovani G., Komorovsky R., Desideri A., Celegon L., Tarantini L., Catania G., Lucci D., Bianchini F., Puodziukynas A., Kavoliuniene A., Barauskiene V., Aidietis A., Barysiene J., Vysniauskas V., Zukauskiene I., Kazakeviciene N., Georgievska-Ismail L., Poposka L., Vataman E., Grosu A. A., op Reimer W. S., de Swart E., Lenzen M., Jansen C., Brons R., Tebbe H., van Hoogenhuyze D. C. A., Veerhoek M. J., Kamps M., Haan D., van Rijn N., Bootsma A., Baur L., van den A., Fransen H., Eurlings L., Meeder J., De Boer M. J., Winter J., Broers H., Werter C., Bijl M., Versluis S., Milkowska M., Wozakowska-Kaplon B., Janion M., Lepska L., Swiatecka G., Kokowicz P., Cybulski J., Gorecki A., Szulc M., Rekosz J., Manczak R., Wnuk-Wojnar A. -M., Trusz-Gluza M., Rybicka-Musialik A., Myszor J., Szpajer M., Cymerman K., Sadowski J., Sniezek-Maciejewska M., Ciesla-Dul M., Gorkiewicz-Kot I., Grodzicki T., Rewiuk K., Kubik L., Lewit J., de Sousa J. M. F. R., Ferreira R., Freitas A., Morais J. C. A., Pires R., Gomes M. J. V., Gago P., Candeias R. A. C., Nunes L., Sa J. V. M., Ventura M., de Oliveira M., Alves L. B., Bostaca I., Olariu C. T., Dan G. A., Dan A., Podoleanu C., Frigy A., Georgescu G. I. M., Arsenescu C., Statescu C., Sascau R., Dimitrascu D. L., Rancea R., Shubik Y. V., Duplyakov D., Shalak M., Danielyan M., Galyavich A., Zakirova V., Hatala R., Kaliska G., Kmec J., Zupan I., Tasie` J., Vokac D., Edvardsson N., Poci D., Gamra H., Denguir H., Sepetoglu A., Arat-Ozkan A., Orynchak M., Paliy E., Vakalyuk I., Malidze D., Prog R., Yabluchansky M. I., Makienko N. V., Potpara T., Knezevic S., Randjelovic M., Nieuwlaat R., Capucci A., Lip G.Y.H., Olsson S.B., Prins M.H., Nieman F.H., Lopez-Sendon J., Vardas P.E., Aliot E., Santini M., Crijns H.J.G.M., Andresen D., Camm A.J., Davies W., Levy S., Breithardt G., Cobbe S., Le Heuzey J.-Y., Manini M., Bramley C., Laforest V., Taylor C., Del Gaiso S., Huber K., De Backer G., Sirakova V., Cerbak R., Thayssen P., Lehto S., Blanc J.-J., Delahaye F., Kobulia B., Zeymer U., Cokkinos D., Karlocai K., Graham I., Shelley E., Behar S., Maggioni A., Goncalves L., Grabauskiene V., Asmussen I., Deckers J., Stepinska J., Mareev V., Vasiljevic Z., Riecansky I., Kenda M.F., Alonso A., Rosengren A., Buser P., Okay T., Sychov O., Fox K., Schofield P., Simoons M., Wood D., Battler A., Boersma E., Komajda M., McGregor K., Mulder B., Priori S., Ryden L., Vahanian A., Wijns W., Sanofi-Aventi, Grigoryan S.V., Apetyan I., Aroyan S., Azarapetyan L., Anvari A., Gottsauner-Wolf M., Pfaffenberger S., Aydinkoc K., Kalla K., Penka M., Drexel H., Langer P., Pierard L.A., Legrand V., Blommaert D., Schroeder E., Mancini I., Geelen P., Brugada P., De Zutter M., Vrints C., Vercammen M., Morissens M., Borisov B., Petrov V.A., Marinova M., Assen A., Goudev R., Peychev Y., Stoyanovsky V., Stoynev E., Kranjcevic S., Moutiris J., Ioannides M., Evequoz D., Spacilova J., Novak M., Eisenberger M., Mullerova J., Kautzner J., Riedlbauchova L., Petru` J., Taborsky M., Cappelen H., Sharaf Y.A., Ibrahim B.S.S., Tammam K., Saad A., Elghawaby H., Sherif H.Z., Farouk H., Mielke A., Engelen M., Kirchhof P., Zimmermann P., Aviles F.F., Rubio J., Malpartida F., Corona M., Sanchez L.T., Miguel J., Herrera L., Quesada A., Garcia A.J.M., Gonzalez C.S., Juango M.S.A., Berjon-Reyero J., Alegret J.M., Fernandez J.M.C., Carrascosa C., Romero R.A.F., Lara M.G., Sendon J.L.L., de Diego J.J.G., Martin L.S., Irurita M., Guttierez N.H., Rubio J.R.S., Antorrena I., Paves A.B., Salvador A., Orriach M.D., Garcia A.A., Epelde F., Martinez V.B., Sanchez A.B., Galvez C.P., Rivero R.F., Madrid A.H., Baron-Esquivias G., Peinado R., Guindal J.A.G., Vera T.R., Fernandez E.L., Gayan R., Garcia J., Bodegas A., Lopez J.T., Florez J.M., Cabezas C.L., de Castroviejo E.V.R., Bellido J.M., Ruiz M.E., Savolainen K., Nieminen M., Toivonen L., Syvanne M., Pietila M., Galley D., Beltra C., Gay A., Daubert J.C., Lecocq G., Poulain C., Cleland J.G.F.C., Shelton R., Choudhury A., Abuladze G., Jashi I., Tsiavou A., Giamouzis G., Dagres N., Kostopoulou A., Tsoutsanis D., Stefanadis C., Latsios G., Vogiatzis I., Gotsis A., Bozia P., Karakiriou M., Koulouris S., Parissis J., Kostakis G., Kouris N., Kontogianni D., Athanasios K., Douras A., Tsanakis T., Marketou M., Patsourakos N., Czopf L., Halmosi R., Preda I., Csoti E., Badics A., Strasberg B., Freedberg N.A., Katz A., Zalzstein E., Grosbard A., Goldhammer E., Nahir M., Epstein M., Vider I., Luria D., Mandelzweig L., Aloisi B., Cavallaro A., Antonielli E., Doronzo B., Pancaldo D., Mazzola C., Buontempi L., Calvi V., Giuffrida G., Figlia A., Ippolito F., Gelmini G.-P., Gaibazzi N., Ziacchi V., De Tommasi F., Lombardi F., Fiorentini C., Terranova P., Maiolino P., Albunni M., Pinna-Pintor P., Fumagalli S., Masotti G., Boncinelli L., Rossi D., Santoro G.M., Fioranelli M., Naccarella F., Maranga S.S., Lepera G., Bresciani B., Seragnoli E., Forti M.C., Cortina V., Baciarello G., Cicconetti P., Lax A., Vitali F., Igidbashian D., Scarpino L., Terrazzino S., Tavazzi L., Cantu F., Pentimalli F., Novo S., Coppola G., Zingarini G., Ambrozio G., Moruzzi P., Callegari S., Saccomanno G., Russo P., Carbonieri E., Paino A., Zanetta M., Barducci E., Cemin R., Rauhe W., Pitscheider W., Meloni M., Marchi S.M., Di Gennaro M., Calcagno S., Squaratti P., Quartili F., Bertocchi P., De Martini M., Mantovani G., Komorovsky R., Desideri A., Celegon L., Tarantini L., Catania G., Lucci D., Bianchini F., Puodziukynas A., Kavoliuniene A., Barauskiene V., Aidietis A., Barysiene J., Vysniauskas V., Zukauskiene I., Kazakeviciene N., Georgievska-Ismail L., Poposka L., Vataman E., Grosu A.A., op Reimer W.S., de Swart E., Lenzen M., Jansen C., Brons R., Tebbe H., van Hoogenhuyze D.C.A., Veerhoek M.J., Kamps M., Haan D., van Rijn N., Bootsma A., Baur L., van den A., Fransen H., Eurlings L., Meeder J., De Boer M.J., Winter J., Broers H., Werter C., Bijl M., Versluis S., Milkowska M., Wozakowska-Kaplon B., Janion M., Lepska L., Swiatecka G., Kokowicz P., Cybulski J., Gorecki A., Szulc M., Rekosz J., Manczak R., Wnuk-Wojnar A.-M., Trusz-Gluza M., Rybicka-Musialik A., Myszor J., Szpajer M., Cymerman K., Sadowski J., Sniezek-Maciejewska M., Ciesla-Dul M., Gorkiewicz-Kot I., Grodzicki T., Rewiuk K., Kubik L., Lewit J., de Sousa J.M.F.R., Ferreira R., Freitas A., Morais J.C.A., Pires R., Gomes M.J.V., Gago P., Candeias R.A.C., Nunes L., Sa J.V.M., Ventura M., de Oliveira M., Alves L.B., Bostaca I., Olariu C.T., Dan G.A., Dan A., Podoleanu C., Frigy A., Georgescu G.I.M., Arsenescu C., Statescu C., Sascau R., Dimitrascu D.L., Rancea R., Shubik Y.V., Duplyakov D., Shalak M., Danielyan M., Galyavich A., Zakirova V., Hatala R., Kaliska G., Kmec J., Zupan I., Tasie` J., Vokac D., Edvardsson N., Poci D., Gamra H., Denguir H., Sepetoglu A., Arat-Ozkan A., Orynchak M., Paliy E., Vakalyuk I., Malidze D., Prog R., Yabluchansky M.I., Makienko N.V., Potpara T., Knezevic S., and Randjelovic M.

Subjects
Adult, Male, medicine.medical_specialty, Oral anticoagulation, Guideline, Risk Assessment, Electrocardiography, Fibrinolytic Agents, Risk Factors, Drug Combination, Antithrombotic, medicine, Humans, Outpatient clinic, Risk factor, Multivariate Analysi, Stroke, Risk stratification, Aged, Antithrombotic therapy, Fibrinolytic Agent, Framingham Risk Score, business.industry, Risk Factor, Atrial fibrillation, Middle Aged, medicine.disease, Drug Combinations, Multivariate Analysis, Practice Guidelines as Topic, Emergency medicine, Physical therapy, Female, Guideline Adherence, Cardiology and Cardiovascular Medicine, business, Cardioversions, Risk assessment, Human
Abstract

Aims To describe guideline adherence and application of different stroke risk stratification schemes regarding antithrombotic therapy in real-life atrial fibrillation (AF) patients and to assess which factors influence antithrombotic management decisions. Methods and results The Euro Heart Survey enrolled 5333 AF patients in 35 countries, in 2003 and 2004. Prescription of antithrombotic drugs, especially oral anticoagulation (OAC), was hardly tailored to the patient's stroke risk profile as indicated by the joint guidelines of the American College of Cardiology, American Heart Association, and the European Society of Cardiology, ACCP guidelines, or CHADS2 and Framingham risk scores. In multivariable analysis, only a limited number of the well-known stroke risk factors triggered OAC prescription. In contrast, less relevant factors, of which clinical type of AF and availability of an OAC monitoring outpatient clinic were the most marked, played a significant role in OAC prescription. Electrical cardioversions and catheter ablations clearly triggered OAC prescription, whereas pharmacological cardioversions even in the presence of stroke risk factors did not. Conclusion Antithrombotic therapy in AF is hardly tailored to the patient's stroke risk profile. Factors other than well-known stroke risk factors were significantly involved in antithrombotic management decisions. To facilitate this tailored treatment, guideline writers and physician educators should focus on providing one uniform and easy to use stroke risk stratification scheme.

