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Article ; Online: Response to a letter to the Editor by Prof Platonov and Prof Holmqvist.

Friberg, Leif

2019 Volume 212, Page(s) 160

MeSH term(s)	Anti-Arrhythmia Agents ; Atrial Fibrillation ; Humans
Chemical Substances	Anti-Arrhythmia Agents
Language	English
Publishing date	2019-03-23
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	80026-0
ISSN	1097-6744 ; 0002-8703
ISSN (online)	1097-6744
ISSN	0002-8703
DOI	10.1016/j.ahj.2019.03.003
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Article ; Online: Short lookback periods causing exaggerated stroke risk estimates in atrial fibrillation may expose patients to unnecessary anticoagulant treatment.

Friberg, Leif

Pharmacoepidemiology and drug safety

2019 Volume 28, Issue 8, Page(s) 1054–1059

Abstract: Purpose: The purpose was to investigate how different lookback periods in observational registry studies affect estimates of stroke risk in patients with atrial fibrillation and stroke risk score CHA: Methods: All 354 854 individuals in Sweden with a ...

Abstract	Purpose: The purpose was to investigate how different lookback periods in observational registry studies affect estimates of stroke risk in patients with atrial fibrillation and stroke risk score CHA Methods: All 354 854 individuals in Sweden with a hospital diagnosis of atrial fibrillation during 2010-2016 were included. At least 13 years of observational data prior to inclusion was available for all patients. The prevalence of hypertension, heart failure, diabetes, previous thromboembolism, and vascular disease was estimated from data with different lookback periods. The incident stroke rates at CHA Results: Depending on duration of lookback period, the proportion of patients with heart failure varied 2.7 times, thromboembolism 3.7 times, hypertension 4.0 times, and diabetes and vascular disease both approximately 4.5 times. During follow-up, 22 237 patients suffered an ischaemic stroke. The estimated risk without anticoagulant treatment at CHA Conclusions: Short lookback periods underestimate comorbidity, cause high-risk patients to be misclassified as low risk, and overestimate stroke risk at CHA
MeSH term(s)	Aged ; Anticoagulants/administration & dosage ; Atrial Fibrillation/complications ; Atrial Fibrillation/drug therapy ; Brain Ischemia/epidemiology ; Brain Ischemia/etiology ; Brain Ischemia/prevention & control ; Female ; Follow-Up Studies ; Humans ; Male ; Registries ; Risk Factors ; Stroke/epidemiology ; Stroke/etiology ; Stroke/prevention & control ; Sweden ; Time Factors ; Unnecessary Procedures
Chemical Substances	Anticoagulants
Language	English
Publishing date	2019-05-21
Publishing country	England
Document type	Journal Article
ZDB-ID	1099748-9
ISSN	1099-1557 ; 1053-8569
ISSN (online)	1099-1557
ISSN	1053-8569
DOI	10.1002/pds.4793
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Zs.A 3395: Show issues

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Article ; Online: Safety of apixaban in combination with dronedarone in patients with atrial fibrillation.

Friberg, Leif

International journal of cardiology

2018 Volume 264, Page(s) 85–90

Abstract: Background: There have been concerns about bleeding risks for patients with atrial fibrillation treated with dronedarone in combination with new oral anticoagulants (NOACs). The aim of the study was to compare the bleeding risks with the apixaban + ... ...

