Expert Review of Cardiovascular Therapy最新文献

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Trends and cardiovascular outcomes of Takotsubo syndrome with cardiogenic shock vs. mixed cardiogenic and septic shock: a nationwide propensity matched analysis. 塔克次氏综合征合并心源性休克与混合型心源性休克和脓毒性休克的趋势和心血管预后:全国范围内的倾向匹配分析。
IF 2
Expert Review of Cardiovascular Therapy Pub Date : 2024-01-01 Epub Date: 2023-12-18 DOI: 10.1080/14779072.2023.2295378
Sadaf Fakhra, Mohammed Faisaluddin, Yasar Sattar, Danielle DeCicco, Asmaa Ahmed, Neel Patel, Senthil Balasubramanian, Dipesh Ludhwani, Hassan Masood, Sameer Raina, Karthik Gonuguntla, Scott C Feitell, Tushar Tarun, Sudarshan Balla
{"title":"Trends and cardiovascular outcomes of Takotsubo syndrome with cardiogenic shock vs. mixed cardiogenic and septic shock: a nationwide propensity matched analysis.","authors":"Sadaf Fakhra, Mohammed Faisaluddin, Yasar Sattar, Danielle DeCicco, Asmaa Ahmed, Neel Patel, Senthil Balasubramanian, Dipesh Ludhwani, Hassan Masood, Sameer Raina, Karthik Gonuguntla, Scott C Feitell, Tushar Tarun, Sudarshan Balla","doi":"10.1080/14779072.2023.2295378","DOIUrl":"10.1080/14779072.2023.2295378","url":null,"abstract":"<p><strong>Introduction: </strong>Takotsubo syndrome (TTS), also known as stress-induced cardiomyopathy, can be complicated by shock. The outcomes of patients with TTS complicated with cardiogenic shock (CS) versus mixed cardiogenic and septic shock (MS) is not known.</p><p><strong>Methods: </strong>We queried Nationwide Inpatient Sample (NIS) from 2009-2020 to compare TTS patients with CS and MS using International Classification of Disease, Ninth & Tenth Edition, Clinical Modification (ICD- 9 & 10-CM) coding. In-hospital outcomes were compared using one: one propensity score matched (PSM) analysis. The primary outcome was in-hospital mortality.</p><p><strong>Results: </strong>Of 23,126 patients with TTS 17,132 (74%) had CS, and 6,269 (26%) had MS. The mean age was 67 years in CS and 66 years in MS, and majority of patients were female (<i>n</i> = 17,775, 77%). On adjusted multivariate analysis, MS patients had higher odds of in-hospital mortality (aOR 1.44, 95% CI 1.36-1.52), AKI (aOR 1.53, 95% CI 1.48-1.58), pressor requirement (aOR 1.37, 95% CI 1.25-1.50). However, had lower odds of MCS use (aOR 0.44, 95% CI 0.40-0.48) and cardiac arrest (aOR: 0.81, 95% CI 0.73-0.90) (p-value <0.0001). Mean LOS and inflation-adjusted hospital charges were higher in MS.</p><p><strong>Conclusion: </strong>MS in the setting of TTS have higher rates of in-hospital mortality, AKI, and pressor requirements.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":"103-109"},"PeriodicalIF":2.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138801030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The clinical characteristics, managements, and outcomes of acute myocardial infarction in osteoarthritis patients; a cross-sectional analysis of 6.5 million patients. 骨关节炎患者急性心肌梗死的临床特征、处理方法和预后;对 650 万患者的横断面分析。
IF 2
Expert Review of Cardiovascular Therapy Pub Date : 2024-01-01 Epub Date: 2024-01-31 DOI: 10.1080/14779072.2024.2311696
Simran Singh Parmar, Mohamed O Mohamed, Mamas A Mamas, Ross Wilkie
{"title":"The clinical characteristics, managements, and outcomes of acute myocardial infarction in osteoarthritis patients; a cross-sectional analysis of 6.5 million patients.","authors":"Simran Singh Parmar, Mohamed O Mohamed, Mamas A Mamas, Ross Wilkie","doi":"10.1080/14779072.2024.2311696","DOIUrl":"10.1080/14779072.2024.2311696","url":null,"abstract":"<p><strong>Objectives: </strong>The prevalence of osteoarthritis (OA) and cardiovascular disease are increasing and both conditions share similar risk factors. We investigated the association between OA and receipt of invasive managements and clinical outcomes in patients with acute myocardial infarction (AMI).