Published
2006

7. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: The euro heart survey

Author

Pisters R., Lane D. A., Nieuwlaat R., De Vos C. B., Crijns H. J. G. M., Lip G. Y. H., Andresen D., Camm A. J., Davies W., Capucci A., Levy S., Olsson B., Aliot E., Breithardt G., Cobbe S., Le Heuzey J. -Y., Santini M., Vardas P., Manini M., Bramley C., Laforest V., Taylor C., Del Gaiso S., Huber K., De Backer G., Sirakova V., Cerbak R., Thayssen P., Lehto S., Blanc J. -J., Delahaye F., Kobulia B., Zeymer U., Cokkinos D., Karlocai K., Graham I., Shelley E., Behar S., Maggioni A., Goncalves L., Grabauskiene V., Asmussen I., Deckers J., Stepinska J., Mareev V., Vasiljevic Z., Riecansky I., Kenda M. F., Alonso A., Lopez-Sendon J. L., Rosengren A., Buser P., Okay T., Sychov O., Fox K., Schofield P., Simoons M., Wood D., Battler A., Boersma E., Komajda M., McGregor K., Mulder B., Priori S., Ryden L., Vahanian A., Wijns W., Sanofi-Aventis, Grigoryan S. V., Apetyan I., Aroyan S., Azarapetyan L., Anvari A., Gottsauner-Wolf M., Pfaffenberger S., Aydinkoc K., Kalla K., Penka M., Drexel H., Langer P., Pierard L. A., Legrand V., Blommaert D., Schroeder E., Mancini I., Geelen P., Brugada P., De Zutter M., Vrints C., Vercammen M., Morissens M., Borisov B., Petrov V. A., Marinova M., Assen A., Goudev R., Peychev Y., Stoyanovsky V., Stoynev E., Kranjcevic S., Moutiris J., Ioannides M., Evequoz D., Spacilova J., Novak M., Eisenberger M., Mullerova J., Kautzner J., Riedlbauchova L., Petru` J., Taborsky M., Cappelen H., Sharaf Y. A., Ibrahim B. S. S., Tammam K., Saad A., Elghawaby H., Sherif H. Z., Farouk H., Mielke A., Engelen M., Kirchhof P., Zimmermann P., Aviles F. F., Rubio J., Malpartida F., Corona M., Sanchez L. T., Miguel J., Herrera L., Quesada A., Garcia A. J. M., Gonzalez C. S., Juango M. S. A., Berjon-Reyero J., Alegret J. M., Fernandez J. M. C., Carrascosa C., Romero R. A. F., Lara M. G., Sendon J. L. L., de Diego J. J. G., Martin L. S., Irurita M., Guttierez N. H., Rubio J. R. S., Antorrena I., Paves A. B., Salvador A., Orriach M. D., Garcia A. A., Epelde F., Martinez V. B., Sanchez A. B., Galvez C. P., Rivero R. F., Madrid A. H., Baron-Esquivias G., Peinado R., Guindal J. A. G., Vera T. R., Fernandez E. L., Gayan R., Garcia J., Bodegas A., Lopez J. T., Florez J. M., Cabezas C. L., de Castroviejo E. V. R., Bellido J. M., Ruiz M. E., Savolainen K., Nieminen M., Toivonen L., Syvanne M., Pietila M., Galley D., Beltra C., Gay A., Daubert J. C., Lecocq G., Poulain C., Cleland J. G. F. C., Shelton R., Choudhury A., Abuladze G., Jashi I., Tsiavou A., Giamouzis G., Dagres N., Kostopoulou A., Tsoutsanis D., Stefanadis C., Latsios G., Vogiatzis I., Gotsis A., Bozia P., Karakiriou M., Koulouris S., Parissis J., Kostakis G., Kouris N., Kontogianni D., Athanasios K., Douras A., Tsanakis T., Marketou M., Patsourakos N., Czopf L., Halmosi R., Preda I., Csoti E., Badics A., Strasberg B., Freedberg N. A., Katz A., Zalzstein E., Grosbard A., Goldhammer E., Nahir M., Epstein M., Vider I., Luria D., Mandelzweig L., Aloisi B., Cavallaro A., Antonielli E., Doronzo B., Pancaldo D., Mazzola C., Buontempi L., Calvi V., Giuffrida G., Figlia A., Ippolito F., Gelmini G. -P., Gaibazzi N., Ziacchi V., De Tommasi F., Lombardi F., Fiorentini C., Terranova P., Maiolino P., Albunni M., Pinna-Pintor P., Fumagalli S., Masotti G., Boncinelli L., Rossi D., Santoro G. M., Fioranelli M., Naccarella F., Maranga S. S., Lepera G., Bresciani B., Seragnoli E., Forti M. C., Cortina V., Baciarello G., Cicconetti P., Lax A., Vitali F., Igidbashian D., Scarpino L., Terrazzino S., Tavazzi L., Cantu F., Pentimalli F., Novo S., Coppola G., Zingarini G., Ambrozio G., Moruzzi P., Callegari S., Saccomanno G., Russo P., Carbonieri E., Paino A., Zanetta M., Barducci E., Cemin R., Rauhe W., Pitscheider W., Meloni M., Marchi S. M., Di Gennaro M., Calcagno S., Squaratti P., Quartili F., Bertocchi P., De Martini M., Mantovani G., Komorovsky R., Desideri A., Celegon L., Tarantini L., Catania G., Lucci D., Bianchini F., Puodziukynas A., Kavoliuniene A., Barauskiene V., Aidietis A., Barysiene J., Vysniauskas V., Zukauskiene I., Kazakeviciene N., Georgievska-Ismail L., Poposka L., Vataman E., Grosu A. A., op Reimer W. S., de Swart E., Lenzen M., Jansen C., Brons R., Tebbe H., van Hoogenhuyze D. C. A., Veerhoek M. J., Kamps M., Haan D., van Rijn N., Bootsma A., Baur L., van den A., Fransen H., Eurlings L., Meeder J., De Boer M. J., Winter J., Broers H., Werter C., Bijl M., Versluis S., Milkowska M., Wozakowska-Kaplon B., Janion M., Lepska L., Swiatecka G., Kokowicz P., Cybulski J., Gorecki A., Szulc M., Rekosz J., Manczak R., Wnuk-Wojnar A. -M., Trusz-Gluza M., Rybicka-Musialik A., Myszor J., Szpajer M., Cymerman K., Sadowski J., Sniezek-Maciejewska M., Ciesla-Dul M., Gorkiewicz-Kot I., Grodzicki T., Rewiuk K., Kubik L., Lewit J., de Sousa J. M. F. R., Ferreira R., Freitas A., Morais J. C. A., Pires R., Gomes M. J. V., Gago P., Candeias R. A. C., Nunes L., Sa J. V. M., Ventura M., de Oliveira M., Alves L. B., Bostaca I., Olariu C. T., Dan G. A., Dan A., Podoleanu C., Frigy A., Georgescu G. I. M., Arsenescu C., Statescu C., Sascau R., Dimitrascu D. L., Rancea R., Shubik Y. V., Duplyakov D., Shalak M., Danielyan M., Galyavich A., Zakirova V., Hatala R., Kaliska G., Kmec J., Zupan I., Tasie` J., Vokac D., Edvardsson N., Poci D., Gamra H., Denguir H., Sepetoglu A., Arat-Ozkan A., Orynchak M., Paliy E., Vakalyuk I., Malidze D., Prog R., Yabluchansky M. I., Makienko N. V., Potpara T., Knezevic S., Randjelovic M., Pisters R., Lane D.A., Nieuwlaat R., De Vos C.B., Crijns H.J.G.M., Lip G.Y.H., Andresen D., Camm A.J., Davies W., Capucci A., Levy S., Olsson B., Aliot E., Breithardt G., Cobbe S., Le Heuzey J.-Y., Santini M., Vardas P., Manini M., Bramley C., Laforest V., Taylor C., Del Gaiso S., Huber K., De Backer G., Sirakova V., Cerbak R., Thayssen P., Lehto S., Blanc J.-J., Delahaye F., Kobulia B., Zeymer U., Cokkinos D., Karlocai K., Graham I., Shelley E., Behar S., Maggioni A., Goncalves L., Grabauskiene V., Asmussen I., Deckers J., Stepinska J., Mareev V., Vasiljevic Z., Riecansky I., Kenda M.F., Alonso A., Lopez-Sendon J.L., Rosengren A., Buser P., Okay T., Sychov O., Fox K., Schofield P., Simoons M., Wood D., Battler A., Boersma E., Komajda M., McGregor K., Mulder B., Priori S., Ryden L., Vahanian A., Wijns W., Sanofi-Aventi, Grigoryan S.V., Apetyan I., Aroyan S., Azarapetyan L., Anvari A., Gottsauner-Wolf M., Pfaffenberger S., Aydinkoc K., Kalla K., Penka M., Drexel H., Langer P., Pierard L.A., Legrand V., Blommaert D., Schroeder E., Mancini I., Geelen P., Brugada P., De Zutter M., Vrints C., Vercammen M., Morissens M., Borisov B., Petrov V.A., Marinova M., Assen A., Goudev R., Peychev Y., Stoyanovsky V., Stoynev E., Kranjcevic S., Moutiris J., Ioannides M., Evequoz D., Spacilova J., Novak M., Eisenberger M., Mullerova J., Kautzner J., Riedlbauchova L., Petru` J., Taborsky M., Cappelen H., Sharaf Y.A., Ibrahim B.S.S., Tammam K., Saad A., Elghawaby H., Sherif H.Z., Farouk H., Mielke A., Engelen M., Kirchhof P., Zimmermann P., Aviles F.F., Rubio J., Malpartida F., Corona M., Sanchez L.T., Miguel J., Herrera L., Quesada A., Garcia A.J.M., Gonzalez C.S., Juango M.S.A., Berjon-Reyero J., Alegret J.M., Fernandez J.M.C., Carrascosa C., Romero R.A.F., Lara M.G., Sendon J.L.L., de Diego J.J.G., Martin L.S., Irurita M., Guttierez N.H., Rubio J.R.S., Antorrena I., Paves A.B., Salvador A., Orriach M.D., Garcia A.A., Epelde F., Martinez V.B., Sanchez A.B., Galvez C.P., Rivero R.F., Madrid A.H., Baron-Esquivias G., Peinado R., Guindal J.A.G., Vera T.R., Fernandez E.L., Gayan R., Garcia J., Bodegas A., Lopez J.T., Florez J.M., Cabezas C.L., de Castroviejo E.V.R., Bellido J.M., Ruiz M.E., Savolainen K., Nieminen M., Toivonen L., Syvanne M., Pietila M., Galley D., Beltra C., Gay A., Daubert J.C., Lecocq G., Poulain C., Cleland J.G.F.C., Shelton R., Choudhury A., Abuladze G., Jashi I., Tsiavou A., Giamouzis G., Dagres N., Kostopoulou A., Tsoutsanis D., Stefanadis C., Latsios G., Vogiatzis I., Gotsis A., Bozia P., Karakiriou M., Koulouris S., Parissis J., Kostakis G., Kouris N., Kontogianni D., Athanasios K., Douras A., Tsanakis T., Marketou M., Patsourakos N., Czopf L., Halmosi R., Preda I., Csoti E., Badics A., Strasberg B., Freedberg N.A., Katz A., Zalzstein E., Grosbard A., Goldhammer E., Nahir M., Epstein M., Vider I., Luria D., Mandelzweig L., Aloisi B., Cavallaro A., Antonielli E., Doronzo B., Pancaldo D., Mazzola C., Buontempi L., Calvi V., Giuffrida G., Figlia A., Ippolito F., Gelmini G.-P., Gaibazzi N., Ziacchi V., De Tommasi F., Lombardi F., Fiorentini C., Terranova P., Maiolino P., Albunni M., Pinna-Pintor P., Fumagalli S., Masotti G., Boncinelli L., Rossi D., Santoro G.M., Fioranelli M., Naccarella F., Maranga S.S., Lepera G., Bresciani B., Seragnoli E., Forti M.C., Cortina V., Baciarello G., Cicconetti P., Lax A., Vitali F., Igidbashian D., Scarpino L., Terrazzino S., Tavazzi L., Cantu F., Pentimalli F., Novo S., Coppola G., Zingarini G., Ambrozio G., Moruzzi P., Callegari S., Saccomanno G., Russo P., Carbonieri E., Paino A., Zanetta M., Barducci E., Cemin R., Rauhe W., Pitscheider W., Meloni M., Marchi S.M., Di Gennaro M., Calcagno S., Squaratti P., Quartili F., Bertocchi P., De Martini M., Mantovani G., Komorovsky R., Desideri A., Celegon L., Tarantini L., Catania G., Lucci D., Bianchini F., Puodziukynas A., Kavoliuniene A., Barauskiene V., Aidietis A., Barysiene J., Vysniauskas V., Zukauskiene I., Kazakeviciene N., Georgievska-Ismail L., Poposka L., Vataman E., Grosu A.A., op Reimer W.S., de Swart E., Lenzen M., Jansen C., Brons R., Tebbe H., van Hoogenhuyze D.C.A., Veerhoek M.J., Kamps M., Haan D., van Rijn N., Bootsma A., Baur L., van den A., Fransen H., Eurlings L., Meeder J., De Boer M.J., Winter J., Broers H., Werter C., Bijl M., Versluis S., Milkowska M., Wozakowska-Kaplon B., Janion M., Lepska L., Swiatecka G., Kokowicz P., Cybulski J., Gorecki A., Szulc M., Rekosz J., Manczak R., Wnuk-Wojnar A.-M., Trusz-Gluza M., Rybicka-Musialik A., Myszor J., Szpajer M., Cymerman K., Sadowski J., Sniezek-Maciejewska M., Ciesla-Dul M., Gorkiewicz-Kot I., Grodzicki T., Rewiuk K., Kubik L., Lewit J., de Sousa J.M.F.R., Ferreira R., Freitas A., Morais J.C.A., Pires R., Gomes M.J.V., Gago P., Candeias R.A.C., Nunes L., Sa J.V.M., Ventura M., de Oliveira M., Alves L.B., Bostaca I., Olariu C.T., Dan G.A., Dan A., Podoleanu C., Frigy A., Georgescu G.I.M., Arsenescu C., Statescu C., Sascau R., Dimitrascu D.L., Rancea R., Shubik Y.V., Duplyakov D., Shalak M., Danielyan M., Galyavich A., Zakirova V., Hatala R., Kaliska G., Kmec J., Zupan I., Tasie` J., Vokac D., Edvardsson N., Poci D., Gamra H., Denguir H., Sepetoglu A., Arat-Ozkan A., Orynchak M., Paliy E., Vakalyuk I., Malidze D., Prog R., Yabluchansky M.I., Makienko N.V., Potpara T., Knezevic S., and Randjelovic M.

Subjects
Male, Fibrinolytic Agent, Prognosi, Incidence, Platelet Aggregation Inhibitor, Risk Factor, Hemorrhage, Risk Assessment, Follow-Up Studie, Europe, Stroke, Prospective Studie, Population Surveillance, Atrial Fibrillation, Female, Aged, Human
Abstract

Objective: Despite extensive use of oral anticoagulation (OAC) in patients with atrial fibrillation (AF) and the increased bleeding risk associated with such OAC use, no handy quantification tool for assessing this risk exists. We aimed to develop a practical risk score to estimate the 1-year risk for major bleeding (intracranial, hospitalization, hemoglobin decrease >2 g/L, and/or transfusion) in a cohort of real-world patients with AF. Methods: Based on 3,978 patients in the Euro Heart Survey on AF with complete follow-up, all univariate bleeding risk factors in this cohort were used in a multivariate analysis along with historical bleeding risk factors. A new bleeding risk score termed HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly (> 65 years), Drugs/alcohol concomitantly) was calculated, incorporating risk factors from the derivation cohort. Results: Fifty-three (1.5%) major bleeds occurred during 1-year follow-up. The annual bleeding rate increased with increasing risk factors. The predictive accuracy in the overall population using significant risk factors in the derivation cohort (C statistic 0.72) was consistent when applied in several subgroups. Application of the new bleeding risk score (HAS-BLED) gave similar C statistics except where patients were receiving antiplatelet agents alone or no antithrombotic therapy, with C statistics of 0.91 and 0.85, respectively. Conclusion: This simple, novel bleeding risk score (HAS-BLED) provides a practical tool to assess the individual bleeding risk of real-world patients with AF, potentially supporting clinical decision making regarding antithrombotic therapy in patients with AF. © 2010 American College of Chest Physicians.

Published
2010

8. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: The Euro Heart Survey on atrial fibrillation

Author

Lip G. Y. H., Nieuwlaat R., Pisters R., Lane D. A., Crijns H. J. G. M., Andresen D., Camm A. J., Davies W., Capucci A., Levy S., Breithardt G., Cobbe S., Le Heuzey J. -Y., Santini M., Vardas P., Manini M., Bramley C., Laforest V., Taylor C., Del Gaiso S., Huber K., De Backer G., Sirakova V., Cerbak R., Thayssen P., Lehto S., Blanc J. -J., Delahaye F., Kobulia B., Zeymer U., Cokkinos D., Karlocai K., Graham I., Shelley E., Behar S., Maggioni A., Goncalves L., Grabauskiene V., Asmussen I., Deckers J., Stepinska J., Mareev V., Vasiljevic Z., Riecansky I., Kenda M. F., Alonso A., Lopez-Sendon J. L., Rosengren A., Buser P., Okay T., Sychov O., Fox K., Schofield P., Simoons M., Wood D., Battler A., Boersma E., Komajda M., McGregor K., Mulder B., Priori S., Ryden L., Vahanian A., Wijns W., Sanofi-Aventis, Grigoryan S. V., Apetyan I., Aroyan S., Azarapetyan L., Anvari A., Gottsauner-Wolf M., Pfaffenberger S., Aydinkoc K., Kalla K., Penka M., Drexel H., Langer P., Pierard L. A., Legrand V., Blommaert D., Schroeder E., Mancini I., Geelen P., Brugada P., De Zutter M., Vrints C., Vercammen M., Morissens M., Borisov B., Petrov V. A., Marinova M., Assen A., Goudev R., Peychev Y., Stoyanovsky V., Stoynev E., Kranjcevic S., Moutiris J., Ioannides M., Evequoz D., Spacilova J., Novak M., Eisenberger M., Mullerova J., Kautzner J., Riedlbauchova L., Petru` J., Taborsky M., Cappelen H., Sharaf Y. A., Ibrahim B. S. S., Tammam K., Saad A., Elghawaby H., Sherif H. Z., Farouk H., Mielke A., Engelen M., Kirchhof P., Zimmermann P., Aviles F. F., Rubio J., Malpartida F., Corona M., Sanchez L. T., Miguel J., Herrera L., Quesada A., Garcia A. J. M., Gonzalez C. S., Juango M. S. A., Berjon-Reyero J., Alegret J. M., Fernandez J. M. C., Carrascosa C., Romero R. A. F., Lara M. G., Sendon J. L. L., de Diego J. J. G., Martin L. S., Irurita M., Guttierez N. H., Rubio J. R. S., Antorrena I., Paves A. B., Salvador A., Orriach M. D., Garcia A. A., Epelde F., Martinez V. B., Sanchez A. B., Galvez C. P., Rivero R. F., Madrid A. H., Baron-Esquivias G., Peinado R., Guindal J. A. G., Vera T. R., Fernandez E. L., Gayan R., Garcia J., Bodegas A., Lopez J. T., Florez J. M., Cabezas C. L., de Castroviejo E. V. R., Bellido J. M., Ruiz M. E., Savolainen K., Nieminen M., Toivonen L., Syvanne M., Pietila M., Galley D., Beltra C., Gay A., Daubert J. C., Lecocq G., Poulain C., Cleland J. G. F. C., Shelton R., Choudhury A., Abuladze G., Jashi I., Tsiavou A., Giamouzis G., Dagres N., Kostopoulou A., Tsoutsanis D., Stefanadis C., Latsios G., Vogiatzis I., Gotsis A., Bozia P., Karakiriou M., Koulouris S., Parissis J., Kostakis G., Kouris N., Kontogianni D., Athanasios K., Douras A., Tsanakis T., Marketou M., Patsourakos N., Czopf L., Halmosi R., Preda I., Csoti E., Badics A., Strasberg B., Freedberg N. A., Katz A., Zalzstein E., Grosbard A., Goldhammer E., Nahir M., Epstein M., Vider I., Luria D., Mandelzweig L., Aloisi B., Cavallaro A., Antonielli E., Doronzo B., Pancaldo D., Mazzola C., Buontempi L., Calvi V., Giuffrida G., Figlia A., Ippolito F., Gelmini G. -P., Gaibazzi N., Ziacchi V., De Tommasi F., Lombardi F., Fiorentini C., Terranova P., Maiolino P., Albunni M., Pinna-Pintor P., Fumagalli S., Masotti G., Boncinelli L., Rossi D., Santoro G. M., Fioranelli M., Naccarella F., Maranga S. S., Lepera G., Bresciani B., Seragnoli E., Forti M. C., Cortina V., Baciarello G., Cicconetti P., Lax A., Vitali F., Igidbashian D., Scarpino L., Terrazzino S., Tavazzi L., Cantu F., Pentimalli F., Novo S., Coppola G., Zingarini G., Ambrozio G., Moruzzi P., Callegari S., Saccomanno G., Russo P., Carbonieri E., Paino A., Zanetta M., Barducci E., Cemin R., Rauhe W., Pitscheider W., Meloni M., Marchi S. M., Di Gennaro M., Calcagno S., Squaratti P., Quartili F., Bertocchi P., De Martini M., Mantovani G., Komorovsky R., Desideri A., Celegon L., Tarantini L., Catania G., Lucci D., Bianchini F., Puodziukynas A., Kavoliuniene A., Barauskiene V., Aidietis A., Barysiene J., Vysniauskas V., Zukauskiene I., Kazakeviciene N., Georgievska-Ismail L., Poposka L., Vataman E., Grosu A. A., op Reimer W. S., de Swart E., Lenzen M., Jansen C., Brons R., Tebbe H., van Hoogenhuyze D. C. A., Veerhoek M. J., Kamps M., Haan D., van Rijn N., Bootsma A., Baur L., van den A., Fransen H., Eurlings L., Meeder J., De Boer M. J., Winter J., Broers H., Werter C., Bijl M., Versluis S., Milkowska M., Wozakowska-Kaplon B., Janion M., Lepska L., Swiatecka G., Kokowicz P., Cybulski J., Gorecki A., Szulc M., Rekosz J., Manczak R., Wnuk-Wojnar A. -M., Trusz-Gluza M., Rybicka-Musialik A., Myszor J., Szpajer M., Cymerman K., Sadowski J., Sniezek-Maciejewska M., Ciesla-Dul M., Gorkiewicz-Kot I., Grodzicki T., Rewiuk K., Kubik L., Lewit J., de Sousa J. M. F. R., Ferreira R., Freitas A., Morais J. C. A., Pires R., Gomes M. J. V., Gago P., Candeias R. A. C., Nunes L., Sa J. V. M., Ventura M., de Oliveira M., Alves L. B., Bostaca I., Olariu C. T., Dan G. A., Dan A., Podoleanu C., Frigy A., Georgescu G. I. M., Arsenescu C., Statescu C., Sascau R., Dimitrascu D. L., Rancea R., Shubik Y. V., Duplyakov D., Shalak M., Danielyan M., Galyavich A., Zakirova V., Hatala R., Kaliska G., Kmec J., Zupan I., Tasie` J., Vokac D., Edvardsson N., Poci D., Gamra H., Denguir H., Sepetoglu A., Arat-Ozkan A., Orynchak M., Paliy E., Vakalyuk I., Malidze D., Prog R., Yabluchansky M. I., Makienko N. V., Potpara T., Knezevic S., Randjelovic M., Lip G.Y.H., Nieuwlaat R., Pisters R., Lane D.A., Crijns H.J.G.M., Andresen D., Camm A.J., Davies W., Capucci A., Levy S., Breithardt G., Cobbe S., Le Heuzey J.-Y., Santini M., Vardas P., Manini M., Bramley C., Laforest V., Taylor C., Del Gaiso S., Huber K., De Backer G., Sirakova V., Cerbak R., Thayssen P., Lehto S., Blanc J.-J., Delahaye F., Kobulia B., Zeymer U., Cokkinos D., Karlocai K., Graham I., Shelley E., Behar S., Maggioni A., Goncalves L., Grabauskiene V., Asmussen I., Deckers J., Stepinska J., Mareev V., Vasiljevic Z., Riecansky I., Kenda M.F., Alonso A., Lopez-Sendon J.L., Rosengren A., Buser P., Okay T., Sychov O., Fox K., Schofield P., Simoons M., Wood D., Battler A., Boersma E., Komajda M., McGregor K., Mulder B., Priori S., Ryden L., Vahanian A., Wijns W., Sanofi-Aventi, Grigoryan S.V., Apetyan I., Aroyan S., Azarapetyan L., Anvari A., Gottsauner-Wolf M., Pfaffenberger S., Aydinkoc K., Kalla K., Penka M., Drexel H., Langer P., Pierard L.A., Legrand V., Blommaert D., Schroeder E., Mancini I., Geelen P., Brugada P., De Zutter M., Vrints C., Vercammen M., Morissens M., Borisov B., Petrov V.A., Marinova M., Assen A., Goudev R., Peychev Y., Stoyanovsky V., Stoynev E., Kranjcevic S., Moutiris J., Ioannides M., Evequoz D., Spacilova J., Novak M., Eisenberger M., Mullerova J., Kautzner J., Riedlbauchova L., Petru` J., Taborsky M., Cappelen H., Sharaf Y.A., Ibrahim B.S.S., Tammam K., Saad A., Elghawaby H., Sherif H.Z., Farouk H., Mielke A., Engelen M., Kirchhof P., Zimmermann P., Aviles F.F., Rubio J., Malpartida F., Corona M., Sanchez L.T., Miguel J., Herrera L., Quesada A., Garcia A.J.M., Gonzalez C.S., Juango M.S.A., Berjon-Reyero J., Alegret J.M., Fernandez J.M.C., Carrascosa C., Romero R.A.F., Lara M.G., Sendon J.L.L., de Diego J.J.G., Martin L.S., Irurita M., Guttierez N.H., Rubio J.R.S., Antorrena I., Paves A.B., Salvador A., Orriach M.D., Garcia A.A., Epelde F., Martinez V.B., Sanchez A.B., Galvez C.P., Rivero R.F., Madrid A.H., Baron-Esquivias G., Peinado R., Guindal J.A.G., Vera T.R., Fernandez E.L., Gayan R., Garcia J., Bodegas A., Lopez J.T., Florez J.M., Cabezas C.L., de Castroviejo E.V.R., Bellido J.M., Ruiz M.E., Savolainen K., Nieminen M., Toivonen L., Syvanne M., Pietila M., Galley D., Beltra C., Gay A., Daubert J.C., Lecocq G., Poulain C., Cleland J.G.F.C., Shelton R., Choudhury A., Abuladze G., Jashi I., Tsiavou A., Giamouzis G., Dagres N., Kostopoulou A., Tsoutsanis D., Stefanadis C., Latsios G., Vogiatzis I., Gotsis A., Bozia P., Karakiriou M., Koulouris S., Parissis J., Kostakis G., Kouris N., Kontogianni D., Athanasios K., Douras A., Tsanakis T., Marketou M., Patsourakos N., Czopf L., Halmosi R., Preda I., Csoti E., Badics A., Strasberg B., Freedberg N.A., Katz A., Zalzstein E., Grosbard A., Goldhammer E., Nahir M., Epstein M., Vider I., Luria D., Mandelzweig L., Aloisi B., Cavallaro A., Antonielli E., Doronzo B., Pancaldo D., Mazzola C., Buontempi L., Calvi V., Giuffrida G., Figlia A., Ippolito F., Gelmini G.-P., Gaibazzi N., Ziacchi V., De Tommasi F., Lombardi F., Fiorentini C., Terranova P., Maiolino P., Albunni M., Pinna-Pintor P., Fumagalli S., Masotti G., Boncinelli L., Rossi D., Santoro G.M., Fioranelli M., Naccarella F., Maranga S.S., Lepera G., Bresciani B., Seragnoli E., Forti M.C., Cortina V., Baciarello G., Cicconetti P., Lax A., Vitali F., Igidbashian D., Scarpino L., Terrazzino S., Tavazzi L., Cantu F., Pentimalli F., Novo S., Coppola G., Zingarini G., Ambrozio G., Moruzzi P., Callegari S., Saccomanno G., Russo P., Carbonieri E., Paino A., Zanetta M., Barducci E., Cemin R., Rauhe W., Pitscheider W., Meloni M., Marchi S.M., Di Gennaro M., Calcagno S., Squaratti P., Quartili F., Bertocchi P., De Martini M., Mantovani G., Komorovsky R., Desideri A., Celegon L., Tarantini L., Catania G., Lucci D., Bianchini F., Puodziukynas A., Kavoliuniene A., Barauskiene V., Aidietis A., Barysiene J., Vysniauskas V., Zukauskiene I., Kazakeviciene N., Georgievska-Ismail L., Poposka L., Vataman E., Grosu A.A., op Reimer W.S., de Swart E., Lenzen M., Jansen C., Brons R., Tebbe H., van Hoogenhuyze D.C.A., Veerhoek M.J., Kamps M., Haan D., van Rijn N., Bootsma A., Baur L., van den A., Fransen H., Eurlings L., Meeder J., De Boer M.J., Winter J., Broers H., Werter C., Bijl M., Versluis S., Milkowska M., Wozakowska-Kaplon B., Janion M., Lepska L., Swiatecka G., Kokowicz P., Cybulski J., Gorecki A., Szulc M., Rekosz J., Manczak R., Wnuk-Wojnar A.-M., Trusz-Gluza M., Rybicka-Musialik A., Myszor J., Szpajer M., Cymerman K., Sadowski J., Sniezek-Maciejewska M., Ciesla-Dul M., Gorkiewicz-Kot I., Grodzicki T., Rewiuk K., Kubik L., Lewit J., de Sousa J.M.F.R., Ferreira R., Freitas A., Morais J.C.A., Pires R., Gomes M.J.V., Gago P., Candeias R.A.C., Nunes L., Sa J.V.M., Ventura M., de Oliveira M., Alves L.B., Bostaca I., Olariu C.T., Dan G.A., Dan A., Podoleanu C., Frigy A., Georgescu G.I.M., Arsenescu C., Statescu C., Sascau R., Dimitrascu D.L., Rancea R., Shubik Y.V., Duplyakov D., Shalak M., Danielyan M., Galyavich A., Zakirova V., Hatala R., Kaliska G., Kmec J., Zupan I., Tasie` J., Vokac D., Edvardsson N., Poci D., Gamra H., Denguir H., Sepetoglu A., Arat-Ozkan A., Orynchak M., Paliy E., Vakalyuk I., Malidze D., Prog R., Yabluchansky M.I., Makienko N.V., Potpara T., Knezevic S., and Randjelovic M.

