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Polo-García J, Pallares-Carratalá V, Turegano-Yedro M, Romero-Vigara JC, Prieto-Díaz MA, Cinza-Sanjurjo S. [Current situation of direct oral anticoagulants in primary care in Spain: Positioning of SEMERGEN in 2023]. Semergen 2024; 50:102136. [PMID: 38052147 DOI: 10.1016/j.semerg.2023.102136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 10/20/2023] [Indexed: 12/07/2023]
Abstract
Oral anticoagulation is the key to reduce the risk of stroke in atrial fibrillation. Although vitaminK antagonists (VKA) have classically been used for this purpose, they have been largely overcome by direct oral anticoagulants (DOAC), as demonstrated by evidence from clinical trials, real-life and population studies. In fact, all clinical practice guidelines recommend their use preferentially over VKA. However, in Spain the prescription of DOAC is subordinated to an inspection visa that includes the clinical conditions defined in the Therapeutic Positioning Report of the Spanish Medicines Agency, and that still imposes important restrictions on their use, limiting the benefits of using DOACs in patients with atrial fibrillation (AF), and also generating inequalities between the different autonomous communities. In fact, the use of DOAC in Spain is much lower than that observed in neighboring countries. This has made that while in other countries the incidence of ischemic stroke has decreased at the population level, along with a reduction in the cost per patient with AF, in Spain this decrease has been modest. For all these reasons, and for assuring the sustainability of the health care system, we ask for the elimination of the visa so that DOAC can be prescribed according to the recommendations made by the guidelines. In addition, we are also committed to reinforce medical education and decisions made by consensus with the patient, with the primary care physician acquiring a key role in the protection of the patient with AF.
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Affiliation(s)
- J Polo-García
- Medicina Familiar y Comunitaria, Centro de Salud Casar de Cáceres, Casar de Cáceres, Cáceres, España
| | - V Pallares-Carratalá
- Medicina Familiar y Comunitaria, Departamento de Medicina, Universidad JaimeI, Castellón, España.
| | - M Turegano-Yedro
- Medicina Familiar y Comunitaria, Centro de Salud Casar de Cáceres, Casar de Cáceres, Cáceres, España
| | - J C Romero-Vigara
- Medicina Familiar y Comunitaria, Centro de Salud Alfajarín, Alfajarín, Zaragoza, España
| | - M A Prieto-Díaz
- Medicina Familiar y Comunitaria, Centro de Salud Vallobín-La Florida, Oviedo, España
| | - S Cinza-Sanjurjo
- Medicina Familiar y Comunitaria, Centro de Salud Milladoiro, Área de Salud de Santiago de Compostela. Instituto de Investigación en Salud de Santiago de Compostela (IDIS). Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Santiago de Compostela, La Coruña, España
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de Burgos-Lunar C, del Cura-González I, Cárdenas-Valladolid J, Gómez-Campelo P, Abánades-Herranz JC, López-de Andrés A, Sotos-Prieto M, Iriarte-Campo V, Salinero-Fort MA. Real-world data in primary care: validation of diagnosis of atrial fibrillation in primary care electronic medical records and estimated prevalence among consulting patients'. BMC PRIMARY CARE 2023; 24:4. [PMID: 36600196 PMCID: PMC9811753 DOI: 10.1186/s12875-022-01961-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 12/28/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Primary care electronic medical records contain clinical-administrative information on a high percentage of the population. Before this information can be used for epidemiological purposes, its quality must be verified. This study aims to validate diagnoses of atrial fibrillation (AF) recorded in primary care electronic medical records and to estimate the prevalence of AF in the population attending primary care consultations. METHODS We performed a cross-sectional validation study of all diagnoses of AF recorded in primary care electronic medical records in Madrid (Spain). We also performed simple random sampling of diagnoses of AF (ICPC-2 code K78) registered by 55 physicians and random age- and sex-matched sampling of the records that included a diagnosis of AF. Electrocardiograms, echocardiograms, and hospital discharge or cardiology clinic reports were matched. Sensitivity, specificity, positive and negative predictive values (PPV and NPV), and overall agreement were calculated using the kappa statistic (κ). The prevalence of AF in the community of Madrid was estimated considering the sensitivity and specificity obtained in the validation. All calculations were performed overall and by sex and age groups. RESULTS The degree of agreement was very high (κ = 0.952), with a sensitivity of 97.84%, specificity of 97.39%, PPV of 97.37%, and NPV of 97.85%. The prevalence of AF in the population aged over 18 years was 2.41% (95%CI 2.39-2.42% [2.25% in women and 2.58% in men]). This increased progressively with age, reaching 16.95% in those over 80 years of age (15.5% in women and 19.44% in men). CONCLUSIONS The validation results obtained enable diagnosis of AF recorded in primary care to be used as a tool for epidemiological studies. A high prevalence of AF was found, especially in older patients.
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Affiliation(s)
- C. de Burgos-Lunar
- grid.411068.a0000 0001 0671 5785Department of Preventive Medicine, Hospital Universitario Clínico de San Carlos, Madrid, Spain ,Research Network on Chronicity, Primary Care and Health Promotion -RICAPPS-(RICORS), Madrid, Spain
| | - I. del Cura-González
- Research Network on Chronicity, Primary Care and Health Promotion -RICAPPS-(RICORS), Madrid, Spain ,Research Unit, Primary Health Care Management, Madrid, Spain ,grid.28479.300000 0001 2206 5938Department of Medical Specialties and Public Health, Faculty of Health Sciences Rey Juan Carlos University, Madrid, Spain
| | - J. Cárdenas-Valladolid
- Information Systems Department, Primary Health Care Management, Madrid, Spain ,Biosanitary Research and Innovation Foundation of Primary Care (FIIBAP), Madrid, Spain ,grid.440081.9The Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain ,grid.464699.00000 0001 2323 8386Alfonso X El Sabio University, Madrid, Spain
| | - P. Gómez-Campelo
- grid.440081.9The Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | | | - A. López-de Andrés
- grid.4795.f0000 0001 2157 7667Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - M. Sotos-Prieto
- grid.5515.40000000119578126Department of Preventive Medicine and Public health, Universidad Autónoma de Madrid, Madrid, Spain ,grid.466571.70000 0004 1756 6246CIBERESP (CIBER of Epidemiology and PublicHealth), Madrid, Spain ,grid.38142.3c000000041936754XDepartment of Environmental Health, Harvard T.H.Chan School of Public Health, Boston, MA USA
| | - V. Iriarte-Campo
- Biosanitary Research and Innovation Foundation of Primary Care (FIIBAP), Madrid, Spain
| | - M. A. Salinero-Fort
- Research Network on Chronicity, Primary Care and Health Promotion -RICAPPS-(RICORS), Madrid, Spain ,Biosanitary Research and Innovation Foundation of Primary Care (FIIBAP), Madrid, Spain ,grid.440081.9The Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain ,grid.464699.00000 0001 2323 8386Alfonso X El Sabio University, Madrid, Spain ,General Subdirectorate of Research and Documentation, Department of Health, Madrid, Spain
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García-Roy Á, Sarsa-Gómez A, Méndez-López F, Urdin-Muñoz B, Sánchez-Calavera MA. Improvement in the Management of Oral Anticoagulation in Patients with Atrial Fibrillation in Primary Health Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6746. [PMID: 35682326 PMCID: PMC9180454 DOI: 10.3390/ijerph19116746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 02/04/2023]
Abstract
(1) Background: Evaluation and improvement of the management of patients with atrial fibrillation in treatment with oral anticoagulants from primary health care. (2) Methods: prospective quasi-experimental study, conducted on 385 patients assisted with Atrial Fibrillation (AF) at the Las Fuentes Norte Health Center, before and after the implementation of actions to improve oral anticoagulants management from October 2015 to July 2017. (3) Results: The ACO-ZAR I study revealed that the population with AF presents a global prevalence of 1.7%, an indication of oral anticoagulants of 92.1%, undertreatment of 24%, suboptimal control of vitamin K antagonists of 43%, use of antiaggregant as primary prevention of 13.42%, and primary health care monitoring of 34%. The implementation of activities aimed at improving the management of oral anticoagulants in the ACO-ZAR II study achieves a reduction in undertreatment up to 16%, in the use of antiaggregant up to 9%, and in suboptimal control up to 30%, as well as an increase in control from primary health care up to 69.2% and of the penetrance of direct oral anticoagulants up to 28%. (4) Conclusions: In conclusion, the application of activities aimed at optimizing the management of oral anticoagulants in health center patients allowed the improvement of risk assessment and registration, undertreatment, use of antiaggregant, suboptimal control of vitamin K antagonists, control by primary health care center, and the penetrance of direct oral anticoagulants.
