1) Women with atrial fibrillation experience worse quality of life and more symptoms than men despite less advanced forms of the disease.
2) While women receive similar rates of oral anticoagulation as men, they spend less time within the therapeutic range.
3) Despite receiving less optimal anticoagulation treatment, women had lower rates of overall and cardiovascular mortality compared to men in the study.
Leicester09 - Evidence Based Screening For Depression In Oncology Settings (N...Alex J Mitchell
This is a lecture from November 2009 to the cancer profressionals in Leicester. The aim was to introduce plans to roll out a screening programme in radiotherapy.
Short talk on my work developing novel tagging methods in Pinto abalone at the National Shellfisheries Association Annual Meeting this year (March 2012) in Seattle.
The document summarizes research conducted on the buying behaviour of consumers towards Sifti Desi Ghee. It found that females are the main decision makers for ghee purchases. Most customers are housewives with monthly incomes below Rs. 5000. The majority of respondents rated the quality of Sifti ghee as good and felt it provided value for money. Most have been buying Sifti ghee for over 4 years and would recommend it to others. The research provides insights for the company to expand into higher income demographics while capitalizing on existing customer satisfaction.
The document discusses workplace wellness programs. It provides data showing increases in health risk factors like obesity in the US population. Unhealthy behaviors can negatively impact employers through increased medical costs and decreased productivity from absenteeism and presenteeism. Wellness programs that conduct health risk assessments and provide resources like smoking cessation programs can generate savings through reduced health risks. The Affordable Care Act includes provisions to promote employer-based wellness programs and grants to help small businesses implement comprehensive programs.
SAN FRANCISCO—Results from ORBIT II, a clinical trial designed to evaluate the safety and efficacy of the Diamondback 360° Orbital Atherectomy System to treat de novo severely calcified coronary lesions, were presented March 9 at the American College of Cardiology (ACC) scientific session.
This document discusses different mechanical atherectomy devices used to treat peripheral artery disease, including directional atherectomy devices like SilverHawk, orbital atherectomy devices like Diamondback, rotational atherectomy like Jetstream, and excimer laser atherectomy. It provides details on the types of lesions each device is best suited for and outcomes from studies on device safety and efficacy.
Leicester09 - Evidence Based Screening For Depression In Oncology Settings (N...Alex J Mitchell
This is a lecture from November 2009 to the cancer profressionals in Leicester. The aim was to introduce plans to roll out a screening programme in radiotherapy.
Short talk on my work developing novel tagging methods in Pinto abalone at the National Shellfisheries Association Annual Meeting this year (March 2012) in Seattle.
The document summarizes research conducted on the buying behaviour of consumers towards Sifti Desi Ghee. It found that females are the main decision makers for ghee purchases. Most customers are housewives with monthly incomes below Rs. 5000. The majority of respondents rated the quality of Sifti ghee as good and felt it provided value for money. Most have been buying Sifti ghee for over 4 years and would recommend it to others. The research provides insights for the company to expand into higher income demographics while capitalizing on existing customer satisfaction.
The document discusses workplace wellness programs. It provides data showing increases in health risk factors like obesity in the US population. Unhealthy behaviors can negatively impact employers through increased medical costs and decreased productivity from absenteeism and presenteeism. Wellness programs that conduct health risk assessments and provide resources like smoking cessation programs can generate savings through reduced health risks. The Affordable Care Act includes provisions to promote employer-based wellness programs and grants to help small businesses implement comprehensive programs.
SAN FRANCISCO—Results from ORBIT II, a clinical trial designed to evaluate the safety and efficacy of the Diamondback 360° Orbital Atherectomy System to treat de novo severely calcified coronary lesions, were presented March 9 at the American College of Cardiology (ACC) scientific session.
This document discusses different mechanical atherectomy devices used to treat peripheral artery disease, including directional atherectomy devices like SilverHawk, orbital atherectomy devices like Diamondback, rotational atherectomy like Jetstream, and excimer laser atherectomy. It provides details on the types of lesions each device is best suited for and outcomes from studies on device safety and efficacy.
