Global public awareness about atrial fibrillation
Aaron M. WendelboeGary E. RaskobPantep AngchaisuksiriA BlancoHarry R. BüllerHenry DdunguJustin D. DvorakBeverley J. HuntElaine M. HylekAjay K. KakkarStavros KonstantinidesMicah McCumberClaire McLintockTetsumei UranoJeffrey I. Weitz
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Abstract:
Atrial fibrillation (AF) is an important cause of ischemic stroke that often remains undetected until stroke occurs. Awareness of the risk factors and symptoms is important so that AF can be diagnosed and thromboprophylaxis given. However, the extent of public awareness of AF is uncertain. We assessed public awareness of AF across six continents and compared it with that of other thrombotic and non-thrombotic disorders.In collaboration with Ipsos-Reid, we conducted an internet-based, cross-sectional survey between September and October of 2016 in 10 countries: Argentina, Australia, Canada, Germany, Japan, Thailand, the Netherlands, Uganda, United Kingdom, and United States. Participants were selected from survey panels in weighted, age-stratified categories (40-60, 61-74, and ≥75 years). The survey included 11 questions about demographics and assessed awareness about AF, as well as that of other thrombotic and non-thrombotic disorders. Proportions and 95% confidence intervals (CI) were calculated.Of a total of 6312 respondents, overall awareness of AF was 48% (95% CI, 46-50%), which was lower than awareness about other thrombotic and non-thrombotic disorders except for deep vein thrombosis (awareness 43%, 95% CI, 41-45%). Awareness about AF ranged from 25% to 69% across countries, while awareness of the risk factors for AF ranged from 8% to 52%, and awareness that AF leads to stroke ranged from 36% to 46%. Among those reporting awareness of AF, 82% correctly identified palpitations as an AF symptom.Global public awareness of AF is low. Improving awareness may empower patients to seek timelier stroke preventive care.Keywords:
Stroke
Demographics
Palpitations
Cross-sectional study
Twenty-two patients who had an acute episode of thrombosis in the deep veins of the legs were studied by a new technique of ascending functional cinephlebography 6 to 12 months after the episode of thrombosis.If the condition was diagnosed within 36 hours and the thrombus was dissolved rapidly valve function was preserved. When diagnosis was delayed there was a very great risk of permanent damage to the valves.
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The upper extremity deep vein thrombosis rate is increasing at the same time that the rate for insertions of peripherally inserted central catheters is on the rise. There is little information on whether the established risk factors for lower extremity deep vein thromboses are effective to predict the occurrence of upper extremity deep vein thrombosis. The purpose of this study was to identify patients at highest risk for upper extremity deep vein thrombosis in order to initiate effective prophylaxis. A retrospective review was undertaken of medical records of all patients with peripherally inserted central catheters inserted in a 6-month period at a Midwestern US hospital. Of the 233 charts reviewed, 17 (7.3%) recorded an upper extremity deep vein thrombosis during the patient's hospital stay. Of the multiple factors identified with deep vein thrombosis in the literature, a weighted risk factor measure, the upper extremity deep vein thrombosis prediction tool, was developed. Sensitivity of the instrument for upper extremity deep vein thrombosis is high (88%), as are its specificity (82%) and negative predictive value (99%), whereas the positive predictive value is low (28%). The total percentage of cases correctly classified is 82%. Further testing is indicated on a larger sample to extend the validity of this instrument.
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Compression sonography in patients with indeterminate or low-probability lung scans: lack of usefulness in the absence of both symptoms of deep-vein thrombosis and thromboembolic risk factors.M P Rosen, R G Sheiman, J Weintraub and C McArdleAudio Available | Share
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Abstract Background The 2020 European Society of Cardiology atrial fibrillation guidelines recommend opportunistic screening for atrial fibrillation by pulse taking or ECG rhythm strip in those aged over 65 years. Hypothesis We aimed to compare the diagnostic accuracy of pulse palpation to ECG rhythm strip when screening for atrial fibrillation. A secondary aim was to investigate whether participants with palpitations were more likely to be diagnosed with new atrial fibrillation. Methods The study population were 75/76 year old individuals that participated in the STROKESTOP II study, a Swedish screening study for atrial fibrillation. Pulse palpation of the radial pulse for 30 sec was performed by healthcare professionals and recorded as regular or irregular. Thereafter a 30‐sec single‐lead ECG was registered. Patients were asked also if they had a history of palpitations. Results Of the 6159 participants included in the study, 461 (7.5%) had irregular pulse. Twenty‐two (4.8%) of those with irregular pulse were diagnosed with atrial fibrillation on single‐lead ECG rhythm strip. Among those with regular pulse, 6 (0.1%) cases of new atrial fibrillation were found. The sensitivity of the pulse palpation test was 78.6% and positive predictive value 4.8%. The proportion of newly diagnosed atrial fibrillation was not different between those with and without history of palpitations. Conclusion Pulse palpation was inferior to single‐lead ECG when screening for atrial fibrillation. We therefore advocate the use of single‐lead ECG rather than pulse palpation when screening for atrial fibrillation. Palpitations did not predict atrial fibrillation.
Palpitations
Palpation
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Isolated calf vein thrombosis in the population of patients with deep vein thrombosis is found approximately in 10 to 25 % of cases. We present 3 cases of calf vein thrombosis which occurred due to unusual causes. Specific characteristics of this form of thromboembolic disease are discussed and compared to proximal deep vein thrombosis with emphasis to symptoms, risk of complications, prognosis and therapeutic approach.
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Objective To investigate how to prevent deep-vein thrombosis(DVT) after total knee replace-ment(TKR).Methods Deep vein thrombosis in 87 patients after TKR from 2004 to 2007 in the Third Hospital Affiliated to Suzhou University was retrospectively analyzed.Results Amony the 87 patients,13 were found having deep vein thrombosis,5 of 38 using low-molecular-weight beparin after TKR having deep vein thrombosis,6 of 35 cases using aspirin after TKR having deep vein thrombosis,5 of the 10 eases using mechanical preventive measures having deep vein thrombosis.The difference between low-molecular-weight heparin and aspirin group was not statistically significant.Conclusion Using low-molecular-weight heparin before TKR can prevent the occurrence of deep-vein thrombosis.Using epidural anesthesia,and a low-molee-ular-weight heparin drugs or aspirin after TKR can better prevent the formation of deep-vein thrombosis.
Key words:
total knee replacement; deep-vein thrombosis; prevention
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In general medical patients presenting with suspected deep vein thrombosis routine use of x ray venography was associated with a large fall in the proportion of patients with a final diagnosis of deep vein thrombosis, from 83% to 25% (p less than 0.001), and with an appreciable shortening of hospital stay, from 13.6 to 7.2 days. The diagnosis of deep vein thrombosis was rejected in only 4% of patients when a venogram was not performed, and it is estimated that two patients were treated with anticoagulants unnecessarily for every patient treated correctly. The risk, expense, and inconvenience of unnecessary anticoagulant treatment far exceeds the risk, expense, and inconvenience of performing venograms routinely. The common practice of misdiagnosing deep vein thrombosis clinically should be abandoned.
Venography
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