Introduction: The burden of Atrial Fibrillation (AF) has previously been associated with a higher... more Introduction: The burden of Atrial Fibrillation (AF) has previously been associated with a higher stroke risk in non-anticoagulated patients. We aim to find whether there is also an association between AF burden and recurrent cerebrovascular events in anticoagulated AF patients after their initial acute ischemic stroke (AIS) or transient ischemic attacks (TIA). Methods: The AREST study (Apixaban for Early Prevention of Recurrent Embolic Stroke and Hemorrhagic Transformation) was a multi-center, randomized controlled trial of early apixaban versus warfarin at one week post-TIA or two weeks post-AIS, in AF patients from 2015 to 2019. Subjects received either 30-day continuous electrocardiographic monitoring or an implantable device (i.e., pacemaker, loop recorder, or defibrillator). Logistic regression and Kendall's tau-b test were utilized to identify an association between AF burden and the proportion of subjects who developed recurrent cerebrovascular events. Results: Of 91 sub...
Background and Purpose: It is unknown when to start anticoagulation after acute ischemic stroke (... more Background and Purpose: It is unknown when to start anticoagulation after acute ischemic stroke (AIS) from atrial fibrillation (AF). Early anticoagulation may prevent recurrent infarctions but may provoke hemorrhagic transformation as AF strokes are typically larger and hemorrhagic transformation-prone. Later anticoagulation may prevent hemorrhagic transformation but increases risk of secondary stroke in this time frame. Our aim was to compare early anticoagulation with apixaban in AF patients with stroke or transient ischemic attack (TIA) versus warfarin administration at later intervals. Methods: AREST (Apixaban for Early Prevention of Recurrent Embolic Stroke and Hemorrhagic Transformation) was an open-label, randomized controlled trial comparing the safety of early use of apixaban at day 0 to 3 for TIA, day 3 to 5 for small-sized AIS (<1.5 cm), and day 7 to 9 for medium-sized AIS (≥1.5 cm, excluding full cortical territory), to warfarin, in a 1:1 ratio at 1 week post-TIA, or ...
Objective: Women with breast cancer (BCA) and cardiovascular disease (CVD) risk factors are at in... more Objective: Women with breast cancer (BCA) and cardiovascular disease (CVD) risk factors are at increased risk of developing cardiovascular complications when exposed to potentially cardiotoxic cancer therapy. The benefit of aggressive CVD risk factor modification to reduce adverse treatment-related psychologic and biologic effects is not well established.Methods: Using a single group pre-test, post-test design, 33 women with BCA receiving anthracycline and/or trastuzumab therapy participated in a 6-month comprehensive CVD risk reduction program involving formal cardio-oncology evaluation along with regular motivational counseling for improved nutrition and physical activity. Study parameters were assessed at baseline and 6 months with paired t-tests used to evaluate changes after the intervention.Results: The mental component summary score assessed by SF-36V2 improved significantly after program completion (45.0 to 48.8, effect size 0.37, p=0.017), however the physical component sum...
Journal of the American College of Cardiology, 2018
Background: Women with breast cancer (BCA) and cardiovascular (CV) risk factors (RF) are at incre... more Background: Women with breast cancer (BCA) and cardiovascular (CV) risk factors (RF) are at increased risk of developing CV complications when exposed to potentially cardiotoxic cancer therapy. The benefit of aggressive CV RF modification to reduce adverse treatment-related effects is not well established. Methods: Using a single group pre-test, post-test design, we enrolled 40 women with BCA receiving anthracycline and/or trastuzumab therapy in a 6-month comprehensive CV risk reduction (RR) program involving formal cardio-oncology evaluation along with regular motivational counseling for improved nutrition and physical activity. Study parameters were assessed at baseline and 6 months with paired t-tests used to evaluate for changes after the intervention. Results: Thirty-three women completed the program (mean age 51 years; 82% anthracycline use). The mental component summary score assessed by SF-36 V2 improved significantly after program completion (45.0 to 48.8, effect size 0.37, p=0.017), however the physical component summary score declined (46.2 to 40.9, effect size-0.53, p=0.004). Despite this decline in perceived physical health, markers of health-related fitness and nutritional status were maintained or improved: muscular endurance (assessed by arm-curl test) significantly improved (18.5 to 21.8, p=0.008) as did dietary habits measured by Rapid Eating Assessment for Participants (REAPS) (26.6 to 28.7, p=0.007). Systolic and diastolic blood pressure also improved after the intervention (136.7 to 124.1mm Hg, p=0.001 and 84.0 to 78.7mm Hg, p=0.031, respectively). No significant change in heart rate, body mass index, lipids, hemoglobin A1c, or left ventricular ejection fraction was observed. Conclusion: Patient-reported mental health improved significantly in women with BCA enrolled in a comprehensive CV RR program despite exposure to potentially cardiotoxic therapies. Although patient-reported physical health declined, measures of health-related fitness, dietary habits and CV health were maintained or improved. This study provides preliminary data for a future randomized controlled trial to evaluate the effects of a CV RR program in this high-risk cohort.
