Insertable Cardiac Monitor Detects ‘Silent’ Atrial Fibrillation in High-Risk Patients:

Something to discuss with your doctor. I bet this is better than the apps available on your smartphone.
http://dgnews.docguide.com/insertable-cardiac-monitor-detects-silent-atrial-fibrillation-high-risk-patients?

May 16, 2017

By Louise Gagnon
CHICAGO -- May 16, 2017 -- The use of an insertable cardiac monitor (ICM) was effective in detecting “silent” atrial fibrillation (AF) in patients at high risk for AF and stroke, according to a study presented here at the 38th Annual Scientific Sessions of the Heart Rhythm Society (HRS).
“Atrial fibrillation unknown by patients or physicians is not uncommon,” said James A. Reiffel, MD, Division of Cardiology, Columbia University, and New York Presbyterian Hospital, New York, New York. “Patients can have AF without having symptoms, so they do not present themselves [to physicians]. There are a significant number of strokes that present without a prior history of AF. Lo and behold, you evaluate patients and find out that they have AF.”
The prospective, single-arm, multicentre study evaluated the presence and quantified the incidence of AF lasting at least 6 minutes in patients with unrecognised AF but at high risk for AF, such as patients with heart failure, hypertension, diabetes, and vascular disease.
The main outcome from the study was detection of AF at 18 months with secondary outcomes being detection rates from 30 days to 30 months. The researchers also looked at detection rates stratified by patients CHADS2 scores.
A total of 385 patients received an ICM and were followed for 22.5 months. The AF detection rate at 18 months was 29.3% with the rate as high as 40.0% at 30 months.
“The yield of the device is impressive,” said Dr. Reiffel, noting that 30 days of monitoring is often not sufficient to detect AF.
The AF detection rate did not differ by CHADS2 scores (P = .23). The median time from the time of insertion of the ICM to identification of the first AF episode was 123 days.
The technology was extremely well-tolerated, and its use did not produce any adverse events, said Dr. Reiffel.
More than half of the patients were prescribed oral anticoagulants after the identification of AF to reduce the risk of stroke.
Funding for this study was provided by Medtronic, Inc.
[Presentation title: High Incidence of Previously Unknown (Silent) Atrial Fibrillation in Patients at High Risk for Atrial Fibrillation and Stroke: Primary Results From the REVEAL-AF study. Abstract C-LBCT02-05]

(a) In patients with atrial fibrillation, 2 tools are best for predicting risk for stroke; a third tool is best for predicting risk for bleeding

I'll soon find out if this applies to me.
http://www.mcmasteroptimalaging.org/full-article/07bd6b405cc395b2de8727fbab083fb7

Lopes RD, Crowley MJ, Shah BR, et al. Stroke Prevention in Atrial Fibrillation AHRQ Comparative Effectiveness Review. Rockville, MD: Agency for Healthcare Research and Quality; 2013 Aug. Report No 13-EHC113-EF.

Review question

How effective are tools for predicting stroke and bleeding risk in patients with atrial fibrillation?

Background

Atrial fibrillation is an abnormal heart rhythm that can cause small clots to form in the heart. These clots can travel to the brain, causing a stroke.

Anticoagulant (or blood thinning) treatment is the therapy of choice for preventing stroke in non-valvular atrial fibrillation. However, anticoagulants can cause bleeding. People with atrial fibrillation vary a lot in their risk of stroke from AF, and in their risk of bleeding.

Prediction tools assess which people are most likely to benefit from treatment and which are most likely to be harmed.

How the review was done

This summary is based on a systematic review of 37 studies on predicting stroke risk and 17 studies on predicting bleeding in people with atrial fibrillation. Average age of participants ranged from 53 to 81 years. Publication period was 2000 to 2012.

What the researchers found

Scores from the CHADS2 and CHA2DS2-VASc are best for predicting risk for stroke. Their average prediction value is 0.70 (ranging from 0.66 to 0.75).

A value of 0.50 means that the tool is no better than chance in predicting an outcome. A value of 1.0 means that the tool predicts an event with certainty.

The strength of the evidence for these 2 tools is low.

The HAS-BLED score is best for predicting bleeding risk. Strength of the evidence is moderate.

Conclusions

The CHADS2 and CHA2DS2-VASc scores are best for predicting stroke in people with atrial fibrillation.

HAS-BLED scores are best for predicting bleeding risk.

