2024
Anticoagulation Alone vs Anticoagulation Plus Aspirin or DAPT Following Left Atrial Appendage Occlusion
Reinhardt S, Gibson D, Hsu J, Kapadia S, Yeh R, Price M, Piccini J, Nair D, Christen T, Allocco D, Freeman J. Anticoagulation Alone vs Anticoagulation Plus Aspirin or DAPT Following Left Atrial Appendage Occlusion. Journal Of The American College Of Cardiology 2024, 84: 889-900. PMID: 39197978, DOI: 10.1016/j.jacc.2024.05.067.Peer-Reviewed Original ResearchConceptsLeft atrial appendage occlusionRate of adverse eventsAdverse eventsLAA closure deviceAppendage occlusionAntithrombotic strategiesP2Y<sub>12</sub> inhibitorsDays of follow-upMultivariable Cox proportional hazards regressionClosure deviceRisk of adverse eventsCox proportional hazards regressionWatchman FLX deviceDual antiplatelet therapyDevice-related thrombusProportional hazards regressionStroke/transient ischemic attackAntithrombotic regimensFLX deviceAntiplatelet therapyDOACsGroup patientsFollow-upMultivariate analysisHazards regression
2023
DAPT Is Comparable to OAC Following LAAC With WATCHMAN FLX A National Registry Analysis
Coylewright M, Holmes D, Kapadia S, Hsu J, Gibson D, Freeman J, Yeh R, Piccini J, Price M, Allocco D, Nair D. DAPT Is Comparable to OAC Following LAAC With WATCHMAN FLX A National Registry Analysis. JACC Cardiovascular Interventions 2023, 16: 2708-2718. PMID: 37943200, DOI: 10.1016/j.jcin.2023.08.013.Peer-Reviewed Original ResearchConceptsDual antiplatelet therapyDevice-related thrombusOral anticoagulationWatchman FLXStroke preventionLong-term oral anticoagulationComposite endpoint rateMedical therapy optionsNational registry analysisSimilar safety profilePropensity-matched analysisAtrial appendage occlusionAspirin patientsDAPT patientsMajor bleedingAntiplatelet therapyComposite endpointDrug regimensMedication regimensAppendage occlusionComorbid conditionsAtrial fibrillationRegistry analysisSafety profileMean age
2022
Left Atrial Appendage Occlusion Versus Oral Anticoagulation in Atrial Fibrillation : A Decision Analysis.
Chew DS, Zhou K, Pokorney SD, Matchar DB, Vemulapalli S, Allen LA, Jackson KP, Samad Z, Patel MR, Freeman JV, Piccini JP. Left Atrial Appendage Occlusion Versus Oral Anticoagulation in Atrial Fibrillation : A Decision Analysis. Annals Of Internal Medicine 2022, 175: 1230-1239. PMID: 35969865, DOI: 10.7326/m21-4653.Peer-Reviewed Original ResearchConceptsDirect oral anticoagulantsHigh bleeding riskLower stroke riskClinical effectiveness dataAtrial fibrillationBleeding riskStroke riskOral anticoagulantsIschemic strokeEffectiveness dataHAS-BLED scoreIndividual riskHigh stroke riskMajor bleeding riskNonvalvular atrial fibrillationPatient's individual riskPrimary end pointAtrial appendage occlusionBase-case analysisOral anticoagulationPrior strokeVASc scoreStroke preventionWatchman deviceAppendage occlusionAntithrombotic Therapy After Left Atrial Appendage Occlusion in Patients With Atrial Fibrillation
Freeman JV, Higgins AY, Wang Y, Du C, Friedman DJ, Daimee UA, Minges KE, Pereira L, Goldsweig AM, Price MJ, Reddy VY, Gibson D, Doshi SK, Varosy PD, Masoudi FA, Curtis JP. Antithrombotic Therapy After Left Atrial Appendage Occlusion in Patients With Atrial Fibrillation. Journal Of The American College Of Cardiology 2022, 79: 1785-1798. PMID: 35512858, PMCID: PMC9097170, DOI: 10.1016/j.jacc.2022.02.047.Peer-Reviewed Original ResearchMeSH KeywordsAnticoagulantsAspirinAtrial AppendageAtrial FibrillationFibrinolytic AgentsFrailtyHumansStrokeTreatment