Subjects
Male, Prognosi, Incidence, Risk Factor, Reproducibility of Result, Risk Assessment, Follow-Up Studie, Europe, Stroke, Retrospective Studie, Population Surveillance, Thromboembolism, Atrial Fibrillation, Female, Aged, Human
Abstract

Background: Contemporary clinical risk stratification schemata for predicting stroke and thromboembolism (TE) in patients with atrial fibrillation (AF) are largely derived from risk factors identified from trial cohorts. Thus, many potential risk factors have not been included. Methods: We refined the 2006 Birmingham/National Institute for Health and Clinical Excellence (NICE) stroke risk stratification schema into a risk factor-based approach by reclassifying and/or incorporating additional new risk factors where relevant. This schema was then compared with existing stroke risk stratification schema in a real-world cohort of patients with AF (n = 1,084) from the Euro Heart Survey for AF. Results: Risk categorization differed widely between the different schemes compared. Patients classified as high risk ranged from 10.2% with the Framingham schema to 75.7% with the Birmingham 2009 schema. The classic CHADS 2 (Congestive heart failure, Hypertension, Age > 75, Diabetes, prior Stroke/transient ischemic attack) schema categorized the largest proportion (61.9%) into the intermediate-risk strata, whereas the Birmingham 2009 schema classified 15.1% into this category. The Birmingham 2009 schema classified only 9.2% as low risk, whereas the Framingham scheme categorized 48.3% as low risk. Calculated C-statistics suggested modest predictive value of all schema for TE. The Birmingham 2009 schema fared marginally better (C-statistic, 0.606) than CHADS 2 . However, those classified as low risk by the Birmingham 2009 and NICE schema were truly low risk with no TE events recorded, whereas TE events occurred in 1.4% of low-risk CHADS 2 subjects. When expressed as a scoring system, the Birmingham 2009 schema (CHA 2 DS 2 -VASc acronym) showed an increase in TE rate with increasing scores ( P value for trend = .003). Conclusion: Our novel, simple stroke risk stratification schema, based on a risk factor approach, provides some improvement in predictive value for TE over the CHADS 2 schema, with low event rates in low-risk subjects and the classification of only a small proportion of subjects into the intermediate-risk category. This schema could improve our approach to stroke risk stratification in patients with AF. © 2010 American College of Chest Physicians.

Published
2010

9. Diabetes known or newly detected, but not impaired glucose regulation, has a negative influence on 1-year outcome in patients with coronary artery disease: a report from the Euro Heart Survey on diabetes and the heart

Author

Lenzen M., Ryden L., Ohrvik J., Bartnik M., Malmberg K., Scholte Op Reimer W., Simoons M. L., Andresen D., Camm A. J., Davies W., Capucci A., Levy S., Olsson B., Aliot E., Breithardt G., Cobbe S., Le Heuzey J. -Y., Santini M., Vardas P., Manini M., Bramley C., Laforest V., Taylor C., Del Gaiso S., Huber K., De Backer G., Sirakova V., Cerbak R., Thayssen P., Lehto S., Blanc J. -J., Delahaye F., Kobulia B., Zeymer U., Cokkinos D., Karlocai K., Graham I., Shelley E., Behar S., Maggioni A., Goncalves L., Grabauskiene V., Asmussen I., Deckers J., Stepinska J., Mareev V., Vasiljevic Z., Riecansky I., Kenda M. F., Alonso A., Lopez-Sendon J. L., Rosengren A., Buser P., Okay T., Sychov O., Fox K., Schofield P., Wood D., Battler A., Boersma E., Komajda M., McGregor K., Mulder B., Priori S., Vahanian A., Wijns W., Sanofi-Aventis, Grigoryan S. V., Apetyan I., Aroyan S., Azarapetyan L., Anvari A., Gottsauner-Wolf M., Pfaffenberger S., Aydinkoc K., Kalla K., Penka M., Drexel H., Langer P., Pierard L. A., Legrand V., Blommaert D., Schroeder E., Mancini I., Geelen P., Brugada P., De Zutter M., Vrints C., Vercammen M., Morissens M., Borisov B., Petrov V. A., Marinova M., Assen A., Goudev R., Peychev Y., Stoyanovsky V., Stoynev E., Kranjcevic S., Moutiris J., Ioannides M., Evequoz D., Spacilova J., Novak M., Eisenberger M., Mullerova J., Kautzner J., Riedlbauchova L., Petru` J., Taborsky M., Cappelen H., Sharaf Y. A., Ibrahim B. S. S., Tammam K., Saad A., Elghawaby H., Sherif H. Z., Farouk H., Mielke A., Engelen M., Kirchhof P., Zimmermann P., Aviles F. F., Rubio J., Malpartida F., Corona M., Sanchez L. T., Miguel J., Herrera L., Quesada A., Garcia A. J. M., Gonzalez C. S., Juango M. S. A., Berjon-Reyero J., Alegret J. M., Fernandez J. M. C., Carrascosa C., Romero R. A. F., Lara M. G., Sendon J. L. L., de Diego J. J. G., Martin L. S., Irurita M., Guttierez N. H., Rubio J. R. S., Antorrena I., Paves A. B., Salvador A., Orriach M. D., Garcia A. A., Epelde F., Martinez V. B., Sanchez A. B., Galvez C. P., Rivero R. F., Madrid A. H., Baron-Esquivias G., Peinado R., Guindal J. A. G., Vera T. R., Fernandez E. L., Gayan R., Garcia J., Bodegas A., Lopez J. T., Florez J. M., Cabezas C. L., de Castroviejo E. V. R., Bellido J. M., Ruiz M. E., Savolainen K., Nieminen M., Toivonen L., Syvanne M., Pietila M., Galley D., Beltra C., Gay A., Daubert J. C., Lecocq G., Poulain C., Cleland J. G. F. C., Shelton R., Choudhury A., Abuladze G., Jashi I., Tsiavou A., Giamouzis G., Dagres N., Kostopoulou A., Tsoutsanis D., Stefanadis C., Latsios G., Vogiatzis I., Gotsis A., Bozia P., Karakiriou M., Koulouris S., Parissis J., Kostakis G., Kouris N., Kontogianni D., Athanasios K., Douras A., Tsanakis T., Marketou M., Patsourakos N., Czopf L., Halmosi R., Preda I., Csoti E., Badics A., Strasberg B., Freedberg N. A., Katz A., Zalzstein E., Grosbard A., Goldhammer E., Nahir M., Epstein M., Vider I., Luria D., Mandelzweig L., Aloisi B., Cavallaro A., Antonielli E., Doronzo B., Pancaldo D., Mazzola C., Buontempi L., Calvi V., Giuffrida G., Figlia A., Ippolito F., Gelmini G. -P., Gaibazzi N., Ziacchi V., De Tommasi F., Lombardi F., Fiorentini C., Terranova P., Maiolino P., Albunni M., Pinna-Pintor P., Fumagalli S., Masotti G., Boncinelli L., Rossi D., Santoro G. M., Fioranelli M., Naccarella F., Maranga S. S., Lepera G., Bresciani B., Seragnoli E., Forti M. C., Cortina V., Baciarello G., Cicconetti P., Lax A., Vitali F., Igidbashian D., Scarpino L., Terrazzino S., Tavazzi L., Cantu F., Pentimalli F., Novo S., Coppola G., Zingarini G., Ambrozio G., Moruzzi P., Callegari S., Saccomanno G., Russo P., Carbonieri E., Paino A., Zanetta M., Barducci E., Cemin R., Rauhe W., Pitscheider W., Meloni M., Marchi S. M., Di Gennaro M., Calcagno S., Squaratti P., Quartili F., Bertocchi P., De Martini M., Mantovani G., Komorovsky R., Desideri A., Celegon L., Tarantini L., Catania G., Lucci D., Bianchini F., Puodziukynas A., Kavoliuniene A., Barauskiene V., Aidietis A., Barysiene J., Vysniauskas V., Zukauskiene I., Kazakeviciene N., Georgievska-Ismail L., Poposka L., Vataman E., Grosu A. A., de Swart E., Jansen C., Brons R., Tebbe H., van Hoogenhuyze D. C. A., Veerhoek M. J., Kamps M., Haan D., van Rijn N., Bootsma A., Baur L., van den A., Fransen H., Eurlings L., Meeder J., De Boer M. J., Winter J., Broers H., Werter C., Bijl M., Versluis S., Milkowska M., Wozakowska-Kaplon B., Janion M., Lepska L., Swiatecka G., Kokowicz P., Cybulski J., Gorecki A., Szulc M., Rekosz J., Manczak R., Wnuk-Wojnar A. -M., Trusz-Gluza M., Rybicka-Musialik A., Myszor J., Szpajer M., Cymerman K., Sadowski J., Sniezek-Maciejewska M., Ciesla-Dul M., Gorkiewicz-Kot I., Grodzicki T., Rewiuk K., Kubik L., Lewit J., de Sousa J. M. F. R., Ferreira R., Freitas A., Morais J. C. A., Pires R., Gomes M. J. V., Gago P., Candeias R. A. C., Nunes L., Sa J. V. M., Ventura M., de Oliveira M., Alves L. B., Bostaca I., Olariu C. T., Dan G. A., Dan A., Podoleanu C., Frigy A., Georgescu G. I. M., Arsenescu C., Statescu C., Sascau R., Dimitrascu D. L., Rancea R., Shubik Y. V., Duplyakov D., Shalak M., Danielyan M., Galyavich A., Zakirova V., Hatala R., Kaliska G., Kmec J., Zupan I., Tasie` J., Vokac D., Edvardsson N., Poci D., Gamra H., Denguir H., Sepetoglu A., Arat-Ozkan A., Orynchak M., Paliy E., Vakalyuk I., Malidze D., Prog R., Yabluchansky M. I., Makienko N. V., Potpara T., Knezevic S., Randjelovic M., Lenzen M., Ryden L., Ohrvik J., Bartnik M., Malmberg K., Scholte Op Reimer W., Simoons M.L., Andresen D., Camm A.J., Davies W., Capucci A., Levy S., Olsson B., Aliot E., Breithardt G., Cobbe S., Le Heuzey J.-Y., Santini M., Vardas P., Manini M., Bramley C., Laforest V., Taylor C., Del Gaiso S., Huber K., De Backer G., Sirakova V., Cerbak R., Thayssen P., Lehto S., Blanc J.-J., Delahaye F., Kobulia B., Zeymer U., Cokkinos D., Karlocai K., Graham I., Shelley E., Behar S., Maggioni A., Goncalves L., Grabauskiene V., Asmussen I., Deckers J., Stepinska J., Mareev V., Vasiljevic Z., Riecansky I., Kenda M.F., Alonso A., Lopez-Sendon J.L., Rosengren A., Buser P., Okay T., Sychov O., Fox K., Schofield P., Wood D., Battler A., Boersma E., Komajda M., McGregor K., Mulder B., Priori S., Vahanian A., Wijns W., Sanofi-Aventi, Grigoryan S.V., Apetyan I., Aroyan S., Azarapetyan L., Anvari A., Gottsauner-Wolf M., Pfaffenberger S., Aydinkoc K., Kalla K., Penka M., Drexel H., Langer P., Pierard L.A., Legrand V., Blommaert D., Schroeder E., Mancini I., Geelen P., Brugada P., De Zutter M., Vrints C., Vercammen M., Morissens M., Borisov B., Petrov V.A., Marinova M., Assen A., Goudev R., Peychev Y., Stoyanovsky V., Stoynev E., Kranjcevic S., Moutiris J., Ioannides M., Evequoz D., Spacilova J., Novak M., Eisenberger M., Mullerova J., Kautzner J., Riedlbauchova L., Petru` J., Taborsky M., Cappelen H., Sharaf Y.A., Ibrahim B.S.S., Tammam K., Saad A., Elghawaby H., Sherif H.Z., Farouk H., Mielke A., Engelen M., Kirchhof P., Zimmermann P., Aviles F.F., Rubio J., Malpartida F., Corona M., Sanchez L.T., Miguel J., Herrera L., Quesada A., Garcia A.J.M., Gonzalez C.S., Juango M.S.A., Berjon-Reyero J., Alegret J.M., Fernandez J.M.C., Carrascosa C., Romero R.A.F., Lara M.G., Sendon J.L.L., de Diego J.J.G., Martin L.S., Irurita M., Guttierez N.H., Rubio J.R.S., Antorrena I., Paves A.B., Salvador A., Orriach M.D., Garcia A.A., Epelde F., Martinez V.B., Sanchez A.B., Galvez C.P., Rivero R.F., Madrid A.H., Baron-Esquivias G., Peinado R., Guindal J.A.G., Vera T.R., Fernandez E.L., Gayan R., Garcia J., Bodegas A., Lopez J.T., Florez J.M., Cabezas C.L., de Castroviejo E.V.R., Bellido J.M., Ruiz M.E., Savolainen K., Nieminen M., Toivonen L., Syvanne M., Pietila M., Galley D., Beltra C., Gay A., Daubert J.C., Lecocq G., Poulain C., Cleland J.G.F.C., Shelton R., Choudhury A., Abuladze G., Jashi I., Tsiavou A., Giamouzis G., Dagres N., Kostopoulou A., Tsoutsanis D., Stefanadis C., Latsios G., Vogiatzis I., Gotsis A., Bozia P., Karakiriou M., Koulouris S., Parissis J., Kostakis G., Kouris N., Kontogianni D., Athanasios K., Douras A., Tsanakis T., Marketou M., Patsourakos N., Czopf L., Halmosi R., Preda I., Csoti E., Badics A., Strasberg B., Freedberg N.A., Katz A., Zalzstein E., Grosbard A., Goldhammer E., Nahir M., Epstein M., Vider I., Luria D., Mandelzweig L., Aloisi B., Cavallaro A., Antonielli E., Doronzo B., Pancaldo D., Mazzola C., Buontempi L., Calvi V., Giuffrida G., Figlia A., Ippolito F., Gelmini G.-P., Gaibazzi N., Ziacchi V., De Tommasi F., Lombardi F., Fiorentini C., Terranova P., Maiolino P., Albunni M., Pinna-Pintor P., Fumagalli S., Masotti G., Boncinelli L., Rossi D., Santoro G.M., Fioranelli M., Naccarella F., Maranga S.S., Lepera G., Bresciani B., Seragnoli E., Forti M.C., Cortina V., Baciarello G., Cicconetti P., Lax A., Vitali F., Igidbashian D., Scarpino L., Terrazzino S., Tavazzi L., Cantu F., Pentimalli F., Novo S., Coppola G., Zingarini G., Ambrozio G., Moruzzi P., Callegari S., Saccomanno G., Russo P., Carbonieri E., Paino A., Zanetta M., Barducci E., Cemin R., Rauhe W., Pitscheider W., Meloni M., Marchi S.M., Di Gennaro M., Calcagno S., Squaratti P., Quartili F., Bertocchi P., De Martini M., Mantovani G., Komorovsky R., Desideri A., Celegon L., Tarantini L., Catania G., Lucci D., Bianchini F., Puodziukynas A., Kavoliuniene A., Barauskiene V., Aidietis A., Barysiene J., Vysniauskas V., Zukauskiene I., Kazakeviciene N., Georgievska-Ismail L., Poposka L., Vataman E., Grosu A.A., de Swart E., Jansen C., Brons R., Tebbe H., van Hoogenhuyze D.C.A., Veerhoek M.J., Kamps M., Haan D., van Rijn N., Bootsma A., Baur L., van den A., Fransen H., Eurlings L., Meeder J., De Boer M.J., Winter J., Broers H., Werter C., Bijl M., Versluis S., Milkowska M., Wozakowska-Kaplon B., Janion M., Lepska L., Swiatecka G., Kokowicz P., Cybulski J., Gorecki A., Szulc M., Rekosz J., Manczak R., Wnuk-Wojnar A.-M., Trusz-Gluza M., Rybicka-Musialik A., Myszor J., Szpajer M., Cymerman K., Sadowski J., Sniezek-Maciejewska M., Ciesla-Dul M., Gorkiewicz-Kot I., Grodzicki T., Rewiuk K., Kubik L., Lewit J., de Sousa J.M.F.R., Ferreira R., Freitas A., Morais J.C.A., Pires R., Gomes M.J.V., Gago P., Candeias R.A.C., Nunes L., Sa J.V.M., Ventura M., de Oliveira M., Alves L.B., Bostaca I., Olariu C.T., Dan G.A., Dan A., Podoleanu C., Frigy A., Georgescu G.I.M., Arsenescu C., Statescu C., Sascau R., Dimitrascu D.L., Rancea R., Shubik Y.V., Duplyakov D., Shalak M., Danielyan M., Galyavich A., Zakirova V., Hatala R., Kaliska G., Kmec J., Zupan I., Tasie` J., Vokac D., Edvardsson N., Poci D., Gamra H., Denguir H., Sepetoglu A., Arat-Ozkan A., Orynchak M., Paliy E., Vakalyuk I., Malidze D., Prog R., Yabluchansky M.I., Makienko N.V., Potpara T., Knezevic S., Randjelovic M., and Cardiology