Abstract	Background: There have been concerns about bleeding risks for patients with atrial fibrillation treated with dronedarone in combination with new oral anticoagulants (NOACs). The aim of the study was to compare the bleeding risks with the apixaban + dronedarone and warfarin + dronedarone combinations. Method: Retrospective study of Swedish nationwide health registers. All patients with atrial fibrillation who used dronedarone in combination with apixaban or warfarin during 2013-2016 were identified. Two propensity matched cohorts of each 1681 patients were compared. The main endpoint included intracranial bleeding, bleedings with hospitalization and fatal bleedings. Results: Bleedings thus defined occurred at rates of 1.31 and 2.14 per 100 years at risk with the apixaban and warfarin combinations respectively (p = 0.121). The hazard ratio with the apixaban combination was 0.66 (CI 0.35-1.23) compared to the warfarin combination. No significant differences were seen regarding secondary endpoints. Conclusion: Major bleedings were rare among patients with atrial fibrillation treated with dronedarone in combination with apixaban or warfarin. No significant differences in favour of either drug combination were found.
MeSH term(s)	Aged ; Anti-Arrhythmia Agents/administration & dosage ; Anti-Arrhythmia Agents/adverse effects ; Anticoagulants/administration & dosage ; Anticoagulants/adverse effects ; Atrial Fibrillation/complications ; Atrial Fibrillation/drug therapy ; Atrial Fibrillation/epidemiology ; Dronedarone/administration & dosage ; Dronedarone/adverse effects ; Drug Interactions ; Drug Therapy, Combination/adverse effects ; Drug Therapy, Combination/methods ; Female ; Hemorrhage/chemically induced ; Hemorrhage/diagnosis ; Hemorrhage/epidemiology ; Humans ; Male ; Middle Aged ; Pyrazoles/administration & dosage ; Pyrazoles/adverse effects ; Pyridones/administration & dosage ; Pyridones/adverse effects ; Registries/statistics & numerical data ; Retrospective Studies ; Risk Assessment ; Stroke/etiology ; Stroke/prevention & control ; Sweden/epidemiology ; Warfarin/administration & dosage ; Warfarin/adverse effects
Chemical Substances	Anti-Arrhythmia Agents ; Anticoagulants ; Pyrazoles ; Pyridones ; apixaban (3Z9Y7UWC1J) ; Warfarin (5Q7ZVV76EI) ; Dronedarone (JQZ1L091Y2)
Language	English
Publishing date	2018-05-19
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	779519-1
ISSN	1874-1754 ; 0167-5273
ISSN (online)	1874-1754
ISSN	0167-5273
DOI	10.1016/j.ijcard.2018.02.055
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Zs.A 1673: Show issues

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Article ; Online: Ventricular arrhythmia and death among atrial fibrillation patients using anti-arrhythmic drugs.

Friberg, Leif

American heart journal

2018 Volume 205, Page(s) 118–127

Abstract: Aim: The aim of the study was to assess and compare the safety of antiarrhythmic drugs (AADs) in an unselected real-world population of patients with atrial fibrillation (AF).: Methods and results: This is a study of all patients with diagnosed AF in ...

Abstract	Aim: The aim of the study was to assess and compare the safety of antiarrhythmic drugs (AADs) in an unselected real-world population of patients with atrial fibrillation (AF). Methods and results: This is a study of all patients with diagnosed AF in the Swedish Patient register who filled a prescription for sotalol, amiodarone, dronedarone, flecainide or disopyramide during 2010 to 2015. The main end point consisted of arrhythmic death, successful resuscitation, new diagnosis of sustained ventricular tachycardia, ventricular fibrillation or implantation of ICD. All-cause mortality was a secondary end point. Minimum follow up was 1 year. Falsification end points were used to assess hidden confounding. 44,995 AF patients on AAD and 267,518 AF patients without AAD were studied during a total time at risk of over 1.1 million years. Compared to sotalol, the risk for the main end point was decreased with dronedarone (hazard ratio [HR] 0.58, 95% confidence interval [CI] 0.37-0.90), similar with flecainide (HR 0.95, 0.69-1.32) and disopyramide (HR 1.30, CI 0.83-2.05). All-cause mortality was lower with dronedarone (HR 0.44, CI 0.34-0.57) and flecainide (HR 0.55, CI 0.44-0.68) than with sotalol. Hidden confounding prevented reliable assessment of amiodarone. Conclusions: Dronedarone was the only anti-arrhythmic drug with significantly lower risk for arrhythmic death, sustained ventricular arrhythmia or ICD implantation than sotalol among patients with atrial fibrillation. Both dronedarone and flecainide were associated with lower all-cause mortality than sotalol.
MeSH term(s)	Aged ; Anti-Arrhythmia Agents/adverse effects ; Anti-Arrhythmia Agents/therapeutic use ; Atrial Fibrillation/drug therapy ; Atrial Fibrillation/mortality ; Cause of Death/trends ; Dronedarone/adverse effects ; Dronedarone/therapeutic use ; Female ; Flecainide/adverse effects ; Flecainide/therapeutic use ; Follow-Up Studies ; Humans ; Incidence ; Male ; Middle Aged ; Registries ; Retrospective Studies ; Risk Assessment/methods ; Risk Factors ; Sotalol/adverse effects ; Sotalol/therapeutic use ; Survival Rate/trends ; Sweden/epidemiology ; Tachycardia, Ventricular/chemically induced ; Tachycardia, Ventricular/epidemiology
Chemical Substances	Anti-Arrhythmia Agents ; Sotalol (A6D97U294I) ; Dronedarone (JQZ1L091Y2) ; Flecainide (K94FTS1806)
Language	English
Publishing date	2018-08-25
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	80026-0
ISSN	1097-6744 ; 0002-8703
ISSN (online)	1097-6744
ISSN	0002-8703
DOI	10.1016/j.ahj.2018.06.018
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Article ; Online: Response to letter regarding article, "High prevalence of atrial fibrillation among patients with ischemic stroke".