OutcomeWarfarinConceptsLeft atrial appendage occlusionAdverse eventsPivotal trialsWatchman deviceTreatment protocolAntithrombotic strategiesAppendage occlusionLower riskFrailty regressionPercutaneous left atrial appendage occlusionNational Cardiovascular Data RegistryContemporary U.S. practiceDual antiplatelet therapyAtrial appendage occlusionConcomitant aspirinPostprocedure careAdjusted riskAntiplatelet therapyAntithrombotic medicationAntithrombotic therapyAtrial fibrillationAdverse outcomesTrial protocolAntithrombotic agentsMedication strategiesPatient-Level Analysis of Watchman Left Atrial Appendage Occlusion in Practice Versus Clinical Trials
Friedman DJ, Du C, Wang Y, Agarwal V, Varosy PD, Masoudi FA, Holmes DR, Reddy VY, Price MJ, Curtis JP, Freeman JV. Patient-Level Analysis of Watchman Left Atrial Appendage Occlusion in Practice Versus Clinical Trials. JACC Cardiovascular Interventions 2022, 15: 950-961. PMID: 35512918, PMCID: PMC9370831, DOI: 10.1016/j.jcin.2022.02.029.Peer-Reviewed Original ResearchConceptsRegistry patientsHemorrhagic stroke riskIschemic strokeWarfarin patientsTrial patientsStroke riskLAAO patientsClinical practiceMore pericardial effusionsPeriprocedural ischemic strokePropensity-matched analysisAtrial appendage occlusionCox proportional hazardsPatient-level dataFine-Gray modelMore comorbiditiesPROTECT AFNoncardiovascular deathPericardial effusionHemorrhagic strokeAppendage occlusionDevice implantationTrial criteriaClinical trialsSimilar riskHeart Rhythm Society Atrial Fibrillation Centers of Excellence Study: A survey analysis of stakeholder practices, needs, and barriers
Sandhu RK, Seiler A, Johnson CJ, Bunch TJ, Deering TF, Deneke T, Kirchhof P, Natale A, Piccini JP, Russo AM, Hills MT, Varosy PD, Araia A, Smith AM, Freeman J. Heart Rhythm Society Atrial Fibrillation Centers of Excellence Study: A survey analysis of stakeholder practices, needs, and barriers. Heart Rhythm 2022, 19: 1039-1048. PMID: 35428582, DOI: 10.1016/j.hrthm.2022.02.022.Peer-Reviewed Original ResearchConceptsStroke preventionHeart failure preventionAF-related complicationsPatient-centered approachTask ForceAdvanced practice professionalsHealth care systemAF careModifiable causesStroke riskEmergency departmentCare pathwayMajor unmetInpatient settingTreatment statusPatientsCare deliveryFrequent barriersOrder setsCare systemStandardized protocolCommon barriersComprehensive questionnairePreventionHospital administratorsTo Occlude or Not to Occlude the Left Atrial Appendage in Women—Reply
Darden D, Freeman JV, Hsu JC. To Occlude or Not to Occlude the Left Atrial Appendage in Women—Reply. JAMA Cardiology 2022, 7: 464-465. PMID: 35171204, DOI: 10.1001/jamacardio.2021.5933.Peer-Reviewed Original Research
2021
Dosing of Direct Oral Anticoagulants in Patients with Moderate Chronic Kidney Disease in US Clinical Practice: Results from the Outcomes Registry for Better Informed Treatment of AF (ORBIT-AF II)
Jackson LR, Schrader P, Thomas L, Steinberg BA, Blanco R, Allen LA, Fonarow GC, Freeman JV, Gersh BJ, Kowey PR, Mahaffey KW, Naccarelli G, Reiffel J, Singer DE, Peterson ED, Piccini JP. Dosing of Direct Oral Anticoagulants in Patients with Moderate Chronic Kidney Disease in US Clinical Practice: Results from the Outcomes Registry for Better Informed Treatment of AF (ORBIT-AF II). American Journal Of Cardiovascular Drugs 2021, 21: 553-561. PMID: 33786798, DOI: 10.1007/s40256-021-00473-x.Peer-Reviewed Original ResearchMeSH KeywordsAged, 80 and