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Guideline adherence of antithrombotic treatment initiated by general practitioners in patients with nonvalvular atrial fibrillation: a Danish survey.

https://arctichealth.org/en/permalink/ahliterature113927
Source
Clin Cardiol. 2013 Jul;36(7):427-32
Publication Type
Article
Date
Jul-2013
Author
Axel Brandes
Mikkel Overgaard
Liane Plauborg
Christian Dehlendorff
Frede Lyck
Jørgen Peulicke
Søren Vinther Poulsen
Steen Husted
Author Affiliation
Department of Cardiology, Odense University Hospital, Odense, Denmark. axel.brandes@rsyd.dk
Source
Clin Cardiol. 2013 Jul;36(7):427-32
Date
Jul-2013
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Anticoagulants - therapeutic use
Atrial Fibrillation - complications - diagnosis - drug therapy
Chi-Square Distribution
Cross-Sectional Studies
Denmark
Drug Utilization Review
Female
Fibrinolytic Agents - therapeutic use
General Practitioners - standards
Guideline Adherence - standards
Health Care Surveys
Humans
Male
Middle Aged
Physician's Practice Patterns - standards
Platelet Aggregation Inhibitors - therapeutic use
Practice Guidelines as Topic - standards
Primary Health Care - standards
Prospective Studies
Risk assessment
Risk factors
Stroke - etiology - prevention & control
Abstract
The aim of this prospective survey was to describe the demographics, stroke risk profile, and the guideline adherence of antithrombotic treatment in a Danish primary care population of patients with nonvalvular atrial fibrillation (AF).
We hypothesized that a significant proportion of patients with nonvalvular AF do not receive guideline-adherent antithrombotic treatment in primary care.
We performed a cross-sectional survey of antithrombotic treatment using data of AF patients from general practices.
Sixty-four general practitioners enrolled 1743 patients with a mean age of 74.8?±?11.2 years. The mean CHADS2 and CHA2 DS2 -VASc scores were 1.9?±?1.3 and 3.5?±?1.8, respectively. Of the patients, 12.4% and 4.04%, respectively, were at truly low risk, with a CHADS2 and CHA2 DS2 -VASc score 0 (P
PubMed ID
23670894 View in PubMed
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A long-term perspective on the protective effects of an early invasive strategy in unstable coronary artery disease: two-year follow-up of the FRISC-II invasive study.

https://arctichealth.org/en/permalink/ahliterature187415
Source
J Am Coll Cardiol. 2002 Dec 4;40(11):1902-14
Publication Type
Article
Date
Dec-4-2002
Author
Bo Lagerqvist
Steen Husted
Fredrik Kontny
Ulf Näslund
Elisabeth Ståhle
Eva Swahn
Lars Wallentin
Author Affiliation
Department of Cardiology, University Hospital, Uppsala, Sweden. bo.lagerqvist@card.uas.lul.se
Source
J Am Coll Cardiol. 2002 Dec 4;40(11):1902-14
Date
Dec-4-2002
Language
English
Publication Type
Article
Keywords
Aged
Angina, Unstable - complications - prevention & control
Coronary Artery Disease - complications - mortality - prevention & control
Female
Follow-Up Studies
Humans
Male
Middle Aged
Myocardial Infarction - complications - mortality - prevention & control
Myocardial Revascularization
Patient Readmission
Prospective Studies
Recurrence
Scandinavia - epidemiology
Survival Analysis
Time
Time Factors
Treatment Outcome
Abstract
We sought to report the first and repeat events and to separate spontaneous and procedure-related events over two years in the Fast Revascularization during InStability in Coronary artery disease (FRISC-II) invasive trial.
The FRISC-II invasive trial compared the long-term effects of an early invasive versus noninvasive strategy, in terms of death and myocardial infarction (MI) and the need for repeat hospital admissions and late revascularization procedures in patients with coronary artery disease (UCAD).
In the FRISC-II trial, 2,457 patients with UCAD were randomized to an early invasive or noninvasive strategy.
At 24 month follow-up, there were reductions in mortality (n = 45 [3.7%] vs. 67 [5.4%]; risk ratio 0.68 [95% confidence interval (CI) 0.47 to 0.98]; p = 0.038), MI (n = 111 [9.2%] vs. 156 [12.7%]; risk ratio 0.72 [95% CI 0.57 to 0.91]; p = 0.005), and the composite end point of death or MI (n = 146 [12.1%] vs. 200 [16.3%]; risk ratio 0.74 [95% CI 0.61 to 0.90]; p = 0.003) in the invasive compared with the noninvasive group. Procedure-related MIs were two to three times more common, but spontaneous ones were three times less common in the invasive than in the noninvasive group. After the first year, there was no difference in mortality (n = 20 [1.7%]) between the two groups and fewer MIs in the invasive group (p = 0.031).
In UCAD, the early invasive approach leads to a sustained reduction in mortality, cardiac morbidity, and the need for repeat hospital admissions and late revascularization procedures. Although the benefits are greatest during the first months, during the second year, cardiac morbidity is lower and the need for hospital care is less in the invasive group.
Notes
Comment In: J Am Coll Cardiol. 2002 Dec 4;40(11):1915-812475449
Comment In: ACP J Club. 2003 Sep-Oct;139(2):3012954022
PubMed ID
12475448 View in PubMed
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Seasonal variation in hospital discharge diagnosis of atrial fibrillation: a population-based study.