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Affiliation(s)
- África García-Roy
- Las Fuentes North Health Center, Aragon Health Service, 50002 Zaragoza, Spain; (Á.G.-R.); (A.S.-G.); (B.U.-M.); (M.A.S.-C.)
| | - Ana Sarsa-Gómez
- Las Fuentes North Health Center, Aragon Health Service, 50002 Zaragoza, Spain; (Á.G.-R.); (A.S.-G.); (B.U.-M.); (M.A.S.-C.)
| | - Fátima Méndez-López
- Aragonese Primary Care Research Group (GAIAP), Aragon Health Research Institute (IISA), 50009 Saragossa, Spain
| | - Blanca Urdin-Muñoz
- Las Fuentes North Health Center, Aragon Health Service, 50002 Zaragoza, Spain; (Á.G.-R.); (A.S.-G.); (B.U.-M.); (M.A.S.-C.)
| | - María Antonia Sánchez-Calavera
- Las Fuentes North Health Center, Aragon Health Service, 50002 Zaragoza, Spain; (Á.G.-R.); (A.S.-G.); (B.U.-M.); (M.A.S.-C.)
- Aragonese Primary Care Research Group (GAIAP), Aragon Health Research Institute (IISA), 50009 Saragossa, Spain
- Department of Internal Medicine, Psychiatry and Dermatology, University of Zaragoza, 50009 Zaragoza, Spain
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Valdivieso MG, Orozco-Beltrán D, López-Pineda A, Gil-Guillén VF, Quesada JA, Carratalá-Munuera C, Nouni-García R. Early Detection of Atrial Fibrillation in Community Pharmacies-CRIFAFARMA Study. J Cardiovasc Pharmacol Ther 2022; 27:10742484221078973. [PMID: 35200057 DOI: 10.1177/10742484221078973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common arrhythmia to appear in clinical practice. People with AF have 5 times the risk of stroke compared to the general population. OBJECTIVE This study aimed to determine the prevalence of AF in people over the age of 50 without known AF, who presented to a community pharmacy to check their cardiovascular risk factors, to identify risk factors associated with AF, and to assess the risk of stroke in people who screened positive for AF. METHODS A multicenter observational descriptive study of a screening program took place from May to December 2016. A blood pressure monitor (Microlife Watch BP Home) was used to screen for AF, and the CHA2DS2-VASc questionnaire was used to assess stroke risk. RESULTS The study included 452 adults over the age of 50. The CRIFAFARMA study detected a prevalence of AF of 9.1%. Risk factors for AF were: age of 75 years or older (P = .024), lack of physical activity (P = .043), diabetes (P < .001), dyslipidemia (P = .003), and history of cardiovascular disease (P = .003). Diabetes (OR 2.79, P = .005) and dyslipidemia (OR 2.16, P = .031) had a combined explanatory capacity in the multivariable logistic regression model adjusted for age. 85% were at high risk of stroke according to the CHA2DS2-VASc scale. CONCLUSIONS AF was detected in more than 9% of the included population. Factors associated with AF were advanced age, lack of physical activity, diabetes, dyslipidemia, and history of cardiovascular disease, with diabetes and dyslipidemia standing out as the factors with independent explanatory capacity.
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Affiliation(s)
| | - Domingo Orozco-Beltrán
- Department of Clinical Medicine, 541992Miguel Hernández University, San Juan de Alicante, Spain
| | - Adriana López-Pineda
- Department of Clinical Medicine, 541992Miguel Hernández University, San Juan de Alicante, Spain
| | | | - José A Quesada
- Department of Clinical Medicine, 541992Miguel Hernández University, San Juan de Alicante, Spain
| | | | - Rauf Nouni-García
- Department of Clinical Medicine, 541992Miguel Hernández University, San Juan de Alicante, Spain
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5
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Cabrera JD, Fluxà G, Fuentes C, Hoyo J, Navarro M, Sant E, de la Poza MA, Altés A, Duch N, Caubet M, Vieytes G, Pérez AM, Herrero MA, Gracia P, Domínguez V, Mont L, Coll-Vinent B. A programme for early diagnosis of atrial fibrillation: a multi-centre study in primary care. Fam Pract 2022; 39:99-105. [PMID: 34160603 DOI: 10.1093/fampra/cmab057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is a morbid disease whose complications can be prevented if prompt and correctly treated. OBJECTIVE To assess the usefulness of an early AF diagnosis programme in at-risk individuals in primary care centres. METHODS In an open-label, multi-centre, controlled interventional study, individuals with one or more risk factors for AF but without known AF were enrolled. They were allocated to intervention and control groups in a 1:2 ratio. Participants in the intervention group had three clinical and educational visits (0, 6 and 12 months). In intervention subgroup A, an electrocardiogram (ECG) was performed at each visit and in subgroup B, only if arrhythmia was detected on auscultation. After 2 years, the medical records of all participants were reviewed. Participants diagnosed with AF were followed for two additional years. RESULTS Of the total 2231 participants enrolled, 1503 (67.36%) were allocated to the control group and 728 (32.63%) to the intervention groups (355 in subgroup A, 373 subgroup B). The groups showed similar clinical characteristics. New-onset AF was diagnosed in 38 patients. Early detection in subgroup B was similar to subgroup A and superior to control group (3.2% versus 1.2%, hazard ratio 3.149, 95% confidence interval 1.503-6.597, P = 0.002). AF patients in subgroups A and B had similar long-term complications and a tendency for fewer complications than AF patients in the control group. CONCLUSIONS An intervention programme consisting of health education, systematic auscultation and opportunistic ECG by a primary care provider is a useful method for the early diagnosis of AF.
