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Disease

Link:Heart Disease and Stroke Statistics – 2016 Update: A Report from the American Heart Association, Mozaffarian D, et al.

Each year, the American Heart Association (AHA), in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together the most up-to-date statistics related to heart disease, stroke, and other cardiovascular and metabolic diseases and presents them in its Heart Disease and Stroke Statistical Update.

Link:Prevalence and antithrombotic management of atrial fibrillation in hospitalised patients, Berti D, et al.

The objective of this study was to determine the prevalence of atrial fibrillation (AF) in a tertiary care centre, to describe the comorbidity profile of hospitalised patients with AF, and to evaluate the appropriateness of their maintenance antithrombotic management.

Link:Risk of Stroke in Non-Rheumatic Atrial Fibrillation, Flegel KM, et al.

Estimates of the risk of stroke for men with non-rheumatic atrial fibrillation were obtained from two large cohort studies—the Whitehall Study of London Civil Servants and the British Regional Heart Study.

Link:Stroke: an infrequent but devastating complication in cardiovascular interventions, Stortecky S, et al.

Stroke is a dreadful complication of cardiovascular interventions owing to the clinical manifestations of neurological deficits and the impact on prognosis.

Link:Possible subclinical leaflet thrombosis in bioprosthetic aortic valves, Makkar RR, et al.

A finding of reduced aortic-valve leaflet motion was noted on computed tomography (CT) in a patient who had a stroke after transcatheter aortic-valve replacement (TAVR) during an ongoing clinical trial.

Link:Atrial Fibrillation as an Independent Risk Factor for Stroke: The Framingham Study, Wolf PA, et al.

The impact of nonrheumatic atrial fibrillation, hypertension, coronary heart disease, and cardiac failure on stroke incidence was examined in 5,070 participants in the Framingham Study after 34 years of follow-up.

Link:Prevalence of Diagnosed Atrial Fibrillation in Adults: National Implications for Rhythm Management and Stroke Prevention: the AnTicoagulation and Risk Factors In Atrial Fibrillation (ATRIA) Study, Go AS, et al.

Atrial fibrillation is the most common arrhythmia in elderly persons and a potent risk factor for stroke. However, recent prevalence and projected future numbers of persons with atrial fibrillation are not well described.

PDF:Atrial fibrillation as an independent risk factor for stroke: the Framingham Study, Wolf PA, et al.

The impact of nonrheumatic atrial fibrillation, hypertension, coronary heart disease, and cardiac failure on stroke incidence was examined in 5,070 participants in the Framingham Study after 34 years of follow-up.

Link: Atrial fibrillation: a major contributor to stroke in the elderly. The Framingham Study, Wolf PA, et al.

Chronic atrial fibrillation without valvular disease has been associated with increased stroke incidence. The impact of atrial fibrillation on the risk of stroke with increasing age was examined in 5184 men and women in the Framingham Heart Study.

Link:Stroke severity in atrial fibrillation. The Framingham Study, Lin HJ, et al.

Stroke occurring with atrial fibrillation (AF) is more likely to be fatal or more severe than non-AF stroke based on clinical series, but data from prospective epidemiological studies are sparse and inconsistent.

Link:Burden of valvular heart diseases: a population-based study, Nko'mo VT, et al.

Valvular heart diseases are not usually regarded as a major public-health problem. The authors' aim was to assess their prevalence and effect on overall survival in the general population.

Link:Aortic-valve stenosis—from patients at risk to severe valve obstruction, Otto CM, et al.

Aortic-valve stenosis is a progressive condition; end-stage disease leads to death due to obstruction of left ventricular outflow. 

Link:The global burden of aortic stenosis, Thaden JJ, et al.

Degenerative, calcific valvular aortic stenosis (AS), caused by an active process of atherosclerosis, calcification and ossification, is the most common cause of AS in industrialized nations.

Link:Silent brain infarcts: a systematic review, Vermeer SE, et al.

As the availability and quality of imaging techniques improve, doctors are identifying more patients with no history of transient ischaemic attack or stroke in whom imaging shows brain infarcts.

Link:Aortic stenosis in the elderly: disease prevalence and number of candidates for transcatheter aortic valve replacement: a meta-analysis and modeling study, Osnabrugge RLJ, et al.

The purpose of this study was to evaluate the prevalence of aortic stenosis (AS) in the elderly and to estimate the current and future number of candidates for transcatheter aortic valve replacement (TAVR).

