Duo Huang

Refinement of ischemic stroke risk in patients with atrial fibrillation and CHA2 DS2 -VASc score of 1.

Patients with atrial fibrillation (AF) with CHA2DS2‐VASc score of 1 (where CHA2DS2‐VASc is CHA2DS2‐Vascular disease, Age 65–74 years, Sex category) are recommended to receive antithrombotic therapy. Nonetheless, it remains unclear whether individual components that constitute CHA2DS2‐VASc score contribute equally to the ischemic stroke risk, particularly in patients with CHA2DS2‐VASc score of 1. The objective was to describe and compare the risk of ischemic stroke of the six individual components constituting CHA2DS2‐VASc among AF patients with CHA2DS2‐VASc score of 1.

Stroke prevention using dabigatran in elderly Chinese patients with atrial fibrillation

BACKGROUND Little is known about the clinical benefit of a non-vitamin K antagonist oral anticoagulant compared with warfarin in elderly Chinese patients with atrial fibrillation (AF). OBJECTIVE The purpose of this study was to evaluate the clinical benefit of dabigatran in elderly (age ≥80 years) Chinese patients with nonvalvular AF with regard to the risk of ischemic stroke and intracranial hemorrhage (ICH). METHODS This was an observational study. RESULTS We studied 571 Chinese patients (mean age 84.8 ± 4.0 years; 58.1% women) with nonvalvular AF. The primary outcome was hospital admission for ischemic stroke, and the secondary outcome was admission for ICH. The mean CHA2DS2-VASc (congestive heart failure [1 point], hypertension [1 point], age 65-74 years [1 point] and age ≥75 years [2 points], diabetes mellitus [1 point], prior stroke or transient ischemic attack [2 points], vascular disease [1 point], sex category [female] [1 point]) and HAS-BLED (hypertension [1 point], abnormal renal/liver function [1 point], stroke [1 point], bleeding history [1 point] or predisposition [1 point], labile international normalized ratio [1 point], elderly [age >65 years] [1 point], drugs/alcohol concomitantly [1 point]) scores were 4.8 ± 1.6 and 2.4 ± 0.8, respectively. Of 571 patients, 129 (22.6%) were taking dabigatran 110 mg twice daily and the remaining were on warfarin. After a mean follow-up of 2.6 years (a total of 1471 patient-years), ischemic stroke occurred in 83 patients on warfarin (6.9% per year) compared with 4 patients on dabigatran (1.4% per year) (hazard ratio 0.22; 95% confidence interval 0.23-0.67). There were 8 incidences of ICH: 7 in patients on warfarin (0.59% per year) and 1 patient on dabigatran (0.35% per year). Dabigatran was associated with a substantially lower ischemic stroke risk (1.4% per year vs 5.4% per year) and similar ICH risk (0.35% per year vs 0.36% per year) as compared with warfarin with time in therapeutic range (TTR) ≥55%. CONCLUSION In elderly Chinese patients with AF, this study suggested that dabigatran achieved superior stroke risk reduction and similar risk of ICH compared with warfarin with TTR ≥55%. Dabigatran may be preferable to warfarin in elderly patients with AF for stroke prevention, particularly in those with poor TTR.

Clinical Characteristics, Management, and Outcomes of Hospitalized Heart Failure in a Chinese Population-The Hong Kong Heart Failure Registry.

BACKGROUND Epidemiological data for heart failure (HF) in the Chinese population is scarce. In this study, we described the clinical characteristics and outcomes of new-onset HF in our population. METHODS AND RESULTS We conducted a retrospective, observational study on consecutive Chinese patients hospitalized for new-onset HF between 2005 and 2012 in our center. A total of 1940 patients (mean age, 78.2 ± 11.8 years, 54.2% female) were identified. The rate of new HF hospitalization was 0.59 per 1000 population. The most prevalent comorbidities were hypertension (69.8%) and coronary artery disease (29.3%), and 52.3% had HF with preserved ejection fraction (HFpEF). The all-cause mortality was 19.5% at 1 year, 32.1% at 2 years, and 54% at 5 years. Cardiovascular mortality was 7.2% at 1 year, 11.8% at 2 years, and 20.7% at 5 years. No difference in all-cause mortality or cardiovascular mortality was observed between those with HF with reduced ejection fraction than HFpEF. CONCLUSIONS Our patients with new-onset HF shared similar clinical characteristics with the Caucasian population. The prognosis was poor with high all-cause mortality for both HFpEF and HF with reduced ejection fraction.

Efficacy and safety of dabigatran, rivaroxaban, and warfarin for stroke prevention in Chinese patients with atrial fibrillation: the Hong Kong Atrial Fibrillation Project

Little is known about the comparative effectiveness and safety of non–vitamin K antagonist oral anticoagulants (NOAC) compared to warfarin in Chinese atrial fibrillation (AF) patients. Our aim was to compare the ischemic stroke risk reduction and incidence of intracranial hemorrhage (ICH) of warfarin in relation to quality of anticoagulation control (as reflected by time in therapeutic range [TTR]), and to dabigatran and rivaroxaban in a real‐world cohort of Chinese AF patients.