---

Tools for predicting stroke or bleeding

Tool	Description
CHADS2	Congestive heart failure; Hypertension; Age 75 or older; Diabetes; prior Stroke [2 points]
CHA2DS2-VASC	Congestive heart failure; Hypertension; Age 75 or older [2 points]; Diabetes; prior Stroke [2 points]; Vascular disease; Age 65 to 74; Sex = female
HAS-BLED	1 point for each of Hypertension; Abnormal kidney or liver function; Stroke; Bleeding history or predisposition; Labile international normalized ratio; Elderly [older than 65]; Drugs/alcohol concomitantly

Study Finds Many AFib Patients Are Not Properly Assessed for Stroke and Bleeding Risks and Might Not Receive Optimal Treatment

You may have to determine yourself if you are receiving the optimal treatment. That would assume you could find the stroke protocol for afib stroke prevention.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=157321&CultureCode=en
Under- and over-prescribing and misdosing of oral anticoagulation therapy also occurring, according to a new report in the Canadian Journal of Cardiology
Patients with atrial fibrillation (AF) have an increased risk for stroke and are often prescribed oral anticoagulation (OAC) therapy. OAC therapy can prevent disastrous strokes, but at the expense of increased bleeding risks. There are now well-established guidelines to assess the risk of stroke and bleeding in AF patients to determine whether OAC is needed. However, in a new study in the Canadian Journal of Cardiology, researchers found that primary care physicians were often under- or over-estimating stroke and/or bleeding risk, in part because they failed to utilize guideline-recommended risk scoring approaches in one-half and three-quarters of their patients, respectively. This, in turn led to under- and over-prescription of OACs, misdosing, and other problems that could result in an unnecessarily increased risk of stroke and bleeding events.
“Anticoagulation in patients at risk for stroke is an important intervention to reduce the risk of this potentially devastating complication,” explained lead investigator Shaun G. Goodman, MD, MSc, of the Canadian Heart Research Centre, a cardiologist at St Michael’s Hospital, and the Heart & Stroke Foundation of Ontario Polo Chair at the University of Toronto. “The Canadian Cardiovascular Society (CCS) AF Guidelines recommend that all patients with AF should be stratified using a predictive index for the risk of stroke and for the risk of bleeding, and that most patients should receive antithrombotic therapy. However, despite these recommendations, the uptake of these evidence-based therapies was suboptimal. Among those who did receive anticoagulation with warfarin, as many as four in 10 patients spent less time in the therapeutic range we know is optimal to reduce the risk of stroke.”
A multi-institutional team of researchers collected data on 4,670 patients from the primary care practices of 474 physicians in Canada. As part of the Canadian Facilitating Review and Education to OptiMize stroke prevention in Atrial Fibrillation (FREEDOM AF) knowledge translation program (February-September 2011), primary care physicians were asked to classify patients for both stroke and bleeding risk as low, intermediate, or high in each category. They also noted whether a specific stroke or bleeding predictive index had been used to evaluate risk. Data included demographics as well as details about current stroke prevention therapies in use and other cardiovascular-related details. The researchers then calculated risk estimates using established systems called CHADS2 for stroke and HAS-BLED for bleeding, two well-known scoring methods that have been validated in many studies.
The investigators found that physicians did not provide any estimates of stroke risk for 15% of their patients and bleeding risk for 25% of patients. When risks were provided, they were based on a predictive stroke and bleeding risk index for only 50% and 26% of patients, respectively. The physicians provided both over- and under-estimation of stroke and bleeding risk in a large proportion of patients. Although antithrombotic therapy with warfarin was prescribed for 90% of the patients, 44% of patients were not receiving a proper dosage for over 70% of the time.
In an accompanying editorial, Laurent Macle, MD, Montreal Heart Institute, University of Montreal, and Jason G. Andrade, MD, Montreal Heart Institute and Vancouver General Hospital, discuss the implications of these results. “This study suggests that the decision to initiate OAC is complex and considers many factors beyond simple risk prediction tools, likely relating to the inherent subjectivity within the risk prediction scores. Specifically, previous studies indicate physicians selectively emphasize components of the risk prediction models, attributing greater weight to certain factors such as previous stroke and age, in preference to others such as hypertension and diabetes. As a result, for the same empiric CHADS2 score, a physician may subjectively categorize a patient as being at higher or lower risk. Given this complexity, the need exists for future knowledge translation activities with respect to the management of AF and stroke prevention, as well as for follow-up studies to ensure these knowledge translation activities are effecting appropriate changes in practice.”
Dr. Macle and Dr. Andrade caution that patients in this study were already being treated with OAC at a significantly greater rate than would be expected in a general AF population, so that the results might not be generalizable. Moreover, these data predate the release of newer OAC drugs such as apixaban, dabigatran, and rivaroxaban, which have different risk-benefit profiles and are now prescribed more frequently than warfarin.
Full bibliographic information“The Risk Stratification and Stroke Prevention Therapy Care Gap in Canadian Atrial Fibrillation Patients: Insights from the FREEDOM AF Program,” by Paul Angaran, MD; Paul Dorian, MD; Mary K. Tan, MSc; Charles R. Kerr, MD; Martin S. Green, MD; David J. Gladstone, MD, PhD; L. Brent Mitchell, MD; Carl Fournier, MD; Jafna L. Cox, MD; Mario Talajic, MD; Peter J. Lin, MD; Anatoly Langer, MD, MSc; Lianne Goldin; Shaun G. Goodman, MD, MSc (DOI: http://dx.doi.org/10.1016/j.cjca.2015.07.012).

