Publications by authors named "Davide A Mei"
Background: In patients with atrial fibrillation (AF), the impact of peripheral artery disease (PAD) on oral anticoagulant (OAC) therapy use and the risk of outcomes remains unclear.
Objective: To analyse the epidemiology of PAD in a large cohort of European and Asian AF patients, and the impact on treatment patterns and risks of adverse outcomes.
Methods: We analysed AF patients from two large prospective observational registries.
Since 1995, the concept of atrial cardiomyopathy (ACM) has been associated with myocardial fibrosis. Despite a consensus document in 2016, ACM's definition primarily relies on histopathological findings. The focus on diagnostic criteria for ACM is driven by the potential link to thromboembolic events even independently on atrial fibrillation (AF).
View Article and Find Full Text PDFBackground: The mAFA-II cluster randomised trial demonstrated the efficacy of a mobile health-technology implemented 'Atrial fibrillation Better Care' (ABC) pathway (mAFA intervention) for integrated care management of patients with AF.
Objective: To evaluate the effect of mAFA intervention across phenotypes of patients with AF.
Design: We conducted a latent-class analysis (LCA) according to eight variables, including age and comorbidities.
Article Synopsis
- The study investigates if using algorithms for right ventricular pacing modulation (RVPm) can lower negative health outcomes compared to traditional dual-chamber pacing (DDD) in patients needing anti-bradycardia treatments.
- The analysis, which included eight studies and over 7,200 patients, revealed that RVPm was associated with a reduced risk of persistent atrial fibrillation and cardiovascular hospitalizations, but no significant impact on overall mortality or adverse symptoms was found.
- Overall, RVPm algorithms appear beneficial in minimizing certain health risks, without increasing unwanted side effects, even for patients with higher levels of atrioventricular block.
Performance of HAS-BLED and DOAC scores to predict major bleeding events in atrial fibrillation patients treated with direct oral anticoagulants: A report from a prospective European observational registry.
Eur J Intern Med
October 2024
Article Synopsis
- The study aimed to assess the effectiveness of two bleeding risk assessment scores—HAS-BLED and DOAC score—among patients with atrial fibrillation who are on direct oral anticoagulants (DOAC).
- Analysis included 2834 patients, revealing that the DOAC score identified a significantly higher proportion of very low-risk patients compared to the HAS-BLED score.
- However, both scoring systems showed only modest predictive abilities for major bleeding events, indicating no strong preference for using the DOAC score over HAS-BLED in this context.
Article Synopsis
- Cardiac resynchronization therapy (CRT) emerged in the 2000s as an important treatment for heart failure patients with poor ejection fraction and wide QRS, but around one-third of patients do not respond well to it.
- The review emphasizes that determining whether a patient is a CRT nonresponder is complex and should consider multiple factors rather than a single criterion.
- New pacing techniques like His-bundle and left bundle branch area pacing offer promising alternatives to CRT, but more comprehensive studies are necessary to validate their effectiveness in treating heart failure with electromechanical dyssynchrony.
The management of patients with atrial fibrillation (AF) requires intricate clinical decision-making to optimize outcomes. In everyday clinical practice, physicians undergo difficult choices to better manage patients with AF. They need to balance thromboembolic and bleeding risk to focus on patients' symptoms and to manage a variety of multiple comorbidities.
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- Clinical complexity in patients with atrial fibrillation (AF) is associated with factors like aging and multiple health issues, which complicate treatment and outcomes.
- * A study of over 32,000 AF patients identified six distinct patient phenotypes based on comorbidities, finding that those with more complex health profiles received different treatments and had varied risks of major health events.
- *The results indicated that patients with high complexity and cardiometabolic issues had significantly higher risks of death and major cardiovascular events compared to those with fewer health issues.