Friberg, Leif

Stroke

2015 Volume 46, Issue 1, Page(s) e12

MeSH term(s)	Atrial Fibrillation/complications ; Brain Ischemia/complications ; Female ; Humans ; Male ; Stroke/complications
Language	English
Publishing date	2015-01
Publishing country	United States
Document type	Comment ; Letter
ZDB-ID	80381-9
ISSN	1524-4628 ; 0039-2499 ; 0749-7954
ISSN (online)	1524-4628
ISSN	0039-2499 ; 0749-7954
DOI	10.1161/STROKEAHA.114.007648
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Zs.A 448: Show issues

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Article ; Online: Prognostic implication of premature ventricular contractions in patients without structural heart disease.

Scorza, Raffaele / Jonsson, Martin / Friberg, Leif / Rosenqvist, Mårten / Frykman, Viveka

Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology

2023 Volume 25, Issue 2, Page(s) 517–525

Abstract: Aims: Premature ventricular contractions (PVCs) are a common form of arrhythmia associated with an unfavourable prognosis in patients with structural heart disease. However, the prognostic significance in absence of heart disease is debated. With this ... ...

Abstract	Aims: Premature ventricular contractions (PVCs) are a common form of arrhythmia associated with an unfavourable prognosis in patients with structural heart disease. However, the prognostic significance in absence of heart disease is debated. With this study, we aim to investigate whether subjects with PVC, without structural heart disease, have a worse prognosis than the general population. Methods and results: Patients evaluated for PVC at a secondary care centre in Stockholm County from January 2010 to December 2016 were identified. We included patients without history of previous heart disease who had undergone echocardiography and exercise test with normal findings. Based on sex and age, we matched the PVC cohort to a four times bigger control group from the general population and compared the outcome in terms of mortality and cardiovascular morbidity during a median follow-up time of 5.2 years. We included 820 patients and 3,264 controls. Based on a non-inferiority analysis, the PVC group did not have a higher mortality than the control group (0.44, CI 0.27-0.72). Sensitivity analysis with propensity score matching confirmed this result. Conclusions: PVC patients, who after thorough evaluation showed no signs of structural heart disease, did not have a worse prognosis when compared to an age- and sex- control group based on the general population.
MeSH term(s)	Humans ; Child, Preschool ; Ventricular Premature Complexes ; Prognosis ; Echocardiography/methods ; Exercise Test ; Disease Progression
Language	English
Publishing date	2023-05-04
Publishing country	England
Document type	Journal Article ; Comment
ZDB-ID	1449879-0
ISSN	1532-2092 ; 1099-5129
ISSN (online)	1532-2092
ISSN	1099-5129
DOI	10.1093/europace/euac184
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Zs.A 5434: Show issues

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Article ; Online: Atrial Fibrillation, Oral Anticoagulants, and Concomitant Active Cancer: Benefits and Risks.