Subjects
Blood Glucose, Male, medicine.medical_specialty, Diabetic Angiopathie, Prognosi, Impaired glucose regulation, Euro Heart Survey, Myocardial Infarction, Coronary Artery Disease, Diabete, Follow-Up Studie, Coronary artery disease, Impaired glucose tolerance, SDG 3 - Good Health and Well-being, Internal medicine, Diabetes mellitus, medicine, Humans, Survival analysis, Aged, business.industry, Hazard ratio, Middle Aged, medicine.disease, Impaired fasting glucose, Prognosis, Survival Analysis, Stroke, Endocrinology, Blood sugar regulation, Female, Cardiology and Cardiovascular Medicine, business, Complication, Diabetic Angiopathies, Human, Follow-Up Studies
Abstract

Aims: Although diabetes is known to be a major contributor to cardiovascular diseases, as well as an independent predictor for adverse outcomes in patients with coronary artery disease (CAD), information on the prognosis of patients with CAD and newly diagnosed diabetes or impaired glucose regulation (IGR) is scarce. The objective of this study was to explore 1-year outcome in relation to different glucometabolic states of patients participating in the Euro Heart Survey on diabetes and the heart. Methods and results: In 4676 out of 4961 patients, information on the relation between 1-year outcome and glucometabolic state, which was based on oral glucose tolerance test (OGTT) or fasting glucose plasma, was available. A normal glucose metabolism was identified in 947 patients, IGR (impaired fasting glucose or impaired glucose tolerance) in 1116 patients, and diabetes in 1877 patients of whom 1425 were previously diagnosed and 452 newly diagnosed. In total, 736 patients could not be classified, as no OGTT or fasting plasma glucose was performed. Previously recognized and newly detected diabetes was associated with an increased risk of 1-year mortality when compared with patients with normal glucose regulation [hazard ratio (HR) 2.4, 95% confidence interval (CI) 1.5-3.8 and HR 2.0, 95% CI 1.1-3.6, respectively)]. IGR, however, could not be identified as an independent predictor for 1-year mortality (HR 1.1, 95% CI 0.6-1.9). Conclusion: This study confirmed that patients with CAD and known diabetes are at high risk for mortality and cardiovascular events and demonstrated that patients with newly diagnosed diabetes are at intermediate risk for adverse outcomes. IGR, however, could not be identified as an independent predictor for adverse outcomes during the 1-year follow-up period. © The European Society of Cardiology 2006. All rights reserved.

Published
2006

10. Gender-related differences in presentation, treatment, and outcome of patients with atrial fibrillation in Europe: a report from the Euro Heart Survey on Atrial Fibrillation

Author

Dagres N., Nieuwlaat R., Vardas P. E., Andresen D., Levy S., Cobbe S., Kremastinos D. Th., Breithardt G., Cokkinos D. V., Crijns H. J. G. M., Camm A. J., Davies W., Capucci A., Olsson B., Aliot E., Le Heuzey J. -Y., Santini M., Manini M., Bramley C., Laforest V., Taylor C., Del Gaiso S., Huber K., De Backer G., Sirakova V., Cerbak R., Thayssen P., Lehto S., Blanc J. -J., Delahaye F., Kobulia B., Zeymer U., Karlocai K., Graham I., Shelley E., Behar S., Maggioni A., Goncalves L., Grabauskiene V., Asmussen I., Deckers J., Stepinska J., Mareev V., Vasiljevic Z., Riecansky I., Kenda M. F., Alonso A., Lopez-Sendon J. L., Rosengren A., Buser P., Okay T., Sychov O., Fox K., Schofield P., Simoons M., Wood D., Battler A., Boersma E., Komajda M., McGregor K., Mulder B., Priori S., Ryden L., Vahanian A., Wijns W., Sanofi-Aventis, Grigoryan S. V., Apetyan I., Aroyan S., Azarapetyan L., Anvari A., Gottsauner-Wolf M., Pfaffenberger S., Aydinkoc K., Kalla K., Penka M., Drexel H., Langer P., Pierard L. A., Legrand V., Blommaert D., Schroeder E., Mancini I., Geelen P., Brugada P., De Zutter M., Vrints C., Vercammen M., Morissens M., Borisov B., Petrov V. A., Marinova M., Assen A., Goudev R., Peychev Y., Stoyanovsky V., Stoynev E., Kranjcevic S., Moutiris J., Ioannides M., Evequoz D., Spacilova J., Novak M., Eisenberger M., Mullerova J., Kautzner J., Riedlbauchova L., Petru` J., Taborsky M., Cappelen H., Sharaf Y. A., Ibrahim B. S. S., Tammam K., Saad A., Elghawaby H., Sherif H. Z., Farouk H., Mielke A., Engelen M., Kirchhof P., Zimmermann P., Aviles F. F., Rubio J., Malpartida F., Corona M., Sanchez L. T., Miguel J., Herrera L., Quesada A., Garcia A. J. M., Gonzalez C. S., Juango M. S. A., Berjon-Reyero J., Alegret J. M., Fernandez J. M. C., Carrascosa C., Romero R. A. F., Lara M. G., Sendon J. L. L., de Diego J. J. G., Martin L. S., Irurita M., Guttierez N. H., Rubio J. R. S., Antorrena I., Paves A. B., Salvador A., Orriach M. D., Garcia A. A., Epelde F., Martinez V. B., Sanchez A. B., Galvez C. P., Rivero R. F., Madrid A. H., Baron-Esquivias G., Peinado R., Guindal J. A. G., Vera T. R., Fernandez E. L., Gayan R., Garcia J., Bodegas A., Lopez J. T., Florez J. M., Cabezas C. L., de Castroviejo E. V. R., Bellido J. M., Ruiz M. E., Savolainen K., Nieminen M., Toivonen L., Syvanne M., Pietila M., Galley D., Beltra C., Gay A., Daubert J. C., Lecocq G., Poulain C., Cleland J. G. F. C., Shelton R., Choudhury A., Abuladze G., Jashi I., Tsiavou A., Giamouzis G., Kostopoulou A., Tsoutsanis D., Stefanadis C., Latsios G., Vogiatzis I., Gotsis A., Bozia P., Karakiriou M., Koulouris S., Parissis J., Kostakis G., Kouris N., Kontogianni D., Athanasios K., Douras A., Tsanakis T., Marketou M., Patsourakos N., Czopf L., Halmosi R., Preda I., Csoti E., Badics A., Strasberg B., Freedberg N. A., Katz A., Zalzstein E., Grosbard A., Goldhammer E., Nahir M., Epstein M., Vider I., Luria D., Mandelzweig L., Aloisi B., Cavallaro A., Antonielli E., Doronzo B., Pancaldo D., Mazzola C., Buontempi L., Calvi V., Giuffrida G., Figlia A., Ippolito F., Gelmini G. -P., Gaibazzi N., Ziacchi V., De Tommasi F., Lombardi F., Fiorentini C., Terranova P., Maiolino P., Albunni M., Pinna-Pintor P., Fumagalli S., Masotti G., Boncinelli L., Rossi D., Santoro G. M., Fioranelli M., Naccarella F., Maranga S. S., Lepera G., Bresciani B., Seragnoli E., Forti M. C., Cortina V., Baciarello G., Cicconetti P., Lax A., Vitali F., Igidbashian D., Scarpino L., Terrazzino S., Tavazzi L., Cantu F., Pentimalli F., Novo S., Coppola G., Zingarini G., Ambrozio G., Moruzzi P., Callegari S., Saccomanno G., Russo P., Carbonieri E., Paino A., Zanetta M., Barducci E., Cemin R., Rauhe W., Pitscheider W., Meloni M., Marchi S. M., Di Gennaro M., Calcagno S., Squaratti P., Quartili F., Bertocchi P., De Martini M., Mantovani G., Komorovsky R., Desideri A., Celegon L., Tarantini L., Catania G., Lucci D., Bianchini F., Puodziukynas A., Kavoliuniene A., Barauskiene V., Aidietis A., Barysiene J., Vysniauskas V., Zukauskiene I., Kazakeviciene N., Georgievska-Ismail L., Poposka L., Vataman E., Grosu A. A., op Reimer W. S., de Swart E., Lenzen M., Jansen C., Brons R., Tebbe H., van Hoogenhuyze D. C. A., Veerhoek M. J., Kamps M., Haan D., van Rijn N., Bootsma A., Baur L., van den A., Fransen H., Eurlings L., Meeder J., De Boer M. J., Winter J., Broers H., Werter C., Bijl M., Versluis S., Milkowska M., Wozakowska-Kaplon B., Janion M., Lepska L., Swiatecka G., Kokowicz P., Cybulski J., Gorecki A., Szulc M., Rekosz J., Manczak R., Wnuk-Wojnar A. -M., Trusz-Gluza M., Rybicka-Musialik A., Myszor J., Szpajer M., Cymerman K., Sadowski J., Sniezek-Maciejewska M., Ciesla-Dul M., Gorkiewicz-Kot I., Grodzicki T., Rewiuk K., Kubik L., Lewit J., de Sousa J. M. F. R., Ferreira R., Freitas A., Morais J. C. A., Pires R., Gomes M. J. V., Gago P., Candeias R. A. C., Nunes L., Sa J. V. M., Ventura M., de Oliveira M., Alves L. B., Bostaca I., Olariu C. T., Dan G. A., Dan A., Podoleanu C., Frigy A., Georgescu G. I. M., Arsenescu C., Statescu C., Sascau R., Dimitrascu D. L., Rancea R., Shubik Y. V., Duplyakov D., Shalak M., Danielyan M., Galyavich A., Zakirova V., Hatala R., Kaliska G., Kmec J., Zupan I., Tasie` J., Vokac D., Edvardsson N., Poci D., Gamra H., Denguir H., Sepetoglu A., Arat-Ozkan A., Orynchak M., Paliy E., Vakalyuk I., Malidze D., Prog R., Yabluchansky M. I., Makienko N. V., Potpara T., Knezevic S., Randjelovic M., Dagres N., Nieuwlaat R., Vardas P.E., Andresen D., Levy S., Cobbe S., Kremastinos D.Th., Breithardt G., Cokkinos D.V., Crijns H.J.G.M., Camm A.J., Davies W., Capucci A., Olsson B., Aliot E., Le Heuzey J.-Y., Santini M., Manini M., Bramley C., Laforest V., Taylor C., Del Gaiso S., Huber K., De Backer G., Sirakova V., Cerbak R., Thayssen P., Lehto S., Blanc J.-J., Delahaye F., Kobulia B., Zeymer U., Karlocai K., Graham I., Shelley E., Behar S., Maggioni A., Goncalves L., Grabauskiene V., Asmussen I., Deckers J., Stepinska J., Mareev V., Vasiljevic Z., Riecansky I., Kenda M.F., Alonso A., Lopez-Sendon J.L., Rosengren A., Buser P., Okay T., Sychov O., Fox K., Schofield P., Simoons M., Wood D., Battler A., Boersma E., Komajda M., McGregor K., Mulder B., Priori S., Ryden L., Vahanian A., Wijns W., Sanofi-Aventi, Grigoryan S.V., Apetyan I., Aroyan S., Azarapetyan L., Anvari A., Gottsauner-Wolf M., Pfaffenberger S., Aydinkoc K., Kalla K., Penka M., Drexel H., Langer P., Pierard L.A., Legrand V., Blommaert D., Schroeder E., Mancini I., Geelen P., Brugada P., De Zutter M., Vrints C., Vercammen M., Morissens M., Borisov B., Petrov V.A., Marinova M., Assen A., Goudev R., Peychev Y., Stoyanovsky V., Stoynev E., Kranjcevic S., Moutiris J., Ioannides M., Evequoz D., Spacilova J., Novak M., Eisenberger M., Mullerova J., Kautzner J., Riedlbauchova L., Petru` J., Taborsky M., Cappelen H., Sharaf Y.A., Ibrahim B.S.S., Tammam K., Saad A., Elghawaby H., Sherif H.Z., Farouk H., Mielke A., Engelen M., Kirchhof P., Zimmermann P., Aviles F.F., Rubio J., Malpartida F., Corona M., Sanchez L.T., Miguel J., Herrera L., Quesada A., Garcia A.J.M., Gonzalez C.S., Juango M.S.A., Berjon-Reyero J., Alegret J.M., Fernandez J.M.C., Carrascosa C., Romero R.A.F., Lara M.G., Sendon J.L.L., de Diego J.J.G., Martin L.S., Irurita M., Guttierez N.H., Rubio J.R.S., Antorrena I., Paves A.B., Salvador A., Orriach M.D., Garcia A.A., Epelde F., Martinez V.B., Sanchez A.B., Galvez C.P., Rivero R.F., Madrid A.H., Baron-Esquivias G., Peinado R., Guindal J.A.G., Vera T.R., Fernandez E.L., Gayan R., Garcia J., Bodegas A., Lopez J.T., Florez J.M., Cabezas C.L., de Castroviejo E.V.R., Bellido J.M., Ruiz M.E., Savolainen K., Nieminen M., Toivonen L., Syvanne M., Pietila M., Galley D., Beltra C., Gay A., Daubert J.C., Lecocq G., Poulain C., Cleland J.G.F.C., Shelton R., Choudhury A., Abuladze G., Jashi I., Tsiavou A., Giamouzis G., Kostopoulou A., Tsoutsanis D., Stefanadis C., Latsios G., Vogiatzis I., Gotsis A., Bozia P., Karakiriou M., Koulouris S., Parissis J., Kostakis G., Kouris N., Kontogianni D., Athanasios K., Douras A., Tsanakis T., Marketou M., Patsourakos N., Czopf L., Halmosi R., Preda I., Csoti E., Badics A., Strasberg B., Freedberg N.A., Katz A., Zalzstein E., Grosbard A., Goldhammer E., Nahir M., Epstein M., Vider I., Luria D., Mandelzweig L., Aloisi B., Cavallaro A., Antonielli E., Doronzo B., Pancaldo D., Mazzola C., Buontempi L., Calvi V., Giuffrida G., Figlia A., Ippolito F., Gelmini G.-P., Gaibazzi N., Ziacchi V., De Tommasi F., Lombardi F., Fiorentini C., Terranova P., Maiolino P., Albunni M., Pinna-Pintor P., Fumagalli S., Masotti G., Boncinelli L., Rossi D., Santoro G.M., Fioranelli M., Naccarella F., Maranga S.S., Lepera G., Bresciani B., Seragnoli E., Forti M.C., Cortina V., Baciarello G., Cicconetti P., Lax A., Vitali F., Igidbashian D., Scarpino L., Terrazzino S., Tavazzi L., Cantu F., Pentimalli F., Novo S., Coppola G., Zingarini G., Ambrozio G., Moruzzi P., Callegari S., Saccomanno G., Russo P., Carbonieri E., Paino A., Zanetta M., Barducci E., Cemin R., Rauhe W., Pitscheider W., Meloni M., Marchi S.M., Di Gennaro M., Calcagno S., Squaratti P., Quartili F., Bertocchi P., De Martini M., Mantovani G., Komorovsky R., Desideri A., Celegon L., Tarantini L., Catania G., Lucci D., Bianchini F., Puodziukynas A., Kavoliuniene A., Barauskiene V., Aidietis A., Barysiene J., Vysniauskas V., Zukauskiene I., Kazakeviciene N., Georgievska-Ismail L., Poposka L., Vataman E., Grosu A.A., op Reimer W.S., de Swart E., Lenzen M., Jansen C., Brons R., Tebbe H., van Hoogenhuyze D.C.A., Veerhoek M.J., Kamps M., Haan D., van Rijn N., Bootsma A., Baur L., van den A., Fransen H., Eurlings L., Meeder J., De Boer M.J., Winter J., Broers H., Werter C., Bijl M., Versluis S., Milkowska M., Wozakowska-Kaplon B., Janion M., Lepska L., Swiatecka G., Kokowicz P., Cybulski J., Gorecki A., Szulc M., Rekosz J., Manczak R., Wnuk-Wojnar A.-M., Trusz-Gluza M., Rybicka-Musialik A., Myszor J., Szpajer M., Cymerman K., Sadowski J., Sniezek-Maciejewska M., Ciesla-Dul M., Gorkiewicz-Kot I., Grodzicki T., Rewiuk K., Kubik L., Lewit J., de Sousa J.M.F.R., Ferreira R., Freitas A., Morais J.C.A., Pires R., Gomes M.J.V., Gago P., Candeias R.A.C., Nunes L., Sa J.V.M., Ventura M., de Oliveira M., Alves L.B., Bostaca I., Olariu C.T., Dan G.A., Dan A., Podoleanu C., Frigy A., Georgescu G.I.M., Arsenescu C., Statescu C., Sascau R., Dimitrascu D.L., Rancea R., Shubik Y.V., Duplyakov D., Shalak M., Danielyan M., Galyavich A., Zakirova V., Hatala R., Kaliska G., Kmec J., Zupan I., Tasie` J., Vokac D., Edvardsson N., Poci D., Gamra H., Denguir H., Sepetoglu A., Arat-Ozkan A., Orynchak M., Paliy E., Vakalyuk I., Malidze D., Prog R., Yabluchansky M.I., Makienko N.V., Potpara T., Knezevic S., and Randjelovic M.

