/pdf/2016-esc-guidelines-for-the-management-of-atrial-36b2cidm1x.pdf

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS: The Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC). Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Endorsed by the European Stroke Organisation (ESO)

The Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC)  

Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC  

Endorsed by the European Stroke Organisation (ESO)

/pdf/2016-esc-guidelines-for-the-management-of-atrial-ba0601yb9m.pdf

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Authors/Task Force Members: Paulus Kirchhof* (Chairperson) (UK/Germany) Stefano Benussi* (Co-Chairperson) (Switzerland), Dipak Kotecha (UK), Anders Ahlsson (Sweden), Dan Atar (Norway), Barbara Casadei (UK), Manuel Castella (Spain), Hans-Christoph Diener (Germany), Hein Heidbuchel (Belgium), Jeroen Hendriks (The Netherlands), Gerhard Hindricks (Germany), Antonis S. Manolis (Greece), Jonas Oldgren (Sweden), Bogdan Alexandru Popescu (Romania), Ulrich Schotten (The Netherlands), Bart Van Putte (The Netherlands), and Panagiotis Vardas (Greece)

/pdf/2016-esc-guidelines-for-the-management-of-atrial-e0lfp612oq.pdf

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS: The Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC)Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESCEndorsed by the European Stroke Organisation (ESO)

Motivational Interviewing: Preparing People for Change

BACKGROUND: Tobacco smoking in pregnancy remains one of the few preventable factors associated with complications in pregnancy, stillbirth, low birthweight and preterm birth and has serious long-term implications for women and babies. Smoking in pregnancy is decreasing in high-income countries, but is strongly associated with poverty and increasing in low- to middle-income countries. OBJECTIVES: To assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes. SEARCH METHODS: In this fifth update, we searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 March 2013), checked reference lists of retrieved studies and contacted trial authors to locate additional unpublished data. SELECTION CRITERIA: Randomised controlled trials, cluster-randomised trials, randomised cross-over trials, and quasi-randomised controlled trials (with allocation by maternal birth date or hospital record number) of psychosocial smoking cessation interventions during pregnancy. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion and trial quality, and extracted data. Direct comparisons were conducted in RevMan, and subgroup analyses and sensitivity analysis were conducted in SPSS. MAIN RESULTS: Eighty-six trials were included in this updated review, with 77 trials (involving over 29,000 women) providing data on smoking abstinence in late pregnancy.In separate comparisons, counselling interventions demonstrated a significant effect compared with usual care (27 studies; average risk ratio (RR) 1.44, 95% confidence interval (CI) 1.19 to 1.75), and a borderline effect compared with less intensive interventions (16 studies; average RR 1.35, 95% CI 1.00 to 1.82). However, a significant effect was only seen in subsets where counselling was provided in conjunction with other strategies. It was unclear whether any type of counselling strategy is more effective than others (one study; RR 1.15, 95% CI 0.86 to 1.53). In studies comparing counselling and usual care (the largest comparison), it was unclear whether interventions prevented smoking relapse among women who had stopped smoking spontaneously in early pregnancy (eight studies; average RR 1.06, 95% CI 0.93 to 1.21). However, a clear effect was seen in smoking abstinence at zero to five months postpartum (10 studies; average RR 1.76, 95% CI 1.05 to 2.95), a borderline effect at six to 11 months (six studies; average RR 1.33, 95% CI 1.00 to 1.77), and a significant effect at 12 to 17 months (two studies, average RR 2.20, 95% CI 1.23 to 3.96), but not in the longer term. In other comparisons, the effect was not significantly different from the null effect for most secondary outcomes, but sample sizes were small.Incentive-based interventions had the largest effect size compared with a less intensive intervention (one study; RR 3.64, 95% CI 1.84 to 7.23) and an alternative intervention (one study; RR 4.05, 95% CI 1.48 to 11.11).Feedback interventions demonstrated a significant effect only when compared with usual care and provided in conjunction with other strategies, such as counselling (two studies; average RR 4.39, 95% CI 1.89 to 10.21), but the effect was unclear when compared with a less intensive intervention (two studies; average RR 1.19, 95% CI 0.45 to 3.12).The effect of health education was unclear when compared with usual care (three studies; average RR 1.51, 95% CI 0.64 to 3.59) or less intensive interventions (two studies; average RR 1.50, 95% CI 0.97 to 2.31).Social support interventions appeared effective when provided by peers (five studies; average RR 1.49, 95% CI 1.01 to 2.19), but the effect was unclear in a single trial of support provided by partners.The effects were mixed where the smoking interventions were provided as part of broader interventions to improve maternal health, rather than targeted smoking cessation interventions.Subgroup analyses on primary outcome for all studies showed the intensity of interventions and comparisons has increased over time, with higher intensity interventions more likely to have higher intensity comparisons. While there was no significant difference, trials where the comparison group received usual care had the largest pooled effect size (37 studies; average RR 1.34, 95% CI 1.25 to 1.44), with lower effect sizes when the comparison group received less intensive interventions (30 studies; average RR 1.20, 95% CI 1.08 to 1.31), or alternative interventions (two studies; average RR 1.26, 95% CI 0.98 to 1.53). More recent studies included in this update had a lower effect size (20 studies; average RR 1.26, 95% CI 1.00 to 1.59), I(2)= 3%, compared to those in the previous version of the review (50 studies; average RR 1.50, 95% CI 1.30 to 1.73). There were similar effect sizes in trials with biochemically validated smoking abstinence (49 studies; average RR 1.43, 95% CI 1.22 to 1.67) and those with self-reported abstinence (20 studies; average RR 1.48, 95% CI 1.17 to 1.87). There was no significant difference between trials implemented by researchers (efficacy studies), and those implemented by routine pregnancy staff (effectiveness studies), however the effect was unclear in three dissemination trials of counselling interventions where the focus on the intervention was at an organisational level (average RR 0.96, 95% CI 0.37 to 2.50). The pooled effects were similar in interventions provided for women with predominantly low socio-economic status (44 studies; average RR 1.41, 95% CI 1.19 to 1.66), compared to other women (26 studies; average RR 1.47, 95% CI 1.21 to 1.79); though the effect was unclear in interventions among women from ethnic minority groups (five studies; average RR 1.08, 95% CI 0.83 to 1.40) and aboriginal women (two studies; average RR 0.40, 95% CI 0.06 to 2.67). Importantly, pooled results demonstrated that women who received psychosocial interventions had an 18% reduction in preterm births (14 studies; average RR 0.82, 95% CI 0.70 to 0.96), and infants born with low birthweight (14 studies; average RR 0.82, 95% CI 0.71 to 0.94). There did not appear to be any adverse effects from the psychosocial interventions, and three studies measured an improvement in women's psychological wellbeing. AUTHORS' CONCLUSIONS: Psychosocial interventions to support women to stop smoking in pregnancy can increase the proportion of women who stop smoking in late pregnancy, and reduce low birthweight and preterm births.