This document provides a summary of 6 late-breaking sessions to attend at the Heart Rhythm Society Scientific Sessions in Boston from May 13-16, 2015. The sessions include: (1) a study on the impact of remote monitoring on clinical events and healthcare utilization; (2) a randomized global trial comparing uninterrupted rivaroxaban to vitamin K antagonists in patients undergoing catheter ablation; and (3) a study comparing cryoballoon versus open irrigated radiofrequency ablation in patients with paroxysmal atrial fibrillation. The other sessions include: (4) first-in-human experience with a miniaturized transcatheter pacing system; (5) results from the Canadian Registry of Card
This document provides details on the top 5 sessions to attend at the HIMSS.15 conference. The sessions cover topics like structured cardiology procedure reporting, connected heart health using American Heart Association resources, using BI and analytics to reduce sepsis and heart failure readmissions, how health information exchanges can support population health through New York's Million Hearts initiative, and a session on transforming data into information and driving transformation. Speakers include doctors, public health experts, and data analysts.
This document provides details on the top 5 sessions to attend at the HIMSS.15 conference. The sessions cover topics like structured cardiology procedure reporting, connected heart health using American Heart Association resources, using BI and analytics to reduce sepsis and heart failure readmissions, how health information exchanges can support population health through New York's Million Hearts initiative, and a session on transforming data into actionable information. The sessions will take place between April 13-16, 2015 and include speakers such as doctors, healthcare executives, and data analysts.
This document summarizes 7 innovative technologies that will be on display at ACC.15:
1) Medtronic's CoreValve transcatheter aortic valve replacement system provides a minimally invasive alternative to open heart surgery for replacing diseased heart valves.
2) St. Jude Medical's CardioMEMS heart failure monitoring system allows clinicians to monitor pulmonary pressures and manage treatment in patients with heart failure.
3) Toshiba's dose-tracking system measures radiation skin dose during interventional procedures to help clinicians monitor patient radiation exposure.
4) Merge Cardio provides a centralized web-based system for physicians to manage multiple aspects of patients' integrated cardiovascular records.
The document summarizes several imaging sessions at the upcoming American College of Cardiology's Annual Scientific Session & Expo on March 14-16 in San Diego. Key sessions include:
1) Results from the PROMISE trial comparing diagnostic testing for chest pain will be presented on Saturday, and costs will be discussed on Sunday.
2) A joint multimodality imaging symposium with several societies will discuss imaging high risk patients, techniques for difficult diagnoses, and radiation safety.
3) An international perspective on cardiac imaging will be provided including a discussion of using CT on Egyptian mummies to study heart disease over millennia.
If you want to avoid damaging litigation, concentrate on dialogue and details. Cardiologists who fail to maintain detailed, two-way conversations with patients and thoroughly assess diagnostic data are at risk of negligence lawsuits, a study shows.
The 2014 RSNA conference in Chicago saw over 56,000 attendees, up 5% from the previous year, with more than 2,000 additional professional registrations. Although exhibitor attendance dipped slightly by 2%, the conference floor was packed with 636 exhibits occupying over 426,000 square feet. The conference featured special exhibits celebrating RSNA's 100th anniversary and highlighting the organization's contributions to advances in medical imaging over the past century.
Aos 213 01 nelson rivaroxaban effectiveness and safety in nvaf finalTrimed Media Group
This study compared the real-world effectiveness and safety of rivaroxaban versus warfarin for stroke prevention in nonvalvular atrial fibrillation patients using claims data. The study found:
1) Rivaroxaban and warfarin had similar risks of major bleeding, stroke, systemic embolism, and venous thromboembolism.
2) Rivaroxaban was associated with a higher risk of gastrointestinal bleeding compared to warfarin.
3) Patients were less likely to discontinue rivaroxaban treatment compared to warfarin, suggesting better treatment persistence with rivaroxaban.
This document summarizes a study examining the length of stay and economic implications of treating pulmonary embolism with rivaroxaban versus low molecular weight heparin-vitamin K antagonist (LMWH-VKA) in an emergency room setting. The study found that among patients in North America from the EINSTEIN PE trial, the median length of stay was 1 day shorter for those treated with rivaroxaban (3 days) compared to LMWH-VKA (4 days). This 1 day reduction in length of stay was associated with an estimated $2040 savings per patient for the rivaroxaban cohort based on average hospital costs. The study concluded that rivaroxaban was associated with a consistent
Shorr and bria innovation at the point-of-care rethinking the doctor-patient...Trimed Media Group
The document discusses innovations in doctor-patient interactions through technology. It proposes two solutions: 1) Creating a "story" of the patient's medical history and presenting issues for doctors to review before visits to improve care. This would be generated through automated document assembly. 2) Developing an "ad hoc" user interface optimized for point-of-care use, allowing doctors to take notes digitally in various formats like ink, checkboxes and dictation to focus on patient interaction instead of formal documentation. The goal is to enhance both the patient and provider experience through disruptive technology.