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Affiliation(s)
- Javier D Cabrera
- Atrial Fibrillation Unit, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Guillem Fluxà
- Primary Care Centre Poble Sec-Manso, Barcelona, Spain
| | | | - Jordi Hoyo
- Primary Care Centre Numancia, Barcelona, Spain
| | - Marta Navarro
- Primary Care Centre Borrell, CAPSE, Barcelona, Spain
| | - Elisenda Sant
- Primary Care Centre Casanova, CAPSE, Barcelona, Spain
| | | | | | - Núria Duch
- Primary Care Centre Poble Sec-Manso, Barcelona, Spain
| | | | | | - Ana M Pérez
- Primary Care Centre Montornès-Montmeló, Barcelona, Spain
| | | | - Pablo Gracia
- Primary Care Centre Borrell, CAPSE, Barcelona, Spain
| | | | - Lluís Mont
- Atrial Fibrillation Unit, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Blanca Coll-Vinent
- Atrial Fibrillation Unit, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Grup de Recerca 'Urgències: processos i patologies', IDIBAPS, Barcelona, Spain
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Direct Oral Anticoagulants versus Warfarin in Octogenarians with Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10225268. [PMID: 34830548 PMCID: PMC8618042 DOI: 10.3390/jcm10225268] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 11/17/2022] Open
Abstract
Direct oral anticoagulants (DOACs) have been demonstrated to be more effective and safer than vitamin-K antagonist (VKA) for stroke prevention in patients with nonvalvular atrial fibrillation (AF). This meta-analysis aims to assess the effect of DOACS vs. VKA in patients ≥ 80 and AF. Primary endpoints were stroke or systemic embolism and all-cause death. Secondary endpoints included major bleeding, intracranial bleeding, and gastrointestinal bleeding. A random-effects model was selected due to significant heterogeneity. A total of 147,067 patients from 16 studies were included, 71,913 (48.90%) treated with DOACs and 75,154 with VKA (51.10%). The stroke rate was significantly lower in DOACs group compared with warfarin group (Relative risk (RR): 0.72; 95% confidence interval (CI): 0.63-0.82; p < 0.001). All-cause mortality was significantly lower in DOACs group compared with warfarin group (RR: 0.82; 95% CI: 0.70-0.96; p = 0.012). Compared to warfarin, DOACs were not associated with reductions in major bleeding (RR: 0.85, 95% CI 0.69-1.04; p = 0.108) or gastrointestinal bleeding risk (RR: 1.08, 95% CI 0.76-1.53; p = 0.678) but a 43% reduction of intracranial bleeding (RR: 0.47, IC 95% 0.36-0.60; p < 0.001) was observed. Our meta-analysis demonstrates that DOACs are effective and safe with statistical superiority when compared with warfarin in octogenarians with AF.
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Genetic and Metabolic Determinants of Atrial Fibrillation in a General Population Sample: The CHRIS Study. Biomolecules 2021; 11:biom11111663. [PMID: 34827661 PMCID: PMC8615508 DOI: 10.3390/biom11111663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 11/24/2022] Open
Abstract
Atrial fibrillation (AF) is a supraventricular arrhythmia deriving from uncoordinated electrical activation with considerable associated morbidity and mortality. To expand the limited understanding of AF biological mechanisms, we performed two screenings, investigating the genetic and metabolic determinants of AF in the Cooperative Health Research in South Tyrol study. We found 110 AF cases out of 10,509 general population individuals. A genome-wide association scan (GWAS) identified two novel loci (p-value < 5 × 10−8) around SNPs rs745582874, next to gene PBX1, and rs768476991, within gene PCCA, with genotype calling confirmed by Sanger sequencing. Risk alleles at both SNPs were enriched in a family detected through familial aggregation analysis of the phenotype, and both rare alleles co-segregated with AF. The metabolic screening of 175 metabolites, in a subset of individuals, revealed a 41% lower concentration of lysophosphatidylcholine lysoPC a C20:3 in AF cases compared to controls (p-adj = 0.005). The genetic findings, combined with previous evidence, indicate that the two identified GWAS loci may be considered novel genetic rare determinants for AF. Considering additionally the association of lysoPC a C20:3 with AF by metabolic screening, our results demonstrate the valuable contribution of the combined genomic and metabolomic approach in studying AF in large-scale population studies.
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8
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Barrios V, Cinza-Sanjurjo S, Gavín O, Egocheaga I, Burgos-Pol R, Soto J, Polanco C, Suárez J, Casado MÁ. Carga y coste del mal control de la anticoagulación con antagonistas de la vitamina K en pacientes con fibrilación auricular no valvular en España. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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9
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Escobar C, Camm AJ. Changing paradigms: from prevention of thromboembolic events to improved survival in patients with atrial fibrillation. Europace 2021; 23:837-843. [PMID: 33221894 DOI: 10.1093/europace/euaa324] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 12/18/2022] Open
Abstract
Atrial fibrillation is associated with a five-fold increase in the risk of stroke. Current guidelines recommend the use of the CHA2DS2-VASc score to stratify the risk of stroke. In addition, guidelines recommend the identification of the conditions that increase the risk of haemorrhage to be modified and thus decrease the risk of bleeding. Nevertheless, many patients with a high thromboembolic risk are prescribed antiplatelet treatment or do not receive any antithrombotic therapy. In addition, therapeutic inertia is common in anticoagulated patients taking vitamin K antagonists, and underdosing is an emerging problem with direct oral anticoagulants, probably because many physicians consider the risk of stroke and the risk of major bleeding to be equal. It is necessary to develop a new approach to risk stratification, an approach that moves from morbidity to mortality, i.e., from stratification of the risk of stroke and major bleeding to stratification of the risk of mortality associated with stroke and the risk of mortality associated with bleeding. In this article, we propose a novel risk stratification approach based on the mortality associated with stroke and bleeding, illustrated by data derived from the literature.
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Affiliation(s)
- Carlos Escobar
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - A John Camm
- Cardiovascular Clinical Academic Group, St. George's University of London, London, UK
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10
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Mostaza JM, Suarez C, Cepeda JM, Manzano L, Sánchez D. Demographic, clinical, and functional determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation. BMC Cardiovasc Disord 2021; 21:384. [PMID: 34372782 PMCID: PMC8351138 DOI: 10.1186/s12872-021-02019-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 04/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background This study assessed the sociodemographic, functional, and clinical determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation (NVAF) attended in the internal medicine setting. Methods A multicenter, cross-sectional study was conducted in NVAF patients who attended internal medicine departments for either a routine visit (outpatients) or hospitalization (inpatients).
Results A total of 961 patients were evaluated. Their antithrombotic management included: no treatment (4.7%), vitamin K antagonists (VKAs) (59.6%), direct oral anticoagulants (DOACs) (21.6%), antiplatelets (6.6%), and antiplatelets plus anticoagulants (7.5%). Permanent NVAF and congestive heart failure were associated with preferential use of oral anticoagulation over antiplatelets, while intermediate-to high-mortality risk according to the PROFUND index was associated with a higher likelihood of using antiplatelet therapy instead of oral anticoagulation. Longer disease duration and institutionalization were identified as determinants of VKA use over DOACs. Female gender, higher education, and having suffered a stroke determined a preferential use of DOACs. Conclusions This real-world study showed that most elderly NVAF patients received oral anticoagulation, mainly VKAs, while DOACs remained underused. Antiplatelets were still offered to a proportion of patients. Longer duration of NVAF and institutionalization were identified as determinants of VKA use over DOACs. A poor prognosis according to the PROFUND index was identified as a factor preventing the use of oral anticoagulation.