Atterman, Adriano / Friberg, Leif / Asplund, Kjell / Engdahl, Johan

TH open : companion journal to thrombosis and haemostasis

2021 Volume 5, Issue 2, Page(s) e176–e182

Abstract: ... ...

Abstract	Aim
Language	English
Publishing date	2021-06-01
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2901738-5
ISSN	2512-9465 ; 2567-3459
ISSN (online)	2512-9465
ISSN	2567-3459
DOI	10.1055/s-0041-1728670
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Zs.A 7138: Show issues

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Article ; Online: A diagnosis of atrial fibrillation is not a predictor for pulmonary embolism.

Friberg, Leif / Svennberg, Emma

Thrombosis research

2020 Volume 195, Page(s) 238–242

Abstract: Background and objectives: Atrial fibrillation causes stroke by embolization of blood clots from the left atrium. This suggests that it also can cause pulmonary embolism through embolization of thrombi from the right atrium. Our objective was to ... ...

Abstract	Background and objectives: Atrial fibrillation causes stroke by embolization of blood clots from the left atrium. This suggests that it also can cause pulmonary embolism through embolization of thrombi from the right atrium. Our objective was to investigate if atrial fibrillation is an independent risk factor for pulmonary embolism. Method: This is a retrospective registry study of a random sample of 1.5 million Swedish residents alive on January 1, 2010 (n = 1,442,028) who were followed until the end of 2017. Information about comorbidity, medication and outcomes was obtained from the Swedish national health registers. The endpoint was a first-time event of pulmonary embolism. Results: The group with atrial fibrillation was >25 years older (mean) than the group without and had almost three times higher incidence of pulmonary embolism (2.91 and 1.09 per 1000 year at risk, p < 0.001). After adjustment for age and other co-factors, atrial fibrillation without oral anticoagulant protection was not associated with increased risk for pulmonary embolism (HR 1.03, CI 0.94-1.13). Adjustment for the competing risk of dying showed similar results (sHR 0.99, CI 0.70-1.40). The higher rate of pulmonary embolism among patients with atrial fibrillation can be fully explained by differences in age and comorbidity. Conclusion: A diagnosis of atrial fibrillation is not a predictor for pulmonary embolism.
MeSH term(s)	Anticoagulants/therapeutic use ; Atrial Fibrillation/complications ; Atrial Fibrillation/diagnosis ; Atrial Fibrillation/epidemiology ; Embolism ; Humans ; Pulmonary Embolism/complications ; Pulmonary Embolism/diagnosis ; Pulmonary Embolism/epidemiology ; Retrospective Studies ; Risk Factors ; Stroke ; Sweden/epidemiology
Chemical Substances	Anticoagulants
Language	English
Publishing date	2020-08-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	121852-9
ISSN	1879-2472 ; 0049-3848
ISSN (online)	1879-2472
ISSN	0049-3848
DOI	10.1016/j.thromres.2020.08.019
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Zs.A 863: Show issues

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Article ; Online: Reduced dementia risk in patients with optimized anticoagulation therapy undergoing atrial fibrillation ablation.

Åkerström, Finn / Charitakis, Emmanouil / Paul-Nordin, Astrid / Braunschweig, Frieder / Friberg, Leif / Tabrizi, Fariborz / Jensen-Urstad, Mats / Drca, Nikola

Heart rhythm

2024

Abstract: Background: Atrial fibrillation (AF) is associated with the development of dementia, and observational studies have shown that oral anticoagulation and catheter ablation reduce dementia risk. However, such studies did not consistently report on ... ...