/pdf/psychosocial-interventions-for-supporting-women-to-stop-i9wndny4ns.pdf

Psychosocial interventions for supporting women to stop smoking in pregnancy

AimsTo establish the prevalence of atrial fibrillation (AF) in the general population in the UK, and in those with risk factors.Methods and resultsThe prevalence of AF on electrocardiography was established in prospectively selected groups: 3960 randomly selected from the population, aged 45; 782 with a previous diagnosis of heart failure; and 1062 with a record of myocardial infarction, hypertension, angina, or diabetes. Patients were also assessed clinically and with echocardiography. Mortality was tracked for 8 years. Atrial fibrillation was found in 78 of the random population sample (2.0). Prevalence was 1.6 in women and 2.4 in men, rising with age from 0.2 in those aged 45-54 to 8.0 in those aged 75 and older. Half of all cases were in patients aged 75 and older. Only 23 of the 78 (29.5) of those in AF took warfarin. Of the 782 patients, 175 (22.4) with a diagnosis of heart failure were in AF, with normal left ventricular function in 95 (54.3) of these. Atrial fibrillation was found in 14 of the 244 (5.7) of those with a history of myocardial infarction, 15 of the 388 (3.9) of those with hypertension, 15 of the 321 (4.7) of those with angina, and 11 of the 208 (5.3) of diabetics. Adjusting for age and sex, mortality was 1.57 times higher for those in AF.ConclusionAtrial fibrillation is common in the elderly and those with clinical risk factors. Screening these groups would identify many with AF. Use of anticoagulation was low at the time of the initial assessments in the late 1990s; practice may have changed recently. © 2012 Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2012. For permissions please email: journals.permissionsoup.com.