Kuperman Health Information Exchange & Care CoordinationTrimed Media Group
1) Care coordination requires improved information sharing both within care teams and across settings using health information exchange (HIE). However, current electronic health records (EHRs) were not designed for care coordination and do not adequately support sharing data and coordinating care.
2) NewYork-Presbyterian Hospital is working to enhance care coordination for patients with diabetes and depression by improving EHR tools, care team workflows, and data sharing across settings using its regional HIE. Key features include standardized screening and monitoring, patient and provider education, population health analytics, and secure messaging.
3) The success of care coordination interventions is being evaluated based on clinical outcomes like HbA1c and depression measures, as well as process measures
This document discusses the need for innovation in healthcare, particularly for the elderly population and their caregivers. It introduces the InfoSAGE project, which aims to create a "living laboratory" to study how technology can improve communication, coordination and collaboration between elderly patients and their families. InfoSAGE will connect various sources of health information and services through identity and content coordination to address the challenges of aging and caregiving. The goal is to develop tools that help address problems around care coordination, respecting patient preferences and reducing caregiver burnout, as electronic health records currently do not adequately meet the needs of elderly patients and their families.
[Hongsermeier] clinical decision support services amdis finalTrimed Media Group
1) Clinical Decision Support Services (CDSS) allow externalization of clinical knowledge and decision support logic from electronic health records (EHRs) to specialized CDSS providers.
2) The Clinical Decision Support Consortium (CDSC) is working on standards for knowledge management, specification, and sharing of CDS content and services.
3) Opportunities exist for EHR vendors to leverage external CDSS as curating all needed clinical knowledge internally is challenging, and most EHR CDS cannot support advanced inferencing required for personalized medicine. Challenges include ensuring appropriate implementation and use of external CDSS within EHR workflows.
This document discusses delivering clinical knowledge and guidance directly into healthcare workflows through clinical decision support (CDS). CDS aims to provide clinicians and patients with intelligently filtered, situation-specific information to enhance patient care. The goal is to repurpose existing clinical content from various sources and deliver the most precise and useful information for each workflow and information need. Physician information needs were analyzed from query data to develop an ontology of needs. Content is curated, indexed as discrete facts, and tailored for specific situations by matching it to patient data, workflows, and information needs. Knowledge delivery aims to integrate actionable tools and options directly into clinical systems like EHRs.
The document summarizes a presentation on providing collaborative and coordinated care for patients with complex illnesses. Some key points:
- To achieve the goals of improved health outcomes, quality of care, and reduced costs ("Triple Aim"), the healthcare system needs to focus on caring for patients with complex chronic conditions who account for a large portion of costs.
- Successful models involve interdisciplinary, team-based care coordinated across care settings. CareMore, a Medicare Advantage plan, achieves better outcomes and lower costs through intensive management of frail patients using nurse practitioners, protocols, home monitoring, and an electronic health record.
- Clinical IT can support collaborative care by enabling documentation, care planning, decision support, and information
This document discusses challenges with using electronic health records (EHRs) to support clinical knowledge management (KM) and continuous learning. It outlines several investments made by Lahey Health to address these challenges, including using an external collaboration platform to manage clinical decision support (CDS) content outside of the EHR. The document argues that EHRs are not designed for collaboration or learning, and that clinical KM 3.0 approaches are needed to help health systems and users continuously self-improve.
The document is from the Intelligent Health Lab and discusses several topics:
1. The Lab's director and its affiliation with Harvard.
2. The potential for an "App Store for Health" where innovators can create and distribute apps across EMR systems, similar to app stores for smartphones.
3. The vision of a "Learning Health System" where evidence is continuously generated from patient data to improve outcomes over time.
Kibbe expect direct health information exchange in the context of state 2 mea...Trimed Media Group
This document provides an introduction to Direct exchange for those engaged in Stage 2 Meaningful Use programs. It discusses how Direct exchange relates to Stage 2 MU objectives and the role of DirectTrust in supporting Direct exchange adoption. Direct exchange allows EHR users using different vendors to securely send and receive messages and attachments. It is one way providers can meet Stage 2 MU requirements for transmitting care summaries during transitions of care and allowing patients to view, download and transmit health information. The document describes how Direct exchange works, involving Health Information Service Providers, Certificate Authorities, Registration Authorities, and X.509 certificates to enable secure exchange between organizations and individuals.
