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Delayed Use of anticoagulants for Atrial Fibrillation Patients Increases Their Risk of Dementia Featured

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New, first-of-its-kind, large-scale study includes more than 76,000 heart patients.A new study has found that dementia rates increase when anticoagulation treatment is delayed for patients with atrial fibrillation.


The first-of-its-kind, large-scale study, conducted by researchers at the Intermountain Medical Center Heart Institute in Salt Lake City, included more than 76,000 atrial fibrillation patients with no prior history of dementia who were treated with an antiplatelet or warfarin, a medication used to treat or prevent blood clots in veins or arteries.
Researchers studied patients from the time of their atrial fibrillation diagnosis to actual start of an antiplatelet agent or anticoagulation therapy. Patients were then divided into two categories: those who received immediate treatment (started less than 30 days from diagnosis) and those who received delayed treatment (started after one year).
Using a measurement scale known as the CHADS2 Vasc score to predict stroke risks and identify those at highest risk of cognitive decline with a delay in therapy, researchers found the risk of dementia in low-risk patients was 30 percent higher for those who received delayed treatment, and a significant 136 percent higher for high-risk patients.
Researchers also found that when the time period of delays were analyzed as a spectrum from less than 30 days; 31 days to one year; one to three years; and longer than three years, there was a linear risk of dementia as the delays in warfarin initiation increased.
Results of the study will be presented at Heart Rhythm 2017, the Heart Rhythm Society’s 38th Annual Scientific Sessions, in Chicago on May 12, 2017.
“Our results reinforce the importance of starting anticoagulation treatment as early as possible after a patient is diagnosed with atrial fibrillation,” said Jared Bunch, MD, director of heart rhythm research at the Intermountain Medical Center Heart Institute and medical director for heart rhythm services for the Intermountain Healthcare system in Salt Lake City. “We saw for the first time that waiting even just 30 days to initiate anticoagulation treatment can increase a patient’s long-term risk of developing dementia.
Anticoagulants, or blood thinners, like antiplatelets and warfarin are powerful stroke prevention interventions and are now being prescribed to millions worldwide. However, there’s often a delay in starting anticoagulants after an initial diagnosis of atrial fibrillation for a variety of reasons, including low risk of stroke, exploration of other treatment options like aspirin, older age, multiple comorbidities, and more.
The study included 76,230 atrial fibrillation patients who had no prior history of dementia or prior use of an anticoagulation treatment. Of those, 26,189 patients were ultimately treated with an antiplatelet (n=21,781) or warfarin anticoagulation (n=4,408).
“We want to ensure we’re doing everything possible to limit the risk of brain injury for our patients, and our study not only shows the importance of early therapy, but also shows the very limited role, if any, of aspirin for stroke prevention,” said Dr. Bunch. “In this study, the benefit was derived from using warfarin, and we hope newer anticoagulants that perform better than warfarin and are easier to start and use will further improve dementia risk.”
The authors of the study call for additional studies to increase understanding of how the risk of dementia increases over a longer period of time.
Researchers at the Intermountain Medical Center Heart Institute have recently launched a prospective study using dabigatran versus warfarin, which will closely study cognitive changes over a two-year period. The growing use of these newer treatments like direct oral anticoagulants — such as dabigatran, apixaban and rivaroxaban — are providing patients with more effective options and should also be studied to determine the risk of dementia, they say.


Source Newsroom: Intermountain Medical Center
CITATIONS
Heart Rhythm 2017, May 2017

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  • Postgrad course on exercise as medicine is being proposed

    Dear prospective applicant,

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    A glimpse of the proposed programme of studies

    Intended for:

    The programme of studies is aimed at a wide and diverse cohort of students wishing to pursue any careers in HEPA sectors mainly: exercise prescription; health promotion (policies and practice); general health and fitness industry; and to further their studies (e.g. PhD). It can also serve as an adjunct to enrich one’s knowledge of his / her established profession or career. Examples include: medical practitioners; pharmacists; nurses; physiotherapists; nutritionists; public health specialists; sport medicine specialists; sport psychologists; teachers of physical education (PE); coaches; gym instructors; and personal trainers. Fitness and sport enthusiasts are also encouraged to apply.

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    Mode of delivery:

    Seventy per cent will be delivered online and the rest of the thought units will be offered on a once weekly two-hour evening basis starting at 18.00hrs.

    Admission criteria:

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    Yours in health & exercise,

    Charles Micallef B.Pharm (Hons), M.Sc PAPH (Staff)                                                8th August 2017

    The two questions hereunder.

    1. In view of the above information, would you be interested in applying for this particular postgrad course leading to a specialisation in physical activity with respect to health, that is, a qualification that gives you the right to prescribe exercise for health, even at population levels?

    Yes or No: 

    1. What would you change from or suggest to what is being proposed?

    Please state your name & surname:

    Your current job / profession:

    Please save your changes and forward your reply to Charles Micallef on: This email address is being protected from spambots. You need JavaScript enabled to view it.

    Your cooperation is greatly appreciated.


    [1] In order to professionally recommend exercise for health, you may need to be registered in the appropriate regulatory board and be in possession of a warrant to operate with the respective titles.

    University of Malta

    Written on August 19, 2017
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