overAnticoagulantsAtrial FibrillationFemaleHumansMaleRegistriesRenal Insufficiency, ChronicUnited StatesConceptsModerate chronic kidney diseaseChronic kidney diseaseAtrial fibrillationRoutine clinical practiceClinical practiceInappropriate dosingOral anticoagulantsKidney diseaseConclusionIn routine clinical practiceMedian CHA2DS2VASc scoreComorbid medical conditionsDirect oral anticoagulantsUS clinical practiceBetter Informed TreatmentCockcroft-Gault formulaOne-thirdML/minCrCl 30CHA2DS2VASc scoreCreatinine clearanceRenal functionMedian ageDosage adjustmentOutcomes RegistryPrescribed doses
2020
Effect of Temporary Interruption of Warfarin Due to an Intervention on Downstream Time in Therapeutic Range in Patients With Atrial Fibrillation (from ORBIT AF)
Madhavan M, Holmes DN, Piccini JP, Freeman JV, Fonarow GC, Hylek EM, Kowey PR, Mahaffey KW, Pieper K, Peterson ED, Chan PS, Allen LA, Singer DE, Naccarelli GV, Reiffel JA, Steinberg BA, Gersh BJ, Investigators O. Effect of Temporary Interruption of Warfarin Due to an Intervention on Downstream Time in Therapeutic Range in Patients With Atrial Fibrillation (from ORBIT AF). The American Journal Of Cardiology 2020, 132: 66-71. PMID: 32826041, DOI: 10.1016/j.amjcard.2020.07.006.Peer-Reviewed Original ResearchConceptsInternational normalized ratioFirst therapeutic international normalized ratioTherapeutic international normalized ratioTherapeutic rangeAtrial fibrillationMajor bleedingTemporary interruptionAF patientsSubtherapeutic international normalized ratioBetter Informed TreatmentLow therapeutic rangeProportional hazards modelOutcomes RegistryNormalized ratioHigh incidenceLower riskHazards modelPatientsInformed TreatmentWarfarinSubsequent outcomesMonthsAnticoagulationRank testWeeksPatterns of oral anticoagulation use with cardioversion in clinical practice
Geurink K, Holmes D, Ezekowitz MD, Pieper K, Fonarow G, Kowey PR, Reiffel JA, Singer DE, Freeman J, Gersh BJ, Mahaffey KW, Hylek EM, Naccarelli G, Piccini JP, Peterson ED, Pokorney SD. Patterns of oral anticoagulation use with cardioversion in clinical practice. Heart 2020, 107: 642-649. PMID: 32591363, DOI: 10.1136/heartjnl-2019-316315.Peer-Reviewed Original ResearchConceptsStroke/transient ischemic attackVitamin K antagonistsNovel oral anticoagulantsTransient ischemic attackTransoesophageal echocardiogramAtrial fibrillationClinical practiceAtrial Fibrillation IIOral anticoagulation useTime of cardioversionBetter Informed TreatmentMonths of enrollmentIncidence of deathLow-risk procedureSimilar ratesAnticoagulation useIschemic attackMajor bleedingK antagonistsOral anticoagulantsClinical outcomesOutcomes RegistryCardiovascular hospitalisationAF diagnosisInclusion criteriaOutcomes of Cardiac Catheterization in Patients With Atrial Fibrillation on Anticoagulation in Contemporary in Practice
Sherwood MW, Piccini JP, Holmes DN, Pieper KS, Steinberg BA, Fonarow GC, Allen LA, Naccarelli GV, Kowey PR, Gersh BJ, Mahaffey KW, Singer DE, Ansell JE, Freeman JV, Chan PS, Reiffel JA, Blanco R, Peterson ED, Rao SV. Outcomes of Cardiac Catheterization in Patients With Atrial Fibrillation on Anticoagulation in Contemporary in Practice. Circulation Cardiovascular Interventions 2020, 13: e008274. PMID: 32408815, DOI: 10.1161/circinterventions.119.008274.