Introduction: The burden of Atrial Fibrillation (AF) has previously been associated with a higher... more Introduction: The burden of Atrial Fibrillation (AF) has previously been associated with a higher stroke risk in non-anticoagulated patients. We aim to find whether there is also an association between AF burden and recurrent cerebrovascular events in anticoagulated AF patients after their initial acute ischemic stroke (AIS) or transient ischemic attacks (TIA). Methods: The AREST study (Apixaban for Early Prevention of Recurrent Embolic Stroke and Hemorrhagic Transformation) was a multi-center, randomized controlled trial of early apixaban versus warfarin at one week post-TIA or two weeks post-AIS, in AF patients from 2015 to 2019. Subjects received either 30-day continuous electrocardiographic monitoring or an implantable device (i.e., pacemaker, loop recorder, or defibrillator). Logistic regression and Kendall's tau-b test were utilized to identify an association between AF burden and the proportion of subjects who developed recurrent cerebrovascular events. Results: Of 91 sub...
Background and Purpose: It is unknown when to start anticoagulation after acute ischemic stroke (... more Background and Purpose: It is unknown when to start anticoagulation after acute ischemic stroke (AIS) from atrial fibrillation (AF). Early anticoagulation may prevent recurrent infarctions but may provoke hemorrhagic transformation as AF strokes are typically larger and hemorrhagic transformation-prone. Later anticoagulation may prevent hemorrhagic transformation but increases risk of secondary stroke in this time frame. Our aim was to compare early anticoagulation with apixaban in AF patients with stroke or transient ischemic attack (TIA) versus warfarin administration at later intervals. Methods: AREST (Apixaban for Early Prevention of Recurrent Embolic Stroke and Hemorrhagic Transformation) was an open-label, randomized controlled trial comparing the safety of early use of apixaban at day 0 to 3 for TIA, day 3 to 5 for small-sized AIS (<1.5 cm), and day 7 to 9 for medium-sized AIS (≥1.5 cm, excluding full cortical territory), to warfarin, in a 1:1 ratio at 1 week post-TIA, or ...
Objective: Women with breast cancer (BCA) and cardiovascular disease (CVD) risk factors are at in... more Objective: Women with breast cancer (BCA) and cardiovascular disease (CVD) risk factors are at increased risk of developing cardiovascular complications when exposed to potentially cardiotoxic cancer therapy. The benefit of aggressive CVD risk factor modification to reduce adverse treatment-related psychologic and biologic effects is not well established.Methods: Using a single group pre-test, post-test design, 33 women with BCA receiving anthracycline and/or trastuzumab therapy participated in a 6-month comprehensive CVD risk reduction program involving formal cardio-oncology evaluation along with regular motivational counseling for improved nutrition and physical activity. Study parameters were assessed at baseline and 6 months with paired t-tests used to evaluate changes after the intervention.Results: The mental component summary score assessed by SF-36V2 improved significantly after program completion (45.0 to 48.8, effect size 0.37, p=0.017), however the physical component sum...
Journal of the American College of Cardiology, 2018
Background: Women with breast cancer (BCA) and cardiovascular (CV) risk factors (RF) are at incre... more Background: Women with breast cancer (BCA) and cardiovascular (CV) risk factors (RF) are at increased risk of developing CV complications when exposed to potentially cardiotoxic cancer therapy. The benefit of aggressive CV RF modification to reduce adverse treatment-related effects is not well established. Methods: Using a single group pre-test, post-test design, we enrolled 40 women with BCA receiving anthracycline and/or trastuzumab therapy in a 6-month comprehensive CV risk reduction (RR) program involving formal cardio-oncology evaluation along with regular motivational counseling for improved nutrition and physical activity. Study parameters were assessed at baseline and 6 months with paired t-tests used to evaluate for changes after the intervention. Results: Thirty-three women completed the program (mean age 51 years; 82% anthracycline use). The mental component summary score assessed by SF-36 V2 improved significantly after program completion (45.0 to 48.8, effect size 0.37, p=0.017), however the physical component summary score declined (46.2 to 40.9, effect size-0.53, p=0.004). Despite this decline in perceived physical health, markers of health-related fitness and nutritional status were maintained or improved: muscular endurance (assessed by arm-curl test) significantly improved (18.5 to 21.8, p=0.008) as did dietary habits measured by Rapid Eating Assessment for Participants (REAPS) (26.6 to 28.7, p=0.007). Systolic and diastolic blood pressure also improved after the intervention (136.7 to 124.1mm Hg, p=0.001 and 84.0 to 78.7mm Hg, p=0.031, respectively). No significant change in heart rate, body mass index, lipids, hemoglobin A1c, or left ventricular ejection fraction was observed. Conclusion: Patient-reported mental health improved significantly in women with BCA enrolled in a comprehensive CV RR program despite exposure to potentially cardiotoxic therapies. Although patient-reported physical health declined, measures of health-related fitness, dietary habits and CV health were maintained or improved. This study provides preliminary data for a future randomized controlled trial to evaluate the effects of a CV RR program in this high-risk cohort.
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