Publications by authors named "Jeff Healey"
Risk of bleeding with the concurrent use of amiodarone and DOACs: A systematic review and meta-analysis.
Eur Heart J Cardiovasc Pharmacother
December 2024
Background And Aims: Amiodarone is frequently prescribed alongside direct oral anticoagulants (DOACs) in atrial fibrillation (AF). There are concerns regarding drug-drug interactions (DDIs) between amiodarone and DOACs. The literature is conflicting on the clinical implications of this DDI, hence we conducted a meta-analysis to compare bleeding risk among patients receiving DOACs, with and without concurrent amiodarone.
View Article and Find Full Text PDFObjectives: Atrial fibrillation is the most common complication of cardiac surgery and occurs frequently in patients without a history of the arrhythmia. We conducted a systematic review and meta-analysis of randomized controlled trials to assess whether prophylactic ablation during cardiac surgery in patients without a history of atrial fibrillation prevents atrial fibrillation.
Methods: We searched CENTRAL, MEDLINE and Embase from inception to August 2024.
Aims: The left atrial appendage (LAA) produces natriuretic peptides and its removal or occlusion might increase the risk of heart failure (HF). We aimed to investigate the incidence of HF after LAA occlusion or removal (LAAO) in the Left Atrial Appendage Occlusion Study (LAAOS III).
Methods And Results: Patients (n = 4811) with atrial fibrillation (AF) and a CHADS-VASc score ≥2, who were having cardiac surgery for another indication, were randomized to undergo surgical LAAO or not.
Background: Clinically important perioperative atrial fibrillation (POAF) is a common cardiac complication after noncardiac surgery. Little is known about how patients with POAF are managed acutely and whether practices have changed over time.
Methods: We conducted an observational substudy of patients who had POAF, were at elevated cardiovascular risk, and were enrolled in the PeriOperative Ischemic Evaluation (POISE)-1, 2 and 3 trials between 2002 and 2021.
Background: Oral anticoagulation is recommended after ablation for atrial fibrillation among patients at high risk for stroke. Left atrial appendage closure is a mechanical alternative to anticoagulation, but data regarding its use after atrial fibrillation ablation are lacking.
Methods: We conducted an international randomized trial involving 1600 patients with atrial fibrillation who had an elevated score (≥2 in men and ≥3 in women) on the CHADS-VASc scale (range, 0 to 9, with higher scores indicating a greater risk of stroke) and who underwent catheter ablation.
Background: Patients with ventricular tachycardia and ischemic cardiomyopathy are at high risk for adverse outcomes. Catheter ablation is commonly used when antiarrhythmic drugs do not suppress ventricular tachycardia. Whether catheter ablation is more effective than antiarrhythmic drugs as a first-line therapy in patients with ventricular tachycardia is uncertain.
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- The study investigates whether living in rural areas affects mortality rates in patients with acute myocardial infarction (AMI) and heart failure (HF), which may impact healthcare access and outcomes.
- A meta-analysis of 37 studies was conducted, encompassing over 21 million AMI patients and nearly 18 million HF patients, to compare rural versus urban patient mortality, focusing on all-cause mortality.
- Results indicate that although rural AMI patients are slightly older and have a higher proportion of females, the analysis aims to provide insights into mortality differences and the factors that may contribute to any observed disparities between rural and urban populations.
Article Synopsis
- Heart failure is a common issue for patients with atrial fibrillation, making risk assessment crucial for clinicians.
- This study analyzed data from three large trials to evaluate how well NT-proBNP, hs-cTnT, and GDF-15 predict heart failure risk in these patients.
- Results showed that higher levels of these biomarkers correlate with a higher risk for cardiovascular death and heart failure-related hospitalization, enhancing the predictive accuracy of clinical assessments.
Background: In the ARTESiA trial (Apixaban for the Reduction of Thromboembolism in Patients With Device-Detected Subclinical Atrial Fibrillation), apixaban, compared with aspirin, reduced stroke or systemic embolism in patients with device-detected subclinical atrial fibrillation (SCAF). Clinical guidelines recommend considering SCAF episode duration when deciding whether to prescribe oral anticoagulation for this population.
Methods: We performed a retrospective cohort study in ARTESiA.
Background And Aims: The optimal antithrombotic therapy in patients with device-detected atrial fibrillation (DDAF) is unknown. Concomitant vascular disease can modify the benefits and risks of anticoagulation.
Methods: These pre-specified analyses of the NOAH-AFNET 6 (n = 2534 patients) and ARTESiA (n = 4012 patients) trials compared anticoagulation with no anticoagulation in patients with DDAF with or without vascular disease, defined as prior stroke/transient ischaemic attack, coronary or peripheral artery disease.
Background: ARCADIA compared apixaban to aspirin for secondary stroke prevention in patients with cryptogenic stroke and atrial cardiopathy. One possible explanation for the neutral result is that biomarkers used did not optimally identify atrial cardiopathy. We examined the relationship between biomarker levels and subsequent detection of AF, the hallmark of atrial cardiopathy.
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- After heart surgery, some patients develop a condition called atrial fibrillation (AF), which can lead to important health issues.
- Researchers are studying how to predict, prevent, and manage this condition in people who have had surgery.