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, OralAgedAnticoagulantsAtrial FibrillationCardiac CatheterizationDrug Administration ScheduleFactor Xa InhibitorsFemaleHemorrhageHumansMaleMiddle AgedPercutaneous Coronary InterventionPlatelet Aggregation InhibitorsRegistriesRisk AssessmentRisk FactorsStrokeTime FactorsTreatment OutcomeUnited StatesWarfarinConceptsDirect-Acting Oral AnticoagulantsActing Oral AnticoagulantsOral anticoagulationCardiac catheterizationRadial artery accessAtrial fibrillationMajor bleedingOral anticoagulantsMedian ageArtery accessAtrial Fibrillation II registryPatients' median ageReal-world registryChronic kidney diseaseThird of patientsBetter Informed TreatmentManagement of patientsOAC typeAntiplatelet therapyDiabetes mellitusFemoral accessContemporary cohortOutcomes RegistryKidney diseaseMyocardial infarctionSwitching warfarin to direct oral anticoagulants in atrial fibrillation: Insights from the NCDR PINNACLE registry
Sciria CT, Maddox TM, Marzec L, Rodwin B, Virani SS, Annapureddy A, Freeman JV, O'Hare A, Liu Y, Song Y, Doros G, Zheng Y, Lee JJ, Daggubati R, Vadlamani L, Cannon C, Desai NR. Switching warfarin to direct oral anticoagulants in atrial fibrillation: Insights from the NCDR PINNACLE registry. Clinical Cardiology 2020, 43: 743-751. PMID: 32378265, PMCID: PMC7368350, DOI: 10.1002/clc.23376.Peer-Reviewed Original ResearchConceptsDirect oral anticoagulantsAF patientsAtrial fibrillationOral anticoagulantsAvailability of DOACsChronic warfarin therapyMultivariable hierarchical regressionNCDR PINNACLE RegistryPattern of anticoagulationProspective cohort studyPractice-level factorsPractice-level variationPINNACLE RegistryPrescribed warfarinSwitched patientsClinical characteristicsCohort studyStroke riskWarfarin therapyCurrent guidelinesPatientsWarfarinAnticoagulationPrivate insuranceSignificant predictorsDecline in renal function and oral anticoagulation dose reduction among patients with atrial fibrillation
Inohara T, Holmes DN, Pieper K, Blanco RG, Allen LA, Fonarow GC, Gersh BJ, Hylek EM, Ezekowitz MD, Kowey PR, Reiffel JA, Naccarelli GV, Chan PS, Mahaffey KW, Singer DE, Freeman JV, Steinberg BA, Peterson ED, Piccini JP. Decline in renal function and oral anticoagulation dose reduction among patients with atrial fibrillation. Heart 2020, 106: heartjnl-2019-315792. PMID: 31911503, DOI: 10.1136/heartjnl-2019-315792.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, OralAgedAged, 80 and overAnticoagulantsAtrial FibrillationFemaleHumansKidneyMaleProspective StudiesConceptsAtrial fibrillationRenal functionOral anticoagulationDose reductionAtrial Fibrillation II registryBetter Informed TreatmentML/minCrCl declineOral anticoagulantsCreatinine clearanceOutcomes RegistryGuideline criteriaPatientsPackage insertsUS FoodDrug AdministrationMean declineInformed TreatmentNOACsAnticoagulationFibrillationRegistryDosingCrClOne-fourthPost–Emergency Department Atrial Fibrillation Clinics A Shifting Paradigm in Care? ∗
Freeman JV, Ganeshan R. Post–Emergency Department Atrial Fibrillation Clinics A Shifting Paradigm in Care? ∗. JACC Clinical Electrophysiology 2020, 6: 53-55. PMID: 31971906, DOI: 10.1016/j.jacep.2019.10.006.Peer-Reviewed Original Research
2019
Outcomes and Anticoagulation Use After Catheter Ablation for Atrial Fibrillation
