Publications by authors named "José Miguel Rivera-Caravaca"

78 Publications

Relationship between multimorbidity and outcomes in atrial fibrillation.

Exp Gerontol 2021 Jul 23;153:111482. Epub 2021 Jul 23.

Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain.

Background: Multimorbidity is common in atrial fibrillation (AF) patients. Charlson comorbidity index (CCI) is used to evaluate multimorbidity in the general population. Limited long-term data are available on the relationship between CCI and AF. We examined the association between CCI, anticoagulation control and outcomes in AF patients.

Methods: We studied 1956 from the FANTASIIA registry, an observational Spanish nationwide study on anticoagulated AF patients. Time in therapeutic range (TTR) was used to evaluate anticoagulation control. Stroke/TIA, major bleeding, cardiovascular (CV) death and all-cause death were study outcomes.

Results: Mean ± SD CCI was 1.1 ± 1.2. Based on CCI quartiles, patients were categorised in four groups: 676 (34.6%) in Q1 (CCI 0); 683 (34.9%) in Q2 (CCI 1); 345 (17.6%) in Q3 (CCI 2); and 252 (12.9%) in Q4 (CCI ≥3). In vitamin K antagonist treated patients, the highest CCI quartile was inversely associated with TTR >70% (odds ratio:0.67, 95% confidence interval (CI):0.45-0.99). During observation, a progressively higher rate of major bleeding, CV death and all-cause death was found across the quartiles (all p < 0.001). The final Cox multivariable regression analysis showed an association with increasing risk for major bleeding occurrence in Q3 and Q4 (hazard ratio (HR):1.69, 95%CI:1.00-2.87 and HR:1.92, 95%CI:1.08-3.41). An increasing risk for all-cause death and CV death was found across CCI quartiles.

Conclusions: In a nationwide contemporary cohort of AF anticoagulated patients, multimorbidity was inversely associated with good anticoagulation control. A progressively higher risk for major bleeding, CV death and all-cause death was found across CCI quartiles.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.exger.2021.111482DOI Listing
July 2021

Antithrombotic Therapy in Patients with Peripheral Artery Disease: A Focused Review on Oral Anticoagulation.

Int J Mol Sci 2021 Jul 1;22(13). Epub 2021 Jul 1.

Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, 30120 Murcia, Spain.

Peripheral artery disease (PAD) is a major cause of morbidity and mortality but it is usually underdiagnosed and undertreated. Patients with PAD present dysregulated procoagulant, anticoagulant, and fibrinolytic pathways leading to arterial and venous thrombosis. The risk of several ischemic-related complications could be mitigated with appropriate antithrombotic therapy, which plays a central role in all types of PAD. For years, antiplatelets have been indicated in patients with symptomatic PAD or those who have undergone revascularization. Unfortunately, a non-negligible proportion of patients with PAD will suffer from adverse events during the follow-up, even despite proper medical therapies for the prevention of PAD complications. Thus, there is room for improving clinical outcomes in these patients. Given the implication of both, primary and secondary hemostasis in arterial thrombosis and the pathophysiology of PAD, the combination of antiplatelets and anticoagulants has emerged as a potential antithrombotic alternative to antiplatelets alone. In this narrative review article, we have highlighted the most recent evidence about antithrombotic therapy in PAD patients, with a special focus on oral anticoagulation. Certainly, COMPASS and VOYAGER PAD trials have shown promising results. Thus, rivaroxaban in combination with aspirin seem to reduce cardiovascular outcomes with a similar bleeding risk compared to aspirin alone. Nevertheless, results from real-world studies are needed to confirm these observations, and other trials will provide novel evidence about the safety and efficacy of emerging anticoagulant agents.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijms22137113DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8267774PMC
July 2021

Direct-acting oral anticoagulants use prior to COVID-19 diagnosis and associations with 30-day clinical outcomes.

Thromb Res 2021 Jun 27;205:1-7. Epub 2021 Jun 27.

Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. Electronic address:

Background: It is unclear if direct-acting oral anticoagulants (DOACs) use before hospitalization due to COVID-19 diagnosis would potentially impact the severity and clinical outcomes thereafter. We compared 30-day hospitalization/re-hospitalization and clinical outcomes between patients on chronic DOAC therapy and patients not on oral anticoagulation (OAC) therapy at time of COVID-19 diagnosis.

Methods: We used data from TriNetX, a global federated health research network. Patients aged ≥18 years who were treated with DOACs at time of COVID-19 diagnosis between 20 January 2020 and 28 February 2021 were included, and matched with patients not on OAC therapy from the same period. All patients were followed-up at 30-days after COVID-19 diagnosis. The primary outcomes were all-cause mortality, hospitalization/re-hospitalization, venous thromboembolism (VTE) and intracranial hemorrhage (ICH).

Results: 738,423 patients were included. After propensity score matching (PSM), 26,006 patients remained in the study (13,003 on DOACs; 13,003 not on OAC). DOAC-treated patients (mean age 67.1 ± 15.4 years, 52.2% male) had higher relative risks (RRs) and lower 30-days event-free survival as compared to patients not on OAC for all-cause mortality (RR 1.27, 95% CI 1.12-1.44; Log-Rank test p = 0.010), hospitalization/re-hospitalization (RR 1.72, 95% CI 1.64-1.82; Log-Rank test p < 0.001) and VTE (RR 4.51, 95% CI 3.91-5.82; Log-Rank test p < 0.001), but not for ICH (RR 0.90, 95% CI 0.54-1.51; Log-Rank test p = 0.513).

Conclusion: In COVID-19 patients, previous DOAC therapy at time of diagnosis was not associated with improved clinical outcomes or lower hospitalization/re-hospitalization rate compared to patients not taking OAC therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.thromres.2021.06.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8236305PMC
June 2021

Number needed to treat for net effect of anticoagulation in atrial fibrillation: Real-world vs. clinical-trial evidence.

Br J Clin Pharmacol 2021 Jun 30. Epub 2021 Jun 30.

Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.

Aims: The net benefit of oral anticoagulants (OACs) in atrial fibrillation (AF) is poorly understood. We aimed to determine the NNT for net effect (NNT ) using calculator of absolute stroke risk (CARS) in anticoagulated patients with AF in real-world and clinical trial cohorts.

Methods: Post-hoc analysis of patient-level data from the real-world Murcia AF Project and AMADEUS clinical trial. Baseline risk of stroke was determined using CARS. The risk of stroke and major bleeding events with OAC were determined using the number of respective events at 1-year. NNT was calculated as a reciprocal of the net effect of absolute risk reduction with OAC (NNT  = 1/(absolute risk reduction of stroke[ARR ] - absolute risk increase of major bleeding[ARI ])).