Subjects
Aged, 80 and over, Heart Failure, Male, Health Status, Health Survey, Middle Aged, Health Surveys, Follow-Up Studie, Health Statu, Europe, Stroke, Sex Factors, Treatment Outcome, Atrial Fibrillation, Quality of Life, Humans, Female, Human, Aged, Follow-Up Studies
Abstract

Objectives: This study sought to investigate gender-related differences in patients with atrial fibrillation (AF) in Europe. Background: Gender-related differences may play a significant role in AF. Methods: We analyzed the data of 5,333 patients (42% female) enrolled in the Euro Heart Survey on Atrial Fibrillation. Results: Compared with men, the women were older, had a lower quality of life (QoL), had more comorbidities, more often had heart failure (HF) with preserved left ventricular systolic function (18% vs. 7%, p < 0.001), and less often had HF with systolic dysfunction (17% vs. 26%, p < 0.001). Among patients with typical AF symptoms (56% of women, 49% of men), there was no gender-related difference in the choice of rate or rhythm control. Among patients with atypical or no symptoms (44% of women, 51% of men), women less frequently underwent rhythm control (39% vs. 51%, p < 0.001) than did men. Women underwent less electrical cardioversion (22% vs. 28%, p < 0.001). Prescription of oral anticoagulants was identical (65%) in both genders. One-year outcome was similar except that women had a higher chance for stroke (odds ratio 1.83 in multivariable regression analysis, p = 0.019). Conclusions: Women with AF had more comorbidities, more HF with preserved systolic function, and a lower QoL than men. In the large group with atypical or no symptoms, women were treated appropriately more conservatively with less rhythm control than men. Women had a higher chance for stroke. Long-term QoL changes and other morbidities and mortality were similar. © 2007 American College of Cardiology Foundation.

Published
2006

11. Atrial fibrillation management: A prospective survey in ESC Member Countries - The Euro Heart Survey on atrial fibrillation

Author

Nieuwlaat R., Capucci A., Camm A. J., Olsson S. B., Andresen D., Davies D. W., Cobbe S., Breithardt G., Le Heuzey J. -Y., Prins M. H., Levy S., Crijns H. J. G. M., Aliot E., Santini M., Vardas P., Manini M., Bramley C., Laforest V., Taylor C., Del Gaiso S., Huber K., De Backer G., Sirakova V., Cerbak R., Thayssen P., Lehto S., Blanc J. -J., Delahaye F., Kobulia B., Zeymer U., Cokkinos D., Karlocai K., Graham I., Shelley E., Behar S., Maggioni A., Grabauskiene V., Deckers J., Asmussen I., Stepinska J., Goncalves L., Mareev V., Vasiljevic Z., Riecansky I., Kenda M. F., Alonso A., Lopez-Sendon J. L., Rosengren A., Buser P., Okay T., Sychov O., Fox K., Schofield P., Simoons M., Wood D., Battler A., Boersma E., Komajda M., McGregor K., Mulder B., Priori S., Ryden L., Tavazzi L., Vahanian A., Wijns W., Grigoryan S. V., Apetyan I., Aroyan S., Azarapetyan L., Anvari A., Gottsauner-Wolf M., Pfaffenberger S., Aydinkoc K., Kalla K., Penka M., Drexel H., Langer P., Pierard L. A., Legrand V., Blommaert D., Schroeder E., Mancini I., Geelen P., Brugada P., De Zutter M., Vrints C., Vercammen M., Morissens M., Borisov B. B., Petrov V. A., Alexandrova M. M., Goudev A. R., Peychev Y., Stoyanovsky V., Stoynev E., Kranjcevic S., Moutiris J., Ioannides M., Evequoz D., Spacilova J., Novak M., Eisenberger M., Mullerova J., Kautzner J., Riedlbauchova L., Petru J., Taborsky M., Cappelen H., Sharaf Y. A., Ibrahim B. S. S., Tammam K., Saad A., Elghawaby H., Sherif H. Z., Farouk H., Mielke A., Engelen M., Kirchhof P., Zimmermann P., Aviles F. F., Rubio J., Malpartida F., Corona M., Sanchez L. T., Herrera J. M. L., Quesada A., Munoz Garcia A. J., Gonzalez C. S., Juango M. S. A., Berjon-Reyero J., Alegret J. M., Fernandez J. M. C., Rosillo C. C., Romero A. F., Lara M. G., Lopez Sendon J. L., De Diego J. J. G., Martin L. S., Irurita M., Guttierez N. H., Rubio J. R. S., Antorrena I., Paves A. B., Salvador A., Orriach M. D., Garcia A. A., Epelde F., Martinez V. B., Sanchez A. B., Galvez C. P., Rivero R. F., Madrid A. H., Baron-Esquivias G., Peinado R., Guindal J. A. G., Vera T. R., Fernandez E. L., Gayan R., Garcia J., Bodegas A., Lopez J. T., Florez J. M., Cabezas C. L., De Castroviejo E. V. R., Bellido J. M., Ruiz M. E., Savolainen K., Nieminen M., Toivonen L., Syvanne M., Pietila M., Galley D., Beltra C., Gay A., Daubert J. C., Lecocq G., Poulain C., Cleland J. G. F. C., Shelton R., Lip G. Y. H., Choudhury A., Abuladze G., Jashi I., Cokkinos D. V., Tsiavou A., Giamouzis G., Dagres N., Kostopoulou A., Domproglou Tsoutsanis, Stefanadis Ch., Latsios G., Vogiatzis I., Gotsis A., Bozia P., Karakiriou M., Koulouris S., Parissis J., Kostakis G., Kouris N., Kontogianni D., Athanasios K., Douras A., Tsanakis T., Marketou M., Patsourakos N., Czopf L., Halmosi R., Preda I., Csoti E., Badics A., Strasberg B., Freedberg N. A., Katz A., Zalzstein E., Grosbard A., Goldhammer E., Nahir M., Epstein M., Vider I., Luria D., Mandelzweig L., Aloisi B., Cavallaro A., Antonielli E., Doronzo B., Pancaldo D., Mazzola C., Buontempi L., Calvi V., Giuffrida G., Figlia A., Ippolito F., Gelmini G. -P., Gaibazzi N., Ziacchi V., De Tommasi F., Lombardi F., Fiorentini C., Terranova P., Maiolino P., Albunni M., Pinna-Pintor P., Fumagalli S., Masotti G., Boncinelli L., Rossi D., Santoro G. M., Fioranelli M., Naccarella F., Maranga S. S., Lepera G., Bresciani B., Seragnoli E., Forti M. C., Cortina V., Baciarello G., Cicconetti P., Lax A., Vitali F., Igidbashian D., Scarpino L., Terrazzino S., Cantu F., Pentimalli F., Novo S., Coppola G., Zingarini G., Ambrozio G., Moruzzi P., Callegari S., Saccomanno G., Russo P., Carbonieri E., Paino A., Zanetta M., Barducci E., Cemin R., Rauhe W., Pitscheider W., Meloni M., Marchi S. M., Di Gennaro M., Calcagno S., Squaratti P., Quartili F., Bertocchi P., De Martini M., Mantovani G., Komorovsky R., Desideri A., Celegon L., Tarantini L., Catania G., Lucci D., Bianchini F., Puodziukynas A., Kavoliuniene A., Barauskiene V., Aidietis A., Barysiene J., Vysniauskas V., Zukauskiene I., Kazakeviciene N., Georgievska-Ismail L., Poposka L., Vataman E., Grosu A. A., Scholte Op Reimer W., De Swart E., Lenzen M., Jansen C., Brons R., Tebbe H., Van Hoogenhuyze D. C. A., Veerhoek M. J., Kamps M., Haan D., Van Rijn N., Bootsma A., Baur L., Van Den Dool A., Fransen H., Eurlings L., Meeder J., De Boer M. J., Winter J., Broers H., Werter C., Bijl M., Versluis S., Milkowska M., Wozakowska-Kaplon B., Janion M., Lepska L., Swiatecka G., Kokowicz P., Cybulski J., Gorecki A., Szulc M., Rekosz J., Manczak R., Wnuk-Wojnar A. -M., Trusz-Gluza M., Rybicka-Musialik A., Myszor J., Szpajer M., Cymerman K., Sadowski J., Sniezek-Maciejewska M., Ciesla-Dul M., Gorkiewicz-Kot I., Grodzicki T., Rewiuk K., Kubik L., Lewit J., De Sousa J. M. F. R., Ferreira R., Freitas A., Morais J. C. A., Pires R., Veloso Gomes M. J., Gago P., Candeias R. A. C., Nunes L., Miranda Sa J. V., Ventura M., De Oliveira M., Alves L. B., Bostaca I., Olariu C. T., Dan G. A., Dan A., Podoleanu C., Frigy A., Georgescu G. I. M., Arsenescu C., Statescu C., Sascau R., Dimitrascu D. L., Rancea R., Shubik Y. V., Duplyakov D., Shalak M., Danielyan M., Galyavich A., Zakirova V., Hatala R., Kaliska G., Kmec J., Zupan I., Tasie J., Vokac D., Edvardsson N., Poci D., Gamra H., Denguir H., Sepetoglu A., Arat-Ozkan A., Orynchak M., Paliy E., Vakalyuk I., Malidze D., Prog R., Yabluchansky M. I., Makienko N. V., Potpara T., Knezevic S., Randjelovic M., Nieuwlaat R., Capucci A., Camm A.J., Olsson S.B., Andresen D., Davies D.W., Cobbe S., Breithardt G., Le Heuzey J.-Y., Prins M.H., Levy S., Crijns H.J.G.M., Aliot E., Santini M., Vardas P., Manini M., Bramley C., Laforest V., Taylor C., Del Gaiso S., Huber K., De Backer G., Sirakova V., Cerbak R., Thayssen P., Lehto S., Blanc J.-J., Delahaye F., Kobulia B., Zeymer U., Cokkinos D., Karlocai K., Graham I., Shelley E., Behar S., Maggioni A., Grabauskiene V., Deckers J., Asmussen I., Stepinska J., Goncalves L., Mareev V., Vasiljevic Z., Riecansky I., Kenda M.F., Alonso A., Lopez-Sendon J.L., Rosengren A., Buser P., Okay T., Sychov O., Fox K., Schofield P., Simoons M., Wood D., Battler A., Boersma E., Komajda M., McGregor K., Mulder B., Priori S., Ryden L., Tavazzi L., Vahanian A., Wijns W., Grigoryan S.V., Apetyan I., Aroyan S., Azarapetyan L., Anvari A., Gottsauner-Wolf M., Pfaffenberger S., Aydinkoc K., Kalla K., Penka M., Drexel H., Langer P., Pierard L.A., Legrand V., Blommaert D., Schroeder E., Mancini I., Geelen P., Brugada P., De Zutter M., Vrints C., Vercammen M., Morissens M., Borisov B.B., Petrov V.A., Alexandrova M.M., Goudev A.R., Peychev Y., Stoyanovsky V., Stoynev E., Kranjcevic S., Moutiris J., Ioannides M., Evequoz D., Spacilova J., Novak M., Eisenberger M., Mullerova J., Kautzner J., Riedlbauchova L., Petru J., Taborsky M., Cappelen H., Sharaf Y.A., Ibrahim B.S.S., Tammam K., Saad A., Elghawaby H., Sherif H.Z., Farouk H., Mielke A., Engelen M., Kirchhof P., Zimmermann P., Aviles F.F., Rubio J., Malpartida F., Corona M., Sanchez L.T., Herrera J.M.L., Quesada A., Munoz Garcia A.J., Gonzalez C.S., Juango M.S.A., Berjon-Reyero J., Alegret J.M., Fernandez J.M.C., Rosillo C.C., Romero A.F., Lara M.G., Lopez Sendon J.L., De Diego J.J.G., Martin L.S., Irurita M., Guttierez N.H., Rubio J.R.S., Antorrena I., Paves A.B., Salvador A., Orriach M.D., Garcia A.A., Epelde F., Martinez V.B., Sanchez A.B., Galvez C.P., Rivero R.F., Madrid A.H., Baron-Esquivias G., Peinado R., Guindal J.A.G., Vera T.R., Fernandez E.L., Gayan R., Garcia J., Bodegas A., Lopez J.T., Florez J.M., Cabezas C.L., De Castroviejo E.V.R., Bellido J.M., Ruiz M.E., Savolainen K., Nieminen M., Toivonen L., Syvanne M., Pietila M., Galley D., Beltra C., Gay A., Daubert J.C., Lecocq G., Poulain C., Cleland J.G.F.C., Shelton R., Lip G.Y.H., Choudhury A., Abuladze G., Jashi I., Cokkinos D.V., Tsiavou A., Giamouzis G., Dagres N., Kostopoulou A., Domproglou, Tsoutsani, Stefanadis Ch., Latsios G., Vogiatzis I., Gotsis A., Bozia P., Karakiriou M., Koulouris S., Parissis J., Kostakis G., Kouris N., Kontogianni D., Athanasios K., Douras A., Tsanakis T., Marketou M., Patsourakos N., Czopf L., Halmosi R., Preda I., Csoti E., Badics A., Strasberg B., Freedberg N.A., Katz A., Zalzstein E., Grosbard A., Goldhammer E., Nahir M., Epstein M., Vider I., Luria D., Mandelzweig L., Aloisi B., Cavallaro A., Antonielli E., Doronzo B., Pancaldo D., Mazzola C., Buontempi L., Calvi V., Giuffrida G., Figlia A., Ippolito F., Gelmini G.-P., Gaibazzi N., Ziacchi V., De Tommasi F., Lombardi F., Fiorentini C., Terranova P., Maiolino P., Albunni M., Pinna-Pintor P., Fumagalli S., Masotti G., Boncinelli L., Rossi D., Santoro G.M., Fioranelli M., Naccarella F., Maranga S.S., Lepera G., Bresciani B., Seragnoli E., Forti M.C., Cortina V., Baciarello G., Cicconetti P., Lax A., Vitali F., Igidbashian D., Scarpino L., Terrazzino S., Cantu F., Pentimalli F., Novo S., Coppola G., Zingarini G., Ambrozio G., Moruzzi P., Callegari S., Saccomanno G., Russo P., Carbonieri E., Paino A., Zanetta M., Barducci E., Cemin R., Rauhe W., Pitscheider W., Meloni M., Marchi S.M., Di Gennaro M., Calcagno S., Squaratti P., Quartili F., Bertocchi P., De Martini M., Mantovani G., Komorovsky R., Desideri A., Celegon L., Tarantini L., Catania G., Lucci D., Bianchini F., Puodziukynas A., Kavoliuniene A., Barauskiene V., Aidietis A., Barysiene J., Vysniauskas V., Zukauskiene I., Kazakeviciene N., Georgievska-Ismail L., Poposka L., Vataman E., Grosu A.A., Scholte Op Reimer W., De Swart E., Lenzen M., Jansen C., Brons R., Tebbe H., Van Hoogenhuyze D.C.A., Veerhoek M.J., Kamps M., Haan D., Van Rijn N., Bootsma A., Baur L., Van Den Dool A., Fransen H., Eurlings L., Meeder J., De Boer M.J., Winter J., Broers H., Werter C., Bijl M., Versluis S., Milkowska M., Wozakowska-Kaplon B., Janion M., Lepska L., Swiatecka G., Kokowicz P., Cybulski J., Gorecki A., Szulc M., Rekosz J., Manczak R., Wnuk-Wojnar A.-M., Trusz-Gluza M., Rybicka-Musialik A., Myszor J., Szpajer M., Cymerman K., Sadowski J., Sniezek-Maciejewska M., Ciesla-Dul M., Gorkiewicz-Kot I., Grodzicki T., Rewiuk K., Kubik L., Lewit J., De Sousa J.M.F.R., Ferreira R., Freitas A., Morais J.C.A., Pires R., Veloso Gomes M.J., Gago P., Candeias R.A.C., Nunes L., Miranda Sa J.V., Ventura M., De Oliveira M., Alves L.B., Bostaca I., Olariu C.T., Dan G.A., Dan A., Podoleanu C., Frigy A., Georgescu G.I.M., Arsenescu C., Statescu C., Sascau R., Dimitrascu D.L., Rancea R., Shubik Y.V., Duplyakov D., Shalak M., Danielyan M., Galyavich A., Zakirova V., Hatala R., Kaliska G., Kmec J., Zupan I., Tasie J., Vokac D., Edvardsson N., Poci D., Gamra H., Denguir H., Sepetoglu A., Arat-Ozkan A., Orynchak M., Paliy E., Vakalyuk I., Malidze D., Prog R., Yabluchansky M.I., Makienko N.V., Potpara T., Knezevic S., and Randjelovic M.