Freeman JV, Shrader P, Pieper KS, Allen LA, Chan PS, Fonarow GC, Gersh BJ, Kowey PR, Mahaffey KW, Naccarelli G, Reiffel JA, Singer DE, Go AS, Hylek EM, Steinberg BA, Peterson ED, Piccini JP. Outcomes and Anticoagulation Use After Catheter Ablation for Atrial Fibrillation. Circulation Arrhythmia And Electrophysiology 2019, 12: e007612. PMID: 31830822, DOI: 10.1161/circep.119.007612.Peer-Reviewed Original ResearchConceptsAF catheter ablationOral anticoagulationRisk of strokeAF ablationCatheter ablationAntiarrhythmic medicationsDe novo AF ablationDiscontinuation of OACPropensity score-matched cohortAtrial fibrillation catheter ablationAF ablation patientsAnti-arrhythmic medicationsAtrial Fibrillation RegistryStroke prevention therapyBetter Informed TreatmentCohort of patientsPatterns of treatmentProportional hazards regressionUS national registryAnticoagulation useCause deathMajor bleedingSystemic embolismCardiovascular deathCause hospitalizationAssociation Between Warfarin Control Metrics and Atrial Fibrillation Outcomes in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation
Pokorney SD, Holmes DN, Thomas L, Fonarow GC, Kowey PR, Reiffel JA, Singer DE, Freeman JV, Gersh BJ, Mahaffey KW, Hylek EM, Naccarelli GV, Ezekowitz MD, Piccini JP, Peterson ED. Association Between Warfarin Control Metrics and Atrial Fibrillation Outcomes in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation. JAMA Cardiology 2019, 4: 756-764. PMID: 31268487, PMCID: PMC6613340, DOI: 10.1001/jamacardio.2019.1960.Peer-Reviewed Original ResearchConceptsInternational normalized ratioBetter Informed TreatmentAtrial fibrillationTherapeutic rangeWarfarin controlThrombotic eventsINR valuesStroke riskClinical factorsOutcomes RegistrySubsequent bleedingInformed TreatmentMaximum international normalized ratioRecent international normalized ratioINR measuresNet reclassification improvement indexAtrial fibrillation outcomesAtrial Fibrillation RegistrySubsequent stroke riskMulticenter cohort studyClinical risk modelTraditional clinical factorsLogistic regression modelsINR controlMajor bleedsTreatment of atrial fibrillation with concomitant coronary or peripheral artery disease: Results from the outcomes registry for better informed treatment of atrial fibrillation II
Inohara T, Shrader P, Pieper K, Blanco RG, Allen LA, Fonarow GC, Gersh BJ, Go AS, Ezekowitz MD, Kowey PR, Reiffel JA, Naccarelli GV, Chan PS, Mahaffey KW, Singer DE, Freeman JV, Steinberg BA, Peterson ED, Piccini JP, Patients and Investigators O. Treatment of atrial fibrillation with concomitant coronary or peripheral artery disease: Results from the outcomes registry for better informed treatment of atrial fibrillation II. American Heart Journal 2019, 213: 81-90. PMID: 31129441, DOI: 10.1016/j.ahj.2019.04.007.Peer-Reviewed Original ResearchMeSH KeywordsAgedAnticoagulantsAtrial FibrillationCardiovascular DiseasesCoronary Artery DiseaseDrug Therapy, CombinationFactor Xa InhibitorsFemaleHemorrhageHumansMaleMiddle AgedMyocardial InfarctionMyocardial RevascularizationPeripheral Arterial DiseasePlatelet Aggregation InhibitorsProportional Hazards ModelsProspective StudiesRegistriesStrokeTreatment OutcomeWarfarinConceptsNew-onset atrial fibrillationDirect oral anticoagulantsConcomitant antiplatelet therapyPeripheral artery diseaseAtrial fibrillationVascular diseaseAntiplatelet therapyMajor bleedingArtery diseaseMyocardial infarctionORBIT-AF II registryAtrial Fibrillation IIImproved cardiovascular outcomesVascular disease patientsProportional hazards modelOutcomes of individualsOral anticoagulationCardiovascular outcomesOral anticoagulantsTriple therapyMost patientsPatient characteristicsCoronary diseaseDual therapyNeurological events
2018
Association of Race/Ethnicity With Oral Anticoagulant Use in Patients With Atrial Fibrillation: Findings From the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II.
