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Atrial Fibrillation Now and Then

Atrial Fibrillation Now and Then. Min-Yen Han,M.D . November 15,2014. AF is a common cardiac rhythm disturbance and increases in prevalence with advancing age Affecting between 2.7 million and 6.1million American adults and by 2050 the number will be 5.6 to 12.1million

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Atrial Fibrillation Now and Then

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  1. Atrial FibrillationNow and Then Min-Yen Han,M.D. November 15,2014

  2. AF is a common cardiac rhythm disturbance and increases in prevalence with advancing age • Affecting between 2.7 million and 6.1million American adults and by 2050 the number will be 5.6 to 12.1million • AF is associated with a 5 fold increased risk of stroke,which is likely to be more severe than non-AF related stroke.

  3. AF is also associated with a 3-fold risk of HF and a 2-fold increased risk of both demantia and mortality • It is estimated that treating patients with AF adds $26 billion to the U.S. healthcare bill annually

  4. AF symptoms range from non-existent to severe,symptoms including fatigue,palpitation • Dyspnea,hypotension,syncope or HF. • AF classification: • Paroxysmal: AF that terminates spontaneuosly or with intervention within 7 days of onset • Persistent: Continous AF that is sustained more than 7 days • Longstanding persistent: Continous AF of more than 12 months • Permanet AF • Nonvalcular AF:AF is the absence of rheumatic mitral stenosis,amachanical or bioprostheric heart valse or mitral valve repair.

  5. Goals of medical management of AF: Rate control Rhythm control Prevention of thromboembolic events

  6. Anticoagulation in AF • Prior to Oct.2010 • Warfarin was the only antigoagulant then • New NOVAL anticoagulants after Oct.2010 • Dabigatran,an direct thrombin inhibitor • Rivaroxaban,,Apixaban and Edoxaban,factor X inhibitor

  7. Advantage and disanvantage of the old and the new antigoagulants

  8. Tools for Assessing Stroke Risk: • CHADS2 Score CHADS2-VASc Score • Risk Factor Score Risk Factor Score • CHF 1 CHF(LV Dys.) 1 • Hypertension 1 Hypertension 1 • Age >75 Y 1 Age >75 1 • Diabetes 1 Diabetes 1 • Stroke or TIA Hx 2 Stroke/TIA/TE 2 • Maximal 6 Vascular diseae 1 • Age 65-74 1 • Female 1 • Maximal 9

  9. Tools for Assesssing Bleeding Risk: • HAS-BLED Score • Risk Factor Score • Hypertension SBP>160mmHg 1 • Abnormal renal or liver function(each) 1 • Stroke 1 • Bleeding hx or predisposition 1 • Labile INR 1 • Elderly age>65y 1 • Drugs or alcohol • Antiplatelets or NSAIDs 1 • Alcohol use >8 servings/wk 1 • Maximal 9

  10. 2014 AHA/ACC/HRS AF Guidelines: • NVAF • Stroke risk assessment using CHA2DS2-VASc • Share decision making:riskfactors,cost, • Tolerability,patientpreference,drug interaction potential, • HAS-BLED score Not recommended for bleed risk assessment

  11. CHA2DS2-VASc Score Recommended • >2 Warfarin(INR2-3), • Apixaban,Dabigatran, • Rivaroxaban • 1 Same as above or • Aspirin or No antithrombotic Rx 0 No antithrombotic Rx

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