Guidelines

PDF:2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS, Kirchhof P, et al.

Guidelines and recommendations should help health professionals to make decisions in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate.

Link:Guideline implementation: Exploring gap between evidence and practice in the CRUSADER quality improvement initiative, Blomkalns A, et al.

Translating research results into routine clinical practice remains difficult. Guidelines, such as the 2002 American College of Cardiology/American Heart Association Guidelines for the Management of Patients with Unstable Angina and non-ST-segment elevation myocardial infarction, have been developed to provide a streamlined, evidence-based approach to patient care that is of high quality and is reproducible.

Link:2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society, January CT, et al.

A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society.

Link:Guidelines on the management of valvular heart disease (version 2012), Vahanian A, et al.

Guidelines summarize and evaluate all evidence available, at the time of the writing process, on a particular issue with the aim of assisting physicians in selecting the best management strategies for an individual patient with a given condition, taking into account the impact on outcome, as well as the risk-benefit-ratio of particular diagnostic or therapeutic means.

Link:Transcatheter aortic valve implantation: a Canadian Cardiovascular Society position statement, Webb J, et al.

Patients with severe symptomatic aortic stenosis have a poor prognosis with medical management alone, and balloon aortic valvuloplasty has failed to provide durable clinical benefit.

Link:2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American HeartAssociation Task Force on Practice Guidelines, Nishimura RA, et al.

The medical profession should play a central role in evaluating evidence related to drugs, devices, and procedures for detection, management, and prevention of disease.

Link:2012 ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement, Holmes Jr DR, et al.

Expert consensus documents are intended to inform practitioners, payers, and other interested parties of the opinion of ACCF and document cosponsors concerning evolving areas of clinical practice and/or technologies that may be widely available or may be new to the practice community.

Outcomes

Link:Comparison of outcomes among patients randomized to warfarin therapy according to anticoagulant control: results from SPORTIF III and V, White HD, et al.

The authors analyzed the relationship between INR control and the rates of death, bleeding, MI, and stroke or SEE among 3587 patients with atrial fibrillation randomized to receive warfarin treatment in the SPORTIF (Stroke Prevention Using an Oral Thrombin Inhibitor in Atrial Fibrillation) III and V trials.

PDF:Major hemorrhage and tolerability of warfarin in the first year of therapy among elderly patients with atrial fibrillation, Hylek EM, et al.

Warfarin is effective in the prevention of stroke in atrial fibrillation but is under used in clinical care. Concerns exist that published rates of hemorrhage may not reflect real-world practice.

Treatment

Link:Why do patients with atrial fibrillation not receive warfarin? Bungard TJ, et al.

Numerous randomized controlled trials of warfarin therapy have conclusively demonstrated that long-term anticoagulation therapy can reduce the risk for ischemic stroke by approximately 68% in patients with nonvalvular AF,6-11 and even more in patients with valvular AF. Despite this conclusive evidence of efficacy, several studies have shown that "real-world" use of warfarin in patients with AF is suboptimal.

Link:Prevention of myocardial infarction and stroke in patients with intermittent claudication; effects of ticlopidine. Results from STIMS, the Swedish Ticlopidine Multicenter Study, Janzon L, et al.

The Swedish Ticlopidine Multicentre Study (STIMS) was a double-blind placebo-controlled trial designed to determine whether ticlopidine, a platelet antiaggregatory agent, reduces the incidence of myocardial infarction, stroke and transitory ischaemic attacks in patients with intermittent claudication.

PDF:CDC Vital Signs - Preventing Stroke Deaths

After decades of decline, progress has slowed in preventing stroke deaths.

Link:Effect of clopidogrel added to aspirin in patients with atrial fibrillation, Connolly S, et al.

Vitamin K antagonists reduce the risk of stroke in patients with atrial fibrillation but are considered unsuitable in many patients, who usually receive aspirin instead. The authors investigated the hypothesis that the addition of clopidogrel to aspirin would reduce the risk of vascular events in patients with atrial fibrillation.

Link:Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomised controlled trial, Connolly S, et al.

Oral anticoagulation therapy reduces risk of vascular events in patients with atrial fibrillation. However, long-term monitoring is necessary and many patients cannot achieve optimum anticoagulation. The authors assessed whether clopidogrel plus aspirin was non-inferior to oral anticoagulation therapy for prevention of vascular events.