Crotty engaging patients in new ways from open notes to social mediaTrimed Media Group
The document discusses new ways to engage patients through open notes and social media. It describes initial findings from the OpenNotes project that showed patients found value in reading clinical notes. It also outlines how patients use social media to find health information and connect with others. The document argues that healthcare providers can leverage these technologies and concepts to reduce information asymmetry, educate patients, and learn from them to provide more engaging and effective care.
This document provides a summary of 6 late-breaking sessions to attend at the Heart Rhythm Society Scientific Sessions in Boston from May 13-16, 2015. The sessions include: (1) a study on the impact of remote monitoring on clinical events and healthcare utilization; (2) a randomized global trial comparing uninterrupted rivaroxaban to vitamin K antagonists in patients undergoing catheter ablation; and (3) a study comparing cryoballoon versus open irrigated radiofrequency ablation in patients with paroxysmal atrial fibrillation. The other sessions include: (4) first-in-human experience with a miniaturized transcatheter pacing system; (5) results from the Canadian Registry of Card
This document provides details on the top 5 sessions to attend at the HIMSS.15 conference. The sessions cover topics like structured cardiology procedure reporting, connected heart health using American Heart Association resources, using BI and analytics to reduce sepsis and heart failure readmissions, how health information exchanges can support population health through New York's Million Hearts initiative, and a session on transforming data into information and driving transformation. Speakers include doctors, public health experts, and data analysts.
This document provides details on the top 5 sessions to attend at the HIMSS.15 conference. The sessions cover topics like structured cardiology procedure reporting, connected heart health using American Heart Association resources, using BI and analytics to reduce sepsis and heart failure readmissions, how health information exchanges can support population health through New York's Million Hearts initiative, and a session on transforming data into actionable information. The sessions will take place between April 13-16, 2015 and include speakers such as doctors, healthcare executives, and data analysts.
This document summarizes 7 innovative technologies that will be on display at ACC.15:
1) Medtronic's CoreValve transcatheter aortic valve replacement system provides a minimally invasive alternative to open heart surgery for replacing diseased heart valves.
2) St. Jude Medical's CardioMEMS heart failure monitoring system allows clinicians to monitor pulmonary pressures and manage treatment in patients with heart failure.
3) Toshiba's dose-tracking system measures radiation skin dose during interventional procedures to help clinicians monitor patient radiation exposure.
4) Merge Cardio provides a centralized web-based system for physicians to manage multiple aspects of patients' integrated cardiovascular records.
The document summarizes several imaging sessions at the upcoming American College of Cardiology's Annual Scientific Session & Expo on March 14-16 in San Diego. Key sessions include:
1) Results from the PROMISE trial comparing diagnostic testing for chest pain will be presented on Saturday, and costs will be discussed on Sunday.
2) A joint multimodality imaging symposium with several societies will discuss imaging high risk patients, techniques for difficult diagnoses, and radiation safety.
3) An international perspective on cardiac imaging will be provided including a discussion of using CT on Egyptian mummies to study heart disease over millennia.
If you want to avoid damaging litigation, concentrate on dialogue and details. Cardiologists who fail to maintain detailed, two-way conversations with patients and thoroughly assess diagnostic data are at risk of negligence lawsuits, a study shows.
The 2014 RSNA conference in Chicago saw over 56,000 attendees, up 5% from the previous year, with more than 2,000 additional professional registrations. Although exhibitor attendance dipped slightly by 2%, the conference floor was packed with 636 exhibits occupying over 426,000 square feet. The conference featured special exhibits celebrating RSNA's 100th anniversary and highlighting the organization's contributions to advances in medical imaging over the past century.
Aos 213 01 nelson rivaroxaban effectiveness and safety in nvaf finalTrimed Media Group
This study compared the real-world effectiveness and safety of rivaroxaban versus warfarin for stroke prevention in nonvalvular atrial fibrillation patients using claims data. The study found:
1) Rivaroxaban and warfarin had similar risks of major bleeding, stroke, systemic embolism, and venous thromboembolism.
2) Rivaroxaban was associated with a higher risk of gastrointestinal bleeding compared to warfarin.
3) Patients were less likely to discontinue rivaroxaban treatment compared to warfarin, suggesting better treatment persistence with rivaroxaban.
