ESC Wrap-up 1: Obesity, heart failure with preserved EF and reduced EF, AF, frailty, evidence translation, and catheter ablation are the topics John Mandrola, MD, discusses in this week’s podcast.
The primary efficacy endpoint was a composite of stroke, systemic embolism, or CV death. Primary safety endpoint was death or major bleeding.
As for efficacy, a primary outcome – stroke, systemic embolism, or CV death —occurred in 3.2% vs 4.0% in the edoxaban vs placebo arm. This hazard ratio was 0.81 but the confidence interval went from 0.60 to 1.08 and thus is not considered statistically significant.First was that this was strong evidence against treating short duration AF with DOACs. Consider that these were high-risk older patients; mean CHADSVASC score was 4. — And bleeding rates were substantially higher than stroke reduction.
Third, NOAH clearly advances knowledge about the prognosis of AF and how it differs depending on the diagnosis. In the past, AF had to last long enough to trigger a clinician to order a standard ECG. Continuous monitoring requires neither symptoms nor long-duration AF.Fourth, NOAH is like FRAIL AF in that it demonstrates the power of the randomized trials. I constantly hear how trials are too expensive to run. And they are pricey.
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