Results: In total, 3511 patients were included (1306 [37.2%] real-world patients and 2205 [62.8%] clinical trial participants). The absolute 1-year stroke risk was similar across both cohorts. In the real-world cohort, OAC was associated with a 4.0% ARR , 25 NNT , 1.0% ARI , 100 NNT and 34 NNT . In the clinical trial cohort, OAC was associated with a 3.8% ARR , 27 NNT , 1.6% ARI , 63 NNT and 46 NNT . In both cohorts, the NNT was significantly lower in patients with an excess stroke risk of ≥2% by CARS.

Conclusion: Overall, the NNT approach in AF incorporates information regarding baseline risk of stroke and major bleeding, and relative effects of OAC with the potential to include multiple additional outcomes and weighting of events based on their perceived effects by individual patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/bcp.14961DOI Listing
June 2021

Mid-term outcomes of rapid deployment aortic prostheses in patients with small aortic annulus.

Interact Cardiovasc Thorac Surg 2021 Jun 28. Epub 2021 Jun 28.

Cardiovascular Surgery Service, Virgen de la Arrixaca University Hospital, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain.

Objectives: The Edwards Intuity valve is a rapid deployment aortic prosthesis that favours less invasive approaches. However, evidence about the clinical behaviour of their smaller sizes is scarce. Herein, we studied haemodynamic behaviours and clinical outcomes of small Intuity prostheses (19-21 mm) in comparison to larger Intuity prostheses (>21 mm).

Methods: This is an observational study including patients implanted with an Edwards Intuity rapid deployment aortic prosthesis. Patients with prosthesis sizes 19-21 and >21 mm were included. Baseline and perioperative variables, as well as adverse events during the follow-up were recorded and compared between groups.

Results: A total of 122 patients (37% female, mean age 75 ± 4.5 years) were included, of whom 54 (45%) were implanted with a small prosthesis and 68 (55%) with a prosthesis >21 mm. There were no significant differences between patients with small Intuity prostheses and patients with larger prostheses regarding in-hospital mortality (2% vs 4%, P = 0.43) or mortality during the follow-up (3.41 vs 2.45 per 100 patients-years; P = 0.58). Survival in the small Intuity valve group was 95% at 1 year and 83% at 6 years, whereas in the larger Intuity valve group was 96% at 1 year and 78% at 6 years. The presence of a small prosthesis did not influence mid-term survival (log-rank P-value = 0.62).

Conclusions: This study showed good clinical performance of Intuity aortic prostheses with appropriate mid-term survival in patients with the small aortic annulus. Thus, the Edwards Intuity rapid deployment aortic prosthesis may be considered as a potential option in patients with the small aortic annulus.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/icvts/ivab175DOI Listing
June 2021

Relationship between sleep habits and academic performance in university Nursing students.

BMC Nurs 2021 Jun 17;20(1):100. Epub 2021 Jun 17.

Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, 30120, Murcia, Spain.

Background: Sleep disorders are composed of a group of diseases of increasing prevalence and with social-health implications to be considered a public health problem. Sleep habits and specific sleep behaviors have an influence on the academic success of students. However, the characteristics of sleep and sleep habits of university students as predictors of poor academic performance have been scarcely analyzed. In the present study, we aimed to investigate sleep habits and their influence on academic performance in a cohort of Nursing Degree students.

Methods: This was a cross-sectional and observational study. An anonymous and self-administered questionnaire was used, including different scales such as the 'Morningness and Eveningness scale', an author-generated sleep habit questionnaire, and certain variables aimed at studying the socio-familial and academic aspects of the Nursing students. The association of sleep habits and other variables with poor academic performance was investigated by logistic regression. The internal consistency and homogeneity of the 'sleep habits questionnaire' was assessed with the Cronbach's alpha test.

Results: Overall, 401 students (mean age of 22.1 ± 4.9 years, 74.8 % females) from the Nursing Degree were included. The homogeneity of the 'sleep habits questionnaire' was appropriate (Cronbach's alpha = 0.710). Nursing students were characterized by an evening chronotype (20.2 %) and a short sleep pattern. 30.4 % of the Nursing students had bad sleep habits. Regarding the academic performance, 47.9 % of the students showed a poor one. On multivariate logistic regression analysis, a short sleep pattern (adjusted OR = 1.53, 95 % CI 1.01-2.34), bad sleep habits (aOR = 1.76, 95 % CI 1.11-2.79), and age < 25 years (aOR = 2.27, 95 % CI 1.30-3.98) were independently associated with a higher probability of poor academic performance.

Conclusions: Almost 1/3 of the Nursing students were identified as having bad sleep habits, and these students were characterized by an evening chronotype and a short sleep pattern. A short sleep pattern, bad sleep habits, and age < 25 years, were independently associated with a higher risk of poor academic performance. This requires multifactorial approaches and the involvement of all the associated actors: teachers, academic institutions, health institutions, and the people in charge in university residences, among others.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12912-021-00635-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8212524PMC
June 2021

Comparison of Aortic Gradient and Ventricular Mass after Valve Replacement for Aortic Stenosis with Rapid Deployment, Sutureless, and Conventional Bioprostheses.

Cardiology 2021 Jun 11:1-11. Epub 2021 Jun 11.

Department of Cardiovascular Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain.

Background: The use of rapid deployment and sutureless aortic prostheses is increasing. Previous reports have shown promising results on haemodynamic performance and mortality rates. However, the impact of these bioprostheses on left ventricular mass (LVM) regression remains unknown. We decided to study the changes in remodelling and LVM regression in isolated severe aortic stenosis treated with conventional or Perceval® or Intuity® valves.

Method And Results: From January 2011 to January 2016, 324 bioprostheses were implanted in our centre. The collected characteristics were divided into 3 groups: conventional valves, Perceval®, and Intuity®, and they were analysed after 12 months. There were 183 conventional valves (56%), 72 Perceval® (22%), and 69 Intuity® (21.2%). The statistical analysis showed significant differences in transprosthetic postoperative peak gradient (23 [18-29] mm Hg vs. 21 [16-29] mm Hg and 18 [14-24] mm Hg, p < 0.001), ventricular mass electrical criteria regression (Sokolow and Cornell products), and 1-year survival (90 vs. 93% and 97%, log rank p value = 0.04) in conventional, Perceval®, and Intuity® groups.

Conclusions: We observed differences in haemodynamic, electrocardiographic, and echocardiographic parameters related to the different types of prosthesis. Patients with the Intuity® prosthesis had the highest reduction in peak aortic gradient and the higher ventricular mass regression. Besides, patients with the Intuity® prosthesis had less risk of mortality during follow-up than the other two groups. Further studies are needed to confirm these findings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000516465DOI Listing
June 2021

Variables affecting the quality of anticoagulation in atrial fibrillation patients newly initiating vitamin K antagonists: insights from the national and multicentre SULTAN registry.