Subjects
Adult, Heart Failure, Male, Rate control, Risk Factor, Cardiology, Coronary Artery Disease, Guideline, Middle Aged, Atrial fibrillation, Europe, Stroke, Anticoagulation, Prospective Studie, Anti-Arrhythmia Agent, Echocardiography, Hypertension, Practice Guidelines as Topic, Rhythm control, Female, Societies, Medical, Aged, Human
Abstract

Aims To describe atrial fibrillation (AF) management in member countries of the European Society of Cardiology (ESC) and to verify cardiology practices against guidelines. Methods and results Among 182 hospitals in 35 countries, 5333 ambulant and hospitalized AF patients were enrolled, in 2003 and 2004. AF was primary or secondary diagnosis, and was confirmed on ECG in the preceding 12 months. Clinical type of AF was reported to be first detected in 978, paroxysmal in 1517, persistent in 1167, and permanent in 1547 patients. Concomitant diseases were present in 90% of all patients, causing risk factors for stroke to be also highly prevalent (86%). As many as 69% of patients were symptomatic at the time of the survey; among asymptomatic patients, 54% were previously experienced symptoms. Oral anticoagulation was prescribed in 67 and 49% of eligible and ineligible patients, respectively. A rhythm control strategy was applied in 67% of currently symptomatic patients and in 44% of patients who never experienced symptoms. Conclusion This survey provides a unique snapshot of current AF management in ESC member countries. Discordance between guidelines and practice was found regarding several issues on stroke prevention and antiarrhythmic therapy.

Published
2005

12. Gender-Related Differences in Presentation, Treatment, and Outcome of Patients With Atrial Fibrillation in Europe. A Report From the Euro Heart Survey on Atrial Fibrillation

Author

Dagres, N. Nieuwlaat, R. Vardas, P.E. Andresen, D. Lévy, S. Cobbe, S. Kremastinos, D.Th. Breithardt, G. Cokkinos, D.V. Crijns, H.J.G.M. Camm, A.J. Davies, W. Capucci, A. Olsson, B. Aliot, E. Le Heuzey, J.-Y. Santini, M. Manini, M. Bramley, C. Laforest, V. Taylor, C. Del Gaiso, S. Huber, K. De Backer, G. Sirakova, V. Cerbak, R. Thayssen, P. Lehto, S. Blanc, J.-J. Delahaye, F. Kobulia, B. Zeymer, U. Karlocai, K. Graham, I. Shelley, E. Behar, S. Maggioni, A. Gonc¸alves, L. Grabauskiene, V. Asmussen, I. Deckers, J. Stepinska, J. Mareev, V. Vasiljevic, Z. Riecansky, I. Kenda, M.F. Alonso, A. Lopez-Sendon, J.L. Rosengren, A. Buser, P. Okay, T. Sychov, O. Fox, K. Schofield, P. Simoons, M. Wood, D. Battler, A. Boersma, E. Fox, K. Komajda, M. McGregor, K. Mulder, B. Priori, S. Ryde´n, L. Vahanian, A. Wijns, W. Sanofi-Aventis Grigoryan, S.V. Apetyan, I. Aroyan, S. Azarapetyan, L. Anvari, A. Gottsauner-Wolf, M. Pfaffenberger, S. Aydinkoc, K. Kalla, K. Penka, M. Drexel, H. Langer, P. Pierard, L.A. Legrand, V. Blommaert, D. Schroeder, E. Mancini, I. Geelen, P. Brugada, P. De Zutter, M. Vrints, C. Vercammen, M. Morissens, M. Borisov, B. Petrov, V.A. Marinova, M. Assen, A. Goudev, R. Peychev, Y. Stoyanovsky, V. Stoynev, E. Kranjcevic, S. Moutiris, J. Ioannides, M. Evequoz, D. Spacilova, J. Novak, M. Eisenberger, M. Mullerova, J. Kautzner, J. Riedlbauchova, L. Petru`, J. Taborsky, M. Cappelen, H. Sharaf, Y.A. Ibrahim, B.S.S. Tammam, K. Saad, A. Elghawaby, H. Sherif, H.Z. Farouk, H. Mielke, A. Engelen, M. Kirchhof, P. Zimmermann, P. Aviles, F.F. Rubio, J. Malpartida, F. Corona, M. Sanchez, L.T. Miguel, J. Herrera, L. Quesada, A. Garcia, A.J.M. Gonzalez, C.S. Juango, M.S.A. Berjon-Reyero, J. Alegret, J.M. Fernandez, J.M.C. Carrascosa, C. Romero, R.A.F. Lara, M.G. Sendon, J.L.L. de Diego, J.J.G. Martin, L.S. Irurita, M. Guttierez, N.H. Rubio, J.R.S. Antorrena, I. Paves, A.B. Salvador, A. Orriach, M.D. Garcia, A.A. Epelde, F. Martinez, V.B. Sanchez, A.B. Galvez, C.P. Rivero, R.F. Madrid, A.H. Baron-Esquivias, G. Peinado, R. Guindal, J.A.G. Vera, T.R. Fernandez, E.L. Gayan, R. Garcia, J. Bodegas, A. Lopez, J.T. Florez, J.M. Cabezas, C.L. de Castroviejo, E.V.R. Bellido, J.M. Ruiz, M.E. Savolainen, K. Nieminen, M. Toivonen, L. Syvanne, M. Pietila, M. Galley, D. Beltra, C. Gay, A. Daubert, J.C. Lecocq, G. Poulain, C. Cleland, J.G.F.C. Shelton, R. Choudhury, A. Abuladze, G. Jashi, I. Tsiavou, A. Giamouzis, G. Kostopoulou, A. Tsoutsanis, D. Stefanadis, C. Latsios, G. Vogiatzis, I. Gotsis, A. Bozia, P. Karakiriou, M. Koulouris, S. Parissis, J. Kostakis, G. Kouris, N. Kontogianni, D. Athanasios, K. Douras, A. Tsanakis, T. Marketou, M. Patsourakos, N. Czopf, L. Halmosi, R. Pre´da, I. Csoti, E. Badics, A. Strasberg, B. Freedberg, N.A. Katz, A. Zalzstein, E. Grosbard, A. Goldhammer, E. Nahir, M. Epstein, M. Vider, I. Luria, D. Mandelzweig, L. Aloisi, B. Cavallaro, A. Antonielli, E. Doronzo, B. Pancaldo, D. Mazzola, C. Buontempi, L. Calvi, V. Giuffrida, G. Figlia, A. Ippolito, F. Gelmini, G.-P. Gaibazzi, N. Ziacchi, V. De Tommasi, F. Lombardi, F. Fiorentini, C. Terranova, P. Maiolino, P. Albunni, M. Pinna-Pintor, P. Fumagalli, S. Masotti, G. Boncinelli, L. Rossi, D. Santoro, G.M. Fioranelli, M. Naccarella, F. Maranga, S.S. Lepera, G. Bresciani, B. Seragnoli, E. Forti, M.C. Cortina, V. Baciarello, G. Cicconetti, P. Lax, A. Vitali, F. Igidbashian, D. Scarpino, L. Terrazzino, S. Tavazzi, L. Cantu, F. Pentimalli, F. Novo, S. Coppola, G. Zingarini, G. Ambrozio, G. Moruzzi, P. Callegari, S. Saccomanno, G. Russo, P. Carbonieri, E. Paino, A. Zanetta, M. Barducci, E. Cemin, R. Rauhe, W. Pitscheider, W. Meloni, M. Marchi, S.M. Di Gennaro, M. Calcagno, S. Squaratti, P. Quartili, F. Bertocchi, P. De Martini, M. Mantovani, G. Komorovsky, R. Desideri, A. Celegon, L. Tarantini, L. Catania, G. Lucci, D. Bianchini, F. Puodziukynas, A. Kavoliuniene, A. Barauskiene, V. Aidietis, A. Barysiene, J. Vysniauskas, V. Zukauskiene, I. Kazakeviciene, N. Georgievska-Ismail, L. Poposka, L. Vataman, E. Grosu, A.A. op Reimer, W.S. de Swart, E. Lenzen, M. Jansen, C. Brons, R. Tebbe, H. van Hoogenhuyze, D.C.A. Veerhoek, M.J. Kamps, M. Haan, D. van Rijn, N. Bootsma, A. Baur, L. van den, A. Fransen, H. Eurlings, L. Meeder, J. De Boer, M.J. Winter, J. Broers, H. Werter, C. Bijl, M. Versluis, S. Milkowska, M. Wozakowska-Kaplon, B. Janion, M. Lepska, L. Swiatecka, G. Kokowicz, P. Cybulski, J. Gorecki, A. Szulc, M. Rekosz, J. Manczak, R. Wnuk-Wojnar, A.-M. Trusz-Gluza, M. Rybicka-Musialik, A. Myszor, J. Szpajer, M. Cymerman, K. Sadowski, J. Sniezek-Maciejewska, M. Ciesla-Dul, M. Gorkiewicz-Kot, I. Grodzicki, T. Rewiuk, K. Kubik, L. Lewit, J. de Sousa, J.M.F.R. Ferreira, R. Freitas, A. Morais, J.C.A. Pires, R. Gomes, M.J.V. Gago, P. Candeias, R.A.C. Nunes, L. Sa, J.V.M. Ventura, M. de Oliveira, M. Alves, L.B. Bostaca, I. Olariu, C.T. Dan, G.A. Dan, A. Podoleanu, C. Frigy, A. Georgescu, G.I.M. Arsenescu, C. Statescu, C. Sascau, R. Dimitrascu, D.L. Rancea, R. Shubik, Y.V. Duplyakov, D. Shalak, M. Danielyan, M. Galyavich, A. Zakirova, V. Hatala, R. Kaliska, G. Kmec, J. Zupan, I. Tasie`, J. Vokac, D. Edvardsson, N. Poci, D. Gamra, H. Denguir, H. Sepetoglu, A. Arat-Ozkan, A. Orynchak, M. Paliy, E. Vakalyuk, I. Malidze, D. Prog, R. Yabluchansky, M.I. Makienko, N.V. Potpara, T. Knezevic, S. Randjelovic, M.

Abstract

Objectives: This study sought to investigate gender-related differences in patients with atrial fibrillation (AF) in Europe. Background: Gender-related differences may play a significant role in AF. Methods: We analyzed the data of 5,333 patients (42% female) enrolled in the Euro Heart Survey on Atrial Fibrillation. Results: Compared with men, the women were older, had a lower quality of life (QoL), had more comorbidities, more often had heart failure (HF) with preserved left ventricular systolic function (18% vs. 7%, p < 0.001), and less often had HF with systolic dysfunction (17% vs. 26%, p < 0.001). Among patients with typical AF symptoms (56% of women, 49% of men), there was no gender-related difference in the choice of rate or rhythm control. Among patients with atypical or no symptoms (44% of women, 51% of men), women less frequently underwent rhythm control (39% vs. 51%, p < 0.001) than did men. Women underwent less electrical cardioversion (22% vs. 28%, p < 0.001). Prescription of oral anticoagulants was identical (65%) in both genders. One-year outcome was similar except that women had a higher chance for stroke (odds ratio 1.83 in multivariable regression analysis, p = 0.019). Conclusions: Women with AF had more comorbidities, more HF with preserved systolic function, and a lower QoL than men. In the large group with atypical or no symptoms, women were treated appropriately more conservatively with less rhythm control than men. Women had a higher chance for stroke. Long-term QoL changes and other morbidities and mortality were similar. © 2007 American College of Cardiology Foundation.

Published
2007

14. Abstracts: Cardiac arrhythmias - non invasive analysis of mechanisms

Author

Tabatabaei, N., primary, Lin, G., additional, Martinez, M., additional, Glockner, J., additional, Brady, P. A., additional, Puntmann, V., additional, Elliott, P. M., additional, Mckenna, W., additional, Camm, A. J., additional, Yap, Y. G., additional, Wozniak-Skowerska, I., additional, Skowerski, M., additional, Wnuk-Wojnar, A. M., additional, Gola, A., additional, Sosnowski, M., additional, Hoffmann, A., additional, Trusz-Gluza, M., additional, Atea, L. F., additional, Perez-David, E., additional, Del Castillo, R., additional, Arenal, A., additional, Celorrio, V., additional, Arbelo, E., additional, Datino, T., additional, Fernandez-Aviles, F., additional, Ahn, M.- S., additional, Kim, J. B., additional, Lee, S. H., additional, Lee, B. H., additional, Hwang, H. J., additional, Lee, M. H., additional, Kim, S. S., additional, Streitner, F., additional, Kuschyk, J., additional, Veltmann, C., additional, Schoene, N., additional, Streitner, I., additional, Borggrefe, M., additional, and Wolpert, C., additional

Published
2009
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15. Poster Session 1: Ablation of SVT and VT

Author

De Groot, N. M. S., primary, Atary, J. Z., additional, Blom, N. A., additional, Van Kuijk, J. P., additional, Schalij, M. J., additional, Tomaske, M., additional, Candinas, R., additional, Weiss, M., additional, Bauersfeld, U., additional, Fassa, A.- A., additional, Ashrafpoor, G., additional, Sunthorn, H., additional, Burri, H., additional, Gentil-Baron, P., additional, Shah, D., additional, Wijnmaalen, A. P., additional, Delgado, V., additional, Holman, E. R., additional, Bax, J. J., additional, Zeppenfeld, K., additional, Kuhne, M., additional, Oral, H., additional, Morady, F., additional, Bogun, F., additional, Schwagten, B., additional, Szili-Torok, T., additional, Knops, P., additional, Kimman, G., additional, Thornton, A., additional, Jordaens, L., additional, Satomi, K., additional, Roland, T., additional, Kamakura, S., additional, Kuck, K., additional, Ouyang, F., additional, Nowak, S., additional, Wnuk-Wojnar, A. M., additional, Hoffmann, A., additional, Czerwinski, C., additional, Szydlo, K., additional, Rybicka-Musialik, A., additional, Wozniak-Skowerska, I., additional, Trusz-Gluza, M., additional, Krynski, T., additional, Stec, S. M., additional, Hachiya, H., additional, Hirao, K., additional, Sasaki, T., additional, Higuchi, K., additional, Isobe, M., additional, Etsadashvili, K., additional, Hintringer, F., additional, Stuehlinger, X., additional, Berger, T., additional, Dichtl, W., additional, Roithinger, F. X., additional, Pachinger, O., additional, Stuehlinger, M., additional, Tanno, K., additional, Onuki, T., additional, Minoura, Y., additional, Kawamura, M., additional, Asano, T., additional, Kobayashi, Y., additional, Bonet, A., additional, Merce Klein, J., additional, De Castro, R., additional, Valdovinos, P., additional, Colomer, I., additional, Garcia, M. I., additional, Serrano, I., additional, Bardaji, A., additional, Peichl, P., additional, Cihak, R., additional, Polasek, R., additional, Kucera, P., additional, Bytesnik, J., additional, Kautzner, J., additional, Schlueter, S., additional, Grebe, O., additional, Vester, E. V., additional, Maury, P., additional, Fourcade, J., additional, Duparc, A., additional, Hebrard, A., additional, Mondoly, P., additional, Rollin, A., additional, Rumeau, P., additional, Delay, M., additional, De Boeck, B. W. L., additional, Teske, A. J., additional, Mohamed Hoesein, F. A. A., additional, Van Driel, V. J. H., additional, Loh, P., additional, Cramer, M. J. M., additional, Prinzen, F. W., additional, Doevendans, P. A. F., additional, Pokushalov, E., additional, Romanov, A., additional, Turov, A., additional, Shugaev, P., additional, Artemenko, S., additional, Shirokova, N., additional, Richter, B., additional, Gwechenberger, M., additional, Socas, A., additional, Zorn, G., additional, Albinni, S., additional, Wojta, J., additional, Binder, T., additional, Goessinger, H., additional, Kettering, K., additional, Mollnau, H., additional, Gramley, F., additional, Weiss, C., additional, Berkowitsch, A., additional, Neumann, T., additional, Kuniss, M., additional, Zaltsberg, S., additional, Wojcik, M., additional, Pitschner, H. F., additional, Wichterle, D., additional, Peca, M., additional, Bulkova, V., additional, Suzuki, A., additional, Yamauchi, Y., additional, Okada, H., additional, Obayashi, T., additional, Sekiguchi, Y., additional, Aonuma, K., additional, Zoppo, F., additional, Bertaglia, E., additional, Zerbo, F., additional, Brandolino, G., additional, Bacchiega, E., additional, Lickfett, L., additional, Bellmann, B., additional, Linhart, M., additional, Schrickel, J. W., additional, Lewalter, T., additional, Schwab, J. O., additional, Nickenig, G., additional, Mittmann-Braun, E. L., additional, Dabrowski, P., additional, Kozluk, E., additional, Stefanczyk, P., additional, Kleinrok, A., additional, Opolski, G., additional, Andronache, M., additional, Abdelaal, A., additional, Magnin-Poull, I., additional, Cedano, J., additional, Groben, L., additional, Mandry, D., additional, Aliot, E., additional, De Chillou, C., additional, Mulder, A. A. W., additional, Wijffels, M. C. E. F., additional, Wever, E. F. D., additional, Boersma, L. V. A., additional, Manfai, B., additional, Faludi, R., additional, Fodi, E., additional, Rausch, P., additional, Simor, T., additional, Sciarra, L., additional, Rebecchi, M., additional, De Ruvo, E., additional, De Luca, L., additional, Zuccaro, L. M., additional, Fagagnini, A., additional, Delise, P., additional, Calo, L., additional, Mikhaylov, E., additional, Van Belle, Y., additional, Janse, P., additional, Lebedev, D., additional, Kanidieva, A., additional, Patel, D., additional, Shaheen, M., additional, Sonne, K., additional, Mohanty, P., additional, Di-Biase, L., additional, Popova, L., additional, Burkhardt, D., additional, Natale, A., additional, Mccann, C. J., additional, Gal, B., additional, Goethals, P., additional, Peychev, P., additional, Geelen, P., additional, Vatasescu, R.- G., additional, Iorgulescu, C., additional, Ieremciuc, I., additional, Alexandru, R., additional, Dorobantu, M., additional, Insulander, P., additional, Bastani, H., additional, Braunschweig, F., additional, Jensen-Urstad, M., additional, Schwieler, J., additional, Tabrizi, F., additional, Kenneback, G., additional, Foldesi, C. S. A. B. A., additional, Kardos, A., additional, Mihalcz, A., additional, Abraham, P. A. L., additional, Som, Z. O. L. T. A. N., additional, Borbola, J. O. Z. S. E. F., additional, Vanyi, J. O. Z. S. E. F., additional, Szili-Torok, T. A. M. A. S., additional, Pastor Fuentes, A., additional, Nunez, A., additional, Tur, N., additional, Berzal, B., additional, G Cosio, F., additional, Mujovic, N., additional, Grujic, M., additional, Mrdja, S., additional, Kocijancic, A., additional, Potpara, T., additional, Polovina, M., additional, Vujisic-Tesic, B., additional, Petrovic, M., additional, Hayashi, T., additional, Furukawa, T., additional, Kawabata, M., additional, Lavalle, C., additional, Ficili, S., additional, Galeazzi, M., additional, Russo, M., additional, Pandozi, A., additional, Pandozi, C., additional, Venditti, F., additional, Santini, M., additional, Pavlikova, K., additional, Psenicka, M., additional, Anger, Z., additional, Linhart, A., additional, Narten, A., additional, Gamelin, A., additional, Mittag, J., additional, Raffa, S., additional, Geller, J.- C., additional, Mocini, D., additional, Groenveld, H. F., additional, Rienstra, M., additional, Van Den Berg, M. P., additional, Hillege, H. L., additional, Van Veldhuisen, D. J., additional, Van Gelder, I. C., additional, Morani, G., additional, Manica, A., additional, Angheben, C., additional, Cicoira, M. A., additional, Pozzani, L., additional, Tomasi, L., additional, Zanotto, G., additional, Vassanelli, C., additional, Ahmed, S., additional, Ranchor, A. V., additional, and Wiesfeld, A. C. P., additional

