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The 4S….
Stroke Risk…
Symptom Severity…
Severity Burden of AF
Substrate of AF
@KTamirisaMD @StavrosStavrak1 @StavrosDrakos @JonathanBehar @bogdienache @mencardio
#ESCCongress /3
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Stroke Risk – Simple – CHA2DS2-VASc Score
& HAS-BLED, to stratify bleeding
Symptom severity- Use the EHRA symptom scale
Burden- paroxysmal, persistent, permanent and if paroxysmal how frequently
Substrate of AF- comorbidities #ESCCongress /4
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Clear message about identification of AF on Atrial High Rate episodes on devices (pacemakers, implantable loop recorders) … Need to see an one lead ECG & there too need >30s. If not able to get this then close monitoring @ecgrhythms
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AF is common… More prevalent in Elderly, Men, Caucasian, lower socioeconomic calss, those with increased cardiometabolic risks and portends an adverse prognosis
@HeartOTXHeartMD @DrToniyaSingh @rahatheart1 @CardioIAN @RafKotronias
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AF is only part of the spectrum of disease for that individual…Everything else needs to be managed too…
Coronary disease
Hypertension
Obesity
Lack of exercise
Diabetes
Kidney failure
at least 6 & 12 month review initially @duanepinto
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New start like the ABC!
A-Anticoagulation – Easy CHA2DS2-VASc score – anticoagulate any man≥1 £ woman≥2 (remember sex is risk modifier not a risk predictor, so I cannot see how women can have score=1 (quoted in the algorithm below)
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Still on A... Check Bleeding risk – HAS-BLED if >3 aim to optimise any reversible conditions… do NOT withhold anticoagulation even if HAS-BLED is high.
@wordfinga @mancunianmedic @duanepinto @SaludHEALTHinfo @pabeda1 @VietHeartPA
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B – Better symptom control – rate controlled preferred! Rhythm controlled also suggested… and EMPHASIS on decision being PATIENT centred
C – cardiovascular risk management – put simple… manage all other cardiac conditions and risk
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Never forget Adherence… it is crucial!
@DrRajivsankar @corinne8154 @novitskiynic @MichaelPapadak2 @DrMichail @psmedic @drahmadzubair @AnkurGuptaMD @timir_paul @hannahcvimaging @hannahzr @SSharmacardio @ShraboniGhosal @docjohnnyg
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Can we predict the future of AF? We know that short episodes become longer and then paroxysmal AF becomes permanent… but here… #whycmr gets a central SPOT! Even as a CMR enthusiast I don't think many centres can identify LA fibrosis
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And on Atrial High Rate Episodes… we will be seeing a lot more of this… but is a 31s AF so different to 28s? We know AF is progressive so I believe more emphasis should be put on the CHA2DS2-VASc score than duration @DrPascalMeier
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And I think I missed some key messages in the flow of the tweetorial!
Heart rate - don't go too low... <110 bpm seems ok
@HolgerNef @PaulDendale @ProfessorHalle @PMarquesVidal @majalisalochen1 @DrTiberi @TharushaGunawa4 @justvick
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Rhythm control or Cardioversion? Putting the patient in control... unless rhythm strategy really fails...
@HEARTinMagnet @hvanspall @heartdoc45 @HanCardiomd @Izanagi_no_mi_ @CJohnston1903 @LopezOpitz @Vilavaite @Kfarooqi
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In short...get the right diagnosis, put the patients on the right management for AF and other conditions (including lifestyle, exercise, nutrition) then rate control-->rhythm control & work as a partnership @exerciseworks
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