“Evidence-Based Anticoagulation Decision Making for Atrial Fibrillation – How We Are Doing (Maybe Not So Well?),” by Laurent Macle, MD, and Jason Guy Andrade, MD (DOI: http://dx.doi.org/10.1016/10.1016/j.cjca.2015.06.025).

Aspirin Still Overprescribed for Stroke Prevention in Atrial Fibrillation

For your doctors consultation, do not do anything on your own.
http://www.docguide.com/aspirin-still-overprescribed-stroke-prevention-atrial-fibrillation?
Aspirin is still overprescribed for stroke prevention in atrial fibrillation (AF) despite the potential for dangerous side effects, according to a study published in the American Journal of Medicine.“The perception that aspirin is a safe and effective drug for preventing strokes in AF needs to be dispelled,” said lead author Gregory Y.H. Lip, MD, University of Birmingham, Birmingham, United Kingdom. “If anything, you could say that giving aspirin to patients with AF is harmful because it is minimally or not effective at stroke prevention, yet the risk of major bleeding or intracranial haemorrhage is not significantly different to well-managed oral anticoagulation.”
“All the contemporary guidelines say that aspirin should not be used for the prevention of stroke in patients with AF,” he added”. And yet our study shows that aspirin is still overprescribed in these patients.”
Prevention of strokes in patients with AF is based on identification of risk factors. Patients with no stroke risk factors (ie, CHA2DS2-VASc score of 0 in males or 1 in females) are considered low-risk and do not need any antithrombotic drugs. Patients with 1 or more risk factors should be offered effective stroke prevention, and thus be given an oral anticoagulant. The use of aspirin, either alone or in combination with an oral anticoagulant, is not recommended.
The study provides the most up-to-date picture of European cardiologists’ prescribing of antithrombotic treatment, which includes oral anticoagulation therapy (warfarin and the novel oral anticoagulants) and antiplatelet drugs (mainly aspirin). The data are from the EORP Atrial Fibrillation General Pilot Registry of more than 3,100 patients in 9 countries.
Overall the study found that the use of oral anticoagulants has improved over the last decade since the last Euro Heart Survey was performed. Where oral anticoagulation was used, most patients (72%) were prescribed warfarin and just 8% were prescribed a new oral anticoagulant.
“Novel oral anticoagulant uptake is still a bit low, probably because of differences in regulatory approval, costs and access to drugs in different countries,” said Dr. Lip. “But the main point is that overall oral anticoagulant uptake as a whole has improved in the last 10 years.”
Aspirin was commonly prescribed, either alone or in combination with an oral anticoagulant, when patients had myocardial infarction or coronary artery disease. The strongest reason to prescribe both drugs was coronary artery disease, which increased the use of combined therapy by more than 8-fold.
“Aspirin is still overused for stroke prevention in AF,” said Dr. Lip. “ESC guidelines say concomitant aspirin should not be given to anticoagulated patients with AF with stable vascular disease. The combination of drugs does not reduce cardiovascular events and stroke but does increase the risk of bleeding.”
Another worrying finding was that oral anticoagulants were under-prescribed in elderly patients, with aspirin alone more commonly prescribed.
“Elderly patients are at the highest risk for stroke and yet they are given aspirin which is not recommended and potentially harmful,” said Dr. Lip. “There is a perception that elderly patients do not do well on anticoagulation. But a number of studies now, including BAFTA, have shown that in elderly patients warfarin is far superior to aspirin in preventing stroke.”
Patients with paroxysmal AF were less likely to receive oral anticoagulation compared with patients with permanent AF.
“Cardiologists are continuing to under-prescribe anticoagulation in paroxysmal AF and the belief that these patients are at less risk is another myth,” said Dr. Lip. “ESC guidelines say that AF patients with stroke risk factors should receive oral anticoagulation irrespective of the type of AF. Our study of antithrombotic prescribing by cardiologists reveals a positive trend of increasing oral anticoagulant use. But worrying misconceptions and practices remain regarding aspirin, treatment of the elderly and paroxysmal AF.”
SOURCE: European Society of Cardiology