https://arctichealth.org/en/permalink/ahliterature47574
Source
Epidemiology. 2002 Mar;13(2):211-5
Publication Type
Article
Date
Mar-2002
Author
Lars Frost
Søren Paaske Johnsen
Lars Pedersen
Steen Husted
Gerda Engholm
Henrik Toft Sørensen
Kenneth J Rothman
Author Affiliation
Department of Clinical Epidemiology, Aarhus University Hospital and Aalborg Sygehus, Denmark. l.frost@dadlnet.dk
Source
Epidemiology. 2002 Mar;13(2):211-5
Date
Mar-2002
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Atrial Fibrillation - epidemiology
Denmark - epidemiology
Female
Humans
Male
Middle Aged
Patient Discharge - statistics & numerical data
Registries
Seasons
Temperature
Abstract
BACKGROUND: Cardiovascular events such as acute myocardial infarction and stroke vary seasonally, with a peak incidence during the winter and a trough during the summer. Few data exist on the seasonal variation of atrial fibrillation. METHODS: We examined the association among season, outdoor temperature, and risk of atrial fibrillation. We identified 32,992 subjects, age 50-89 years, in a random sample of half the people with an incident hospital discharge diagnosis of atrial fibrillation in the Danish National Hospital Discharge Register from 1980 to 1993. We used a periodic regression model to evaluate any seasonal distribution. RESULTS: We found a winter peak and a summer trough in the incidence of atrial fibrillation. The relative incidence of atrial fibrillation during winter as compared with summer, estimated as the ratio of the incidence in the month of the peak relative to the incidence in the month of the trough, was small (relative risk = 1.20; 95% confidence interval = 1.12-1.29). Stratification by sex, age, and the presence or absence of diabetes and underlying cardiovascular diseases did not affect the seasonal pattern. We also found an inverse relation between mean outdoor temperature and incidence of atrial fibrillation. CONCLUSION: The risk of atrial fibrillation was modestly higher during the winter and was inversely associated with outdoor temperature.
Notes
Comment In: Epidemiology. 2003 Jan;14(1):12712500064
PubMed ID
11880763 View in PubMed
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Substantial differences in initiation of oral anticoagulant therapy and clinical outcome among non-valvular atrial fibrillation patients treated in inpatient and outpatient settings.

https://arctichealth.org/en/permalink/ahliterature281045
Source
Europace. 2016 Apr;18(4):492-500
Publication Type
Article
Date
Apr-2016
Author
Anders Pretzmann Mikkelsen
Morten Lock Hansen
Jonas Bjerring Olesen
Morten Winther Hvidtfeldt
Deniz Karasoy
Steen Husted
Søren Paaske Johnsen
Axel Brandes
Gunnar Gislason
Christian Torp-Pedersen
Morten Lamberts
Source
Europace. 2016 Apr;18(4):492-500
Date
Apr-2016
Language
English
Publication Type
Article
Keywords
Administration, Oral
Aged
Aged, 80 and over
Ambulatory Care - standards
Anticoagulants - administration & dosage - adverse effects
Atrial Fibrillation - complications - diagnosis - drug therapy
Chi-Square Distribution
Denmark
Female
Healthcare Disparities - standards
Hemorrhage - chemically induced
Humans
Inpatients
Linear Models
Male
Middle Aged
Practice Patterns, Physicians' - standards
Proportional Hazards Models
Quality Indicators, Health Care
Registries
Retrospective Studies
Risk factors
Stroke - etiology - prevention & control
Thromboembolism - etiology - prevention & control
Time Factors
Treatment Outcome
Warfarin - administration & dosage - adverse effects
Abstract
Patients with atrial fibrillation (AF) are encountered and treated in different healthcare settings, which may affect the quality of care. We investigated the use of oral anticoagulant (OAC) therapy and the risk of thrombo-embolism (TE) and bleeding, according to the healthcare setting.
Using national Danish registers, we categorized non-valvular AF patients (2002-11) according to the setting of their first-time AF contact: hospitalization (inpatients), ambulatory (outpatients), or emergency department (ED). Event rates and hazard ratios (HRs), calculated using Cox regression analysis, were estimated for outcomes of TE and bleeding. We included 116 051 non-valvular AF patients [mean age 71.9 years (standard deviation 14.1), 51.3% males], of whom 55.2% were inpatients, 41.9% outpatients, and 2.9% ED patients. OAC therapy 180 days after AF diagnosis among patients with a CHADS2 = 2 was 42.1, 63.0, and 32.4%, respectively. Initiation of OAC therapy was only modestly influenced by CHADS2 and HAS-BLED scores, regardless of the healthcare setting. The rate of TE was 4.30 [95% confidence interval (CI) 4.21-4.40] per 100 person-years for inpatients, 2.28 (95% CI 2.22-2.36) for outpatients, and 2.30 (95% CI 2.05-2.59) for ED patients. The adjusted HR of TE, with inpatients as reference, was 0.74 (95% CI 0.71-0.77) for outpatients and 0.89 (95% CI 0.79-1.01) for ED patients.
In a nationwide cohort of non-valvular AF patients, outpatients were much more likely to receive OAC therapy and had a significantly lower risk of stroke/TE compared with inpatients and ED patients. However, across all settings investigated, OAC therapy was far from optimal.
PubMed ID
26443443 View in PubMed
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Thromboembolic risk in 16 274 atrial fibrillation patients undergoing direct current cardioversion with and without oral anticoagulant therapy.