/pdf/prevalence-of-atrial-fibrillation-in-the-general-population-1hhfaxidoa.pdf

Prevalence of atrial fibrillation in the general population and in high-risk groups: The ECHOES study

Atrial fibrillation (AF) is the commonest cardiac arrhythmia and is associated with high risk of embolic stroke, which can be reduced by anticoagulation. To have an impact on the population as a whole, patients must first be identified, and screening would be most cost-effective if targeted on patients at high risk of the condition. We have investigated the prevalence of AF in different age groups in the general population, and in those in high risk groups. Methods: We have analysed the prevalence of AF and associated echocardiographic risk actors in patients in the following groups: Random population sample, aged 45+; existing clinical diagnosis of heart failure (made by GP); previous MI; hypertension; angina; and diabetes. Patients were assessed clinically and with ECG and echocardiography, as part of a large heart failure epidemiology study. Results: The table details the prevalence of AF in the patient groups. Other associated risk factors for embolic stroke (mitral valve disease, left atrial enlargement or impaired LV function) are also listed, and the proportion anticoagulated at the time of screening. AF Abnormal echo in pts with AF On warfarin Population aged 45+ 43/2552 (1.7%) 29/43 (67%) 9/43 (21%) of which: 45-54 1/858 (0.1%) 1/1 (100%) 1/1 (100%) 55-64 7/785 (0.9%) 2/7 (29%) 1/7 (14%) 65-74 9/615 (1.5%) 6/9 (67%) 4/9 (44%) 75+ 26/294 (8.8%) 20/26 (77%) 3/26 (12%) Clinical heart failure 69/279 (24.7%) 61/69 (88%) 24/69 (35%) Previous MI 8/117 (6.8%) 6/8 (75%) 3/8 (37%) Hypertension 5/192 (2.6%) 2/5 (40%) 1/5 (20%) Angina 4/120 (3.3%) 3/4 (75%) 2/4 (50%) Diabetes 3/58 (5.2%) 3/3 (100%) 2/3 (67%) Conclusions: AF prevalence in the population sample was 1.7%, and in the high-risk groups overall was 11.6%; these patients had other embolic risk factors more frequently also. Targeting screening on such patients would identify many patients at high stroke risk.

Prevalence of atrial fibrillation in the general population and in high-risk groups

(1) Waris Qidwai Department of Family medicine, Aga Khan University E-mail: waris.qidwai@aku.edu (2) Tabinda Ashfaq Department of Family Medicine Aga Khan University E-mail: tabinda.ashfaq@aku.edu (3) Tawfik A M Khoja Director General, Executive Board, Health Ministers’ Council for Cooperation Council States Email: sgh@sgh.org.sa (4) Ketki Merchant Consultant, Mumbai, India E-mail: ketkimerchant@hotmail.com

/pdf/equity-in-healthcare-status-barriers-and-challenges-2g164sexly.pdf

Equity in healthcare: status, barriers, and challenges

Review: The effectiveness of a brief eating disorder training programme in medical settings

Background: People with Huntington’s disease (HD) often require tailored healthcare and support packages that develop as the disease progresses. The Client Service Receipt Inventory (CSRI) gathers retrospective information on service utilization. This study investigated the use of formal services and informal care as measured by the CSRI and explored associations between informal care, disease severity and functional ability as measured by the Unified Huntington’s Disease Rating Scale Total Motor Score (UHDRS-TMS) and functional scales. 

Methods: All monitored longitudinal data from annual clinical assessments of UHDRS-TMS and functional assessments and CSRI collected under the auspices of the European Huntington’s Disease Network (EHDN) REGISTRY study between the years 2004 and 2009 were utilised in the analyses. Disease severity was reflected by UHDRS-TMS. Functional ability was measured using the UHDRS functional scales. CSRI data were analysed according to percentage use of individual formal services and total estimated hours per week of informal care. Regression analyses were conducted to identify any associations between disease severity, functional ability and hours of informal care.

Results: 451 HD patients (212 female; 239 male) completed one visit; 105 patients (54 females; 51 males) completed two visits and 47 patients (20 females; 27 males) completed three visits in total over the 5 year period. The mean time between visits was 1.2 years. At visit one, 74% of the participants reported being in receipt of at least one formal hospital-based service in the previous six months, and 89% reported receipt of formal primary and community care services. In contrast, at the third visit, 62% of people had used hospital based services and 94% formal community based services in the previous six months. Fifty % of individuals required some form of informal care in the home at visit 1; this increased to 68% at visits 2 and 3. The mean (SD) estimated weekly total informal care hours at visits 1, 2 and 3 were 32.8 (49.4); 21.6 (53.6) and 21.3 (62.4) respectively. Only the scores on the Functional Assessment Scale (FAS) accounted for the variance in the weekly total informal care hours at each visit. 

Conclusions: Although it must be acknowledged that service use is supply driven, most HD patients across Europe surveyed as part of this study were in receipt of formal primary and community care services and to a lesser extent formal hospital based services. There was however a large reliance on informal care in the home. The FAS appear to have predictive value on informal care requirements and may have utility in facilitating pro-active service provision and in particular when managing carer burden in this population.

Utilisation of Healthcare and Associated Services in Huntington's disease: a data mining study.

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