Atrial fibrillation: Difference between revisions
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==Treatment== | ==Treatment== | ||
===Rate control versus rhythm control=== | |||
Among patients with [[heart failure]], rhythm control was associated with slight, although statistically insignificant, increase in mortality.<ref name="pmid18565859">{{cite journal |author=Roy D, Talajic M, Nattel S, ''et al'' |title=Rhythm control versus rate control for atrial fibrillation and heart failure |journal=N. Engl. J. Med. |volume=358 |issue=25 |pages=2667–77 |year=2008 |month=June |pmid=18565859 |doi=10.1056/NEJMoa0708789 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=18565859 |issn=}}</ref> | |||
===Anticoagulation=== | ===Anticoagulation=== | ||
[[Anticoagulation]] can prevent recurrent [[stroke]]. Among patients with nonvalvular [[atrial fibrillation]], [[anticoagulation]] can reduce [[stroke]] by 60% while antiplatelet agents can reduce stroke by 20%. <ref name="pmid17577005">{{cite journal |author=Hart RG, Pearce LA, Aguilar MI |title=Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation |journal=Ann. Intern. Med. |volume=146 |issue=12 |pages=857-67 |year=2007 |pmid=17577005 |doi=}}</ref>. However, a recent [[meta-analysis]] suggests harm from anti-coagulation started early after an embolic stroke.<ref name="pmid17204681"> {{cite journal |author=Paciaroni M, Agnelli G, Micheli S, Caso V |title=Efficacy and safety of anticoagulant treatment in acute cardioembolic stroke: a meta-analysis of randomized controlled trials |journal=Stroke |volume=38 |issue=2 |pages=423-30 | year=2007 |pmid=17204681 |doi=10.1161/01.STR.0000254600.92975.1f }} [http://www.acpjc.org/Content/147/1/issue/ACPJC-2007-147-1-017.htm ACP JC synopsis ]</ref> | [[Anticoagulation]] can prevent recurrent [[stroke]]. Among patients with nonvalvular [[atrial fibrillation]], [[anticoagulation]] can reduce [[stroke]] by 60% while antiplatelet agents can reduce stroke by 20%. <ref name="pmid17577005">{{cite journal |author=Hart RG, Pearce LA, Aguilar MI |title=Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation |journal=Ann. Intern. Med. |volume=146 |issue=12 |pages=857-67 |year=2007 |pmid=17577005 |doi=}}</ref>. However, a recent [[meta-analysis]] suggests harm from anti-coagulation started early after an embolic stroke.<ref name="pmid17204681"> {{cite journal |author=Paciaroni M, Agnelli G, Micheli S, Caso V |title=Efficacy and safety of anticoagulant treatment in acute cardioembolic stroke: a meta-analysis of randomized controlled trials |journal=Stroke |volume=38 |issue=2 |pages=423-30 | year=2007 |pmid=17204681 |doi=10.1161/01.STR.0000254600.92975.1f }} [http://www.acpjc.org/Content/147/1/issue/ACPJC-2007-147-1-017.htm ACP JC synopsis ]</ref> | ||
==References== | ==References== | ||
<references/> | <references/> | ||
Revision as of 23:44, 28 June 2008
Diagnosis
Routine office evaluation
A study of routine pulse checks or electrocardiograms during routine office visits, found that the annual rate of detection of atrial fibrillation in elderly patients improved from 1.04% to 1.63%.[1] This implies that the sensitivity of the routine examination is 64% (1.04/1.63).
Electrocardiogram
Regarding the accuracy of the electrocardiogram[2]:
- Interpreted by software:
- sensitivity = 83%
- specificity = 99%
- Interpreted by a primary care physician:
- sensitivity = 80%
- specificity = 92%
- Interpreted by a primary care physician with software:
- sensitivity = 92%
- specificity = 91%
Prognosis
Risk of stroke
The risk of stroke in a patient with atrial fibrillation can be predicted with the CHADS2 score.
Treatment
Rate control versus rhythm control
Among patients with heart failure, rhythm control was associated with slight, although statistically insignificant, increase in mortality.[3]
Anticoagulation
Anticoagulation can prevent recurrent stroke. Among patients with nonvalvular atrial fibrillation, anticoagulation can reduce stroke by 60% while antiplatelet agents can reduce stroke by 20%. [4]. However, a recent meta-analysis suggests harm from anti-coagulation started early after an embolic stroke.[5]
References
- ↑ Fitzmaurice DA, Hobbs FD, Jowett S, et al (2007). "Screening versus routine practice in detection of atrial fibrillation in patients aged 65 or over: cluster randomised controlled trial". DOI:10.1136/bmj.39280.660567.55. PMID 17673732. Research Blogging.
- ↑ Mant J, Fitzmaurice DA, Hobbs FD, et al (2007). "Accuracy of diagnosing atrial fibrillation on electrocardiogram by primary care practitioners and interpretative diagnostic software: analysis of data from screening for atrial fibrillation in the elderly (SAFE) trial". DOI:10.1136/bmj.39227.551713.AE. PMID 17604299. Research Blogging.
- ↑ Roy D, Talajic M, Nattel S, et al (June 2008). "Rhythm control versus rate control for atrial fibrillation and heart failure". N. Engl. J. Med. 358 (25): 2667–77. DOI:10.1056/NEJMoa0708789. PMID 18565859. Research Blogging.
- ↑ Hart RG, Pearce LA, Aguilar MI (2007). "Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation". Ann. Intern. Med. 146 (12): 857-67. PMID 17577005. [e]
- ↑ Paciaroni M, Agnelli G, Micheli S, Caso V (2007). "Efficacy and safety of anticoagulant treatment in acute cardioembolic stroke: a meta-analysis of randomized controlled trials". Stroke 38 (2): 423-30. DOI:10.1161/01.STR.0000254600.92975.1f. PMID 17204681. Research Blogging. ACP JC synopsis