Europace 2021 Jun 11. Epub 2021 Jun 11.

Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Ctra. Madrid-Cartagena s/n, 30120 El Palmar, Murcia, Spain.

Aims: Vitamin K antagonists (VKAs) are effective drugs reducing the risk for stroke in atrial fibrillation (AF), but the benefits derived from such therapy depend on the international normalized ratio (INR) maintenance in a narrow therapeutic range. Here, we aimed to determine independent variables driving poor anticoagulation control [defined as a time in therapeutic range (TTR) <65%] in a 'real world' national cohort of AF patients.

Methods And Results: The SULTAN registry is a multicentre, prospective study, involving patients with non-valvular AF from 72 cardiology units expert in AF in Spain. At inclusion, all patients naïve for oral anticoagulation were started with VKAs for the first time. For the analysis, the first month of anticoagulation and those patients with <3 INR determinations were disregarded. Patients were followed up during 1 year. A total of 870 patients (53.9% male, the mean age of 73.6 ± 9.2 years, mean CHA2DS2-VASc and HAS-BLED of 3.3 ± 1.5 and 1.4 ± 0.9, respectively) were included in the full analysis set. In overall, 7889 INR determinations were available. At 1-year, the mean TTR was 63.1 ± 22.1% and 49.2% patients had a TTR < 65%. Multivariate Cox regression analysis showed that coronary artery disease [odds ratio (OR) 1.81, 95% confidence interval (CI) 1.14-2.87; P = 0.012] and amiodarone use (OR 1.54, 95% CI 1.01-2.34; P = 0.046) were independently associated with poor quality of anticoagulation (TTR <65%).

Conclusion: This study demonstrated that the quality of anticoagulation in AF patients newly starting VKAs is sub-optimal. Previous coronary artery disease and concomitant use of amiodarone were identified as independent variables affecting the poor quality of VKA therapy during the first year.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/europace/euab131DOI Listing
June 2021

Cardiovascular risk factors, cardiovascular disease, and COVID-19: an umbrella review of systematic reviews.

Eur Heart J Qual Care Clin Outcomes 2021 07;7(4):330-339

Liverpool Centre for Cardiovascular Science, University of Liverpool & Liverpool Heart and Chest Hospital, William Henry Duncan Building, 6 West Derby Street, Liverpool L7 8TX, UK.

Aims: To consolidate evidence to determine (i) the association between cardiovascular risk factors and health outcomes with coronavirus 2019 (COVID-19); and (ii) the impact of COVID-19 on cardiovascular health.

Methods And Results: An umbrella review of systematic reviews was conducted. Fourteen medical databases and pre-print servers were searched from 1 January 2020 to 5 November 2020. The review focused on reviews rated as moderate or high-quality using the AMSTAR 2 tool. Eighty-four reviews were identified; 31 reviews were assessed as moderate quality and one was high-quality. The following risk factors were associated with higher mortality and severe COVID-19: renal disease [odds ratio (OR) (95% confidence interval) for mortality 3.07 (2.43-3.88)], diabetes mellitus [OR 2.09 (1.80-2.42)], hypertension [OR 2.50 (2.02-3.11)], smoking history [risk ratio (RR) 1.26 (1.20-1.32)], cerebrovascular disease [RR 2.75 (1.54-4.89)], and cardiovascular disease [OR 2.65 (1.86-3.78)]. Liver disease was associated with higher odds of mortality [OR 2.81 (1.31-6.01)], but not severe COVID-19. Current smoking was associated with a higher risk of severe COVID-19 [RR 1.80 (1.14-2.85)], but not mortality. Obesity associated with higher odds of mortality [OR 2.18 (1.10-4.34)], but there was an absence of evidence for severe COVID-19. In patients hospitalized with COVID-19, the following incident cardiovascular complications were identified: acute heart failure (2%), myocardial infarction (4%), deep vein thrombosis (7%), myocardial injury (10%), angina (10%), arrhythmias (18%), pulmonary embolism (19%), and venous thromboembolism (25%).

Conclusion: Many of the risk factors identified as associated with adverse outcomes with COVID-19 are potentially modifiable. Primary and secondary prevention strategies that target cardiovascular risk factors may improve outcomes for people following COVID-19.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ehjqcco/qcab029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8294691PMC
July 2021

Adherence to the 'Atrial Fibrillation Better Care' Pathway in Patients with Atrial Fibrillation: Impact on Clinical Outcomes-A Systematic Review and Meta-Analysis of 285,000 Patients.

Thromb Haemost 2021 May 21. Epub 2021 May 21.

Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.

Objective:  The 'Atrial fibrillation Better Care' (ABC) pathway has been recently proposed as a holistic approach for the comprehensive management of patients with atrial fibrillation (AF). We performed a systematic review of current evidence for the use of the ABC pathway on clinical outcomes.

Methods And Results:  We performed a systematic review and meta-analysis according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed and EMBASE were searched for studies reporting the prevalence of ABC-pathway-adherent management in AF patients, and its impact on clinical outcomes (all-cause death, cardiovascular death, stroke, and major bleeding). Meta-analysis of odds ratio (OR) was performed with random-effects models; subgroup analysis and meta-regression were performed to account for heterogeneity. Among the eight studies included, we found a pooled prevalence of ABC-adherent management of 21% (95% confidence interval, CI: 13-34%), with a high grade of heterogeneity, explained by the increasing adherence to each ABC criterion. Patients treated according to the ABC pathway showed a lower risk of all-cause death (OR: 0.42; 95% CI: 0.31-0.56), cardiovascular death (OR: 0.37; 95% CI: 0.23-0.58), stroke (OR: 0.55; 95% CI: 0.37-0.82) and major bleeding (OR: 0.69; 95% CI: 0.51-0.94), with moderate heterogeneity. Prevalence of comorbidities was moderators of heterogeneity for all-cause and cardiovascular death, while longer follow-up was associated with increased effectiveness for all outcomes.

Conclusion:  Adherence to the ABC pathway was suboptimal, being adopted in one in every five patients. Adherence to the ABC pathway was associated with a reduction in the risk of major adverse outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/a-1515-9630DOI Listing
May 2021

Validating scores predicting atrial fibrillation recurrence post catheter ablation in patients with concurrent atrial fibrillation and pulmonary diseases.

Ann Palliat Med 2021 Apr 1;10(4):4299-4307. Epub 2021 Apr 1.

Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China.

Background: Several scores were available for predicting atrial fibrillation (AF) recurrence post radiofrequency ablation. However, the role of different scores predicting AF recurrence after ablation in patients with concurrent AF and pulmonary diseases (PDs) remained obscure. Herein, we aimed to investigate their predicting values and differences in patients with concurrent AF and PDs.