- There are currently 121 studies happening, mostly focusing on preventing AF, but more work is needed to understand how to control it over time.
Background: Despite many atrial fibrillation (AF) patients being at risk of bleeding, very limited data are available on bleeding rates of different direct oral anticoagulants based on the spectrum of bleeding risk.
Objective: We aimed to compare the risk of major bleeding and thromboembolic events with apixaban vs rivaroxaban for AF patients stratified by bleeding risk.
Methods: We conducted a population-based, retrospective cohort study of all adult patients (66 years or older) with AF in Ontario, Canada, who were treated with apixaban or rivaroxaban between April 1, 2011, and March 31, 2020.
Subclinical, device-detected atrial fibrillation (AF) is frequently recorded by pacemakers and other implanted cardiac rhythm devices. Patients with device-detected AF have an elevated risk of stroke, but a lower risk of stroke than similar patients with clinical AF captured with surface electrocardiogram. Two randomized clinical trials (NOAH-AFNET 6 and ARTESiA) have tested a direct oral anticoagulant (DOAC) against aspirin or placebo.
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- The study aimed to evaluate the day-to-day variability in the frequency of premature atrial complexes (PACs) and premature ventricular complexes (PVCs) using 14-day ECG recordings from 8245 patients.
- Results showed that significant daily variability exists; for PACs, 25% of patients had daily frequencies that differed by over 50% from their 14-day average after just 3 days, while for PVCs, it took 7 days to see similar variation.
- The findings indicate that when patients report very high frequencies (≥10,000), single-day ECG results are highly specific and do not require longer recordings for confirmation.
Importance: Major gaps in the delivery of appropriate oral anticoagulation therapy (OAC) exist, leaving a large proportion of persons with atrial fibrillation (AF) unnecessarily at risk for stroke and its sequalae.
Objective: To investigate whether pharmacist-led OAC prescription can increase the delivery of stroke risk reduction therapy in individuals with AF.
Design, Setting, And Participants: This prospective, open-label, patient-level randomized clinical trial of early vs delayed pharmacist intervention from January 1, 2019, to December 31, 2022, was performed in 27 community pharmacies in Alberta, Canada.
Background: Mounting evidence indicates that even device-detected subclinical atrial fibrillation is associated with a higher risk of heart failure (HF). However, the potential impact of atrial fibrillation screening on HF remains unknown.
Methods: The LOOP Study (Atrial Fibrillation detected by Continuous ECG Monitoring using Implantable Loop Recorder to prevent Stroke in High-risk Individuals) evaluated the effects of atrial fibrillation screening on stroke prevention using an implantable loop recorder (ILR) versus usual care in older individuals with additional stroke risk factors.
Article Synopsis
- The ARTESiA study found that apixaban significantly lowers the risk of stroke and systemic embolism compared to aspirin in patients with subclinical atrial fibrillation, but it also increases the risk of major bleeding.
- Researchers analyzed the effectiveness and safety of apixaban based on patients' CHADS-VASc scores, which assess their risk of stroke, revealing that higher scores correlate with greater benefits from apixaban.
- For patients with CHADS-VASc scores over 4, the advantages of taking apixaban for stroke prevention outweigh the bleeding risks, while those with scores below 4 may not benefit as much, emphasizing the need for patient-centered treatment decisions.
Background: There are no randomized data to inform the extent to which transvenous cardiac leads cause tricuspid regurgitation (TR).
Objectives: This study sought to determine the effect of a transvenous implantable cardioverter-defibrillator (TV-ICD) on TR severity, and secondarily, on right ventricular (RV) size and function.
Methods: We evaluated TR severity before and 6 months after implantable cardioverter-defibrillator insertion in a post hoc analysis of adults randomized to receive a transvenous (n = 252) or subcutaneous implantable cardioverter-defibrillator (S-ICD) (n = 251) device.
Article Synopsis
- - The text discusses Calcium Release Deficiency Syndrome (CRDS), a serious genetic heart condition that can cause sudden cardiac arrest without clear reasons and is not detectable through standard tests.
- - The study aimed to analyze electrocardiogram (ECG) responses after brief periods of fast heart rates followed by pauses in order to develop a diagnostic test for CRDS.
- - Findings showed that patients with CRDS had a significantly greater change in T-wave amplitude on their ECG after a pause compared to control groups, indicating a potential diagnostic marker for this syndrome.
Article Synopsis
- There are currently no direct comparisons of the effectiveness and safety of the two most common oral anticoagulants, apixaban and rivaroxaban, for older patients with atrial fibrillation (AF), creating uncertainty regarding which drug is better.
- This study examined older adults (66 and older) in Ontario, Canada, comparing the incidence of major bleeding and thromboembolic events in patients treated with either apixaban or rivaroxaban from 2011 to 2020.
- The findings revealed that apixaban was associated with a significantly lower risk of major and any bleeding compared to rivaroxaban, while both drugs had similar risks for thromboembolic events.
Background: Cardiovascular failure is recognized as a common final pathway at the end of life but there is a paucity of data describing terminal arrhythmias.
Aim: We aimed to describe arrhythmias recorded peri-mortem in critically ill patients.
Study Design: We enrolled intensive care unit patients admitted to two tertiary Canadian medico-surgical centres.