https://arctichealth.org/en/permalink/ahliterature266081
Source
Europace. 2015 Jan;17(1):18-23
Publication Type
Article
Date
Jan-2015
Author
Morten Lock Hansen
Rikke Malene H G Jepsen
Jonas Bjerring Olesen
Martin Huth Ruwald
Deniz Karasoy
Gunnar Hilmar Gislason
Jim Hansen
Lars Køber
Steen Husted
Christian Torp-Pedersen
Source
Europace. 2015 Jan;17(1):18-23
Date
Jan-2015
Language
English
Publication Type
Article
Keywords
Administration, Oral
Aged
Aged, 80 and over
Anticoagulants - administration & dosage
Atrial Fibrillation - epidemiology - mortality
Combined Modality Therapy
Comorbidity
Defibrillators, Implantable - statistics & numerical data
Denmark - epidemiology
Female
Hospitalization - statistics & numerical data
Humans
Incidence
Male
Retrospective Studies
Risk assessment
Survival Rate
Thromboembolism - mortality - prevention & control
Abstract
To study the risk of thromboembolism in a nationwide cohort of atrial fibrillation patients undergoing direct current (DC) cardioversion with or without oral anticoagulant coverage.
A retrospective study of 16 274 patients in Denmark discharged from hospital after a first-time DC cardioversion for atrial fibrillation between 2000 and 2008. Use of oral anticoagulant therapy within 90 days prior and 360 days after DC cardioversion was obtained from the Danish Register of Medicinal Product Statistics. The risk of thromboembolism was estimated by calculating incidence rates and by multivariable adjusted Cox proportional-hazard models. During the initial 30 days following discharge, the thromboembolic incidence rate was 10.33 per 100 patient-years for the no prior oral anticoagulant therapy group [n = 5084 (31.2%)], as compared with 4.00 per 100 patient-years for the prior oral anticoagulant therapy group [n = 11 190 (68.8%)], [hazard ratio associated with no prior oral anticoagulant therapy was 2.25; 95% confidence interval (CI), 1.43-3.53]. Thromboembolic risk stratification by the CHADS2 and CHA2DS2-VASc scores did not change the results. Hazard ratio with no oral anticoagulant therapy was 2.21; 95% CI, 0.79-6.77 and 2.40; 95% CI, 1.46-3.95 with CHA2DS2-VASc score 0-1 and CHA2DS2-VASc score 2 or more, respectively.
Direct current cardioversion for atrial fibrillation without oral anticoagulation is associated with a high risk of thromboembolism. Notably, the risk is high in the initial period after cardioversion, indicating a hazardous association between DC cardioversion without anticoagulation and thromboembolism.
Notes
Comment In: Europace. 2015 Jan;17(1):3-425345828
PubMed ID
25231909 View in PubMed
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Trends in Risk of Stroke in Patients with a Hospital Diagnosis of Nonvalvular Atrial Fibrillation: National Cohort Study in Denmark, 1980-2002.