Methods: From January 2008 to April 2015, 304 patients with concurrent AF and PDs treated with catheter ablation were divided into 2 groups according to whether they experienced AF recurrence in our centers. Factors related with AF recurrence were explored using Cox regression and scores predicting recurrent AF were compared in these patients using ROC curves.

Results: During a median of 6-month of follow-up, factors correlating with late AF recurrence included heart failure (HF) history [hazard ratio (HR): 2.79; 95% confidence interval (CI): 1.49-5.22, P=0.001], current smoking (1.73; 1.13-2.68, P=0.01) and early AF recurrence (3.85; 95% CI: 2.62-5.66, P<0.001) according to univariate Cox regression analysis. When analyzed using multivariate Cox model, HF history (2.21; 1.12-4.37, P=0.02), hypertension history (1.54; 1.02-2.33, P=0.04) and early AF recurrence (3.90; 2.60-5.85, P<0.001) were related to late AF recurrence. The BASE-AF2 score had higher c-index than the MB-LATER, APPLE, CHADS2, CHA2DS2-VASc, CAAP-AF and HATCH scores when compared using ROC curves analysis (all P<0.05). The optimal point for predicting AF recurrence of the BASE-AF2 score in the ROC analysis was 1 point with sensitivity of 69.03% and specificity of 60.21%.

Conclusions: The predicting AF recurrence value of BASE-AF2 score was superior to MB-LATER, APPLE, CHADS2, CHA2DS2-VASc, CAAP-AF and HATCH scores in patients with concurrent AF and PDs, which can be an effective and helpful score for making AF treatment decisions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/apm-21-437DOI Listing
April 2021

Short- and medium-term complications after emergency department treatment of patients with atrial fibrillation: design and internal validation of the CoSTuM risk scale.

Emergencias 2021 Abr;33(2):85-92

Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Universidad de Alicante, Alicante, España.

Objectives: To design and validate a clinical risk scale for 90-day adverse events after emergency department (ED) discharge of patients with atrial fibrillation (AF).

Material And Methods: Prospective, observational CoSTuM (Spanish acronym for comorbidity, symptoms, treatments, and poor heart rate control) study of patients with AF. We recorded all adverse events occurring during follow-up and used multivariate logistic regression analysis to identify variables independently associated with the occurrence of any such event. A risk model was developed with data from a random sample of 66% of the patients. Data for the remaining patients were used for internal validation of the model.

Results: We analyzed data for 645 patients (50.2% women; median [interquartile range] age, 76 (67-81 years). At 90 days, at least 1 adverse event had occurred in 165 patients (25.6%); 114 were in the development sample and 51 were in the validation sample. Independent variables associated with risk for adverse events were age 70 years or older; vascular disease; heart failure; chronic obstructive pulmonary disease; kidney disease; obesity; poorly controlled AF symptoms (European Heart Rhythm Association score, III-IV); use of oxygen therapy, digoxin, or other antiarrhythmics in the ED; and poor control of heart rate. The CoSTuM scale based on these variables demonstrated optimal predictive value in both the development sample (c statistic, 0.901; 95% CI, 0.869-0.928; P .001) and the validation sample (c statistic, 0.850, 95% CI, 0.796-0.894; P .001).

Conclusion: The CoSTuM risk score was a good predictor of 90-day adverse events after ED discharge of patients treated for AF.
View Article and Find Full Text PDF

Download full-text PDF

Source
March 2021

Gut Microbiota and the Quality of Oral Anticoagulation in Vitamin K Antagonists Users: A Review of Potential Implications.

J Clin Med 2021 Feb 11;10(4). Epub 2021 Feb 11.

Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, 30120 Murcia, Spain.

The efficacy and safety of vitamin K antagonists (VKAs) as oral anticoagulants (OACs) depend on the quality of anticoagulation control, as reflected by the mean time in therapeutic range (TTR). Several factors may be involved in poor TTR such as comorbidities, high inter-individual variability, interacting drugs, and non-adherence. Recent studies suggest that gut microbiota (GM) plays an important role in the pathogenesis of cardiovascular diseases, but the effect of the GM on anticoagulation control with VKAs is unknown. In the present review article, we propose different mechanisms by which the GM could have an impact on the quality of anticoagulation control in patients taking VKA therapy. We suggest that the potential effects of GM may be mediated first, by an indirect effect of metabolites produced by GM in the availability of VKAs drugs; second, by an effect of vitamin K-producing bacteria; and finally, by the structural modification of the molecules of VKAs. Future research will help confirm these hypotheses and may suggest profiles of bacterial signatures or microbial metabolites, to be used as biomarkers to predict the quality of anticoagulation. This could lead to the design of intervention strategies modulating gut microbiota, for example, by using probiotics.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm10040715DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7916955PMC
February 2021

Should we make the risk stratification process more complex in patients with atrial fibrillation?

Europace 2021 Jun;23(6):978

Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/europace/euab007DOI Listing
June 2021

Novel insights in the relationship of gut microbiota and coronary artery diseases.

Crit Rev Food Sci Nutr 2021 Jan 5:1-13. Epub 2021 Jan 5.

Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain.

Atherosclerosis is a chronic, progressive, inflammatory disease in the vasculature and is common in both coronary and peripheral arteries. Human beings harbor a complex and dynamic population of microorganisms defined as the microbiota. Importantly, alterations in the bacterial composition (dysbiosis) and the metabolic compounds produced by these bacteria have been associated with the pathogenesis of many inflammatory diseases and infections. There is also a close relationship between intestinal microbiota and cardiovascular diseases. The aim of this review was to analyze how changes in the gut microbiota and their metabolites might affect coronary artery diseases. The most representative groups of bacteria that make up the intestinal microbiota are altered in coronary artery disease patients, resulting in a decrease in and an increase in . In relation to metabolites, trimethylamine-N-oxide plays an important role in atherosclerosis and may act as a cardiovascular risk predictor. In addition, the use of probiotics, prebiotics, diet modulation, and fecal transplantation, which may represent alternative treatments for these diseases, is thoroughly discussed. Finally, the role of lipid-lowering treatments is also analyzed as they may affect and alter the gut microbiota and, conversely, gut microbiota diversity could be associated with resistance or sensitivity to these treatments.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/10408398.2020.1868397DOI Listing
January 2021

Stroke and Thromboembolism in Warfarin-Treated Patients with Atrial Fibrillation: Comparing the CHA2DS2-VASc and GARFIELD-AF Risk Scores.

Thromb Haemost 2021 Aug 9;121(8):1107-1114. Epub 2020 Dec 9.

Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.