Link:Transcatheter versus surgical aortic-valve replacement in high-risk patients, Smith CR, et al.

The use of transcatheter aortic-valve replacement has been shown to reduce mortality among high-risk patients with aortic stenosis who are not candidates for surgical replacement.

Link:Transcatheter aortic-valve replacement with a self-expanding prosthesis, Adams DH, et al.

The authors compared transcatheter aortic-valve replacement (TAVR), using a self-expanding transcatheter aortic-valve bioprosthesis, with surgical aortic-valve replacement in patients with severe aortic stenosis and an increased risk of death during surgery.

Link:Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery, Leon MB, et al.

Many patients with severe aortic stenosis and coexisting conditions are not candidates for surgical replacement of the aortic valve.

Link:Descriptive analysis of the process and quality of oral anticoagulation management in real-life practice in patients with chronic non-valvular atrial fibrillation: the international study of anticoagulation management (ISAM), Ansell J, et al.

The authors set out to assess the quality of anticoagulation management in five countries in patients receiving vitamin K antagonists (VKAs) for stroke prophylaxis in chronic non-valvular atrial fibrillation (NVAF), and to compare the anticoagulation management practices in these countries.

Link:Patterns of use of antithrombotic therapy and quality of anticoagulation among patients with non-valvular atrial fibrillation in clinical practice, Boulanger L, et al.

The authors conducted a retrospective cohort study of thromboprophylaxis rates and the quality of anticoagulation control among patients with atrial fibrillation (AF) using a large, geographically diverse database of electronic medical records.

PDF:Misperceptions of aspirin efficacy and safety may perpetuate anticoagulant underutilization in atrial fibrillation, Freedman BS, et al.

The general public has been conditioned over many years to accept aspirin as an effective, safe, and inexpensive remedy for heart attacks and for primary and secondary prevention of cardiovascular events.

Link:Current Status of Stroke Risk Stratification in Patients With Atrial Fibrillation, Hart RG, et al.

Identifying independent risk factors for stroke in patients with atrial fibrillation is important for 2 main reasons: it sheds light on stroke pathogenesis associated with this common cardiac dysrhythmia, and it allows stratification of stroke risk for individual patients.

Link:Factors associated with undertreatment of atrial fibrillation in geriatric outpatients with Alzheimer disease, Tavassoli N, et al.

Treatment with a vitamin K antagonist is recommended in patients with atrial fibrillation in the presence of a high thromboembolic risk factor, or at least two moderate risk factors. In patients with a major contraindication, the vitamin K antagonist can be replaced by an antiplatelet agent. These recommendations are not systematically observed in patients with Alzheimer disease. The aim of the study was to determine the factors associated with undertreatment of AF in geriatric outpatients with AD.

Link:Antithrombotic treatment in transcatheter aortic valve implantation: insights for cerebrovascular and bleeding events, Rodes-Cabau J, et al.

Transcatheter aortic valve implantation (TAVI) has emerged as a therapeutic alternative for patients with symptomatic aortic stenosis at high or prohibitive surgical risk.

Link:Histopathology of embolic debris captured during transcatheter aortic valve replacement, Van Mieghem NM, et al.

Recent transcatheter aortic valve replacement studies have raised concerns about adverse cerebrovascular events. The etiopathology of the embolized material is currently unknown.

Link:Dual antiplatelet therapy versus aspirin alone in patients undergoing transcatheter aortic valve implantation, Ussia GP, et al.

Dual antiplatelet therapy (DAPT) with clopidogrel and aspirin is a widely accepted strategy in patients undergoing transcatheter aortic valve implantation (TAVI), but this approach is not evidence based.

Janssen's Commitment to Treating Cardiovascular Disease +

Our vision is to improve the lives of the millions of people with cardiovascular disease and diabetes, and to work tirelessly to eliminate these diseases. Every year 19 million people around the world die from cardiovascular and metabolic diseases. This tremendous global burden compels us to develop new therapies that will change the face of these diseases and, ultimately, eliminate them. We focus on finding and developing truly transformational therapies that target underlying disease pathways, important pathways, and novel mechanisms of action. We have a very successful track record demonstrated by the development and recent successful launches of our products for the treatment of patients suffering from thrombosis and type 2 diabetes. And we continue to seek and develop the next generation of transformational cardiovascular and metabolic therapies.

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