Publications by authors named "Antoniou Sotiris"

Public Health England outlines a national ambition of anticoagulating 90% of eligible patients with atrial fibrillation (AF) by 2029. In 2019/2020, two out of three boroughs reviewed in this study were in the bottom 10% of boroughs compared with others within England. Stroke National Audit data for these three boroughs from 2019 to 2020 identified that in patients with known AF admitted to hospital with strokes, 37% were not anticoagulated.

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Article Synopsis
  • The study focuses on contrast-induced nephropathy (CIN), a type of kidney injury that can happen during heart procedures, and looks at how inorganic nitrate might help prevent it.
  • In the trial called NITRATE-CIN, high-risk patients were given either potassium nitrate or a placebo for 5 days to see if it could lower the chances of developing CIN.
  • Results showed that patients taking inorganic nitrate had a much lower rate of CIN (9.1%) compared to those on placebo (30.5%), and it also helped improve kidney function and reduce heart problems.
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Recently, there has been growing interest in the early discharge strategy for low-risk patients who have undergone primary percutaneous coronary intervention (PCI) to treat ST-segment elevation myocardial infarction (STEMI). So far findings have suggested there are multiple advantages of shorter hospital stays, including that it could be a safe way to be more cost- and resource-efficient, reduce cases of hospital-acquired infection and boost patient satisfaction. However, there are remaining concerns surrounding safety, patient education, adequate follow-up and the generalisability of the findings from current studies which are mostly small-scale.

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  • For patients with cardiac implantable electronic devices, detecting arrhythmias like atrial fibrillation (AF) allows for quick treatment actions such as starting anticoagulation to prevent strokes and other cardiological issues.
  • A virtual clinic was established for pharmacists to evaluate referrals from CIED clinics, helping to decide on the best anticoagulation therapy based on individual patient needs, along with optimizing blood pressure and lipid levels.
  • Over two years, the clinic helped 315 patients, resulting in 322 successful interventions and quicker initiation of anticoagulation, which likely improved health outcomes by reducing risks associated with strokes and other cardiovascular complications.
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Background: Little is known about the relationship between workplace support and mental health and burnout among health care professionals (HCPs) during the COVID-19 pandemic. In this cohort study, we sought to evaluate the association between perceived level of (and changes to) workplace support and mental health and burnout among HCPs, and to identify what constitutes perceived effective workplace support.

Methods: Online surveys at baseline (July-September 2020) and follow-up 4 months later assessed the presence of generalized anxiety disorder (using the 7-item Generalized Anxiety Disorder scale [GAD-7]), clinical insomnia, major depressive disorder (using the 9-item Patient Health Questionnaire), burnout (emotional exhaustion and depersonalization) and mental well-being (using the Short Warwick-Edinburgh Mental Wellbeing Score).

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The technological evolution and widespread availability of wearables and handheld ECG devices capable of screening for atrial fibrillation (AF), and their promotion directly to consumers, has focused attention of health care professionals and patient organizations on consumer-led AF screening. In this Frontiers review, members of the AF-SCREEN International Collaboration provide a critical appraisal of this rapidly evolving field to increase awareness of the complexities and uncertainties surrounding consumer-led AF screening. Although there are numerous commercially available devices directly marketed to consumers for AF monitoring and identification of unrecognized AF, health care professional-led randomized controlled studies using multiple ECG recordings or continuous ECG monitoring to detect AF have failed to demonstrate a significant reduction in stroke.

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Objective: There has been limited systematic evaluation of outcomes and drivers of inappropriate non-vitamin K antagonist oral anticoagulants (NOACs) dosing among patients with atrial fibrillation (AF). This review identified and systematically evaluated literature on clinical and economic outcomes of inappropriate NOAC dosing and associated patient characteristics.

Methods: MEDLINE, Embase, Cochrane Library, International Pharmaceutical Abstracts, Econlit, PubMed and NHS EEDs databases were searched for English language observational studies from all geographies published between 2008 and 2020, examining outcomes of, or factors associated with, inappropriate NOAC dosing in adult patients with AF.

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Introduction: The 2019 European Society of Cardiology and European Atherosclerosis Society (2019 ESC/EAS) guidelines stress the importance of managing low-density lipoprotein cholesterol (LDL-C) after myocardial infarction (MI) to reduce the risk of cardiovascular events. Information on guideline implementation is limited. The aim of this survey was to describe current clinical practice regarding LDL-C management in the first year post-MI across Europe, improving understanding of the role of ESC/EAS guidelines on clinical practice.

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Article Synopsis
  • The COVID-19 pandemic negatively impacted the mental health of healthcare professionals (HCPs), particularly those who engage directly with patients, highlighting a concerning trend in mental health issues like burnout, depression, and anxiety over time.
  • A study examining HCPs and non-HCPs through online surveys revealed that while both groups faced mental health challenges, patient-facing HCPs exhibited significantly higher rates of burnout and emotional exhaustion, especially at later phases of the study.
  • Overall, the findings emphasize the urgent need for support and interventions targeting the mental health of HCPs, as they are disproportionately affected compared to non-HCPs.
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  • A study was conducted to evaluate the safety and effectiveness of a new early discharge pathway for low-risk STEMI patients after they received primary PCI treatments.
  • Out of 600 patients discharged within 48 hours, follow-up showed a very low occurrence of major adverse cardiovascular events (MACE) and no cardiovascular deaths during a median follow-up period of 271 days.
  • Results indicated that this early discharge approach, combined with structured virtual follow-ups, is feasible and safe compared to historical data of patients who remained hospitalized for longer periods.
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Background: Contrast-induced nephropathy (CIN), an acute kidney injury resulting from the administration of intravascular iodinated contrast media, is a significant cause of morbidity/mortality following coronary angiographic procedures in high-risk patients. Despite preventative measures intended to mitigate the risk of CIN, there remains a need for novel effective treatments. Evidence suggests that delivery of nitric oxide (NO) through chemical reduction of inorganic nitrate to NO may offer a novel therapeutic strategy to reduce CIN and thus preserve long term renal function.