Background:  Evaluation of thromboembolic risk is essential in anticoagulated atrial fibrillation (AF) patients. The CHADS-VASc score is largely validated and recommended by most guidelines. The GARFIELD-AF Stroke score has been proposed as an alternative risk score.

Methods:  We analyzed warfarin-treated patients from SPORTIF III and V studies. Any thromboembolic event (TE) was an study outcome. We compared the two scores' capacity in predicting any TE occurrence.

Results:  A total of 3,665 patients (median [interquartile range] age: 72 [66-77] years; 30.5% female) were included in this analysis. After a mean (standard deviation) follow-up of 566.3 (142.5) days, 148 (4.03%) TEs were recorded. Both continuous CHADS-VASc and GARFIELD-AF were associated with TE (hazard ratio [HR]: 1.37, 95% confidence interval [CI]: 1.22-1.53 and HR: 2.43, 95% CI: 1.72-3.42), with modest predictive ability (c-indexes: 0.63, 95% CI: 0.59-0.68 and 0.61, 95% CI: 0.56-0.66, respectively), with no differences. CHADS-VASc quartiles showed an increasing cumulative risk, while in GARFIELD-AF only the highest quartile (Q4) demonstrated an increased TE risk. On multivariate Cox regression analysis, CHADS-VASc quartiles were associated with increasing risk of TE, whereas for GARFIELD-AF only Q4 showed an association with TE. Discrimination analysis showed that GARFIELD-AF quartiles were associated with a 48.7% reduction in discriminatory ability. Using decision curve analysis, CHADS-VASc was associated with improved clinical usefulness and net clinical benefit, compared with GARFIELD-AF.

Conclusion:  In a warfarin-treated trial cohort of AF patients, both CHADS-VASc and GARFIELD-AF Stroke scores were associated with adjudicated TE events, with modest predictive capacity. The simpler CHADS-VASc score improved discriminatory capacity compared with the more complex GARFIELD-AF score, demonstrating improved clinical usefulness and net clinical benefit.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/a-1333-4448DOI Listing
August 2021

Outcomes in VKA-treated patients with atrial fibrillation and chronic kidney disease: Clinical trials vs 'real-world'.

Int J Clin Pract 2021 Apr 15;75(4):e13888. Epub 2020 Dec 15.

Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.

Background: Our objectives were to evaluate the risk of adverse events in a 'real-world' vs 'clinical trial' cohort of atrial fibrillation (AF) patients with chronic kidney disease (CKD).

Methods: We studied patient-level data for vitamin K antagonist-treated AF patients with a creatinine clearance <60 mL/min from the Murcia AF Project and AMADEUS trial. The study end-points were ischaemic stroke, major bleeding, all-cause mortality, myocardial infarction and intracranial haemorrhage.

Results: This study included 1,108 AF patients with CKD. The annual rate of the composite study outcome of ischaemic stroke, major bleeding and all-cause mortality was higher in the real-world (13.4%) vs AMADEUS (6.6%) cohort with an IRR of 2.04 (95% CI,1.34-3.09), P < .001. Individual annual rates of major bleeding, all-cause mortality and non-cardiovascular mortality were significantly greater in the real-world cohort. Similar findings were demonstrated even after multivariable adjustment, with the composite outcome HR of 2.85 (95% CI,1.74-4.66), P < .001. In a propensity score matched cohort, this risk remained significantly higher in the real-world cohort (IRR 2.95 [95% CI,1.03-10.28], P = .027), as did the risk of major bleeding and all-cause mortality.

Conclusion: Vitamin K antagonist-treated AF patients with CKD are exposed to significant annual rates of major adverse events including all-cause mortality. This risk may be under-appreciated in the idealised environment of randomised controlled trials.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ijcp.13888DOI Listing
April 2021

Reliability and Validity of a Stress Scale in Public Employees from Murcia (Spain).

Int J Environ Res Public Health 2020 11 30;17(23). Epub 2020 Nov 30.

Department of Nursing Science, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, 04120 Almería, Spain.

Stress is common in all work environments. Technostress and the difficulty of separating the family arena from the work environment are some of the new and emerging risks faced by companies, employees and society in general. Most of the available instruments for measuring stress in workers have been focused on education professionals and healthcare workers. Therefore, it is necessary to validate simple and friendly-use tools to detect stress levels in public workers. The aim of this study was to determine the internal consistency of an adapted version of the Student Stress Inventory-Stress Manifestations (SSI-SM) for public employees and to determine if high-stress levels are related to personal and work-related factors. A cross-sectional and descriptive study was conducted from October 2016 to February 2019 including 468 Spanish public workers based in Murcia. An adapted version of the SSI-SM was administered and data on personal and work-related factors were collected. Results showed that all of the factors had Cronbach's α over 0.700, and no items need to be deleted due to correlations with the factor exceeding 0.300. Factor 1, has a Cronbach's α of 0.868, with values of 15.62 ± 4.99; factor 2, Cronbach's α: 0.853, with mean values of 13.33 ± 4.17; factor 3, , Cronbach's α: 0.704, mean value of 5.35 ± 1.90 and: factor 4, Cronbach's α: 0.746, with a mean value of 8.19 ± 2.51. In conclusion, the internal consistency of the adapted SSI-SM for public employees with different work positions and shifts has been validated and determined. This study provides a useful tool for the early detection of stress in public employees and may be potentially useful for preventing the harmful consequences of stress.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijerph17238894DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7729552PMC
November 2020

Letter by Ding et al Regarding Article, "Direct-Acting Oral Anticoagulants Versus Warfarin in Medicare Patients With Chronic Kidney Disease and Atrial Fibrillation".

Stroke 2020 12 23;51(12):e361-e362. Epub 2020 Nov 23.

Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, United Kingdom (W.Y.D., J.M.R.-C., G.Y.H.L.).

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/STROKEAHA.120.031780DOI Listing
December 2020

Pilot Study on the Role of Circulating miRNAs for the Improvement of the Predictive Ability of the 2MACE Score in Patients with Atrial Fibrillation.

J Clin Med 2020 Nov 12;9(11). Epub 2020 Nov 12.

Department of Hematology and Medical Oncology, Hospital General Universitario Morales Meseguer, University of Murcia, Centro Regional de Hemodonación, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), 30003 Murcia, Spain.