Published
2009
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23. A multicentre, double-blind randomized crossover comparative study on the efficacy and safety of dofetilide vs sotalol in patients with inducible sustained ventricular tachycardia and ischaemic heart disease.

Author

Boriani G, Lubinski A, Capucci A, Niederle R, Kornacewicz-Jack Z, Wnuk-Wojnar AM, Borggrefe M, Brachmann J, Biffi M, and Butrous GS

Subjects
Adult, Aged, Anti-Arrhythmia Agents adverse effects, Cross-Over Studies, Double-Blind Method, Female, Humans, Male, Middle Aged, Myocardial Ischemia drug therapy, Phenethylamines adverse effects, Sotalol adverse effects, Statistics as Topic, Sulfonamides adverse effects, Tachycardia, Ventricular mortality, Anti-Arrhythmia Agents therapeutic use, Phenethylamines therapeutic use, Sotalol therapeutic use, Sulfonamides therapeutic use, Tachycardia, Ventricular drug therapy
Abstract

Background: Antiarrhythmic drugs are still used for the treatment of ventricular tachyarrhythmias, in combination with implantable cardioverter-defibrillators or without them., Aim of the Study: In a double-blind randomized crossover design, the short- and long-term efficacy and safety of oral dofetilide or oral sotalol were compared in 135 patients with ischaemic heart disease and inducible sustained ventricular tachycardia., Methods: The inducibility of ventricular tachycardia was determined by programmed electrophysiological stimulation at baseline. Patients were then blindly randomized to receive either oral dofetilide 500 microg twice daily or oral sotalol 160 mg twice daily, for 3 to 5 days. Suppression of inducible ventricular tachycardia on the drug was then assessed by programmed electrophysiological stimulation. After a wash-out period of at least 2.5 days, the patients received the alternative treatment for 3 to 5 days. Suppression of inducible ventricular tachycardia on the alternate drug was again determined by programmed electrophysiological stimulation. Selection of long-term treatment was allocated blindly according to programmed electrophysiological stimulation results., Results: During the acute phase, 128 patients received both dofetilide and sotalol. Sixty-seven patients were responders to either drug. Forty-six patients (35.9%) were responders to dofetilide compared with 43 (33.6%) to sotalol (P=ns). Only 23 patients responded to both dofetilide and sotalol. Adverse events, deemed to be treatment related, were seen in 2.3% of patients receiving dofetilide and 8.6% of patients receiving sotalol (P=0.016). Three patients on dofetilide had torsade de pointes. Two patients receiving sotalol died during the acute phase (one was arrhythmic death, and the other was due to heart failure). During the long-term phase, two of 42 patients (4.8%) receiving dofetilide and three of 27 patients (11.1%) receiving sotalol withdrew from treatment due to lack of efficacy. Overall, during the long-term phase, 23.8% of the patients receiving dofetilide and 37.0% of the patients receiving sotalol, withdrew from treatment with a similar pattern of withdrawals for the two drugs., Conclusion: Dofetilide was as efficacious as sotalol in preventing the induction of sustained ventricular tachycardia. There was no concordance in the response rate in two-thirds of the patients. Dofetilide was significantly better tolerated during the acute phase than sotalol. Both dofetilide and sotalol were well tolerated during the long term with no statistically significant difference in the adverse events.

Published
2001
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24. Efficacy and safety of dofetilide in the prevention of symptomatic episodes of paroxysmal supraventricular tachycardia: a 6-month double-blind comparison with propafenone and placebo.

Author

Tendera M, Wnuk-Wojnar AM, Kulakowski P, Malolepszy J, Kozlowski JW, Krzeminska-Pakula M, Szechinski J, Droszcz W, Kawecka-Jaszcz K, Swiatecka G, Ruzyllo W, and Graff O

Subjects
Administration, Oral, Aged, Double-Blind Method, Female, Humans, Male, Middle Aged, Proportional Hazards Models, Survival Analysis, Treatment Outcome, Anti-Arrhythmia Agents therapeutic use, Phenethylamines therapeutic use, Propafenone therapeutic use, Sulfonamides therapeutic use, Tachycardia, Supraventricular prevention & control
Abstract

Background: Existing drug therapies for paroxysmal supraventricular tachycardia (PSVT) have potentially serious adverse effects. Dofetilide, a pure class III antiarrhythmic agent, may offer an effective and safe alternative for treating PSVT. This study compared the efficacy and safety of dofetilide with that of propafenone and placebo in the prevention of PSVT., Methods: This multicenter, randomized, placebo-controlled, parallel-group study compared the effectiveness of oral dofetilide 500 microg given twice daily with that of propafenone 150 mg given 3 times a day and placebo in preventing the recurrence of PSVT in 122 symptomatic patients. Episodes of PSVT were documented by symptom diaries and Hertcard (Hertford Medical, Hertfordshire, UK) event recorders., Results: After 6 months of treatment, patients taking dofetilide, propafenone, and placebo had a 50%, 54%, and 6% probability, respectively, of remaining free of episodes of PSVT (P <.001 for both dofetilide and propafenone vs placebo). Both dofetilide and propafenone also decreased the frequency of episodes of PSVT; the median numbers of episodes in the dofetilide- and propafenone-treated groups were 1 and 0.5, respectively, compared with 5 in the placebo-treated group. Dofetilide was well tolerated; no proarrhythmia occurred. Three patients taking propafenone had serious treatment-related adverse effects that required drug discontinuation., Conclusions: Dofetilide and propafenone were equally effective in preventing the recurrence of or decreasing the frequency of PSVT.

Published
2001
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25. The terminal portion of the T wave: a new electrocardiographic marker of risk of ventricular arrhythmias.

Author

Lubinski A, Kornacewicz-Jach Z, Wnuk-Wojnar AM, Adamus J, Kempa M, Królak T, Lewicka-Nowak E, Radomski M, and Swiatecka G

Subjects
Aged, Cardiac Pacing, Artificial, Coronary Disease complications, Coronary Disease physiopathology, Electrophysiologic Techniques, Cardiac, Female, Humans, Male, Middle Aged, Myocardial Infarction physiopathology, Predictive Value of Tests, Risk Assessment, Tachycardia, Ventricular complications, Tachycardia, Ventricular physiopathology, Electrocardiography, Myocardial Infarction diagnosis, Tachycardia, Ventricular diagnosis
Abstract

Experimental studies have shown that transmural dispersion of repolarization (DoR), defined as the difference in action potential duration between mid-myocardial M-cells, epicardial, and endocardial cells is reflected in the duration of the terminal portion of the T wave (TpTe) on the surface ECG. Since DoR is an important factor associated with the propensity for reentrant arrhythmias, this study examined if TpTe may serve as a marker of risk of ventricular arrhythmias. Data from 18 patients with coronary artery disease and inducible sustained ventricular tachycardia (VT group) were compared with those of 16 survivors of myocardial infarction without inducible VT (control group). TpTe was automatically measured in each beat of 24-hour ECG recordings, and programmed ventricular stimulation was performed in the antiarrhythmic drug-free state. TpTe was expressed as the absolute interval in milliseconds, and relative to the duration of QTe (TpTe/QTe x 100%). TpTe duration was 74 +/- 14 ms in the VT group versus 63 +/- 16 ms in the control group (P < 0.004). The TpTe interval expressed as a percent of the QT interval was 21 +/- 4% in the VT group versus 17 +/- 3% in the control group (P = 0.02). In patients with coronary artery disease. TpTe was longer in patients with, versus without, inducible VT. The results of this study support the hypothesis that TpTe reflects transmural dispersion of repolarization.

Published
2000
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26. Failure of an ACE inhibitor to improve exercise tolerance. A randomized study of trandolapril. Trandolapril study group.

Author

Hampton JR, Cowley AJ, and Wnuk-Wojnar AM

Subjects
Double-Blind Method, Exercise Test, Female, Follow-Up Studies, Heart Failure physiopathology, Humans, Male, Middle Aged, Time Factors, Treatment Failure, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Exercise Tolerance drug effects, Heart Failure drug therapy, Indoles therapeutic use
Abstract

Background: There has been conflicting evidence of the effect of angiotensin-converting enzyme (ACE) inhibitors on exercise tolerance. Meta-analysis of published results has suggested that a beneficial effect of ACE inhibitors is demonstrated if a trial design is adequate., Setting: Multicentre International Trial., Methods: In a double-blind, randomized, multicentre trial, 292 patients with moderate (New York Heart Association Grades II and III) heart failure were treated with trandolapril or placebo in addition to diuretics, and followed for 16 weeks. Exercise tolerance on a treadmill was assessed at baseline and after 4, 8, 12 and 16 weeks of treatment. Both a modified Bruce and a modified Naughton protocol were used., Results: Exercise tolerance improved in both treatment groups, with no significant benefit from trandolapril treatment., Conclusion: Trandolapril does not improve exercise tolerance as measured by treadmill testing.

Published
1998
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27. The use of exogenous creatine phosphate for myocardial protection in patients undergoing coronary artery bypass surgery.

Author

Cisowski M, Bochenek A, Kucewicz E, Wnuk-Wojnar AM, Morawski W, Skalski J, and Grzybek H

Subjects
Bicarbonates chemistry, Calcium Chloride chemistry, Cardiotonic Agents administration & dosage, Female, Heart Arrest, Induced, Humans, Magnesium chemistry, Male, Middle Aged, Phosphocreatine administration & dosage, Potassium Chloride chemistry, Sodium Chloride chemistry, Cardioplegic Solutions chemistry, Cardiotonic Agents therapeutic use, Coronary Artery Bypass, Myocardial Reperfusion Injury prevention & control, Phosphocreatine therapeutic use
Abstract

A key component in the development of ischemic functional and structural myocardial injury during cardiosurgical procedures is an inadequate cellular energy supply which occurs as a consequence of the cessation of oxidative metabolism. In such conditions high energy phosphates are rapidly depleted. As they play a critical role in the maintenance of cell viability and postischemic recovery of contractile function, their conservation is therefore a primary objective in any procedure designed to reduce ischemic injury. Exogenous administration of phosphocreatine (CP) has been suggested as being beneficial to the ischemic heart. The aim of present study was to evaluate the possible cardioprotective effect of exogenous CP during coronary artery surgery (CABG). Forty patients undergoing CABG procedure were randomly assigned to receive creatine phosphate-enriched (group I) or standard-St. Thomas' Hospital (group II) cardioplegic solution; each group comprised 20 patients. Group I received: 6.0 g of exogenous CP (Neoton) daily in two 20-min intravenous infusions during 3 days preoperatively; during surgical procedure they were administered standard cardioplegic solution enriched in CP at the concentration of 10 mmol/l and -- 2 days postoperatively -- 4.0 g CP daily in two intravenous injections. Group II did not receive CP at all In both groups were analysed. Haemodynamic parameters. Continuous 48-h ECG recording (Holter monitoring) outcome. Laboratory values of serum CK and CK-MB. Inotropic support required (drugs, mechanical support). Ultrastructural findings (biopsy data). Statistical analysis was carried out using Student's "t"-test and the chi2 test. Values of p<0.05 were taken as the criterion of significant difference. The results of the study were: Significantly lower average number and energy of DC-shocks needed to restore cardiac function after cardiopulmonary bypass procedure in group 1. Statistically significant beneficial effect on the presence of ventricular arrhythmias during surgery and in early postoperative period in group I. Significantly lower requirements for inotropic drugs postoperatively in group I. Statistically significant lower degree of sarcolemmal damages in myocardial biopsies in group I. Concluding, the authors wish to state that: Exogenous phosphocreatine (Neoton) perioperative administration in coronary artery bypass patients reduced the need for inotropic drugs, which is clinically manifested in lower frequency of low cardiac output syndrome. Perioperative administration of exogenous CP improves electrophysiological stability of the myocardium. Advantageous clinical and electrophysiological effect of exogenous CP may result from its properties to protect sarcolemma of the cardiomyocytes.

Published
1996

28. [Serious ventricular arrhythmias in patients without structural heart disease. Results of electrophysiologic testing].

Author

Wnuk-Wojnar AM

Subjects
Adult, Electrocardiography, Ambulatory, Electrophysiology, Humans, Middle Aged, Predictive Value of Tests, Arrhythmias, Cardiac etiology, Electric Stimulation, Heart Diseases diagnosis
Abstract

Invasive electrophysiological testing with programmed electrical stimulation (PES) of the heart is widely used to reproduce spontaneous ventricular tachycardia (VT). In patients with coronary heart disease it has been demonstrated, that induction of sustained monomorphic VT (SMVT) was highly predictive of an increased risk of sudden death. The value of the results of PES in patients with idiopathic VT is still controversial. In this study clinical and electrophysiological data were analyzed for 34 patients with apparently normal heart and serious ventricular arrhythmias: 17 of them (group A) had documented VT (n = 9) or VT was suspected on the basis of the presence of unexplained syncope and ventricular arrhythmias in Holter monitoring (n = 8). The other causes of syncope (carotic sinus syndrome, sick sinus syndrome, atrio-ventricular block, neurological causes) were excluded in these patients. The remaining 17 patients suffered only palpitations (group B): in 5 of them Lown's grade 4 and in 12 Lown's grade 1 or 2 ventricular arrhythmia was recorded in Holter monitoring. In both groups coronary heart disease, congenital or acquired valvular heart disease, cardiomyopathy and myocarditis were excluded by means of noninvasive (physical examination, X-ray, ultrasonocardiography, electrocardiographical stress testing) and, when needed, invasive (selective coronarography, endomyocardial biopsy) evaluations. There was no significant differences in age and sex between the groups. All patients underwent baseline drug-free electrophysiologic studies with programmed right ventricular stimulation. The end point of stimulation was the induction of SMVT.(ABSTRACT TRUNCATED AT 250 WORDS)

Published
1993

29. Long-term antiarrhythmic pharmaco-therapy guided by Holter monitoring in patients with malignant ventricular arrhythmias and ischemic heart disease.

Author

Trusz-Gluza M, Gasior Z, Wnuk-Wojnar AM, Filipecki A, Szydło K, and Giec L

Subjects
Adult, Aged, Arrhythmias, Cardiac diagnosis, Evaluation Studies as Topic, Female, Heart Ventricles drug effects, Humans, Male, Middle Aged, Myocardial Ischemia diagnosis, Prospective Studies, Ventricular Fibrillation drug therapy, Ventricular Function, Anti-Arrhythmia Agents therapeutic use, Arrhythmias, Cardiac drug therapy, Electrocardiography, Ambulatory, Myocardial Ischemia drug therapy
Abstract

In 126 patients with clinical ventricular tachycardia and/or fibrillation, ischemic heart disease and repetitive and/or frequent ventricular ectopic beats long-term therapy guided by Holter ecg was assessed. Criteria for efficacy of antiarrhythmic drugs were following: 1) > 75% decrease in ectopic beats, 2) elimination of salvos, 3) > 90% reduction of couples and R/T and 4) reduction of multiformity up to 2 forms. They were fulfilled in 71% of patients (responders). During follow-up 1-49 months, mean 20, rate of sudden death was lower in responders as compared with nonresponders (p < 0.05). However, suppression of ventricular ectopic beats was not predictive for a favorable outcome, because the incidence of arrhythmic events and total cardiac death was similar in the two groups.