Atrial fibrillation (AF) may be asymptomatic and the extensive monitoring capabilities of cardiac implantable electronic devices (CIEDs) revealed asymptomatic atrial tachi-arrhythmias of short duration (minutes-hours) occurring in patients with no prior history of AF and without AF detection at a conventional surface ECG. Both the terms "AHRE" (Atrial High-Rate Episodes) and subclinical AF were used in a series of prior studies, that evidenced the association with an increased risk of stroke. Two randomized controlled studies were planned in order to assess the risk-benefit profile of anticoagulation in patients with AHRE/subclinical AF: the NOAH and ARTESiA trials.
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- The study examined the relationship between chronic obstructive pulmonary disease (COPD) and atrial fibrillation (AF) using data from the global GLORIA-AF registry, focusing on how COPD affects treatment and outcomes.
- Out of 36,263 patients, 6.2% had COPD, with varying prevalence in different regions; factors like age, gender, and smoking were linked to COPD presence.
- COPD patients experienced different medication patterns and significantly worse health outcomes, including higher risks of death, major adverse cardiovascular events (MACEs), and major bleeding compared to patients without COPD.
Aims: The influence of social determinants of health (SDOH) on the prognosis of Heart Failure and reduced Ejection Fraction (HFrEF) is increasingly reported. We aim to evaluate the contribution of educational status on outcomes in patients with HFrEF.
Methods: We used data from the WARCEF trial, which randomized HFrEF patients with sinus rhythm to receive Warfarin or Aspirin; educational status of patients enrolled was collected at baseline.
We aimed to investigate the sex-related differences in the clinical course of patients with Atrial Fibrillation (AF) enrolled in the Asia-Pacific-Heart-Rhythm-Society Registry. Logistic regression was utilized to investigate the relationship between sex and oral anticoagulant, rhythm control strategies and the 1-year chance to maintain sinus rhythm. Cox-regression was utilized to assess the 1-year risk of all-cause, and cardiovascular death, thromboembolic events, acute coronary syndrome, heart failure, and major bleeding.
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- The study investigates the impact of asymptomatic versus symptomatic atrial fibrillation (AF) on patient outcomes, focusing on heart failure (HF) severity and left ventricular ejection fraction (LVEF).
- It involved 8,096 patients with varied conditions, revealing that asymptomatic AF patients with HF and reduced LVEF had worse outcomes, including higher risks of all-cause death and major adverse cardiac events (MACE).
- Overall, while asymptomatic AF's effects were similar for the entire cohort, it posed significant risks for those with severe heart failure (LVEF≤40%).
Article Synopsis
- * Data from the GLORIA-AF Registry included 34,421 patients, revealing that Asian patients had lower OAC prescriptions but higher discontinuation rates compared to non-Asian patients, with varying results among specific Asian subgroups.
- * Despite higher OAC discontinuation rates, Asian patients experienced a lower risk of adverse outcomes like all-cause death and major cardiovascular events, highlighting distinct ethnic factors affecting AF management.
The differentiation of left ventricular (LV) hypertrophic phenotypes is challenging in patients with normal ejection fraction (EF). The myocardial contraction fraction (MCF) is a simple dimensionless index useful for specifically identifying cardiac amyloidosis (CA) and hypertrophic cardiomyopathy (HCM) when calculated by cardiac magnetic resonance. The purpose of this study was to evaluate the value of MCF measured by three-dimensional automated, machine-learning-based LV chamber metrics (dynamic heart model [DHM]) for the discrimination of different forms of hypertrophic phenotypes.
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- The study investigated the relationship between metabolic status, body mass index (BMI), and outcomes in patients with atrial fibrillation (AF) among over 24,000 participants.
- It found that higher BMI is linked with poorer metabolic health and a greater likelihood of receiving intensive treatments, like oral anticoagulants.
- Additionally, the risks of major adverse cardiovascular events varied among different BMI groups, with metabolically unhealthy individuals facing the highest risks of complications.
Aims: To know the prevalence of atrial fibrillation (AF), as well as the incidence of postoperative AF (POAF) in vascular surgery for arterial diseases and its outcome implications.
Methods: We performed a systematic review and meta-analysis following the PRISMA statement.
Results: After the selection process, we analyzed 44 records (30 for the prevalence of AF history and 14 for the incidence of POAF).