Burden of upper gastrointestinal symptoms in patients prescribed dabigatran for stroke prevention

Background: Dabigatran, a non-vitamin K antagonist oral anticoagulant, has been shown to prevent stroke in patients with non-valvular atrial fibrillation. Nonetheless, studies show that 10%–30% of those prescribed dabigatran experience dyspepsia that may eventually lead to discontinuation of therapy and loss of clinical benefit. Aim: To evaluate the gastrointestinal tolerability of dabigatran utilizing a validated questionnaire, as well as determining subsequent non-compliance and drug discontinuation. Method: This is an observational study. All patients were assessed by a validated questionnaire, Hong Kong dyspepsia index, prior to drug prescription and again 4 weeks later. Results: In this study, 115 patients with non-valvular atrial fibrillation (mean age: 74.6 ± 11.4 years; mean CHA2DS2-VASc score was 3.39 ± 1.59) were prescribed dabigatran. At baseline, the mean Hong Kong dyspepsia index was 12.9 ± 1.6 and nine patients had significant dyspepsia (Hong Kong dyspepsia index ⩾ 16). After 4 weeks, the mean Hong Kong dyspepsia index was similar at 12.6 ± 1.9 (p = 0.23). There was no change in Hong Kong dyspepsia index after initiation of dabigatran in 59 (51.3%) patients, and improvement in 37 (32.2%). Only 19 (16.5%) patients had worsening of Hong Kong dyspepsia index, and among these 19 patients, only 1 patient (0.9%) discontinued dabigatran due to significant dyspepsia. Conclusion: Worsening of dyspepsia with dabigatran 110 mg twice daily was uncommon with correct drug administration and clear instructions provided. Systematic assessment of dyspeptic symptoms using a validated questionnaire (i.e. Hong Kong dyspepsia index) before and after treatment initiation allows a more objective comparison of dyspeptic symptoms.

Secular trends and etiologies of venous thromboembolism in Chinese from 2004 to 2016

INTRODUCTION Current epidemiological data for venous thromboembolism (VTE) are derived primarily from Caucasian populations from North America. Little is known for other ethnic groups. This study aimed to describe the incidence, etiologies, and the secular trends of VTE in a Chinese population. MATERIALS AND METHODS This was an observational study using a hospital VTE registry. RESULTS AND CONCLUSIONS Between 2004 and 2016, 2214 patients (mean age 66.2 ± 17.4 years, 57.2% female) were hospitalized for a novel occurrence of venous thromboembolism. Of these, 1444 patients (65.2%) had deep venous thrombosis and 770 patients (34.8%) had pulmonary embolism. Over the 13-year period, there was an increasing trend in the incidence of VTE from 28.1 per 100,000 population per year in 2004 to 48.3 per 100,000 population per year in 2016. There has been a disproportional increase in the incidence of VTE among those aged 75 years or above. Etiologically, the most common cause of VTE was active malignancy with an incidence that increased from 34.8% in 2005 to 60.9% in 2014. In conclusion, the incidence of venous thromboembolism in Hong Kong appears to be lower than that in previous Caucasian series. Nonetheless there has been an increasing incidence of VTE over the past decade, primarily related to aging and malignancy.

Impact of provision of time in therapeutic range value on anticoagulation management in atrial fibrillation patients on warfarin

Introduction The importance of time in therapeutic range (TTR) in patients prescribed warfarin therapy for stroke prevention in atrial fibrillation (AF) cannot be overemphasised. Aim To evaluate the impact of provision of TTR results during clinic visits on anticoagulation management. Design Single-centred, randomised controlled study. Setting Fifteen arrhythmia clinics in Hong Kong. Patients AF patients prescribed warfarin. Interventions Provision of TTR or no provision of TTR. Main outcome measures A documented discussion between doctors and patients about switching warfarin to a non-vitamin K oral anticoagulant (NOAC). Results Four hundred and eighty one patients with AF prescribed warfarin were randomly assigned to (1) a TTR provision group or (2) control. Their mean age was 73.6±12.0 years and 60.7% were men. The mean CHA2DS2-VASc score was 3.2±1.6 and the mean HASBLED score was 1.7±1.2. The mean TTR was 63.9%±29.9%. At the index clinic visit, 71 of 481 patients (14.8%) had a documented discussion about switching warfarin to a NOAC. Patients with provision of TTR results were more likely to discuss switching warfarin to a NOAC than controls (19.1% vs 10.6%, P=0.03), especially those with a TTR <65% (35.2% vs 10.6%, P<0.001). A higher proportion of patients with provision of TTR results switched to a NOAC (5.9% vs 4.1%, P=0.49). Conclusions The provision of TTR among patients on warfarin was associated with a discussion about switching from warfarin to a NOAC in those with TTR <65%, but did not result in actual switching to a NOAC, suggesting additional barriers.

Rationale and design of the screening of pulmonary hypertension in systemic lupus erythematosus (SOPHIE) study

Current guideline-recommended screening for pulmonary hypertension in patients with systemic sclerosis has not been evaluated in systemic lupus erythematosus (SLE), which is disproportionately prevalent in Asians. This multicentre, cross-sectional screening study aims to study the prevalence of pulmonary hypertension among SLE patients using these guidelines, and identify independent predictors and develop a prediction model for pulmonary hypertension in SLE patients. SLE patients from participating centres will undergo an echocardiography- and biomarker-based pulmonary hypertension screening procedure as in the DETECT study. Standard right heart catheterisation will be provided to patients with intermediate or high echocardiographic probability of pulmonary hypertension. Those with low echocardiographic probability will rescreen within 1 year. The primary measure will be the diagnosis and types of pulmonary hypertension and prevalence of pulmonary hypertension in SLE patients. The secondary measures will be the predictors and prediction models for pulmonary hypertension in SLE patients. The estimated sample size is approximately 895 participants. The results of the SOPHIE study will be an important contribution to the literature of SLE-related pulmonary hypertension and may be immediately translatable to real clinical practice. Ultimately, this study will provide the necessary evidence for establishing universal guidelines for screening of pulmonary hypertension in SLE patients. Screening pulmonary hypertension among SLE patients: SOPHIE study http://ow.ly/3iS930hlNPw