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Affiliation(s)
- Jose María Mostaza
- Department of Internal Medicine, Hospital Carlos III, Calle Sinesio Delgado, 10, 28029, Madrid, Spain.
| | - Carmen Suarez
- Department of Internal Medicine, Hospital Universitario de La Princesa, Madrid, Spain
| | - Jose María Cepeda
- Department of Internal Medicine, Hospital Vega Baja, Orihuela, Alicante, Spain
| | - Luis Manzano
- Department of Internal Medicine, Hospital Ramón Y Cajal, Universidad de Alcalá, Ramón Y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | - Demetrio Sánchez
- Department of Internal Medicine, Hospital Nuestra Señora De Sonsoles, Ávila, Spain
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11
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Direct oral anticoagulants today. Med Clin (Barc) 2021; 157:238-240. [PMID: 34353625 DOI: 10.1016/j.medcli.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 11/22/2022]
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12
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Meng X, Nie Y, Wang K, Fan C, Zhao J, Yuan Y. Identification of Atrial Fibrillation-Associated Genes ERBB2 and MYPN Using Genome-Wide Association and Transcriptome Expression Profile Data on Left-Right Atrial Appendages. Front Genet 2021; 12:696591. [PMID: 34276800 PMCID: PMC8278573 DOI: 10.3389/fgene.2021.696591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/03/2021] [Indexed: 11/18/2022] Open
Abstract
More reliable methods are needed to uncover novel biomarkers associated with atrial fibrillation (AF). Our objective is to identify significant network modules and newly AF-associated genes by integrative genetic analysis approaches. The single nucleotide polymorphisms with nominal relevance significance from the AF-associated genome-wide association study (GWAS) data were converted into the GWAS discovery set using ProxyGeneLD, followed by merging with significant network modules constructed by weighted gene coexpression network analysis (WGCNA) from one expression profile data set, composed of left and right atrial appendages (LAA and RAA). In LAA, two distinct network modules were identified (blue: p = 0.0076; yellow: p = 0.023). Five AF-associated biomarkers were identified (ERBB2, HERC4, MYH7, MYPN, and PBXIP1), combined with the GWAS test set. In RAA, three distinct network modules were identified and only one AF-associated gene LOXL1 was determined. Using human LAA tissues by real-time quantitative polymerase chain reaction, the differentially expressive results of ERBB2, MYH7, and MYPN were observed (p < 0.05). This study first demonstrated the feasibility of fusing GWAS with expression profile data by ProxyGeneLD and WGCNA to explore AF-associated genes. In particular, two newly identified genes ERBB2 and MYPN via this approach contribute to further understanding the occurrence and development of AF, thereby offering preliminary data for subsequent studies.
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Affiliation(s)
- Xiangguang Meng
- Laboratory of Cardiovascular Disease and Drug Research, Zhengzhou No. 7 People's Hospital, Zhengzhou, China
| | - Yali Nie
- Department of Pharmacology, School of Medicine, Zhengzhou University, Zhengzhou, China
| | - Keke Wang
- Laboratory of Cardiovascular Disease and Drug Research, Zhengzhou No. 7 People's Hospital, Zhengzhou, China
| | - Chen Fan
- Skin Research Institute of Singapore, Agency for Science, Technology and Research (A∗STAR), Singapore, Singapore
| | - Juntao Zhao
- Department of Cardiac Surgery, Zhengzhou No. 7 People's Hospital, Zhengzhou, China
| | - Yiqiang Yuan
- Department of Cardiovascular Internal Medicine, Henan Provincial Chest Hospital, Zhengzhou, China
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Freixa-Pamias R, Blanch Gràcia P, Rodríguez Latre ML, Basile L, Sanchez Chamero P, Gomez-Choco M, Armario P, Martínez-Rubio A, Lupón J. Impact of prescription patterns of antithrombotic treatment on atrial fibrillation-related ischemic stroke. Curr Med Res Opin 2021; 37:357-365. [PMID: 33326304 DOI: 10.1080/03007995.2020.1865892] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To analyze the temporal trends of atrial fibrillation (AF)-related ischemic stroke (IS) and their relationship with the prescription patterns of antithrombotic treatment from 2013 to 2019 in the Health Assistance Area of a regional hospital. METHODS First, a retrospective ecological study of aggregate data to analyze the annual incidence of IS between 2013 and 2019 was performed. Second, we selected those patients diagnosed with AF between 2013 and 2019 and performed a retrospective longitudinal study to assess the role of antithrombotic therapy in the development of AF-related IS. RESULTS During this period, whereas the annual incidence of IS remained stable (from 1.3 in 2013 to 1.2 cases per 1000 inhabitants in 2019; adjusted P for trend .829), the annual incidence of AF-related IS decreased over time (from 23.8 to 18.8 cases per 1000 inhabitants, respectively; adjusted P for trend .001). Among AF patients, the use of direct oral anticoagulants increased from 5.5% to 46.8%, while the prescription of antiplatelets and vitamin K antagonists decreased from 21.9% to 6.0% and from 63.8% to 36.1%, respectively. Overall, the use of oral anticoagulants increased from 69.3% to 82.9%; p < .001. Patients under antiplatelet agents had a higher probability of presenting IS than those patients taking oral anticoagulants, either vitamin K antagonists or direct oral anticoagulants (adjusted OR 1.89; 95% CI 1.52-2.37; p < .001). CONCLUSIONS The prescription of oral anticoagulants, particularly direct oral anticoagulants, has increased from 2013 to 2019 in our Health Assistance Area. This increase might partially explain the reduction in AF-related IS.
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Affiliation(s)
- Román Freixa-Pamias
- Department of Cardiology, Consorci Sanitari Integral, Hospital de Sant Joan Despí Moisès Broggi, Barcelona, Spain
- Coordinator of the Catalan Society of Cardiology & the Catalan Society of Family & Community Medicine (CAMFiC) Working Group for coordination between Cardiology & Primary Care, Barcelona, Spain
- Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Pedro Blanch Gràcia
- Cardiology Service, Consorci Sanitari Integral, Hospital de Sant Joan Despí Moisès Broggi, Barcelona, Spain
| | - Maria Lluïsa Rodríguez Latre
- Methodology, Evaluation and Quality Care, Primary Care Service Baix Llobregat Centre, Institut Català de la Salut, Barcelona, Spain
| | - Luca Basile
- Cardiology Service, Consorci Sanitari Integral, Hospital de Sant Joan Despí Moisès Broggi, Barcelona, Spain
- Public Health Agency of Catalonia, Generalitat de Catalunya, Barcelona, Spain
| | - Pilar Sanchez Chamero
- Cardiology Service, Consorci Sanitari Integral, Hospital de Sant Joan Despí Moisès Broggi, Barcelona, Spain
| | - Manuel Gomez-Choco
- Neurology Service, Consorci Sanitari Integral, Hospital de Sant Joan Despí Moisès Broggi, Barcelona, Spain
| | - Pedro Armario
- Internal Medicine Service, Consorci Sanitari Integral, Hospital de Sant Joan Despí Moisès Broggi, Barcelona, Spain
| | - Antoni Martínez-Rubio
- Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
- Director of Cardiology of the University Hospital of Sabadell (Universitat Autònoma de Barcelona), Sabadell, Spain
| | - Josep Lupón
- Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
- Heart Failure Clinic and Cardiology Service, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Badalona, Spain
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
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14
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Formiga F, Fernández Rodriguez JM. [Diabetes and atrial fibrillation, a frequent and worrisome association in the old people]. Rev Esp Geriatr Gerontol 2021; 56:127-128. [PMID: 33581940 DOI: 10.1016/j.regg.2020.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Francesc Formiga
- Programa de Geriatría, Servicio Medicina Interna, IDEBELL, Hospital Universitari de Bellvitge, ĹHospitalet de Llobregat, Barcelona, España.