Essien UR, Holmes DN, Jackson LR, Fonarow GC, Mahaffey KW, Reiffel JA, Steinberg BA, Allen LA, Chan PS, Freeman JV, Blanco RG, Pieper KS, Piccini JP, Peterson ED, Singer DE. Association of Race/Ethnicity With Oral Anticoagulant Use in Patients With Atrial Fibrillation: Findings From the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II. JAMA Cardiology 2018, 3: 1174-1182. PMID: 30484833, PMCID: PMC6583087, DOI: 10.1001/jamacardio.2018.3945.Peer-Reviewed Original ResearchConceptsDirect-acting oral anticoagulantsAtrial Fibrillation IIOral anticoagulant useOral anticoagulantsBetter Informed TreatmentAtrial fibrillationAnticoagulant useRace/ethnicityWhite individualsOutcomes RegistryHispanic individualsBlack individualsInformed TreatmentOne-year persistenceOral anticoagulant discontinuationQuality of anticoagulationEthnic differencesSelf-reported race/ethnicitySocioeconomic factorsQuality of careHispanic groupsAnticoagulant discontinuationDOAC useInappropriate dosingCohort studyB-type natriuretic peptide, disease progression and clinical outcomes in atrial fibrillation
Inohara T, Kim S, Pieper K, Blanco RG, Allen LA, Fonarow GC, Gersh BJ, Ezekowitz MD, Kowey PR, Reiffel JA, Naccarelli GV, Chan PS, Mahaffey KW, Singer DE, Freeman JV, Steinberg BA, Peterson ED, Piccini JP. B-type natriuretic peptide, disease progression and clinical outcomes in atrial fibrillation. Heart 2018, 105: 370. PMID: 30228248, DOI: 10.1136/heartjnl-2018-313642.Peer-Reviewed Original ResearchConceptsB-type natriuretic peptideAtrial fibrillationAF progressionBNP levelsMajor bleedingBNP valuesNatriuretic peptideDisease progressionAtrial Fibrillation II registryBiomarker-based risk stratificationElevated BNP valuesBetter Informed TreatmentPersistent atrial fibrillationCox frailty modelCardiovascular outcomesComposite outcomeBNP concentrationsNeurological eventsClinical outcomesOutcomes RegistryRisk stratificationPatient outcomesInformed TreatmentPatientsBleedingPharmacotherapy for Atrial Fibrillation in Patients With Chronic Kidney Disease: Insights From ORBIT‐AF
Washam JB, Holmes DN, Thomas LE, Pokorney SD, Hylek EM, Fonarow GC, Mahaffey KW, Gersh BJ, Kowey PR, Ansell JE, Go AS, Reiffel JA, Freeman JV, Singer DE, Naccarelli G, Blanco R, Peterson ED, Piccini JP. Pharmacotherapy for Atrial Fibrillation in Patients With Chronic Kidney Disease: Insights From ORBIT‐AF. Journal Of The American Heart Association 2018, 7: e008928. PMID: 30371218, PMCID: PMC6222961, DOI: 10.1161/jaha.118.008928.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, OralAgedAged, 80 and overAnti-Arrhythmia AgentsAnticoagulantsAtrial FibrillationDabigatranDrug Therapy, CombinationFemaleFollow-Up StudiesHumansMaleMiddle AgedProspective StudiesRegistriesRenal Insufficiency, ChronicRisk FactorsStrokeTime FactorsTreatment OutcomeWarfarinConceptsBackground Chronic kidney diseaseAntiarrhythmic drug useTransient ischemic attackChronic kidney diseaseAtrial fibrillationAdvanced CKDCKD statusIschemic attackSystemic embolismCause mortalityCreatinine clearanceRhythm controlKidney diseaseDrug useAtrial fibrillation scoreBaseline renal functionOral anticoagulant useRhythm control strategyCox proportional hazardsCKD patientsMajor bleedingOAC useCardiovascular deathCKD stageHigher CHA