Study of First-in-Class WATCHMAN® Device Shows 75 Percent Reduction in Stroke Risk in Patients with Atrial Fibrillation Not Eligible for Oral Anticoagulation Therapy

Another A-fib option to ask your doctor about. From the African Business Review.
http://www.africanbusinessreview.co.za/press_releases/study-of-first-in-class-watchman-device-shows-75-percent-reduction-in-stroke-risk-in-patients-with-a
 Boston Scientific Corporation (NYSE: BSX) announces results from the ASA Plavix (ASAP) Study, which studied the WATCHMAN® Left Atrial Appendage Closure (LAAC) device.  The data showed a reduction in the risk of ischemic stroke by 75 percent in patients with atrial fibrillation who have a contraindication to oral anticoagulants such as warfarin.  Vivek Reddy, M.D., Director of Cardiac Arrhythmia Service at Mount Sinai Medical Center in New York and Coordinating Investigator of the study presented results today during a late-breaking session at the Heart Rhythm Society's 33rd Annual Scientific Sessions in Boston.
The prospective multi-center ASAP Study evaluated 150 patients with contraindications to warfarin, who were implanted with the WATCHMAN Device and treated with dual antiplatelet therapy for six months post-procedure.  Subjects were followed for a mean average of 14.4 months.  The study employed the widely recognized CHADS2 risk stratification score, which provides a clinical prediction tool for estimating the risk of stroke in patients with atrial fibrillation.  The CHADS2 score has been validated by numerous studies and is regularly used to determine whether treatment is required with anticoagulation or antiplatelet therapy.
"WATCHMAN is the most studied LAA closure device with more than 2,000 patients enrolled in prospective studies and nearly 4,000 patient-years of follow up," said Keith D. Dawkins, M.D., global chief medical officer for Boston Scientific.  "This novel device has been well received in more than 30 countries where it offers a safe and effective alternative to long-term treatment with oral anticoagulants."
Atrial fibrillation affects approximately 15 million patients worldwide and is a disorder that disrupts the ability of the heart to beat regularly and pump blood efficiently.  Patients in atrial fibrillation are at greater risk for stroke due to the migration of clots formed in the left atrial appendage (LAA).  Anticoagulants such as warfarin have traditionally been the only therapy for reducing stroke risk in these patients.  The Boston Scientific percutaneously delivered WATCHMAN Device is an alternative to long-term anticoagulation in patients eligible for anticoagulant therapy.  It is designed to close the LAA, thereby preventing clots forming within the appendage and being dislodged into the bloodstream where they can potentially cause a stroke. 
"Findings from the ASAP Study are promising in that closure of the LAA with the WATCHMAN Device produced a significant reduction in the expected ischemic stroke rate for this patient population," said Dr. Reddy.  "These results are very impressive and show potential for an effective device-based solution for higher-risk patients with limited pharmacologic options to reduce their risk of stroke."
For patients in the ASAP Study, the average baseline CHADS2 score of 2.8 equated to a predicted ischemic stroke rate of approximately 7.1 percent per year.  The observed rate of ischemic stroke for patients implanted with the WATCHMAN Device was 1.7 percent per year, a 75 percent reduction in stroke risk from the predicted stroke rate based on the CHADS2 score (p<0.01).  The corresponding upper confidence bound yielded a stroke rate of 4.4 percent per year, lower than the predicted stroke rate of 7.1 percent. 
Stroke rates in the ASAP study were similar to those observed in the PROTECT AF study, which assessed similar subjects not contraindicated to warfarin.   In the multi-center, randomized PROTECT AF trial, the WATCHMAN Device proved to be non-inferior to warfarin and demonstrated a 38 percent relative risk reduction for stroke, cardiovascular death and systemic embolism compared to long-term warfarin therapy in 707 patients. 
The WATCHMAN Device was approved for marketing in Europe and other CE Mark countries in 2009.  Boston Scientific is currently enrolling U.S. patients in the PREVAIL study, a confirmatory study designed to gain U.S. Food and Drug Administration approval.  Enrollment is expected to be completed in the second quarter of 2012.  The WATCHMAN Device is contraindicated in patients who are not eligible for anticoagulation therapy.  In the U.S., the WATCHMAN Device is an investigational device, limited by applicable law to investigational use and not available for sale.  The device was developed by Atritech, which Boston Scientific acquired in March 2011.  For more information, visit www.Atritech.net.   