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Barrios V, Cinza-Sanjurjo S, Gavín O, Egocheaga I, Burgos-Pol R, Soto J, Polanco C, Suárez J, Casado MÁ. Cost and burden of poor anticoagulation control with vitamin K antagonists in patients with nonvalvular atrial fibrillation in Spain. ACTA ACUST UNITED AC 2020; 74:773-780. [PMID: 32980294 DOI: 10.1016/j.rec.2020.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 06/05/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND OBJECTIVES The aim of this analysis was to evaluate the burden and cost of complications due to poor anticoagulation control in patients with nonvalvular atrial fibrillation (NVAF) treated with vitamin K antagonists (VKA) in Spain. METHODS An analytical model was used to estimate annual differences in ischemic stroke, major bleeding, deaths, costs, and potential years of life lost between patients with poor anticoagulation control (time in therapeutic range <65%) and adequate control (time in therapeutic range ≥ 65%) with a 1-year time horizon. Information on the target population (patients ≥ 65 years), event rates, and costs were obtained from national sources. Direct costs in euros (2018) were included from the perspective of the national health system (NHS) and direct and indirect costs from the societal perspective. A sensitivity analysis was performed with post-hoc data from the SPORTIF III/V trials. RESULTS We analyzed a hypothetical cohort of 594 855 patients, 48.3% with poor anticoagulation control, with an increase of 2321 ischemic strokes, 2236 major bleeding events and 14 463 deaths, and an annual incremental cost between €29 578 306 from the NHS perspective and €75 737 451 from the societal perspective. The annual impact of mortality was 170 502 potential years of life lost. The results of the sensitivity analysis showed that the annual cost would reach €97 787 873 from the societal perspective. CONCLUSIONS Poor anticoagulation control with AVK has a strong impact on loss of health and on increased spending for the NHS.
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Affiliation(s)
- Vivencio Barrios
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain.
| | - Sergio Cinza-Sanjurjo
- Centro de Salud Porto do Son, Área Sanitaria de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Olga Gavín
- Servicio de Hematología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Ramón Burgos-Pol
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain
| | - Javier Soto
- Farmacoeconomía e Investigación de Resultados, Pfizer S.L.U., Madrid, Spain
| | - Carlos Polanco
- Health Economics and Outcomes Research, Bristol-Myers Squibb, Madrid, Spain
| | - Jorge Suárez
- Health Economics and Outcomes Research, Bristol-Myers Squibb, Madrid, Spain
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Gorczyca I, Jelonek O, Michalska A, Chrapek M, Wałek P, Wożakowska-Kapłon B. Stroke prevention and guideline adherent antithrombotic treatment in elderly patients with atrial fibrillation: A real-world experience. Medicine (Baltimore) 2020; 99:e21209. [PMID: 32702889 PMCID: PMC7373526 DOI: 10.1097/md.0000000000021209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Patients aged ≥75 years with the diagnosis of atrial fibrillation (AF) are at a higher risk of stroke and, according to recent recommendations, should receive oral anticoagulant (OAC) therapy. This study aimed to assess the recommended prophylactic antithrombotic therapy among patients with AF aged ≥ 75 years and its compliance with current guidelines. We also aimed to identify predisposing factors associated with the administration of non-vitamin K antagonist oral anticoagulants (NOACs) in elderly patients with AF.This was a retrospective, single-center observational study. Patients with AF aged ≥75 years hospitalized at a reference cardiology center from 2014 to 2017 were included in the analysis.Among the 1236 eligible patients (43.4% male; mean age, 82 years), OACs were recommended in 90.1% of cases. Of these, 59.8% of patients used NOACs and 40.2% used vitamin K antagonists. Additionally, 3.3% of patients received antiplatelet (AP) therapy and 2.5% were administered low molecular weight heparin. Only 4.5% of patients did not receive any anticoagulant treatment. The majority (89.9%) of patients received relevant prophylactic antithrombotic therapy according to current guidelines; only 1.4% were overtreated and 8.7% were undertreated. The significant predictors of NOAC therapy among patients treated with anticoagulants were non-permanent AF (odds ratio [OR] = 1.68, 95% confidence interval [CI] = 1.30-2.18, P = .0001), age-by 5 years (OR = 1.33, 95% CI = 1.16-1.52, P = .0001), and glomerular filtration rate-by 5 units (OR = 1.06, 95% CI = 1.02-1.10, P = .0066).A high percentage of AF patients aged ≥75 years receive OACs, mainly NOACs. Most patients are treated according to the current guidelines; under treatment is primarily observed in patients receiving AP therapy. Non-permanent AF, age, and preservation of renal function are significant predictors of NOAC use.
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Affiliation(s)
- Iwona Gorczyca
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre
- Collegium Medicum, The Jan Kochanowski University
| | - Olga Jelonek
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre
| | | | - Magdalena Chrapek
- Faculty of Mathematics and Natural Sciences, The Jan Kochanowski University, Kielce, Poland
| | - Paweł Wałek
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre
| | - Beata Wożakowska-Kapłon
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre
- Collegium Medicum, The Jan Kochanowski University
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17
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Escobar C, Borrás X, Bover Freire R, González-Juanatey C, Morillas M, Muñoz AV, Gómez-Doblas JJ. A Delphi consensus on the management of oral anticoagulation in patients with non-valvular atrial fibrillation in Spain: ACOPREFERENCE study. PLoS One 2020; 15:e0231565. [PMID: 32479502 PMCID: PMC7263623 DOI: 10.1371/journal.pone.0231565] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 03/26/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate the level of agreement between cardiologists regarding the management of oral anticoagulation (OAC) in patients with non-valvular atrial fibrillation (NVAF) in Spain. MATERIALS AND METHODS A two-round Delphi study was performed using an online survey. In round 1, panel members rated their level of agreement with the questionnaire items on a 9-point Likert scale. Item selection was based on acceptance by ≥66.6% of panellists and the agreement of the scientific committee. In round 2, the same panellists evaluated those items that did not meet consensus in round 1. RESULTS A total of 238 experts participated in round 1; of these, 217 completed the round 2 survey. In round 1, 111 items from 4 dimensions (Thromboembolic and bleeding risk evaluation for treatment decision-making: 18 items; Choice of OAC: 39 items; OAC in specific cardiology situations: 12 items; Patient participation and education: 42 items) were evaluated. Consensus was reached for 92 items (83%). Over 80% of the experts agreed with the use of DOACs as the initial anticoagulant treatment when OAC is indicated. Panellists recommended the use of DOACs in patients at high risk of thromboembolic complications (CHA2DS2-VASc ≥3) (83%), haemorrhages (HAS-BLED ≥3) (89%) and poor quality of anticoagulation control (SAMe-TT2R2 >2) (76%), patients who fail to achieve an optimal therapeutic range after 3 months on VKA treatment (93%), and those who are to undergo cardioversion (80%). Panellists agreed that the efficacy and safety profile of each DOAC (98%), the availability of a specific reversal agent (72%) and patient's preference (85%) should be considered when prescribing a DOAC. A total of 97 items were ultimately accepted after round 2. CONCLUSIONS This Delphi panel study provides expert-based recommendations that may offer guidance on clinical decision-making for the management of OAC in NVAF. The importance of patient education and involvement has been highlighted.
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Affiliation(s)
- Carlos Escobar
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
- * E-mail:
| | - Xavier Borrás
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ramón Bover Freire
- Cardiology Department, Hospital Clínico San Carlos, CIBERCV, Madrid, Spain
| | | | - Miren Morillas
- Cardiology Department, Hospital de Galdakao, Galdakao, Bizkaia, Spain
| | | | - Juan José Gómez-Doblas
- Cardiology Department, Hospital Universitario Virgen de la Victoria, CIBERCV, Málaga, Spain
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18
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Barón-Esquivias G, Roldán Rabadán I, García Quintana A, Cerezo Manchado JJ, Antorrena Miranda I, Gómez-Barrado JJ, Pérez Paredes M, Santas E, Pindado Rodríguez J, Muñoz-Robles JA, Oliver-Miñarro D, Santamaría A. Use of edoxaban in clinical practice: Comparison of data from the Spanish population in the ETNA-AF-Europe registry. Future Cardiol 2020; 16:469-480. [PMID: 32228182 DOI: 10.2217/fca-2020-0024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Aim: To ascertain the clinical profile and management of edoxaban in clinical practice. Materials & methods: Prospective, noninterventional postauthorization study of nonselected patients with atrial fibrillation treated with edoxaban from 12 European countries. Patients' baseline characteristics are presented. Results: A total of 13,638 patients (73.6 ± 9.5 years; 76.6/23.4% edoxaban 60/30 mg; CHA2DS2-VASc 3.1; 838 [6.1%] from Spain) were included. In Spain, the percentage of very elderly and fragile patients was greater and the risk of thromboembolism (CHA2DS2-VASc ≥2, 98.0 vs 87.3%; p < 0.001) and bleeding (HAS-BLED, 3.2 vs 2.7; p < 0.001) was greater in patients treated with edoxaban 30 mg. The proportion of patients taking edoxaban 30 mg was similar than in ENGAGE AF-TIMI 48. Conclusion: In Spain, patients treated with edoxaban were older and fragile.