This document summarizes a study examining the length of stay and economic implications of treating pulmonary embolism with rivaroxaban versus low molecular weight heparin-vitamin K antagonist (LMWH-VKA) in an emergency room setting. The study found that among patients in North America from the EINSTEIN PE trial, the median length of stay was 1 day shorter for those treated with rivaroxaban (3 days) compared to LMWH-VKA (4 days). This 1 day reduction in length of stay was associated with an estimated $2040 savings per patient for the rivaroxaban cohort based on average hospital costs. The study concluded that rivaroxaban was associated with a consistent
Shorr and bria innovation at the point-of-care rethinking the doctor-patient...Trimed Media Group
The document discusses innovations in doctor-patient interactions through technology. It proposes two solutions: 1) Creating a "story" of the patient's medical history and presenting issues for doctors to review before visits to improve care. This would be generated through automated document assembly. 2) Developing an "ad hoc" user interface optimized for point-of-care use, allowing doctors to take notes digitally in various formats like ink, checkboxes and dictation to focus on patient interaction instead of formal documentation. The goal is to enhance both the patient and provider experience through disruptive technology.
Kuperman Health Information Exchange & Care CoordinationTrimed Media Group
1) Care coordination requires improved information sharing both within care teams and across settings using health information exchange (HIE). However, current electronic health records (EHRs) were not designed for care coordination and do not adequately support sharing data and coordinating care.
2) NewYork-Presbyterian Hospital is working to enhance care coordination for patients with diabetes and depression by improving EHR tools, care team workflows, and data sharing across settings using its regional HIE. Key features include standardized screening and monitoring, patient and provider education, population health analytics, and secure messaging.
3) The success of care coordination interventions is being evaluated based on clinical outcomes like HbA1c and depression measures, as well as process measures
This document discusses the need for innovation in healthcare, particularly for the elderly population and their caregivers. It introduces the InfoSAGE project, which aims to create a "living laboratory" to study how technology can improve communication, coordination and collaboration between elderly patients and their families. InfoSAGE will connect various sources of health information and services through identity and content coordination to address the challenges of aging and caregiving. The goal is to develop tools that help address problems around care coordination, respecting patient preferences and reducing caregiver burnout, as electronic health records currently do not adequately meet the needs of elderly patients and their families.
[Hongsermeier] clinical decision support services amdis finalTrimed Media Group
1) Clinical Decision Support Services (CDSS) allow externalization of clinical knowledge and decision support logic from electronic health records (EHRs) to specialized CDSS providers.
2) The Clinical Decision Support Consortium (CDSC) is working on standards for knowledge management, specification, and sharing of CDS content and services.
3) Opportunities exist for EHR vendors to leverage external CDSS as curating all needed clinical knowledge internally is challenging, and most EHR CDS cannot support advanced inferencing required for personalized medicine. Challenges include ensuring appropriate implementation and use of external CDSS within EHR workflows.
This document discusses delivering clinical knowledge and guidance directly into healthcare workflows through clinical decision support (CDS). CDS aims to provide clinicians and patients with intelligently filtered, situation-specific information to enhance patient care. The goal is to repurpose existing clinical content from various sources and deliver the most precise and useful information for each workflow and information need. Physician information needs were analyzed from query data to develop an ontology of needs. Content is curated, indexed as discrete facts, and tailored for specific situations by matching it to patient data, workflows, and information needs. Knowledge delivery aims to integrate actionable tools and options directly into clinical systems like EHRs.
The document summarizes a presentation on providing collaborative and coordinated care for patients with complex illnesses. Some key points:
- To achieve the goals of improved health outcomes, quality of care, and reduced costs ("Triple Aim"), the healthcare system needs to focus on caring for patients with complex chronic conditions who account for a large portion of costs.
- Successful models involve interdisciplinary, team-based care coordinated across care settings. CareMore, a Medicare Advantage plan, achieves better outcomes and lower costs through intensive management of frail patients using nurse practitioners, protocols, home monitoring, and an electronic health record.
- Clinical IT can support collaborative care by enabling documentation, care planning, decision support, and information
This document discusses challenges with using electronic health records (EHRs) to support clinical knowledge management (KM) and continuous learning. It outlines several investments made by Lahey Health to address these challenges, including using an external collaboration platform to manage clinical decision support (CDS) content outside of the EHR. The document argues that EHRs are not designed for collaboration or learning, and that clinical KM 3.0 approaches are needed to help health systems and users continuously self-improve.