Abstract	Background: Atrial fibrillation (AF) is associated with the development of dementia, and observational studies have shown that oral anticoagulation and catheter ablation reduce dementia risk. However, such studies did not consistently report on periprocedural anticoagulation and long-term oral anticoagulation coverage, for which reason the separate effect of AF ablation on dementia risk could not be established. Objective: We evaluated the protective effect of AF ablation in a large cohort of patients who received optimized anticoagulation and compared them with patients who were managed medically. Methods: We retrospectively included 5912 consecutive patients who underwent first-time catheter ablation for AF between 2008 and 2018 and compared them with 52,681 control individuals from the Swedish Patient Register. Propensity score matching produced 2 cohorts of equal size (n = 3940) with similar baseline characteristics. Dementia diagnosis was identified by International Classification of Diseases codes from the patient register. Results: Most propensity score-matched patients were taking an oral anticoagulant at the start (94.5%) and end (75.0%) of the study. Mean follow-up was 4.9 ± 2.8 years. Catheter ablation was associated with lower risk for the dementia diagnosis compared with the control group (hazard ratio [HR], 0.44; 95% confidence interval [CI], 0.22-0.86; P = .017). The result was similar when including patients with a stroke diagnosis before inclusion (HR, 0.50; 95% CI, 0.28-0.89; P = .019) and after adjustment for the competing risk of death (HR, 0.41; 95% CI, 0.20-0.86; P = .018). Conclusion: Catheter ablation of AF in patients with optimized oral anticoagulation therapy was associated with a reduction in dementia diagnosis, even after adjustment for potential confounders and for competing risk of death.
Language	English
Publishing date	2024-04-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	2229357-7
ISSN	1556-3871 ; 1547-5271
ISSN (online)	1556-3871
ISSN	1547-5271
DOI	10.1016/j.hrthm.2024.04.038
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Zs.A 6278: Show issues

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Article ; Online: Safety of dronedarone in routine clinical care.

Friberg, Leif

Journal of the American College of Cardiology

2014 Volume 63, Issue 22, Page(s) 2376–2384

Abstract: Objectives: The aim of this study was to examine mortality and liver disease among patients exposed to dronedarone.: Background: There has been concern about the safety of dronedarone, especially for patients with heart failure and permanent atrial ... ...

Abstract	Objectives: The aim of this study was to examine mortality and liver disease among patients exposed to dronedarone. Background: There has been concern about the safety of dronedarone, especially for patients with heart failure and permanent atrial fibrillation (AF). There have also been suspicions about liver toxicity. Methods: All 174,995 patients with a diagnosis of AF during 2010 to 2012 were identified in the Swedish Patient Register. Of these, 4,856 patients had received dronedarone according to the Swedish Drug Register, and 170,139 patients who had not were used as a control population. Mean follow-up was 1.6 years, with a minimal follow-up of 6 months. Results: Patients prescribed dronedarone were younger (age 65.5 years vs. 75.7 years, p < 0.0001) and healthier than control patients. The annual mortality rate among patients who received dronedarone was 1.3% compared with 14.0% in the control population. There were no sudden cardiac deaths and no deaths related to liver failure among patients who received treatment with dronedarone. After propensity score matching and adjustment for cofactors, patients who received dronedarone had lower mortality than other AF patients (hazard ratio [HR]: 0.41; 95% confidence interval [CI]: 0.33 to 0.51). Dronedarone patients with heart failure had lower mortality than other heart failure patients (HR: 0.40; 95% CI: 0.30 to 0.53). They also had lower mortality than expected from the general population (standardized mortality ratio: 0.67; 95% CI: 0.55 to 0.78), which indicates the selection of low-risk patients. The risk of liver disease was not increased (HR: 0.57; 95% CI: 0.34 to 0.92). Conclusions: Dronedarone, as prescribed to AF patients in Sweden, has not exposed patients to increased risks of death or liver disease.
MeSH term(s)	Aged ; Amiodarone/adverse effects ; Amiodarone/analogs & derivatives ; Anti-Arrhythmia Agents/adverse effects ; Atrial Fibrillation/drug therapy ; Female ; Heart Failure/chemically induced ; Heart Failure/mortality ; Humans ; Liver Failure/chemically induced ; Liver Failure/mortality ; Male
Chemical Substances	Anti-Arrhythmia Agents ; dronedarone (JQZ1L091Y2) ; Amiodarone (N3RQ532IUT)
Language	English
Publishing date	2014-06-10
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	605507-2
ISSN	1558-3597 ; 0735-1097
ISSN (online)	1558-3597
ISSN	0735-1097
DOI	10.1016/j.jacc.2014.02.601
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