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Affiliation(s)
| | | | - Antonio García Quintana
- Cardiology Service, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain
| | | | | | | | - Matías Pérez Paredes
- Cardiology Service, Hospital General Universitario Morales Meseguer, Murcia, Spain
| | - Enrique Santas
- Cardiology Service, Hospital Clínico Universitario, Valencia, Spain
| | | | | | | | - Amparo Santamaría
- Hematology service, Hospital Universitario del Vinalopó, Torrevieja, Spain
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19
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Giner-Soriano M, Casajuana M, Roso-Llorach A, Vedia C, Morros R. [Effectiveness, safety and costs of stroke prevention in non-valvular auricular fibrillation. Study of cohorts matched by Propensity score]. Aten Primaria 2020; 52:176-184. [PMID: 31551166 PMCID: PMC7063152 DOI: 10.1016/j.aprim.2019.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/28/2019] [Accepted: 06/05/2019] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To analyze the use, effectiveness, safety and costs of stroke prevention in non-valvular atrial fibrillation (AF) in patients initiating treatment with dabigatran or vitamin K antagonists (VKA). SETTING Primary Care (PC) at the Catalan Health Institute (ICS) in Catalonia, during 2011-2013. PARTICIPANTS Patients attended in ICS PC centres with a registered diagnosis of AF who initiate dabigatran or VKA. INTERVENTIONS Not applicable MAIN MEASUREMENTS: Number of prescriptions and reimbursements of dabigatran and VKA, incidence of stroke and haemorrhages, incidence of mortatlity, number of sickness leave, and costs associated to all the previous variables. RESULTS 14,930 patients were included; 94.6% initiated VKA and 5.4%, dabigatran. Dabigatran patients were younger and with less comorbidity. There were no statistically significant differences between VKA and dabigatran in the risk of stroke, haemorrhages or death. The costs associated to AF management were higher for PC visits in the VKA group, and higher for laboratory and pharmacy in the dabigatran group, although overall costs were not statistically different. CONCLUSIONS Most patients initiated VKA. We found no differences between VKA and dabigatran in the risk of stroke, haemorrhages or mortality.
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Affiliation(s)
- Maria Giner-Soriano
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, España; Institut Català de la Salut, Departament de Salut, Generalitat de Catalunya, Barcelona, España.
| | - Marc Casajuana
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, España
| | - Albert Roso-Llorach
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, España
| | - Cristina Vedia
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, España; Unitat de Farmàcia, Servei d'Atenció Primària Barcelonès Nord i Maresme, Institut Català de la Salut, Badalona, Barcelona, España
| | - Rosa Morros
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, España; Institut Català de la Salut, Departament de Salut, Generalitat de Catalunya, Barcelona, España
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20
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Riera-Mestre A, Camafort M, María Suriñach J, Muñoz Rodríguez FJ, Padilla F, Francisco-Pascual J, Mateo Arranz J, Martínez Rubio A, Villuendas Sabaté R, Freixa-Pamias R, Suárez Fernández C, Santamaría A. Anticoagulación del paciente anciano pluripatológico con fibrilación auricular no valvular: papel del rivaroxabán. REVISTA ESPAÑOLA DE CARDIOLOGÍA SUPLEMENTOS 2020. [DOI: 10.1016/s1131-3587(20)30011-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Anguita M, de la Figuera M, Cabeza AIP, Fernández CS. Clinical profile and management of rivaroxaban in patients with atrial fibrillation in routine practice in Spain: data from six nationwide studies. Drugs Context 2019; 8:212606. [PMID: 31692949 PMCID: PMC6822684 DOI: 10.7573/dic.212606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/03/2019] [Accepted: 09/09/2019] [Indexed: 11/21/2022] Open
Abstract
AIMS To analyze the clinical profile and management of patients with nonvalvular atrial fibrillation taking rivaroxaban in routine practice in Spain. METHODS Clinical data from the observational studies HEROIC (cardiology and hematology; n=1,727), EMIR (cardiology; n=1,493), BRONCE-AP (primary care; n=133), SILVER-AP (primary care; n=457), ALADIN (internal medicine and neurology; n=249), and ESPARTA (internal medicine; n=110) of patients taking rivaroxaban were analyzed. The clinical profile was compared with those of the XANTUS and ROCKET-AF studies. RESULTS Overall, mean age was 74.9±9.4 years, CHA2DS2-VASc score was 3.7±1.5, and 43.2% had a HAS-BLED score ≥3. Patients included in the HEROIC and EMIR studies were older and more frequently had a creatinine clearance <50 mL/min and a higher thromboembolic risk than those in the XANTUS study, and patients included in the ALADIN study were older and had more prior cerebrovascular disease, but a lower thromboembolic risk than those in the ROCKET-AF trial. In those studies with available data, medication adherence and satisfaction with rivaroxaban were high. CONCLUSION Bearing in mind differences according to the clinical setting of each study, atrial fibrillation patients taking rivaroxaban in Spain were elderly and had a high thromboembolic risk. Medication adherence and satisfaction with rivaroxaban were high.
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Affiliation(s)
- Manuel Anguita
- Cardiology Department, Hospital Universitario Reina Sofia, Córdoba, Spain
| | | | | | - Carmen Suarez Fernández
- Internal Medicine Department, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain
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22
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Sebastián OG, Fernández MI, Fernández RM, Bernal LP. Use of rivaroxaban in patients attending a hematology unit in clinical practice. Future Cardiol 2019; 15:347-353. [PMID: 31468995 DOI: 10.2217/fca-2018-0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To determine drug persistence and rates of events among patients treated with rivaroxaban in a hematology unit. Methods: Retrospective study of patients that started treatment with rivaroxaban, in the hematology unit of a tertiary hospital. Results: A total of 161 patients were included, of whom 83.9% had atrial fibrillation and 11.2% venous thromboembolism, and 76.4% of patients were taking rivaroxaban 20 mg, 22.4% 15 mg and 1.2% 10 mg. After a follow-up of 1.8 ± 1.1 years, only four patients (2.5%) discontinued treatment. Rates of thromboembolic events, major bleeding/clinically relevant nonmajor bleeding and intracranial hemorrhage were 1.1, 2.8, 0.3 events per 100 patient-years, respectively. Conclusion: In patients attended in a hematology unit, medication persistence was high, and the incidence of outcomes low.