. Atrial fibrillation (AF) increases the risk for stroke but also for non-stroke major adverse cardiovascular events (MACE). The 2MACE score was recently proposed to predict these events. Since the interest of microRNAs (miRNAs) in cardiovascular diseases is increasing, we aimed to investigate whether miRNA levels may improve the predictive performance of the 2MACE score. . We included consecutive AF patients stable on vitamin K antagonist therapy. Blood samples were drawn at baseline and plasma expression of miRNAs was assessed. During a median of 7.6 (interquartile range (IQR) 5.4-8.0) years, the occurrence of any MACE (nonfatal myocardial infarction/cardiac revascularization and cardiovascular death) was recorded. . We conducted a miRNA expression analysis in plasma from 19 patients with and without cardiovascular events. The miRNAs selected (miR-22-3p, miR-107, and miR-146a-5p) were later measured in 166 patients (47% male, median age 77 (IQR 70-81) years) and all were associated with a higher risk of MACE. The addition of miR-107 and miR-146a-5p to the 2MACE score significantly increased the predictive performance (c-indexes: 0.759 vs. 0.694, = 0.004), and the model with three miRNAs also improved the predictive performance compared to the original score (c-indexes: 0.762 vs. 0.694, = 0.012). 2MACE models with the addition of miRNAs presented higher net benefit and potential clinical usefulness. . Higher miR-22-3p andmiR-107 and lower miR-146a-5p levels were associated with a higher risk of MACE. The addition of these miRNAs to the 2MACE score significantly increased the predictive performance for MACE, which may aid to some extent in the decision-making process about risk stratification in AF.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm9113645DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7698124PMC
November 2020

Particulate Matter and Temperature: Increased Risk of Adverse Clinical Outcomes in Patients With Atrial Fibrillation.

Mayo Clin Proc 2020 11;95(11):2360-2369

Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain.

Objective: To test the hypothesis that particulate matter with an aerodynamic diameter of less than 10 μm (PM) and temperature are associated with an increased risk of adverse clinical outcomes in patients with atrial fibrillation (AF) taking vitamin K antagonists (VKAs).

Patients And Methods: We included patients with AF whose condition was stable while taking VKAs (international normalized ratio, 2.0 to 3.0) for 6 months seen in a tertiary hospital (recruitment from May 1, 2007, to December 1, 2007). During a median follow-up of 6.5 years (interquartile range, 4.3 to 7.9 years), ischemic strokes, major bleeding, adverse cardiovascular events, and mortality were recorded. From 2007 to 2016, data on average temperature and PM were compared with clinical outcomes.

Results: The study group included 1361 patients (663 [48.7%] male; median age, 76 years [interquartile range, 71 to 81 years]). High PM and low temperatures were associated with higher risk of major bleeding (adjusted hazard ratio [aHR], 1.44; 95% CI, 1.22 to 1.70 and aHR, 1.03; 95% CI, 1.01 to 1.05, respectively) and mortality (aHR, 1.50; 95% CI, 1.34 to 1.69 and aHR, 1.04; 95% CI, 1.02 to 1.06, respectively); PM was also associated with ischemic stroke and temperature with cardiovascular events. The relative risk (RR) for cardiovascular events and mortality increased in months in the lower quartile of temperature (RR, 1.12; 95% CI, 1.04 to 1.21 and RR, 1.41; 95% CI, 1.15 to 1.74, respectively). Comparing seasons, there were higher risks of cardiovascular events in spring, autumn, and winter than in summer, whereas the risk of mortality increased only in winter.

Conclusion: In patients with AF taking VKAs, high PM and low temperature were associated with increased risk of ischemic stroke and cardiovascular events, respectively. Both factors increased major bleeding and mortality risks, which were higher during colder months and seasons.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.mayocp.2020.05.046DOI Listing
November 2020

Novel biomarkers in Alzheimer's disease using high resolution proteomics and metabolomics: miRNAS, proteins and metabolites.

Crit Rev Clin Lab Sci 2021 May 2;58(3):167-179. Epub 2020 Nov 2.

Proteomic Unit, Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Universidad de Murcia, Murcia, Spain.

Alzheimer's disease (AD) is the most common form of dementia. It affects approximately 6% of people over the age of 65 years. It is a clinicopathological, degenerative, chronical and progressive disease that exhibits a deterioration of memory, orientation, speech and other functions. Factors contributing to the pathogenesis of the disease are the presence of extracellular amyloid deposits, called neuritic senile plaques, and fibrillary protein deposits inside neurons, known as neurofibrillary bundles, that appear mainly in the frontal and temporal lobes. AD has a long preclinical latency and is difficult to diagnose and prevent at early stages. Despite the advent of novel high-throughput technologies, it is a great challenge to identify precise biomarkers to understand the progression of the disease and the development of new treatments. In this sense, important knowledge is emerging regarding novel molecular and biological candidates with diagnostic potential, including microRNAs that have a key role in gene repression. On the other hand, proteomic approaches offer a platform for the comprehensive analysis of the whole proteome in a certain physiological time. Proteomic technology investigates protein expression directly and reveals post-translational modifications known to be determinant for many human diseases. Clinically, there is growing evidence for the role of proteomic and metabolomic technologies in AD biomarker discovery. This review discusses the role of several miRNAs identified using genomic technologies, and the importance of novel proteomic and metabolomic approaches to identify new proteins and metabolites that may be useful as biomarkers for monitoring the progression and treatment of AD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/10408363.2020.1833298DOI Listing
May 2021

Clinical profile and prognosis in patients on oral anticoagulation before admission for COVID-19.

Eur J Clin Invest 2021 Jan 7;51(1):e13436. Epub 2020 Nov 7.

Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain.

Background: The coronavirus disease 2019 (COVID-19) shows high morbidity and mortality, particularly in patients with concomitant cardiovascular diseases. Some of these patients are under oral anticoagulation (OAC) at admission, but to date, there are no data on the clinical profile, prognosis and risk factors of such patients during hospitalization for COVID-19.

Design: Subanalysis of the international 'real-world' HOPE COVID-19 registry. All patients with prior OAC at hospital admission for COVID-19 were suitable for the study. All-cause mortality was the primary endpoint.

Results: From 1002 patients included, 110 (60.9% male, median age of 81.5 [IQR 75-87] years, median Short-Form Charlson Comorbidity Index [CCI] of 1 [IQR 1-3]) were on OAC at admission, mainly for atrial fibrillation and venous thromboembolism. After propensity score matching, 67.9% of these patients died during hospitalization, which translated into a significantly higher mortality risk compared to patients without prior OAC (HR 1.53, 95% CI 1.08-2.16). After multivariate Cox regression analysis, respiratory insufficiency during hospitalization (HR 6.02, 95% CI 2.18-16.62), systemic inflammatory response syndrome (SIRS) during hospitalization (HR 2.29, 95% CI 1.34-3.91) and the Short-Form CCI (HR 1.24, 95% CI 1.03-1.49) were the main risk factors for mortality in patients on prior OAC.

Conclusions: Compared to patients without prior OAC, COVID-19 patients on OAC therapy at hospital admission showed lower survival and higher mortality risk. In these patients on OAC therapy, the prevalence of several comorbidities is high. Respiratory insufficiency and SIRS during hospitalization, as well as higher comorbidity, pointed out those anticoagulated patients with increased mortality risk.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/eci.13436DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7645931PMC
January 2021

The COVID-19 Pandemic and Its Impact on Homebound Nursing Students.

