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Beyond anticoagulant therapy. The not benign impact of atrial fibrillation on patients’ outcomes in a real world ‘scenario’

Published:March 17, 2020DOI:https://doi.org/10.1016/j.ejim.2020.03.013
      Some weeks ago, while I was visiting an old lady with a first episode of atrial fibrillation (AF), a friend of mine, a very clever cardiologist and scientist, said: “Do not worry madam, you have an AF, the heart equivalent of an appendicitis”. Many cardiologists and internists still think that AF is a common but not severe cardiac condition, characterized by a benign prognosis provided that patients go on taking their anticoagulant medications. This concept is presently and continuously challenged by some relevant evidence, which clearly demonstrates how the clinical weight of AF goes well beyond that represented by the increased thromboembolic risk.

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      References

        • Cemin R.
        • Colivicchi F.
        • Maggioni A.P.
        • Boriani G.
        • De Luca L.
        • Di Lenarda A.
        • et al.
        One-year clinical events and management of patients with atrial fibrillation hospitalized in cardiology centers: data from the BLITZ-AF study.
        Eur J Intern Med. 2020;
        • Magnussen C.
        • Niiranen T.J.
        • Ojeda F.M.
        • Gianfagna F.
        • Blankenberg S.
        • Njolstad I.
        • et al.
        Sex differences and similarities in atrial fibrillation epidemiology, risk factors, and mortality in community cohorts: results from the biomarcare consortium (Biomarker for cardiovascular risk assessment in europe).
        Circulation. 2017; 136: 1588-1597
        • Lane D.A.
        • Skjoth F.
        • Lip G.Y.H.
        • Larsen T.B.
        • Kotecha D
        Temporal trends in incidence, prevalence, and mortality of atrial fibrillation in primary care.
        J Am Heart Assoc. 2017; 6
        • Rich M.W.
        • Chyun D.A.
        • Skolnick A.H.
        • Alexander K.P.
        • Forman D.E.
        • Kitzman D.W.
        • et al.
        Knowledge Gaps in Cardiovascular Care of the Older Adult Population: A Scientific Statement From the American Heart Association, American College of Cardiology, and American Geriatrics Society.
        J Am Coll Cardiol. 2016; 67: 2419-2440
        • Alexander K.P.
        • Brouwer M.A.
        • Mulder H.
        • Vinereanu D.
        • Lopes R.D.
        • Proietti M.
        • et al.
        Outcomes of apixaban versus warfarin in patients with atrial fibrillation and multi-morbidity: insights from the ARISTOTLE trial.
        Am Heart J. 2019; 208: 123-131
        • Dietzel J.
        • Haeusler K.G.
        • Endres M
        Does atrial fibrillation cause cognitive decline and dementia?.
        in: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 20. 2018: 408-419
        • Fumagalli S.
        • Potpara T.S.
        • Bjerregaard Larsen T.
        • Haugaa K.H.
        • Dobreanu D.
        • Proclemer A.
        • et al.
        Frailty syndrome: an emerging clinical problem in the everyday management of clinical arrhythmias. the results of the european heart rhythm association survey.
        in: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 19. 2017: 1896-1902
        • Lopes R.D.
        • Rordorf R.
        • De Ferrari G.M.
        • Leonardi S.
        • Thomas L.
        • Wojdyla D.M.
        • et al.
        Digoxin and mortality in patients with atrial fibrillation.
        J Am Coll Cardiol. 2018; 71: 1063-1074
        • Kirchhof P.
        • Benussi S.
        • Kotecha D.
        • Ahlsson A.
        • Atar D.
        • Casadei B.
        • et al.
        2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS.
        in: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 18. 2016: 1609-1678
        • Fumagalli S.
        • Said S.A.M.
        • Laroche C.
        • Gabbai D.
        • Marchionni N.
        • Boriani G.
        • et al.
        Age-Related differences in presentation, treatment, and outcome of patients with atrial fibrillation in europe: the eorp-af general pilot registry (EURObservational research programme-atrial fibrillation).
        JACC: Clinical Electrophysiology. 2015; 1: 326-334
        • Gibson C.M.
        • Mehran R.
        • Bode C.
        • Halperin J.
        • Verheugt F.W.
        • Wildgoose P.
        • et al.
        Prevention of bleeding in patients with atrial fibrillation undergoing pci.
        The New England journal of medicine. 2016; 375: 2423-2434
        • Cannon C.P.
        • Bhatt D.L.
        • Oldgren J.
        • Lip G.Y.H.
        • Ellis S.G.
        • Kimura T.
        • et al.
        Dual antithrombotic therapy with dabigatran after pci in atrial fibrillation.
        The New England journal of medicine. 2017; 377: 1513-1524
        • Lopes R.D.
        • Heizer G.
        • Aronson R.
        • Vora A.N.
        • Massaro T.
        • Mehran R.
        • et al.
        Antithrombotic therapy after acute coronary syndrome or pci in atrial fibrillation.
        The New England journal of medicine. 2019; 380: 1509-1524
        • Vranckx P.
        • Valgimigli M.
        • Eckardt L.
        • Tijssen J.
        • Lewalter T.
        • Gargiulo G.
        • et al.
        Edoxaban-based versus vitamin K antagonist-based antithrombotic regimen after successful coronary stenting in patients with atrial fibrillation (ENTRUST-AF PCI): a randomised, open-label, phase 3b trial.
        Lancet. 2019; 394: 1335-1343
        • Kim D.
        • Yang P.S.
        • Yu H.T.
        • Kim T.H.
        • Jang E.
        • Sung J.H.
        • et al.
        Risk of dementia in stroke-free patients diagnosed with atrial fibrillation: data from a population-based cohort.
        Eur Heart J. 2019;
        • Potpara T.S.
        • Mujovic N.
        • Lip G.Y.H
        Challenges in stroke prevention among very elderly patients with atrial fibrillation: discerning facts from prejudices.
        in: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 22. 2020: 173-176
        • Fumagalli S.
        • Chen J.
        • Dobreanu D.
        • Madrid A.H.
        • Tilz R.
        • Dagres N
        The role of the arrhythmia team, an integrated, multidisciplinary approach to treatment of patients with cardiac arrhythmias: results of the european heart rhythm association survey.
        in: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 18. 2016: 623-627