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Affiliation(s)
- Olga Gavín Sebastián
- Servicio de Hematología y Hemoterapia, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | | | - Luis Palomera Bernal
- Servicio de Hematología y Hemoterapia, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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23
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Barrios V, Escobar C, Barón Esquivias G, Gómez Doblas J, Recalde del Vigo E, Segura Martínez L, Alvarez Garcia P, Alonso Valladares F, Toril Lopez J, Chopo Alcubilla J. Quality of life, adherence and satisfaction of patients with auricular fibrillation treated with dabigatran or vitamin K antagonists. Rev Clin Esp 2019. [DOI: 10.1016/j.rceng.2018.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Leal Hernández M, Ruiz Merino G, Leal Casas T, Abellán Alemán J. [Control of blood pressure in patients with atrial fibrillation treated with acenocoumarol and with an altered Rosendaal index]. HIPERTENSION Y RIESGO VASCULAR 2019; 36:165-166. [PMID: 31010669 DOI: 10.1016/j.hipert.2019.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 02/14/2019] [Accepted: 02/25/2019] [Indexed: 11/24/2022]
Affiliation(s)
- M Leal Hernández
- Cátedra de Riesgo Cardiovascular, Universidad Católica de Murcia, IMIB Arrixaca, Murcia, España.
| | - G Ruiz Merino
- Fundación para Formación e Investigación Sanitaria, Región de Murcia, Murcia, España
| | - T Leal Casas
- Cátedra de Riesgo Cardiovascular, Universidad Católica de Murcia, IMIB Arrixaca, Murcia, España
| | - J Abellán Alemán
- Cátedra de Riesgo Cardiovascular, Universidad Católica de Murcia, IMIB Arrixaca, Murcia, España
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25
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Atienza-Martín F, Barrios V, Egocheaga M, Hidalgo R, Marín-Montañés N, Ramis C. El método AMFE (Análisis Modal de Fallos y Efectos) aplicado a la anticoagulación de pacientes con fibrilación auricular no valvular. Semergen 2019; 45:169-179. [DOI: 10.1016/j.semerg.2018.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/10/2018] [Accepted: 04/26/2018] [Indexed: 10/27/2022]
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Cervantes CE, Merino JL, Barrios V. Edoxaban for the prevention of stroke in patients with atrial fibrillation. Expert Rev Cardiovasc Ther 2019; 17:319-330. [DOI: 10.1080/14779072.2019.1598263] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Carlos Escobar Cervantes
- Cardiology Service, Unidad de electrofisiología cardíaca robotizada, Hospital Universitario La Paz, Madrid, Spain
| | - José Luis Merino
- Cardiology Service, Unidad de electrofisiología cardíaca robotizada, Hospital Universitario La Paz, Madrid, Spain
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27
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Barrios V, Escobar C, Barón Esquivias G, Gómez Doblas JJ, Recalde Del Vigo E, Segura Martínez L, Alvarez Garcia P, Alonso Valladares F, Toril Lopez J, Chopo Alcubilla JM. Quality of life, adherence and satisfaction of patients with auricular fibrillation treated with dabigatran or vitamin K antagonists. Rev Clin Esp 2019; 219:285-292. [PMID: 30894251 DOI: 10.1016/j.rce.2018.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/18/2018] [Accepted: 12/19/2018] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To analyse the quality of life, adherence and satisfaction of patients with nonvalvular auricular fibrillation (NVAF) treated with dabigatran versus vitamin K antagonists (VKA) in cardiology consultations in Spain. METHODS We conducted an observational, comparative, prospective and multicentre study of patients with NVAF treated in cardiology departments, who started treatment with dabigatran or VKA in the month prior to the baseline visit. The follow-up lasted 6 months. We analysed quality of life (using the validated AF-QoL 18 questionnaire [0, minimum; 100, maximum]), adherence (using the Morisky-Green test) and the cardiologist's perception (using a specific questionnaire [0, completely dissatisfied; 10, completely satisfied]). RESULTS We analysed 1015 patients (mean age, 73.3±9.4 years; 57% men; CHA2DS2VASc, 3.4±1.5; HAS-BLED, 1.5±1.0) who were treated with dabigatran (74.7%) or with VKA (25.3%). The total quality-of-life scores remained constant throughout the follow-up (47.9±23.5 and 48.6±24.4 at baseline and at 6 months, respectively; P=NS) but were higher at 6 months for the dabigatran group (50.6±24.7 vs. 42.8±22.5; P<.001). Treatment adherence was high during the study but greater with dabigatran at 6 months (89.2% vs. 81.1%; P=.001). There was a better perception of the cardiologist regarding the satisfaction of the patients treated with dabigatran at 6 months (9.0±1.2 vs. 6.6±2.2; P<.001). CONCLUSIONS For patients with NVAF and high thromboembolic risk treated in cardiology consultations, the adherence, satisfaction and quality of life were higher for the patients treated with dabigatran than for those treated with VKA.
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Affiliation(s)
- V Barrios
- Departamento de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, España.
| | - C Escobar
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, España
| | | | - J J Gómez Doblas
- Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, España
| | | | | | - P Alvarez Garcia
- Servicio de Cardiología, Fundación Hayge, Viladecans, Barcelona, España
| | | | - J Toril Lopez
- Servicio de Cardiología, Centre Medic Castelldefels, Castelldefels, Barcelona, España
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Cerdá M, Cerezo-Manchado JJ, Johansson E, Martínez F, Fernández M, Varela A, Rodríguez S, Bosch F, Santamaría A. Facing real-life with direct oral anticoagulants in patients with nonvalvular atrial fibrillation: outcomes from the first observational and prospective study in a Spanish population. J Comp Eff Res 2019; 8:165-178. [DOI: 10.2217/cer-2018-0134] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Aim: To analyze the effectiveness and safety of direct oral anticoagulants (DOACs) in atrial fibrillation (AF) patients attended in clinical practice. Methods: Observational and prospective study of AF patients that started treatment with DOACs. Results: 1443 patients (age 77.2 ± 9.7 years, CHA2DS2-VASc = 4.1 ± 1.5) were included. 46.0% were taking rivaroxaban, 24.4% dabigatran, 22.5% apixaban and 7.1% edoxaban. Patients taking dabigatran were younger, had lower CHA2DS2-VASc and lesser renal insufficiency. Patients taking apixaban had higher CHA2DS2-VASc and more renal insufficiency. Rates of stroke/major bleeding/intracranial bleeding were 0.7/1.3/0.2 events/100 patient-years, respectively. Conclusion: This was the first prospective study that analyzed the use of all DOACs in AF patients in Spain, showing a good profile in terms of safety and effectiveness in accordance with pivotal studies.