Int J Environ Res Public Health 2020 Oct 10;17(20). Epub 2020 Oct 10.

Department of Cardiology, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Hospital Clínico Universitario Virgen de la Arrixaca, CIBERCV, 30120 Murcia, Spain.

University students are predisposed to stress, which could be even higher in Nursing students since they are directly related to the COVID-19 pandemic given their health training and area of knowledge. Our purpose was to assess the stress levels of Nursing students before and during lockdown due to the COVID-19 pandemic in Murcia (Spain), its influence on taking an online exam and how it was affected by physical exercise. This was an observational and prospective study including Nursing students from the second year of the Nursing Degree from 3 February to 23 April 2020. Three measurements were performed: one before lockdown and two during lockdown. Stress increased substantially during lockdown. Financial, family or emotional problems, as well as physical exercise, also increased. Indeed, at 40 days of lockdown, those students with financial, family or emotional problems, and less physical exercise reported significantly higher stress levels. In addition, those who passed the online exam had lower stress levels compared to those who failed. In conclusion, during lockdown, stress in Nursing students increased. This could be triggered by students' personal problems, and physical exercise may be used as a way to reduce stress. Academic performance was better in those students reporting less stress.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijerph17207383DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7600682PMC
October 2020

Influence of the matrix type over the concentration of GDF-15.

J Investig Med 2020 12 8;68(8):1402-1404. Epub 2020 Sep 8.

Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIBArrixaca), CIBERCV, Murcia, Spain

Growth differentiation factor 15 (GDF-15) has been suggested as a prognostic biomarker for bleeding and mortality in atrial fibrillation (AF). To date, serum and EDTA matrices are standardized for the GDF-15 assay but it is unclear if it can be measured also in citrate. In this study, we aim to investigate if the Elecsys GDF-15 assay (Roche Diagnostics, Mannheim, Germany) can be determined accurately in citrate samples in a cohort of 10 patients with AF and 10 healthy controls. From January 2018 to March 2018, we included healthy controls and patients with AF under vitamin K antagonists in a tertiary hospital. Blood samples were drawn in both groups. We included 10 controls (50% males, mean age 36.4±8.9 years) and 10 patients with AF (80% males, mean age 76.5±16.6 years). The mean GDF-15 levels were increased in patients with AF in comparison to healthy controls, as expected by the presence of a heart-related condition and the higher age of this population. In healthy controls, GDF-15 levels showed an optimal correlation between EDTA-serum (r=0.975; p<0.001), EDTA-citrate (r=0.972; p<0.001), and serum-citrate (r=0.997; p<0.001) samples. This was also observed in patients with AF: EDTA-serum (r=0.975; p<0.001), serum-citrate (r=0.835; p=0.003), and EDTA-citrate (r=0.768; p=0.009). Our results demonstrate that citrate samples may be used for the determination of GDF-15 in AF given the positive and good correlation with EDTA and serum matrices. Further studies should validate these observations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/jim-2020-001351DOI Listing
December 2020

Work Shift and Circadian Rhythm as Risk Factors for Poor Sleep Quality in Public Workers from Murcia (Spain).

Int J Environ Res Public Health 2020 08 13;17(16). Epub 2020 Aug 13.

Faculty of Nursing, Catholic University of Murcia (UCAM), 30107 Murcia, Spain.

The purpose of this study was to determine the prevalence of sleep quality and to investigate variables predicting the risk of poor sleep quality in public workers from Murcia (Spain). A cross-sectional and prospective study was conducted from October 2013 to February 2016 in 476 public workers. The Pittsburgh Sleep Quality Index was used to measure the quality of sleep, and the reduced scale of the Horne and Österberg Morningness-Eveningness Questionnaire was applied to analyze the circadian typology. The predictive variables of self-reported poor sleep quality were identified by multivariate logistic regression. No significant differences were found according to sex in the overall sleep quality scores (5 ± 2.9 versus 5.1 ± 3, = 0.650), but there were in the duration of sleep. Three percent of females slept <5 hours compared to 2% of men ( = 0.034). Fixed morning shifts (OR = 1.9, 95% CI 1.3-3.1; = 0.007) and evening chronotypes (OR = 1.6, 95% CI 1.0-2.3; = 0.017) were independent predictors of suffering from poor sleep quality. In conclusion, the frequency of self-reported poor sleep quality among public workers from Murcia was 37.4%. Being a public worker with a fixed morning shift and having an evening chronotype demonstrated to be associated with the quality of sleep.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijerph17165881DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7459974PMC
August 2020

A nurse-led atrial fibrillation clinic: Impact on anticoagulation therapy and clinical outcomes.

Int J Clin Pract 2020 Dec 25;74(12):e13634. Epub 2020 Aug 25.

Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), University of Murcia, CIBERCV, Spain.

Background: Nurses play a central role in the management of atrial fibrillation (AF) patients. An unresolved question is whether a nurse-led clinic would improve clinical outcomes. Herein, we investigated the impact of a nurse-led clinic on anticoagulation therapy and clinical outcomes in a cohort of naïve AF patients.

Methods: Prospective study including AF patients starting vitamin K antagonists (VKAs) into a nurse-led AF clinic. These patients were followed in this specific AF clinic. Additionally, AF patients already taking VKAs for 6 months followed according to the routine clinical practice were included as comparison group. The quality of anticoagulation was assessed at 6 months. Efficacy and safety endpoints were recorded during follow-up.

Results: We included 223 patients (Nurse-led clinic: 107; Usual care: 116). The mean time in therapeutic range and the proportion of INRs within the therapeutic range were similar in both groups. During 2.06 (IQR 1.01-2.94) years of follow-up, 64 (28.7%) patients changed to direct-acting oral anticoagulants. The proportion of switchers was higher in the nurse-led clinic (37.4%) than in the usual care group (20.7%) (P = .006) and these patients spent less time to switch (2.0 [IQR 0.7-2.9] vs 6.0 [IQR 3.7-11.2] years; P < .001). Importantly, the annual rate of ischaemic stroke/TIA was significantly lower in the nurse-led clinic (0.47%/year vs 3.88%/year, P = .016), without differences in safety endpoints.

Conclusion: A nurse-led AF clinic may offer a "patient-centered" review and holistic follow-up, and it would be associated with a reduction of ischaemic stroke/TIA, without increasing bleeding complications. Further studies should confirm these results.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ijcp.13634DOI Listing
December 2020

Treatment strategies for patients with atrial fibrillation and anticoagulant-associated intracranial hemorrhage: an overview of the pharmacotherapy.