</p><p><strong>Methods: </strong>Using the National Inpatient Sample, adjusted binary logistic regression determined the association between OA and each outcome variable.</p><p><strong>Results: </strong>Of 6,561,940 AMI hospitalizations, 6.3% had OA. OA patients were older and more likely to be female. OA was associated with a decreased odds of coronary angiography (adjusted odds ratio 0.91; 95% confidence interval 0.90, 0.92), PCI (0.87; 0.87, 0.88), and coronary artery bypass grafting (0.98; 0.97, 1.00). OA was associated with a decreased odds of adverse outcomes (in-hospital mortality: 0.68; 0.67, 0.69; major acute cardiovascular and cerebrovascular events: 0.71; 0.70, 0.72; all-cause bleeding: 0.76; 0.74, 0.77; and stroke/TIA: 0.84; 0.82, 0.87).</p><p><strong>Conclusions: </strong>This study of a representative sample of the US population highlights that OA patients are less likely to be offered invasive interventions following AMI. OA was also associated with better outcomes post-AMI, possibly attributed to a misclassification bias where unwell patients with OA were less likely to receive an OA code because codes for serious illness took precedence.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":"121-129"},"PeriodicalIF":2.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139569364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Physical activity, exercise and adverse cardiovascular outcomes in individuals with pre-existing cardiovascular disease: a narrative review. 原有心血管疾病患者的体育活动、锻炼和不良心血管后果:叙述性综述。
IF 2
Expert Review of Cardiovascular Therapy Pub Date : 2024-01-01 Epub Date: 2024-03-15 DOI: 10.1080/14779072.2024.2328644
Setor K Kunutsor, Jari A Laukkanen
{"title":"Physical activity, exercise and adverse cardiovascular outcomes in individuals with pre-existing cardiovascular disease: a narrative review.","authors":"Setor K Kunutsor, Jari A Laukkanen","doi":"10.1080/14779072.2024.2328644","DOIUrl":"10.1080/14779072.2024.2328644","url":null,"abstract":"<p><strong>Introduction: </strong>The evidence supporting the cardiovascular health benefits of physical activity and/or exercise training is well-established. While the role of physical activity in primary prevention is unequivocal, its significance in secondary prevention (among those with preexisting cardiovascular disease) is less definitive. Though guidelines universally recommend physical activity as part of the secondary preventive strategy, the empirical evidence underpinning these recommendations is not as robust as that for primary prevention.</p><p><strong>Areas covered: </strong>This review distills the body of available observational and interventional evidence on the relationship between physical activity, exercise, and adverse cardiovascular outcomes among those with preexisting cardiovascular disease. The postulated biologic mechanisms underlying the relationships, areas of prevailing uncertainty, and potential public health implications are also discussed.</p><p><strong>Expert opinion: </strong>A physical activity level of 500 MET-min/week (equivalent to 150 min of moderate-intensity physical activity or 75 min of vigorous-intensity physical activity or an equivalent combination) may be a minimum requirement for patients with preexisting CVD. However, to reap the maximum benefits of physical activity and also minimize adverse effects, physical activity and/or exercise regimens should be tailored to unique factors such as individual's baseline physical activity habits, cardiovascular health status and the specific nature of their cardiovascular disease.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":"91-101"},"PeriodicalIF":2.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11057847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140131106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Preventive cardiology for the aging population: how can we better design clinical trials of statins? 针对老龄人口的预防心脏病学:如何更好地设计他汀类药物的临床试验?