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Introduction: The COVID-19 pandemic has led to unprecedented strain to healthcare systems worldwide and posed unique challenges to the healthcare professionals (HCPs) and the general public.

Objectives: The aim of this study is to evaluate the impact of COVID-19 on the mental health, behavioral, and physical wellbeing of HCPs in the early and mid-term periods of the pandemic in comparison to non-HCPs. Thus, facilitating and guiding optimum planning and delivery of support to HCPs.

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Countries strive to find suitable solutions to offer health services to their populations. Pharmacist-led services are a possible solution to supplement the care offer with a clear advantage of proximity, with demonstrated expertise in medication use. This paper aims to audit the scope of antithrombotic care services available; and to describe the arrangements adopted for meeting the needs of the population.

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Aim: Current guidelines recommend the use of vitamin K antagonist (VKA) for up to 3-6 months for treatment of left ventricular (LV) thrombus post-acute myocardial infarction (AMI). However, based on evidence supporting non-inferiority of novel oral anticoagulants (NOAC) compared to VKA for other indications such as deep vein thrombosis, pulmonary embolism (PE), and thromboembolic prevention in atrial fibrillation, NOACs are being increasingly used off licence for the treatment of LV thrombus post-AMI. In this study, we investigated the safety and effect of NOACs compared to VKA on LV thrombus resolution in patients presenting with AMI.

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SARS-CoV2 is dramatically impacting the global population. Worldwide, pharmacists are changing their roles and being increasingly recognized for their role as essential service providers. This commentary provides some examples collected from Asia, Europe, the Americas and Africa, ranging from essential services to meet human rights basic needs, extended generalist services developed to ensure continuity of care and supply of essential medicines to the development of differentiated extended responsibilities in emergency care.

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Background: This position paper highlights the opportunistic integral role of the pharmacist across the patient pathway utilizing cardiovascular care as an example. The paper aims to highlight the potential roles that pharmacists worldwide can have (or already have) to provide efficient patient care in the context of interprofessional collaboration.

Methods: It results from a literature review and experts seeking advice to identify existing interventions and potential innovative interventions.

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Nationally, anticoagulation for atrial fibrillation (AF) is improving but remains characterised by marked provider variation. Uncontrolled blood pressure and coronary artery disease further increase cardiovascular risk. Redbridge Clinical Commissioning Group (CCG) and local National Health Service (NHS) hospital trusts supported a programme to improve anticoagulation, blood pressure and cholesterol management; the ABC of AF improvement.

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Atrial fibrillation (AF) accounts for up to one third of strokes, one of the lead mortality causes worldwide. The European Society of Cardiology guidelines recommend opportunistic screening as a means to increase the odds of early detection and institution of appropriate treatment according to risk factors identified. However, in most countries there are various barriers to effective uptake of screening, including low awareness.

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Background: Despite simpler regimens than vitamin K antagonists (VKAs) for stroke prevention in atrial fibrillation (AF), adherence (taking drugs as prescribed) and persistence (continuation of drugs) to direct oral anticoagulants are suboptimal, yet understudied in electronic health records (EHRs).

Objective: We investigated (1) time trends at individual and system levels, and (2) the risk factors for and associations between adherence and persistence.

Methods: In UK primary care EHR (The Health Information Network 2011-2016), we investigated adherence and persistence at 1 year for oral anticoagulants (OACs) in adults with incident AF.

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Background: Atrial fibrillation (AF) is a cardiac arrhythmia responsible for one third of ischemic strokes. Early detection of AF plays an important role in preventing embolic stroke.

Objectives: This study aimed to test the feasibility of an awareness event including opportunistic screening for atrial fibrillation; and to test the reliability of the innovative portable electrocardiogram (ECG) device used.

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Background Oral anticoagulation therapy has proven beneficial impact on the prevention of thromboembolic events. However, the use of antocoagulatns also increases the risk of bleeds. To maximize the benefits and minimize the risks of the treatment, guidance on appropriate use of oral anticoagulants is essential.

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The lack of antidotes for activated factor X-inhibitor direct oral anticoagulants (DOACs) means that management of bleeding consists largely of existing supportive therapies. This study aimed to: (i) examine the relative frequency of DOAC-related major bleeding in relation to DOAC prescriptions over the study period; (ii) describe the presentation and haematological management of DOAC-related major bleeding; and (iii) evaluate the association between the use of prothrombin-complex-concentrate (PCC) and in-hospital mortality. Over a 3-year period, 32 UK hospitals submitted data on haematological management of DOAC-related bleeding.

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