Expert Opin Pharmacother 2020 Oct 13;21(15):1867-1881. Epub 2020 Jul 13.

Department of Cardiology, Hospital Clínico Universitario Virgen De La Arrixaca, Instituto Murciano De Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia , Spain.

Introduction: Oral anticoagulants (OAC) reduce stroke/systemic embolism and mortality risks in atrial fibrillation (AF). However, there is an inherent bleeding risk with OAC, where intracranial hemorrhage (ICH) is the most feared, disabling, and lethal complication of this therapy. Therefore, the optimal management of OAC-associated ICH is not well defined despite multiple suggested strategies.

Areas Covered: In this review, the authors describe the severity and risk factors for OAC-associated ICH and the associated implications for using DOACs in AF patients. We also provide an overview of the management of OAC-associated ICH and treatment reversal strategies, including specific and nonspecific reversal agents as well as a comprehensive summary of the evidence about the resumption of DOAC and the optimal timing.

Expert Opinion: In the setting of an ICH, supportive care/measures are needed, and reversal of anticoagulation with specific agents (including administration of vitamin K, prothrombin complex concentrates, idarucizumab and andexanet alfa) should be considered. Most patients will likely benefit from restarting anticoagulation after an ICH and permanently withdrawn of OAC is associated with worse clinical outcomes. Although the timing of OAC resumption is still under debate, reintroduction after 4-8 weeks of the bleeding event may be possible, after a multidisciplinary approach to decision-making.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/14656566.2020.1789099DOI Listing
October 2020

Predicting Adverse Events beyond Stroke and Bleeding with the ABC-Stroke and ABC-Bleeding Scores in Patients with Atrial Fibrillation: The Murcia AF Project.

Thromb Haemost 2020 Aug 7;120(8):1200-1207. Epub 2020 Jun 7.

Department of Hematology and Clinical Oncology, Hospital General Universitario Morales Meseguer, University of Murcia, IMIB-Arrixaca, Murcia, Spain.

Background:  The ABC (age, biomarkers, and clinical history)-stroke and ABC-bleeding are biomarker-based scores proposed to predict stroke and bleeding, but non-specificity of biomarkers is common, predicting different clinical events at the same time. We assessed the predictive performance of the ABC-stroke and ABC-bleeding scores, for outcomes beyond ischemic stroke and major bleeding, in a cohort of atrial fibrillation (AF) patients.

Methods:  We included AF patients stable on vitamin K antagonists for 6 months. The ABC-stroke and ABC-bleeding were calculated and the predictive values for myocardial infarction (MI), acute heart failure (HF), a composite of cardiovascular events, and all-cause deaths were compared.

Results:  We included 1,044 patients (49.2% male; median age 76 [71-81] years). During 6.5 (4.3-7.9) years, there were 58 (5.6%) MIs, 98 (9.4%) acute HFs, 167 (16%) cardiovascular events, and 418 (40%) all-cause deaths. There were no differences in mean ABC-stroke and ABC-bleeding scores in patients with/without MI ( = 0.367 and  = 0.286, respectively); both scores were higher in patients with acute HF, cardiovascular events, or death (all  < 0.05). Predictive performances for the ABC-stroke and ABC-bleeding scores were similar, ranging from "poor" for MI (-indexes ∼0.54), "moderate" for acute HF and cardiovascular events (-indexes ∼0.60 and ∼0.64, respectively), and "good" for all-cause mortality (-indexes > 0.70). Clinical usefulness whether assessed by ABC-stroke or ABC-bleeding was similar for various primary endpoints.

Conclusion:  In AF patients, the ABC-stroke and ABC-bleeding scores demonstrated similar predictive ability for outcomes beyond stroke and bleeding, including MI, acute HF, a composite of cardiovascular events, and all-cause deaths. This is consistent with nonspecificity of biomarkers that predict "sick" patients or poor prognosis overall.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0040-1712914DOI Listing
August 2020

One-year efficacy and safety of prasugrel and ticagrelor in patients with acute coronary syndromes: Results from a prospective and multicentre ACHILLES registry.

Br J Clin Pharmacol 2020 06 3;86(6):1052-1061. Epub 2020 Feb 3.

Department of Cardiology. Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria, CIBER-CV, Murcia, Spain.

Background: Prasugrel and ticagrelor have demonstrated higher efficacy than clopidogrel in their main clinical trials for patients with acute coronary syndrome (ACS). However, the long-term prognosis and different clinical characteristics related to the type of antiplatelet prescription in current clinical practice ACS patients have not been analysed in depth. The objective of this study was to analyse the clinical profile of ACS and the efficacy and safety of novel oral P2Y inhibitors in current clinical practice patients discharged afterACS.

Methods: We collected data from the ACHILLES registry, and an observational, prospective and multicentre registry of patients discharged after ACS. We analysed baseline characteristics, clinical profile and therapy during ACS admission and compared with the different treatments at discharge. After 1 year of follow-up, ischaemic and major bleeding events were analysed. Multivariate Cox regression analysis and Kaplan Meier curves were also plotted.

Results: Of 1717 consecutive patients, 1294 (75.4%) were discharged with a P2Y12 inhibitor without oral anticoagulation. Novel oral P2Y inhibitors were indicated in 47%. Patients treated with clopidogrel were elderly (69.1 ± 13.4 vs 60.4 ± 11.5 years; P < .001) and had a higher prevalence of cardiovascular risk factors. GRACE and CRUSADE scores were higher in the clopidogrel than in novel oral P2Y inhibitors group (P < .001). After 1 year of follow-up, 64(5.0%/year) patients had a new myocardial infarction, 127(10.0%/year) had a major adverse cardiovascular event (MACE) and 78(6.1%/year) died. Patients treated with clopidogrel had a significantly higher annual rate of cardiovascular mortality, MACE and all-cause mortality (allP < .001) without differences in major bleeding (P = .587) compared with novel oral P2Y inhibitors. After multivariate adjustment for the main clinical variables related to adverse prognosis in ACS patients, the discharge with novel oral P2Y inhibitors therapy was independently associated with lower risk of all-cause mortality (HR0.49, 95% CI [0.24-0.98], P = .044) and lower risk of MACE (HR0.64, 95% CI [0.41-0.98], P = .044).

Conclusions: In this prospective, observational and current clinical practice ACS registry, the use of novel oral P2Y inhibitors was associated with a reduction in adverse events compared with clopidogrel in patients with ACS. Novel oral P2Y inhibitors prescription at discharge was independently associated with lower all-cause mortality and MACE without differences in bleeding events. However, clopidogrel remained the most common P2Y12 inhibitor employed for ACS, especially in older and high-risk patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/bcp.14213DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7256120PMC
June 2020
-->