Atrial Fibrilation, HF, QTc Prolongation Flashcards
(54 cards)
AFib is caused by…
Abnormal electrical conduction in atria, resulting in chaotic, uncoordinated contraction of atrial chambers
Patients with AFib may experience…
SOB, fatigue, palpitations
Chest discomfort
Anxiety, sweating
Or may be asymptomatic - patients can flip in + out of AFib
Two key clinical issues with AFib are…
Significant increased risk of ischemic stroke
Increased heart rate increases risk of heart failure
Stroke risk in AFib is managed via…
Anticoagulation with warfarin or DOAC’s
The dilemna of age with AFib and anticoagulation is…
Incidence of AFib increases with age, but advanced age increases risk for both stroke + major bleeds
Advanced age is a deterrent to anticoagulation due to…
Bleed risk
Adherence/INR monitoring with warfarin
Underestimation of benefit
Evidence for anticoagulation in Afib was shown via…
BAFTA trial - warfarin vs. ASA; anticoagulation significantly reduced strokes with no significant difference in major bleed rates
If individuals with AFib are unsuitable for anticoagulation, we could try…
ASA + clopidogrel to decrease stroke risk
However, did increase risk of major bleeding
Advantages of DOAC’s over warfarin include…
Equal/superior efficacy
Less ICH
No INR monitoring, fewer drug/food interactions
Disadvantages of DOAC’s over warfarin include…
More GI bleeds
Less long-term safety data
Caution in renal impairment/CI in severe renal impairment
Not indicated with mechanical heart valves
Some are $$$
Warfarin may be preferable over a DOAC when…
Someone has labile INR’s
Severe renal dysfunction
Unique points of dabigatran include…
Most GI upsetting
Most highly renally eliminated
BID dosing
Unique points of rivaroxaban include…
Needs to be taken with food for adequate absorption
OD dosing
Unique points of edoxaban include…
Has more DI’s
OD dosing
Unique points of apixaban include…
Best safety data so far
Shows superior efficacy compared to warfarin
BID dosing
Best choice when renal function is borderline
To determine risk of bleeding, we can use…
HAS-BLED criteria
Caution if score is 3+
Does anticoagulation contribute to fall risk?
Overall benefit with stroke prevention heavily outweighs risk of falls
Anticoagulation + Antiplatelet therapy combined may be warranted for…
Post-PCI with high risk features for thrombotic CV events
Adherence with DOAC’s is important due to…
Rapid onset/offset - unreliable adherence will cause periods of no anticoagulation
Warfarin should be avoided in individuals with cognitive impairment, due to…
Frequent INR monitoring - likely will not have ability to self-manage dosage adjustments
Factors to consider when deciding between rate vs. rhythm control include…
Duration of AFib
Bothersome AFib symptoms
Comorbid heart failure
Likelihood of successful rhythm control decreases as Afib duration increases. Therefore, with persistent Afib we would focus on…
Rate control
A trial that explored rhythm control in patients with early AFib (<1 year) found that…
Risks > Benfits - serious AE’s related to antiarrhythmic treatment
Abalation is often less desirable for older adults due to…
Increased risk of procedural AE’s, and increased likelihood of Afib recurrence post-ablation