For more news about Boston Scientific at the Heart Rhythm Society 33rd Annual Scientific Sessions, please follow us on Twitter @BostonSci.
About Boston ScientificBoston Scientific is a worldwide developer, manufacturer and marketer of medical devices that are used in a broad range of interventional medical specialties.  For more information, please visit: www.bostonscientific.com.  
Cautionary Statement Regarding Forward-Looking StatementsThis press release contains forward-looking statements within the meaning of Section 27A of the Securities Act of 1933 and Section 21E of the Securities Exchange Act of 1934.  Forward-looking statements may be identified by words like "anticipate," "expect," "project," "believe," "plan," "estimate," "intend" and similar words.  These forward-looking statements are based on our beliefs, assumptions and estimates using information available to us at the time and are not intended to be guarantees of future events or performance.  These forward-looking statements include, among other things, statements regarding markets for our products and launch cadence, regulatory approvals, clinical studies, trials and outcomes, product performance and competitive offerings.  If our underlying assumptions turn out to be incorrect, or if certain risks or uncertainties materialize, actual results could vary materially from the expectations and projections expressed or implied by our forward-looking statements.  These factors, in some cases, have affected and in the future (together with other factors) could affect our ability to implement our business strategy and may cause actual results to differ materially from those contemplated by the statements expressed in this press release.  As a result, readers are cautioned not to place undue reliance on any of our forward-looking statements. 
Factors that may cause such differences include, among other things: future economic, competitive, reimbursement and regulatory conditions; new product introductions; demographic trends; intellectual property; litigation; financial market conditions; and future business decisions made by us and our competitors.  All of these factors are difficult or impossible to predict accurately and many of them are beyond our control.  For a further list and description of these and other important risks and uncertainties that may affect our future operations, see Part I, Item 1A – Risk Factors in our most recent Annual Report on Form 10-K filed with the Securities and Exchange Commission, which we may update in Part II, Item 1A – Risk Factors in Quarterly Reports on Form 10-Q we have filed or will file hereafter.  We disclaim any intention or obligation to publicly update or revise any forward-looking statements to reflect any change in our expectations or in events, conditions or circumstances on which those expectations may be based, or that may affect the likelihood that actual results will differ from those contained in the forward-looking statements.  This cautionary statement is applicable to all forward-looking statements contained in this document.

CHADS2 predicts problems in AF patients taking dabigatran, warfarin

Make sure you talk to your doctor on the scoring for this. More charts at the link. 

CHADS2 predicts problems in AF patients taking dabigatran, warfarin

In patients with atrial fibrillation, a higher CHADS₂ score is associated with increased risk for stroke or systemic embolism, bleeding, and death, even with optimal anticoagulation with warfarin or dabigatran, according to a subgroup analysis of the Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) trial [1].

In anticoagulated patients, "the commonly used CHADS₂ risk score not only predicts stroke (as it was developed for), but also mortality and major bleeding," said first author Dr Jonas Oldgren (Uppsala University Hospital, Sweden).

The analysis was published November 15 in Annals of Internal Medicine.

Prediction rule

CHADS₂ is a simple and validated clinical prediction rule for estimating stroke risk in patients with atrial fibrillation not on anticoagulants, the authors note in their paper. Its value in predicting thrombotic and bleeding complications in patients on anticoagulant therapy is unclear.