https://arctichealth.org/en/permalink/ahliterature76048
Source
Neuroepidemiology. 2006 Apr 25;26(4):212-219
Publication Type
Article
Date
Apr-25-2006
Author
Lars Frost
Ljubica Vukelic Andersen
Peter Vestergaard
Steen Husted
Leif Spange Mortensen
Author Affiliation
Department of Cardiology A, Aarhus University Hospital, Aarhus, Denmark.
Source
Neuroepidemiology. 2006 Apr 25;26(4):212-219
Date
Apr-25-2006
Language
English
Publication Type
Article
Abstract
Aim: We examined trends in incidence of stroke of any nature (ischemic and/or hemorrhagic) in subjects with a hospital diagnosis of nonvalvular atrial fibrillation or flutter in Denmark from 1980 to 2002 by sex, age and conditions of comorbidity. Methods: We identified all individuals, aged 40-89 years, with an incident hospital diagnosis of atrial fibrillation or flutter and no history of stroke or heart valve disease in the Danish National Registry of Patients, and subjects were followed in the Danish National Registry of Patients for occurrence of an incident diagnosis of stroke of any nature (ischemic and/or hemorrhagic) and in the Danish Civil Registration System (emigration and vital status). We used multivariate Cox proportional hazard regression analysis to estimate trends in incidence of stroke. Results: Nonvalvular atrial fibrillation or flutter was diagnosed in 141,493 subjects (75,126 men and 66,367 women), and during follow-up 15,964 subjects had an incident diagnosis of stroke. The hazard ratios for stroke in the last 3-year period compared to the first 5-year period, adjusted for 10-year age group, conditions of comorbidity, and general stroke trend in the Danish population were 0.78 (95% CI 0.70-0.86) in men, and 0.80 (95% CI 0.72-0.88) in women. The reduction in risk of stroke by calendar year was most prominent in patients aged 40-74 years. Conclusion: We observed a modest decrease in risk of stroke in subject with atrial fibrillation in Denmark during calendar years 1980-2002. However, we could not control for any changes in diagnostic performance, admission practice, and medical management of patients with atrial fibrillation. Copyright (c) 2006 S. Karger AG, Basel.
PubMed ID
16645320 View in PubMed
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Venous thromboembolism in patients having knee replacement and receiving thromboprophylaxis: a Danish population-based follow-up study.

https://arctichealth.org/en/permalink/ahliterature132658
Source
J Bone Joint Surg Am. 2011 Jul 20;93(14):1281-7
Publication Type
Article
Date
Jul-20-2011
Author
Alma B Pedersen
Frank Mehnert
Soren P Johnsen
Steen Husted
Henrik T Sorensen
Author Affiliation
Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, 8200 Aarhus N, Denmark. abp@dce.au.dk
Source
J Bone Joint Surg Am. 2011 Jul 20;93(14):1281-7
Date
Jul-20-2011
Language
English
Publication Type
Article
Keywords
Adolescent
Age Factors
Aged
Aged, 80 and over
Arthritis, Rheumatoid - surgery
Arthroplasty, Replacement, Knee
Cardiovascular Diseases - epidemiology
Child
Comorbidity
Denmark - epidemiology
Female
Follow-Up Studies
Hospitalization - statistics & numerical data
Humans
Joint Diseases - epidemiology
Male
Middle Aged
Postoperative Complications - epidemiology
Pulmonary Embolism - epidemiology - prevention & control
Risk factors
Venous Thromboembolism - epidemiology - prevention & control
Venous Thrombosis - epidemiology - prevention & control
Young Adult
Abstract
We examined the rate of venous thromboembolism, as well as changes over time, in a population-based cohort of patients who underwent knee arthroplasty.
Using medical databases, we identified all patients who underwent primary knee arthroplasties with pharmacological thromboprophylaxis performed in Denmark from 1997 to 2007. The outcome was hospitalization with symptomatic venous thromboembolism within ninety days of surgery. We examined several potential patient and surgery-related predictors for venous thromboembolism using Cox regression analyses.
The overall rate of hospitalization for venous thromboembolism among 37,223 patients within ninety days after primary knee arthroplasty was 1.2% (441 patients) at a median of fifteen days. The rate of hospitalization was 0.9% (323 patients) for deep venous thrombosis and 0.3% (127 patients) for pulmonary embolism, with nine patients who had both. The rate of venous thromboembolism increased during the ten-year study period. Patients with a high score on the Charlson comorbidity index had an increased relative risk for venous thromboembolism compared with patients with a low score (adjusted relative risk = 1.73; 95% confidence interval, 1.24 to 2.41). Patients with a history of cardiovascular disease or a previous venous thromboembolism had an increased risk for postoperative venous thromboembolism compared with patients without these conditions. Surgery-related factors were not predictors for venous thromboembolism.
Despite pharmacological thromboprophylaxis, patients undergoing knee arthroplasty remain susceptible for venous thromboembolism events after surgery. Future efforts should focus on the improvement of prophylaxis following hospital discharge, particularly among elderly patients and those with a history of cardiovascular diseases or previous venous thromboembolism.
Notes
Comment In: J Bone Joint Surg Am. 2011 Jul 20;93(14):e8121792484
PubMed ID
21792493 View in PubMed
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8 records – page 1 of 1.