The document is from the Intelligent Health Lab and discusses several topics:
1. The Lab's director and its affiliation with Harvard.
2. The potential for an "App Store for Health" where innovators can create and distribute apps across EMR systems, similar to app stores for smartphones.
3. The vision of a "Learning Health System" where evidence is continuously generated from patient data to improve outcomes over time.
Kibbe expect direct health information exchange in the context of state 2 mea...Trimed Media Group
This document provides an introduction to Direct exchange for those engaged in Stage 2 Meaningful Use programs. It discusses how Direct exchange relates to Stage 2 MU objectives and the role of DirectTrust in supporting Direct exchange adoption. Direct exchange allows EHR users using different vendors to securely send and receive messages and attachments. It is one way providers can meet Stage 2 MU requirements for transmitting care summaries during transitions of care and allowing patients to view, download and transmit health information. The document describes how Direct exchange works, involving Health Information Service Providers, Certificate Authorities, Registration Authorities, and X.509 certificates to enable secure exchange between organizations and individuals.
Crotty engaging patients in new ways from open notes to social mediaTrimed Media Group
The document discusses new ways to engage patients through open notes and social media. It describes initial findings from the OpenNotes project that showed patients found value in reading clinical notes. It also outlines how patients use social media to find health information and connect with others. The document argues that healthcare providers can leverage these technologies and concepts to reduce information asymmetry, educate patients, and learn from them to provide more engaging and effective care.
Crotty engaging patients in new ways from open notes to social media
ACC slides: ORBIT AF elucidates gender disparities for AF patients
1. Quality of Care, Symptoms, and 1-Year Outcomes
for Women vs Men with Atrial Fibrillation:
Primary Results from the ORBIT AF Registry
Jonathan P. Piccini, Sunghee Kim, Benjamin A. Steinberg, Rosalia Blanco,
Jack Ansell, Gregg C. Fonarow, Bernard J. Gersh, Alan S. Go, Elaine Hylek,
Peter R. Kowey, Kenneth W. Mahaffey, Laine Thomas, Paul Chang,
Eric D. Peterson on behalf of the ORBIT AF Investigators & Patients
ORBIT AF was funded by a research grant from Janssen.
2. Background
„ The prevalence of AF
is increasing in both
women and men
„ Few data exist on
quality of life and
subsequent outcomes
in women versus men
with AF
Our objective was to test whether women with AF receive
differential treatment and experience worse outcomes
relative to men.
PATH-AF Investigators. Circ Cardiovasc Qual Outcomes. 2012;5:85–93.
3. Outcomes Registry for Better Informed Treatment
of Atrial Fibrillation
„ Study Design
— Prospective, multicenter, outpatient AF registry
— Incident / Prevalent AF
„ Diverse practice settings (primary care, cardiology, EP)
— 184 sites
„ Enrollment period: June 29, 2010 to Aug 9, 2011
„ Follow-up every 6 months to 3 years
— Serial AF-related quality-of-life assessments (n=1339)
„ Adjusted relative rates for 1-year outcomes determined via
Cox proportional hazards modeling
Piccini JP. Am Heart J. 2011;162:606-12.
4. Baseline Characteristics
Men Women
N=5842 N=4290 P-value
Age, years 73 (65,80) 77 (69,83) <0.0001
Race 0.01
White 90 88
Black 5 6
Other 5 5
Private insurance 29 21 <0.0001
Prior/current smoker 58 36 <0.0001
5. Baseline Characteristics
Men, % Women, %
N=5842 N=4290 P-value
Hypertension 81 86 <0.0001
Diabetes mellitus 30 28 0.02
Heart failure 33 31 0.006
Prior stroke or TIA 14 17 <0.0001
Coronary disease 39 23 <0.0001
GI bleed 9 9 0.95
Obstructive sleep apnea 22 14 <0.0001
Family history of AF 14 16 <0.0001
6. Type of AF
60
54 Men Women
50 48
P<0.0001
40
Percent
29
30 26
20 18
16
10
5 5
0
First-detected Paroxysmal Persistent Permanent
11. ACC/AHA/Physician Consortium 2008
AF Performance Measures at 1 Year
Men Women
N=5842 N=4290 P-value
Oral anticoagulation in
those with CHADS2 >1 65% 65% 0.34
& no contraindication
Proportion with mean time
23% 20% 0.002
between INRs >30 days
Estes M. J Am Coll Cardiol, 2008; 51:865-884.