IF 2
Expert Review of Cardiovascular Therapy Pub Date : 2024-01-01 Epub Date: 2024-01-23 DOI: 10.1080/14779072.2024.2302122
Anthony S Wierzbicki
{"title":"Preventive cardiology for the aging population: how can we better design clinical trials of statins?","authors":"Anthony S Wierzbicki","doi":"10.1080/14779072.2024.2302122","DOIUrl":"10.1080/14779072.2024.2302122","url":null,"abstract":"<p><strong>Introduction: </strong>Older adults form a fast-increasing proportion of the world population. However, gains in increasing quantity of life have not been accompanied by similar gains in quality of life. Older people frequently experience frailty, memory problems, and chronic diseases including cardiovascular disease (CVD) and neurodegenerative diseases. Recent trials have demonstrated the efficacy of anti-hypertensive therapy in older populations but failed to show benefits for aspirin.</p><p><strong>Area covered: </strong>Statins clearly reduce CVD events in middle-aged populations. There seems to be evidence that the effect is similar in primary prevention older populations based on meta-analyses mainly from sub-groups in large trials, but this becomes less clear with increasing age. However, given differences in drug metabolism and possibly efficacy, competing co-morbidities, their effects on mortality, disability, and dementia in this age group remain to be determined.</p><p><strong>Expert opinion: </strong>Two large trials are now underway to clarify the role of statin therapy in people aged over 70 years using endpoints of mortality, disability, and neurocognitive endpoints as well as standard cardiovascular disease outcomes. They may provide also provide more evidence on how to approach the over 80 year age group.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":"13-18"},"PeriodicalIF":2.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139519467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impella devices: a comprehensive review of their development, use, and impact on cardiogenic shock and high-risk percutaneous coronary intervention. Impella装置:对其发展、使用以及对心源性休克和高危经皮冠状动脉介入治疗的影响的全面综述。
IF 2
Expert Review of Cardiovascular Therapy Pub Date : 2023-07-01 Epub Date: 2023-08-08 DOI: 10.1080/14779072.2023.2244874
Tzvi Fishkin, Ameesh Isath, Edmund Naami, Wilbert S Aronow, Avi Levine, Alan Gass
{"title":"Impella devices: a comprehensive review of their development, use, and impact on cardiogenic shock and high-risk percutaneous coronary intervention.","authors":"Tzvi Fishkin,&nbsp;Ameesh Isath,&nbsp;Edmund Naami,&nbsp;Wilbert S Aronow,&nbsp;Avi Levine,&nbsp;Alan Gass","doi":"10.1080/14779072.2023.2244874","DOIUrl":"10.1080/14779072.2023.2244874","url":null,"abstract":"<p><strong>Introduction: </strong>Impella devices have emerged as a critical tool for temporary mechanical circulatory support (TMCS) in the management of cardiogenic shock (CS) and high-risk percutaneous coronary interventions (PCI). The purpose of this review is to examine the history of the different Impella devices, their hemodynamic profiles, and how the data supports their use.</p><p><strong>Areas covered: </strong>This review covers the development and specifications of the Impella 2.5, Impella CP, Impella 5.0/Left Direct (LD), Impella RP, and Impella 5.5 devices. This review also covers the clinical trials that illuminate the Impella devices' use in their appropriate clinical contexts. These studies examine the effectiveness of Impella devices and have begun to yield promising results, demonstrating improved survival rates when compared to the historically high mortality rates associated with CS. It is important to weigh the benefits of Impella devices in light of their contraindications. A literature search was conducted by searching the PubMed database for reviews, meta-analyses, and clinical trials pertinent to Impella devices.</p><p><strong>Expert opinion: </strong>Impella devices are a crucial tool for management of patients undergoing high-risk PCI and those with CS. There is evidence that early Impella implantation is beneficial in the treatment of patients presenting with CS. Further randomized controlled trials are needed to better elucidate the benefits of Impella devices in various clinical settings.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":"21 9","pages":"613-620"},"PeriodicalIF":2.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10219270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Screening of atrial fibrillation in dental practices: a qualitative feasibility study. 牙科实践中心房颤动的筛查:一项定性可行性研究。
IF 2
Expert Review of Cardiovascular Therapy Pub Date : 2023-07-01 Epub Date: 2023-09-04 DOI: 10.1080/14779072.2023.2254679
Amaar Obaid Hassan, Rosa Moreno Lopez, Deirdre A Lane, Gregory Y H Lip, Rebecca V Harris, Asfa Mughal, Corina Weir
