Hi, everyone... it's still the Christmas season for me! but news about AF is always on my radar, so here's something I just noticed.
Cardiologist/EP Dr. John Mandrola just published a very interesting Substack article on whether and how the duration of an AF episode affects whether to take an anticoagulant. He quotes from and analyzes some significant studies that would be of interest to many of us. He's also looking at whether there is much stroke risk when you have SCAF--"sub-clinical AF". That's the silent and short kind that gets picked up by medical devices (that only last seconds to a few hours), and from this, it appears the stroke risk is 1% . Makes for some interesting reading and discussion! As always, more studies are needed. (Where have we heard THAT before? )
You will want to read the whole thing (& read very carefully) the specifics at johnmandrola.substack.com. Click on the title as above, "AF Duration? Another big story from 2023." You can also subscribe free to his Substack articles, which I can recommend.
We are always hoping for more randomized clinical trials (RCT's) to give us real-life data about the risks and rewards of various treatments, and I appreciate that this EP/cardiologist is spending time watching, analyzing, and critiquing these AF-related studies as they come out. He seems to be a careful analyst respects the details, and doesn't make unsupported generalizations.
Always grateful for the kindness of this group. Wishing constant NSR and many joys in 2024 to everyone! Cheers, Diane
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healingharpist
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HH: We are always hoping for more randomized clinical trials (RCT's) to give us real-life data about the risks and rewards of various treatments
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We got one 😄
REACT-AF is a US, multi-institutional trial in conjunction with Apple Watch.
It will among other things, try and show whether stroke risk is dependent on afib frequency and duration, or not. To do so, one randomized group will take thinners daily and the other group, only when the Watch shows an event lasting longer than 60 minutes and then only for 30 days. Both groups will be CHADS 1-4.
The idea is to limit/eliminate exposure/risk to thinners, if data shows one group's approach not inferior to the other.
A number of EP's such as Mandrola (and mine), are already incorporating afib burden/duration into their risk calculation for stroke based on smaller studies, but others are waiting for more trial data such as REACT-AF will hopefully provide.
Thanks to you, too, Jim. I know Mandrola is waiting eagerly for the REACT-AF results. BTW, like yours, 2 of my cardio/EP's and my GP, over the last few yrs, have also considered my afib burden and my overall health picture (low blood pressure, ulcerative colitis history, non smoker, normal heart, etc. etc.) in our discussions of stroke risk & whether to take anti-coagulants (not at this time). So glad we are starting to get more data. Diane
Hi Cookie, It started in July, 2023 at Johns Hopkins University (Baltimore, MD) and is running until 2029. Here's the Clinical Trial info--scroll down to see the inclusion criteria and other details: classic.clinicaltrials.gov/...
They are currently recruiting patients into the study. There will no doubt be some reports coming out as the enrollment for the trial builds, and they begin to accumulate data. Diane
Thanks for this post. I'm really interested in this topic. Information about short-lived irregular atrial activity is often either vague or non-existant. I will certainly have a read of the article.
You're welcome, John. And please don't miss mjames1's response about the REACT-AF trial, an important one for this subject; we're awaiting the results. Best, Diane
There's also this interesting article by Dr. Rod Passman (lead investigator on REACT-AF trial) that includes duration of AF events and Chads2 score in a stroke risk assessment table ...
Interesting Bob, In the smartwatch, wearable section he mentions an updated Apple algorithm for those with known AF that measures more regularly and shows weekly burden. I wonder if that’s only in new Watches or whether we can download the update….
Sorry, I'm from a generation that never used smart watches, and I have subsequently avoided being seduced by the Apple machine. So no Apple smart watch, but if the trial is successful re PIP anticoagulation in 7 (?) years time, I might have to change the habit of a "lifetime". 🤔
I suggest you ask mjames1 re your query, as he seems to understand such matters.
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