Published
1992

30. Electrophysiologic properties of transplanted human heart with and without rejection.

Author

Wnuk-Wojnar AM, Zembala M, Religa Z, Bochenek A, Jaklik A, Drzewiecki J, and Giec L

Subjects
Arrhythmias, Cardiac etiology, Biopsy, Electrocardiography, Heart Transplantation immunology, Humans, Male, Middle Aged, Myocardium pathology, Pacemaker, Artificial, Refractory Period, Electrophysiological physiology, Arrhythmias, Cardiac diagnosis, Cardiac Pacing, Artificial, Graft Rejection, Heart Conduction System physiopathology, Heart Transplantation physiology
Abstract

Twelve male heart transplant recipients underwent routine electrophysiologic evaluation. None were taking cardioactive drugs, and only two had symptoms of arrhythmia. Two patients had endocardial VVI pacemakers because of previous early sinus node dysfunction. With simultaneous endomyocardial biopsy, we found seven patients with no evidence of rejection (group 1) and five patients with mild rejection (group 2; three initial or mild; two definite rejection). In two group 1 patients with presyncope, corrected sinus node recovery time was prolonged, and pacemakers were implanted into the endocardium. In all patients atrioventricular conduction was normal. One patient had evidence of functional duality of anterograde atrioventricular nodal conduction. In group 2 patients prolongation of effective refractory period of the donor atrium, functional refractory period of the atrioventricular node, and effective refractory period of the right ventricle were observed. This prolongation of refractoriness may be one of the earliest markers of rejection.

Published
1992

31. Biocompatibility of extracorporeal circulation with autooxygenation.

Author

Bochenek A, Religa Z, Kokot F, Wnuk-Wojnar AM, Wojnar J, Wnuk R, Gallert G, and Skiba J

Subjects
Blood Loss, Surgical, Blood Platelets physiology, Cardiopulmonary Bypass methods, Complement Activation, Complement C3a analysis, Complement C5a analysis, Hemoglobins analysis, Humans, Leukocyte Count, Middle Aged, Cardiopulmonary Bypass instrumentation, Heart-Lung Machine
Abstract

Platelet damage, complement activation and neutropenia during cardiopulmonary bypass are the result of blood contact with artificial surfaces, mainly in the oxygenator. To evaluate biocompatibility of this kind of bypass we compared two techniques of extracorporeal circulation in 40 patients undergoing elective coronary bypass operations. In 20, a standard technique with a bubble oxygenator was used (group 1), and in the remaining 20 patients with autooxygenation, the patients' own lungs were included in the perfusion circuit (group 2). Several blood samples were taken before, during and after perfusion to estimate the corrected platelet numbers and pulmonary leucocyte sequestration in all patients, and additionally in 6 patients from each group, complement C3a and C5a anaphylatoxins were measured (radioimmunoassay). At the end of cardiopulmonary bypass, the decline of platelet number corrected to haematocrit platelet number in group 1 was significantly higher than in group 2 (P less than 0.01). There was a significant increase in circulating white blood cells when compared to pre-bypass time in both groups (P less than 0.05). However, comparison of differences between leucocyte counts in the blood of the patients' right and left atria showed enhanced leucocyte sequestration in group 1, 1.46 +/- 0.5 x 10(3)/mm3 vs only 0.34 +/- 0.2 x 10(3)/mm3 in group 2. The C3a rose progressively during extracorporeal circulation: in group 1 from 268 +/- 46 ng/l to 521 +/- 65 ng/l, and in group 2 from 244 +/- 46 ng/l to 418 +/- 34 ng/l (P less than 0.05). No characteristic changes in C5a activation were observed in either group.(ABSTRACT TRUNCATED AT 250 WORDS)

Published
1992
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32. Improved biocompatibility of extracorporeal circulation by the use of auto-oxygenation instead of artificial oxygenator in perfusion circuit.

Author

Bochenek A, Religa Z, Kustosz R, Wnuk-Wojnar AM, Wnuk R, Wojnar J, Woś S, Wites M, Zembala M, and Spyt T

Subjects
Bleeding Time, Blood Platelets physiology, Cardiopulmonary Bypass adverse effects, Cardiopulmonary Bypass methods, Complement Activation, Extracorporeal Circulation adverse effects, Hemoglobins metabolism, Humans, Leukocyte Count, Materials Testing, Middle Aged, Platelet Count, Biocompatible Materials, Extracorporeal Circulation methods, Oxygenators
Abstract

The aim of this study was to determine the biocompatibility of an auto-oxygenation technique of cardiopulmonary bypass. Forty patients undergoing coronary bypass surgery were studied in two groups: A (auto-oxygenation, patients' lungs used in cardiopulmonary bypass) and B (conventional technique of cardiopulmonary bypass with bubble oxygenator). The platelet count decreased to -73% of initial value in group B vs only -27% in group A, P less than 0.001. Platelet aggregation to ADP decreased slightly in group A and hardly at all in group B, P less than 0.001. A transpulmonary leukocyte sequestration was greater in group B: 1.46 +/- 0.5 x 10(3)/mm3 vs only 0.34 +/- 0.2 x 10(3)/mm3 in group A, P less than 0.001. The level of C3a increased in group A from 244 +/- 46 ng/ml to 418 +/- 34 ng/ml and in group B from 268 +/- 46 ng/ml to 521 +/- 65 ng/ml, P less than 0.001, but in group A the levels were significantly less, P less than 0.001. The current study clearly confirms the superior biocompatibility of cardiopulmonary bypass with lung over oxygenator.

Published
1991

33. Predictors of ventricular tachycardia inducibility in programmed electrical stimulation and the effectiveness of serial drug testing: Polish multicenter study.

Author

Wnuk-Wojnar AM, Giec L, Drzewiecki J, Trusz-Gluza M, Dabrowski A, and Pasyk S

Subjects
Adult, Aged, Coronary Disease physiopathology, Electrocardiography, Female, Humans, Male, Middle Aged, Myocardial Contraction drug effects, Myocardial Contraction physiology, Poland, Probability, Prognosis, Survival Rate, Tachycardia etiology, Time Factors, Ventricular Fibrillation etiology, Ventricular Fibrillation physiopathology, Ventricular Function drug effects, Anti-Arrhythmia Agents therapeutic use, Cardiac Pacing, Artificial, Tachycardia physiopathology, Ventricular Function physiology
Abstract

In 100 patients with IHD and complex ventricular arrhythmias, programmed electrical stimulation was performed using up to three extrastimuli at sinus rhythm, and paced 100, 120 and 140 beats/min delivered from the RV apex, outflow tract or the LV with ventricular mapping to evaluate late potentials (LP) in 41 patients. Sustained monomorphic VT (SMVT) was provoked in 91% of 42 patients with a history of VT/VF, P less than 0.001, all five patients had SMVT in 24-hour ECG, P less than 0.005, and 91% of 21 patients with LV dyskinesis, P less than 0.01. After depolarizations were found in 62% of 21 patients with a history of VT, in 58% of 31 patients with inducible VT, P less than 0.01 and in five of six patients with LV dyskinesis. In patients with inducible VT, LP had a higher amplitude (105 +/- 35 vs 60 +/- 47 microV) and were more delayed (202 +/- 96 vs 133 +/- 75 msec) than in noninducible patients. In 17 patients, serial drug testing was performed after oral administration using mexilitene, disopyramide, chinidine, propafenone, sotalol, and amiodarone. If one drug was tested, the therapy efficacy was 25%, if two drugs-60%, and if three drugs-75%. In eight patients, VT was inducible in all tests, but in only one of these patients chronic antiarrhythmic therapy was not effective. We conclude that the most important predictors of VT inducibility are a history of VT or 24-hour ECG, and LV dyskinesis. Serial drug testing is efficient only when many drugs are tested, but even if VT is inducible, it does not exclude the possibility of a good clinical outcome in chronic therapy.

Published
1990
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34. [Late right and left ventricular potentials using inter-cardiac recording in patients with ischemic heart disease--methodologic and clinical problems].

Author

Wnuk-Wojnar AM, Drzewiecki J, Pasyk S, Kopeć P, Buszman P, Pruski M, and Szczogiel J

Subjects
Electrocardiography, Ambulatory, Evoked Potentials physiology, Humans, Ventricular Function, Left physiology, Ventricular Function, Right physiology, Coronary Disease physiopathology, Electrocardiography
Abstract

The aim of the study was to compare detection frequency of late inter-cardiac potentials recorded from the right and left ventricle. There was also estimated relationship between their incidence and ventricular tachycardia or fibrillation occurrence. 41 patients with ischemic heart disease underwent the study. Electrophysiologic examination were performed because of ventricular tachycardia and/or fibrillation attacks or complex ventricular arrhythmias recorded in ECG Holter monitoring. In 11 patients intracardiac electrocardiograms were recorded from both ventricles, in 29 only from the right and in 1 from the left one. All patients underwent programmed right and/or left ventricular stimulation. Left ventricular end-diastolic diameter, segmental contractility and ejection fraction were echocardiographically estimated. Study results were statistically analyzed by means of CHI2 and t-Student tests for unpaired variables. Late potentials were more frequently observed in patients with left ventricular dyskinesis (p less than 0.01) and decreased ejection fraction. Late potentials recorded in patients with a history of ventricular tachycardia or fibrillation were more delayed to proceeded QRS complex and had a greater amplitude. This prolongation of ventricular activation can make an anatomic substrate for dangerous ventricular arrhythmias occurrence. Since the presence of late potentials in patients with contractility disorders is connected with more frequent incidence of spontaneous and provoked ventricular arrhythmias, endocardial late potentials recording may be of a prognostic value, if it is performed from both ventricles.

Published
1990

35. Haemocompatibility of extracorporeal circulation technique with autooxygenation: influence on platelet function and homologous blood requirement.

Author

Wojnar J, Bochenek A, Wnuk-Wojnar AM, Religa Z, and Hołowiecki J

Subjects
Bleeding Time, Blood Coagulation Factors analysis, Blood Loss, Surgical, Blood Transfusion, Coronary Artery Bypass, Fibrin Fibrinogen Degradation Products analysis, Hemoglobins analysis, Hemostasis, Humans, Male, Middle Aged, Platelet Aggregation, beta-Thromboglobulin, Blood Platelets physiology, Extracorporeal Circulation methods, Oxygen blood
Abstract

Forty male patients: group A-autooxygenation and group B-bubble oxygenator used in extracorporeal circulation (ECC) were studied to evaluate the haemocompatibility of 2 types of ECC. The Plt count dropped significantly in group B patients: -73% of initial value vs only -27% in group A, (p less than 0.001). In both groups a rise in BTG was shown, but higher in group B, p less than 0.001. At the end of CPB aggregation decreased only slightly in group A after epinephrine and 4-ADP, and decreased hardly in group B with the significant difference between two groups (p less than 0.02 and p less than 0.001, respectively). In group A the mean blood loss was 278 +/- 49 ml/m2 and 483 +/- 67 ml/m2 in group B, p less than 0.001. The mean blood transfusion in group A and B was 198 +/- 82 ml/m2 and 427 +/- 85 ml/m2, respectively (p less than 0.001). We are positive that the elimination of artificial oxygenator from the ECC diminished markedly the decline in Plt count and Plt activation during CPB.

Published
1990

36. [Incidence of fetal hemoglobin in patients with hematologic proliferative syndromes].

Author

Wnuk-Wojnar AM, Holowiecki J, and Harbut-Grylka A

Subjects
Acute Disease, Adult, Anemia diagnosis, Blood Donors, Cytodiagnosis, Diagnosis, Differential, Fetal Hemoglobin biosynthesis, Humans, Infant, Newborn, Leukemia diagnosis, Methods, Microscopy, Phase-Contrast, Polycythemia diagnosis, Fetal Hemoglobin analysis, Leukemia blood
Published
1974

37. [Sucrose test in leukemias].

Author

Wnuk-Wojnar AM, Holowiecki J, Wojnar J, and Wnuk R

Subjects
ABO Blood-Group System, Humans, Leukemia, Lymphoid diagnosis, Leukemia, Myeloid diagnosis, Leukemia, Myeloid, Acute diagnosis, Hemolysis, Leukemia diagnosis, Sucrose
Abstract

In 29 patients with blood diseases, in 40 with other diseases and 22 healthy blood donors sucrose test for presence of plasma haemolytic factor was performed by the method of Hartmann et al. in the modification of Hansen. The percent index of haemolysis of erythrocytes after incubation with serum in 10% sucrose solution was calculated. The results were evaluated in 4 variants: 1) positive sucrose test for presence of SHF against own erythrocytes, 2) positive sucrose test for presence of SHF against foreign erythrocytes, 3) authohaemolysis in 10% sucrose and 0.9% NaCl solution, 4) haemolysis of foreign erythrocytes in 10% sucrose and 0.9% NaCl. The test was usually negative in healthy controls and patients with non-haematological diseases and in patients with leukemia it was positive in 17%.

Published
1977

38. [Atrial hyperexcitability provoked by stimulation--clinical aspects].

Author

Trusz-Gluza M, Giec L, Drzewiecki J, Wnuk-Wojnar AM, and Kośmider J

Subjects
Adolescent, Adult, Atrial Fibrillation etiology, Electric Stimulation, Female, Heart Atria physiopathology, Humans, Male, Middle Aged, Sinoatrial Node physiopathology, Atrial Fibrillation diagnosis, Wolff-Parkinson-White Syndrome physiopathology
Published
1984

40. Predictive value of various types of ventricular response to programmed ventricular stimulation: relation to Holter monitoring.

Author

Wnuk-Wojnar AM, Giec L, Drzewiecki J, Trusz-Gluza M, and Szulc A

Subjects
Coronary Disease diagnosis, Humans, Prospective Studies, Risk Factors, Arrhythmias, Cardiac diagnosis, Cardiac Pacing, Artificial, Electrocardiography, Heart Conduction System physiopathology, Monitoring, Physiologic methods
Abstract

Unlabelled: The study was performed to determine the predictive value of programmed stimulation for identification of pts with ventricular arrhythmias: 75 patients were studied by means of 24-hour ambulatory ECG (24 ECG) and programmed right (in some patients also left) ventricle stimulation at sinus and two or three pacing rates using two (standard) and three extrastimuli or burst stimulation (extensive protocol). Lown classes 0, 1-3 and 4a-4b were observed in 24 ECG in 35, 14, and 26 patients, respectively. In programmed stimulation 1-6 repetitive ventricular responses (RVR) were found in 56 pts, nonsustained ventricular tachycardia in 11 and sustained ventricular tachycardia in 21 pts. High incidence of induced VT was found in pts with complex ventricular arrhythmia in 24 ECG, 81% of this group, in all but six pts only standard protocol was used. The 1-6 RVR were observed in almost 40% of pts without any arrhythmia., Conclusion: Only VT induction is a useful index for high risk patients.

Published
1988
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41. [Our experience with transvenous ablation of the atrioventricular node].

Author

Drzewiecki J, Jaklik A, Wnuk-Wojnar AM, Trusz-Gluza M, and Giec L

Subjects
Adult, Aged, Electrocardiography, Female, Humans, Male, Middle Aged, Tachycardia, Supraventricular diagnosis, Veins, Atrioventricular Node, Electric Countershock methods, Heart Conduction System, Tachycardia, Supraventricular therapy
Abstract

In 7 patients conventional a-v nodal ablation was performed using electrical energy delivered from the cardioverter via a catheter-electrode positioned near His bundle area. In all patients indication for the ablation were rapid symptomatic supraventricular arrhythmias refractory to previous pharmacological treatment. During the ablation 1-2 discharges of 200-300 J energy were used, repeating the procedure in 2 patients after 24 hours. In all patients the complete a-v block was obtained and the injury of the postero-septal accessory pathway in 3 subjects. Patients were pacemaker dependent without recurrences of supraventricular arrhythmias with rapid ventricular response. Except mild and local myocardial lesion expressed by transient increase of indicatory enzymes we did not observed any other complications directly related to the ablation procedure. Our modest experience in application of conventional a-v nodal ablation proves that this procedure could and should be used in selected patients at the medical centers having the appropriate equipment and experience in clinical electrophysiology.

Published
1989

44. Clinical studies on aclacinomycin A cardiotoxicity in adult patients with acute non lymphoblastic leukaemia.

Author

Wojnar J, Mandecki M, Wnuk-Wojnar AM, and Hołowiecki J

Subjects
Aclarubicin administration & dosage, Adult, Cytarabine administration & dosage, Electrocardiography, Female, Humans, Infusions, Intravenous, Male, Aclarubicin adverse effects, Arrhythmias, Cardiac chemically induced, Leukemia, Myeloid, Acute drug therapy
Abstract

Nine patients with acute non lymphoblastic leukaemia (ANLL) were treated with Aclacinomycin in the doses of 20 mg/m2/day x 7 days in 30' lasting intravenous infusion and Cytosin arabinosid 100 mg/m2/day x 7 days in continuous infusion as well as control group consisted of 30 healthy people were examined by means of 24 hrs Holter ECG monitoring and ultrasonocardiography (UCG) to evaluate the influence of Aclacinomycin A (Aclaplastin - Behring) on cardiac rhythm and function. The UCG and Holter examinations were performed before Aclacinomycin and after 7-10 days from the beginning of the therapy. There were no statistical differences between the results of UCG examination in Aclacinomycin-treated group before the therapy and the control group. A slight nonsignificant decrease in left ventricular stroke volume and ejection fraction were observed after Aclacinomycin. Cardiac index decreased after the therapy (p less than 0.05) but was of normal value. The only true significant (p less than 0.001) decrease was observed in the contractility of cardiac fibres but the cardiac failure was not observed. No alterations in left ventricular posterior wall and intraventricular septum thickness were found. The effusion to pericardium was observed in 2 pts in the initial study and in 1 of them also after the therapy. The obtained results supported the clinical observations that Aclacinomycin A is promising agent for the treatment of ANLL because of its low cardiotoxicity.

Published
1989

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