{"title":"Screening of atrial fibrillation in dental practices: a qualitative feasibility study.","authors":"Amaar Obaid Hassan,&nbsp;Rosa Moreno Lopez,&nbsp;Deirdre A Lane,&nbsp;Gregory Y H Lip,&nbsp;Rebecca V Harris,&nbsp;Asfa Mughal,&nbsp;Corina Weir","doi":"10.1080/14779072.2023.2254679","DOIUrl":"10.1080/14779072.2023.2254679","url":null,"abstract":"ABSTRACT Objectives To increase the detection of unknown atrial fibrillation (AF), general practitioners have started screening their patients using small hand-held devices. It is thought that dental settings could be utilized for screening as they have regular access to patients. The aim of this study was to explore the perceptions of dental staff of screening for AF using a hand-held electronic device in primary dental care. Methods The research took place in one large mixed NHS and private general dental practice. Views from staff including dentists, dental therapists, dental nurses, and managers were elicited via semi-structured interviews conducted face-to-face, audio recorded, and transcribed verbatim. Interviews continued until there were no new themes or patterns emerging from the data, and thematic saturation had been achieved. Results Eleven participants were interviewed. The main themes generated were methodology for screening, acceptability for screening within the practice, attitudes to screening, and implementation of screening. Overall, participants were positive about implementing AF screening in a dental practice but expressed concerns about time and remuneration. Staff also gave encouraging feedback regarding the simplicity of the portable screening device. Conclusions Participants felt that AF screening in primary care dental practices was a good concept but may be challenging to implement in NHS Dentistry, especially due to the pandemic.","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":"21 9","pages":"643-649"},"PeriodicalIF":2.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10274551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The clinical role of invasive hemodynamics in the evaluation and treatment of structural heart disease. 有创血流动力学在结构性心脏病评估和治疗中的临床作用。
IF 2
Expert Review of Cardiovascular Therapy Pub Date : 2023-07-01 DOI: 10.1080/14779072.2023.2219058
Joshua Rezkalla, Mackram F Eleid
{"title":"The clinical role of invasive hemodynamics in the evaluation and treatment of structural heart disease.","authors":"Joshua Rezkalla,&nbsp;Mackram F Eleid","doi":"10.1080/14779072.2023.2219058","DOIUrl":"https://doi.org/10.1080/14779072.2023.2219058","url":null,"abstract":"<p><strong>Introduction: </strong>Recognition and evaluation of structural heart disease has become more common in clinical practice and will continue to grow as the population ages. With the growing availability of surgical and transcatheter interventional options, appropriate evaluation and patient selection for therapy is required. While echocardiography can frequently provide the required anatomic and hemodynamic information required to guide therapeutic decisions, there remains subsets of patients in which noninvasive testing yields inconclusive results prompting the need for invasive hemodynamics.</p><p><strong>Areas covered: </strong>This article reviews the indications and strengths of invasive hemodynamics in a variety of structural heart diseases. We describe the utilization and benefits of continuous hemodynamics during transcatheter interventions and review the prognostic information that can be gleaned from changes in hemodynamics after intervention.</p><p><strong>Expert opinion: </strong>The advancement of transcatheter therapies for structural heart disease has sparked a renewed interest in the utilization of invasive hemodynamics. Continued growth and accessibility of comprehensive hemodynamics for clinical practice will rely on clinicians to continually review, refine, and develop procedural techniques beyond the current training standards in order to further advance the field.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":"21 7","pages":"483-499"},"PeriodicalIF":2.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9689175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Time to treat the climate and nature crisis as one indivisible global health emergency. 是时候将气候和自然危机视为一个不可分割的全球卫生紧急事件了。
IF 2
Expert Review of Cardiovascular Therapy Pub Date : 2023-07-01 Epub Date: 2023-12-10 DOI: 10.1080/14779072.2023.2276518
Kamran Abbasi, Parveen Ali, Virginia Barbour, Thomas Benfield, Kirsten Bibbins-Domingo, Gregory E Erhabor, Stephen Hancocks, Richard Horton, Laurie Laybourn-Langton, Robert Mash, Peush Sahni, Wadeia Mohammad Sharief, Paul Yonga, Chris Zielinski
{"title":"Time to treat the climate and nature crisis as one indivisible global health emergency.","authors":"Kamran Abbasi, Parveen Ali, Virginia Barbour, Thomas Benfield, Kirsten Bibbins-Domingo, Gregory E Erhabor, Stephen Hancocks, Richard Horton, Laurie Laybourn-Langton, Robert Mash, Peush Sahni, Wadeia Mohammad Sharief, Paul Yonga, Chris Zielinski","doi":"10.1080/14779072.2023.2276518","DOIUrl":"10.1080/14779072.2023.2276518","url":null,"abstract":"","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":"717-719"},"PeriodicalIF":2.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71411248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
How can we improve the management of individuals with attention deficit hyperactivity disorders and co-occurring cardiometabolic disease? 我们如何改善注意力缺陷多动障碍和合并心脏代谢疾病患者的管理?