Oldgren and colleagues used data from the RE-LY trial to assess thrombotic and bleeding risk according to baseline CHADS₂ score.

The study involved 18 112 patients with atrial fibrillation at risk of stroke randomized to dabigatran (Pradaxa, Boehringer Ingelheim), 110 mg or 150 mg twice daily, or warfarin at a dose adjusted to an international normalized ratio (INR) of 2.0-3.0 for a median of two years.

The main RE-LY results, published in 2009 in the New England Journal of Medicine, showed that the rates of stroke or systemic embolism and death each decreased by 0.5% per year with dabigatran 150 mg twice daily compared with dose-adjusted warfarin [2]. Rates of major bleeding did not differ, but intracranial bleeding was less common with dabigatran.

The CHADS₂ risk score assigns 1 point for a history of congestive heart failure, hypertension, diabetes, or being older than 75 years, and 2 points for a history of stroke or transient ischemic attack. In the RE-LY cohort, 5775 patients had CHADS₂ scores of 0-1, 6455 had scores of 2, and 5882 patients had scores of 3-6. Even on anticoagulation treatment, the risk of the primary outcome of stroke or systemic embolism increased with increasing CHADS₂ score, the authors report.

New Echo Method Triages Afib Stroke Risk

This one I'll leave to the doctors to decipher but you could impress your doctor by asking about it.
http://www.medpagetoday.com/clinical-context/Strokes/26189
Among patients with atrial fibrillation, a relatively new technique called speckle tracking echocardiography may help predict who is at risk for stroke, researchers reported.
The technique allows calculation of the global left atrial strain -- a measure of how much the dimension of the region changes over time, according to Partho Sengupta, MD, of the University of California Irvine in Irvine, Calif., and colleagues.
In a small cohort study, the global left atrial strain was significantly reduced in patients with atrial fibrillation, Sengupta and colleagues reported in the May issue of the Journal of the American Society of Echocardiography.
As well, it was the only echocardiographic variable associated with an increased risk of thromboembolism, as measured by the CHADS₂ scale, the researchers reported.
"To our knowledge, this is the first study that substantiates the relationship between (left atrial) strain and the clinical risk for stroke as quantified with CHADS₂ score," the researchers wrote.
Indeed, the study "throws new light on this relatively new measure of (left atrial) function," argued Christopher Choong, MBBChir, PhD, of the Royal North Shore Hospital in Sydney, Australia, in an accompanying editorial.
The results suggest that left atrial strain has the potential to be "one of the long-awaited missing links in stroke risk prediction using transthoracic echocardiography," Choong said.
But because the study is small, he added, it remains "premature to draw firm conclusions at this time about prognostic value and stroke risk prediction."
Indeed, the overall study included only 36 subjects with atrial fibrillation and 41 control participants and a substudy, evaluating the prognostic value of the strain measurement, included only 26, the researchers reported.
Sengupta and colleagues found that all conventional echocardiographic parameters except left ventricular diameter and filling pressure were significantly different (at P<0.001 for all comparisons) between patients and controls.
Indexed left atrial volume was significantly higher in subjects with atrial fibrillation than in controls, and the emptying fraction was reduced (at P<0.001 for both).
Using the speckle tracking method, the researchers were able to assess regional strain in 97% of left atrial segments, they reported.
They found that global longitudinal left atrial strain was significantly reduced (at P<0.001) in patients compared with controls, at 17.7 versus 35.5.
In a multivariate regression analysis, they reported, only indexed left atrial volume and atrioventricular plane displacement were independent predictors of global left atrial longitudinal strain, at P=0.004 and P<0.001, respectively.
In a logistic regression analysis, global left atrial strain was the only echocardiographic variable associated with greater odds of having a CHADS₂ score of at least 2. The odds ratio was 0.86, with a 95% confidence interval from 0.76 to 0.9, which was significant at P=0.02.
The researchers followed 26 of the fibrillation patients for a median period of 394 days, during which nine required inpatient care and three died.
Among those patients, they found, the CHADS₂ score was not significantly associated with the risk of admission or death but a second model, adding indexed left atrial volume, increased the predictive value significantly (at P<0.001).
A third model including both volume and global strain was significantly better than the second model at P=0.003, Sengupta and colleagues reported.
They cautioned that the study is small and needs confirmation in larger, prospective analyses.