12. Percent Time in Therapeutic INR Range (TTR)
Men Women
N=3531 N=2602
Median time in Median time in
range range
INR (25th, 75th) (25th, 75th) P-value
<2.0 15 (3, 32) 17 (5,35) 0.0021
2.0 to 3.0 (TTR) 68 (49, 84) 65 (47, 81) <0.0001
>3.0 7 (0, 19) 8 (0, 20) 0.0025
13. Cumulative Incidence of TIA, Stroke,
or Systemic Embolism
Adjusted HR 1.24 (95% CI 0.89–1.71)
P=0.2039 1.96
1.28
# at risk:
Women 4038 4022 4005 3439 3415
Men 5446 5425 5410 4606 4595
14. Cumulative Incidence of New Onset HF
Adjusted HR 0.86 (95% CI 0.58–1.27)
2.14
P=0.4434 1.90
# at risk:
Women 4038 4018 3991 3421 3407
Men 5446 5420 5389 4584 4569
15. Cumulative Incidence of Cardiovascular Death
Adjusted HR 0.46 (95% CI 0.32–0.67)
2.15
P<0.0001
1.49
# at risk:
Women 4038 3989 3947 3906 3876
Men 5415 5365 5311 5253 5181
16. Cumulative Incidence of All-Cause Death
4.88
Adjusted HR 0.59 (95% CI 0.48–0.73) 4.06
P<0.0001
# at risk:
Women 4038 4003 3961 3914 3879
Men 5446 5390 5338 5271 5193
17. Major Outcomes at 1 Year
Men Women
# events # events Adjusted
(# events/ (# events/ HR
Outcome 100 pt-yrs) 100 pt-yrs) (95% CI) P-value
All-cause 266 164 0.59
<0.0001
death
(4.99)
(4.14)
(0.48,0.73)
Cardiovascular 117 60 0.46
<0.0001
death
(2.20)
(1.52)
(0.32,0.67)
Non-cardiovascular 118 88
—
—
death
(2.22)
(2.23)
New-onset/ 97 81 0.86
0.4434
HF diagnosis
(1.94)
(2.18)
(0.58,1.27)
Stroke or non-CNS 65 73 1.24
0.2039
embolism or TIA
(1.30)
(1.96)
(0.89,1.71)
1st hospitalization 1657 1306 1.02
0.6535
(all-cause)
(37.26)
(40.06)
(0.95,1.09)
Favors Favors
Women Men
18. Bleeding Outcomes at 1 Year
Men Women
# events # events Adjusted
(#events/ (#events/ HR
Outcome 100 pt-yrs) 100 pt-yrs) (95% CI) P-value
ISTH major 196 161 0.97
0.7552
bleeding
(3.96)
(4.38)
(0.80,1.17)
Fall in 133 103
—
—
hemoglobin
(2.69)
(2.80)
Transfusion of ≥2 U 100 79
—
—
PRBC/whole blood
(2.02)
(2.15)
Bleeding in 46 33
—
—
a critical site
(0.93)
(0.90)
Fatal 12 8
—
—
bleeding
(0.24)
(0.22)
Favors Favors
Women Men
19. Median AFEQT Scores at Baseline*
Men Women
120
P<0.0001
P=0.001 P=0.0138
P<0.0001 96 P<0.0001
100 92 94 92
86 89
81 81 83
80 73
60
40
20
0
Overall Symptoms Daily Tx Concern Tx
Activities Satisfaction
*P-values are unadjusted
20. Median AFEQT Scores at 1 Year*
Men Women
120
P<0.0001 P=0.001 P=0.0127
P<0.0001 100 97 100
100 P=0.0006
92 92 92
88
81 81
80 71
60
40
20
0
Overall Symptoms Daily Tx Concern Tx
Activities Satisfaction
*P-values are unadjusted
21. Limitations
„ Voluntary site participation
„ Potential for residual & unmeasured confounding
„ Underpowered to detect a difference in relatively
uncommon clinical events like stroke
— Prospectively powered for 2 years
22. Conclusions
„ Compared with men, women with AF have —
— Higher stroke risk
— Similar rates of oral anticoagulation
— Less time in therapeutic range
— More symptoms (despite less advanced AF)
— More functional limitation
— Worse quality of life
„ Women experienced lower adjusted overall and CV-related
death rates than men