IF 2
Expert Review of Cardiovascular Therapy Pub Date : 2023-07-01 Epub Date: 2023-12-10 DOI: 10.1080/14779072.2023.2279608
Henrik Larsson
{"title":"How can we improve the management of individuals with attention deficit hyperactivity disorders and co-occurring cardiometabolic disease?","authors":"Henrik Larsson","doi":"10.1080/14779072.2023.2279608","DOIUrl":"10.1080/14779072.2023.2279608","url":null,"abstract":"","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":" ","pages":"725-728"},"PeriodicalIF":2.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71479811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Managing older people with atrial fibrillation and preventing stroke: a review of anticoagulation approaches. 管理患有心房颤动的老年人并预防中风:抗凝方法综述。
IF 2
Expert Review of Cardiovascular Therapy Pub Date : 2023-07-01 Epub Date: 2023-12-13 DOI: 10.1080/14779072.2023.2276892
Leona A Verma, Peter E Penson, Asangaedem Akpan, Gregory Y H Lip, Deirdre A Lane
{"title":"Managing older people with atrial fibrillation and preventing stroke: a review of anticoagulation approaches.","authors":"Leona A Verma, Peter E Penson, Asangaedem Akpan, Gregory Y H Lip, Deirdre A Lane","doi":"10.1080/14779072.2023.2276892","DOIUrl":"https://doi.org/10.1080/14779072.2023.2276892","url":null,"abstract":"<p><strong>Introduction: </strong>Oral anticoagulants (OACs) are the cornerstone of stroke prevention in atrial fibrillation (AF), but prescribing decisions in older people are complicated. Clinicians must assess the net clinical benefit of OAC in the context of multiple chronic conditions, polypharmacy, frailty and life expectancy. The under-representation of high-risk, older adult sub-populations in clinical trials presents the challenge of choosing the right OAC, where a 'one-size-fits-all' approach cannot be taken.</p><p><strong>Areas covered: </strong>This review discusses OAC approaches for stroke prevention in older people with AF and presents a prescribing aid to support clinicians' decision-making. High-risk older adults with multiple chronic conditions, specifically chronic kidney disease, dementia/cognitive impairment, previous stroke/transient ischemic attack or intracranial hemorrhage, polypharmacy, frailty, low body weight, high falls risk, and those aged ≥75 years are considered.</p><p><strong>Expert opinion: </strong>Non-vitamin K antagonist OACs are the preferred first-line OAC in older adults with AF, including high-risk subpopulations, after individual assessment of stroke and bleeding risk, except those with mechanical heart valves and moderate-to-severe mitral stenosis. Head-to-head comparisons of NOACs are not available, therefore the choice of drug (and dose) should be based on an individual's risk (stroke and bleeding) and incorporate their treatment preferences. Treatment decisions must be person-centered and principles of shared decision-making applied.</p>","PeriodicalId":12098,"journal":{"name":"Expert Review of Cardiovascular Therapy","volume":"21 12","pages":"963-983"},"PeriodicalIF":2.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138801031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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