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Affiliation(s)
- María Cerdá
- Servicio de Hematología, Hospital Vall d'Hebron, Barcelona, Spain
| | | | - Erik Johansson
- Servicio de Hematología, Hospital Vall d'Hebron, Barcelona, Spain
| | | | | | - Ana Varela
- Servicio de Hematología, Hospital Vall d'Hebron, Barcelona, Spain
| | - Saray Rodríguez
- Servicio de Hematología, Hospital Vall d'Hebron, Barcelona, Spain
| | - Francesc Bosch
- Servicio de Hematología, Hospital Vall d'Hebron, Barcelona, Spain
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Rodríguez-Mañero M, López-Pardo E, Cordero-Fort A, Martínez-Sande JL, Peña-Gil C, Platas JN, García-Seara J, Mazón P, Varela-Román A, García-Acuña JM, González-Juanatey JR. Prevalence and outcomes of atrial fibrillation in a European healthcare area gained through the processing of a health information technology system. Rev Port Cardiol 2019; 38:21-29. [DOI: 10.1016/j.repc.2018.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 03/04/2018] [Accepted: 06/03/2018] [Indexed: 01/23/2023] Open
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30
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Rodríguez-Mañero M, López-Pardo E, Cordero-Fort A, Martínez-Sande JL, Peña-Gil C, Platas JN, García-Seara J, Mazón P, Varela-Román A, García-Acuña JM, González-Juanatey JR. Prevalence and outcomes of atrial fibrillation in a European healthcare area gained through the processing of a health information technology system. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2019.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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31
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Polo García J, Vargas Ortega D, Formiga F, Unzueta I, Fernández de Cabo S, Chaves J. Profiling of patients with non-valvular atrial fibrillation and moderate-to-high risk of stroke not receiving oral anticoagulation in Spain. Semergen 2018; 45:396-405. [PMID: 30573367 DOI: 10.1016/j.semerg.2018.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/28/2018] [Accepted: 10/17/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In non-valvular atrial fibrillation (NVAF) with embolic risk, the guidelines recommend oral anticoagulation (OAC), although not all patients receive it. In this study, an attempt is made to identify these patients, and to study factors related to non-anticoagulation. MATERIAL AND METHODS Non-interventional, cross-sectional, multicentre study was performed on a population of patients ≥18 years with a NVAF diagnosis, moderate-high embolic risk (CHADS2 score≥2), not treated with OAC. Atrial fibrillation (AF) prevalence was also collected. RESULTS AF prevalence was 4.5%, and 80.7% of the patients had NVAF (20.0% did not receive OAC). A total of 1310 non-OAC-treated patients were included (51.8% male, mean age: 76.0 years). The mean time since AF diagnosis was 58.4 months. The main therapeutic decision for stroke prevention was prescription of antiplatelet agents (82.4%, n=1078), and the main reasons were: patient refusal to monitoring (37.3%), high bleeding risk (31.1%), uncontrolled hypertension (27.9%), and frequent falls (27.6%). The mean CHA2DS2-VASc score was 4.6, and the HAS-BLED was 2.7 (55.9% of patients scoring HAS-BLED≥3). The most common thromboembolic risk factors were: hypertension (89.1%), age≥75 years (61.5%); the haemorrhagic factors: use of drugs increasing the bleeding risk (41.2%), uncontrolled blood pressure (33.7%). CONCLUSIONS About 20% of Spanish NVAF patients do not receive OAC in the clinical practice and are treated with antiplatelet agents, which do not reduce haemorrhagic risk. Most patients do not clearly show a contraindication to OACs, particularly considering that there are other available options (direct oral anticoagulant drugs [DOACs]).
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Affiliation(s)
- J Polo García
- Centro de Salud Cañaveral, Calle Doctor Boticario Jiménez 32, 10820 Cáceres, Spain.
| | - D Vargas Ortega
- Unidad de Hospitalización del Hospital de Alta Resolución el Toyo, Camino de la Botica s/n, 04131 Almería, Spain
| | - F Formiga
- Servicio de Medicina Interna del Hospital Bellvitge, Carrer de la Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - I Unzueta
- Medical Department Pfizer (PIH), Avda. Europa 20B, 20108 Alcobendas, Madrid, Spain
| | - S Fernández de Cabo
- Medical Department Pfizer (PIH), Avda. Europa 20B, 20108 Alcobendas, Madrid, Spain
| | - J Chaves
- Medical Department Pfizer (PIH), Avda. Europa 20B, 20108 Alcobendas, Madrid, Spain
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Suárez-Fernández C, Gullón A. [The challenge of antitrombotic treatment prescription in older adults with atrial fibrillation. Does age justify the anti-thrombotic strategy in elderly patients with atrial fibrillation?]. Rev Esp Geriatr Gerontol 2018; 53:317-318. [PMID: 30430995 DOI: 10.1016/j.regg.2018.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 05/30/2018] [Indexed: 01/26/2023]
Affiliation(s)
| | - Alejandra Gullón
- Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, España
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Gonzalez-Loyola F, Abellana R, Verdú-Rotellar JM, Bustamante Rangel A, Clua-Espuny JL, Muñoz MA. Mortality in heart failure with atrial fibrillation: Role of digoxin and diuretics. Eur J Clin Invest 2018; 48:e13014. [PMID: 30091171 DOI: 10.1111/eci.13014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/28/2018] [Accepted: 08/02/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND The impact of atrial fibrillation (AF) on mortality of patients with heart failure (HF) has been established. Nevertheless, the effect of some factors in mortality, such as digoxin or diuretic use, remains controversial. This study aims at assessing mortality in community-dwelling patients with stable HF related to AF and determines the relation of these drugs with prognosis. MATERIALS AND METHODS Community-based cohort study of HF patients diagnosed between January 2010 and December 2014 attended at any one of the 279 primary healthcare centres of the Catalan Institute of Health (Spain). Follow-up ended on December 31, 2015, and the main outcome was mortality for all causes. The effect of clinical and demographic characteristics on survival was assessed by Cox proportional hazards model. RESULTS A total of 13 334 HF patients were included. Mean age was 78.7 years (SD 10.1), and 36.8% had AF. Mean follow-up was 26.9 months (SD 14.0). At the end of the study, 25.8% patients had died, and mortality was higher when AF was present (28.8% vs 24.1%, P < 0.001, respectively). Multivariate model confirmed the higher risk of death for AF patients (HR 1.10 95%, CI 1.02-1.19). Digoxin and diuretics were not associated with higher mortality in AF patients (HR 1.04 95% CI 0.92-1.18 and HR 1.04 95% CI 0.85-1.26, respectively). CONCLUSIONS An excess of mortality in HF patients with AF was found in a large retrospective community-based cohort. Digoxin and diuretics did not affect mortality in HF patients with AF.
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Affiliation(s)
- Felipe Gonzalez-Loyola
- Institut de Recerca en Atencio Primaria Jordi Gol, Barcelona, Spain.,Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain.,Facultad de Medicina, Departament de Pediatría, Obstetricia i Ginecología i Medicina Preventiva, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Rosa Abellana
- Institut de Recerca en Atencio Primaria Jordi Gol, Barcelona, Spain.,Facultat de Medicina, Departament de Fonaments Clínics, Universitat de Barcelona, Barcelona, Spain
| | - José-Maria Verdú-Rotellar
- Institut de Recerca en Atencio Primaria Jordi Gol, Barcelona, Spain.,Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain.,Facultad de Medicina, Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Alejandro Bustamante Rangel
- Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR) - Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Josep Lluís Clua-Espuny
- EAP Tortosa 1-Est, Institut Català Salut, SAP Terres de l'Ebre, Tortosa, Spain.,Universidad Miguel Hernández, Elche, Spain
| | - Miguel-Angel Muñoz
- Institut de Recerca en Atencio Primaria Jordi Gol, Barcelona, Spain.,Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain.,Facultad de Medicina, Departament de Pediatría, Obstetricia i Ginecología i Medicina Preventiva, Universitat Autònoma de Barcelona, Bellaterra, Spain
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Casajuana M, Giner-Soriano M, Roso-Llorach A, Vedia C, Violan C, Morros R. Annual costs attributed to atrial fibrillation management: cross-sectional study of primary healthcare electronic records. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:1129-1136. [PMID: 29464418 DOI: 10.1007/s10198-018-0961-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 02/14/2018] [Indexed: 06/08/2023]
Abstract
Atrial fibrillation (AF) is the most common chronic arrhythmia, with increasing healthcare and economic burden and a prevalence which increases with progressive ageing. This study aims to describe overall annual costs per patient for management of non-valvular AF in a primary healthcare (PHC) setting and compare these costs between the groups of patients treated with vitamin K antagonists, antiplatelets or non-treated through a population-based study conducted with electronic health records. We analysed annual costs per person of 19,787 patients in 2012; PHC visits, hospital admissions, AF-related events requiring hospital admission, referrals to secondary specialists, sick leave, diagnostic tests and laboratory tests at PHC level, including INR determinations performed in PHC, and drug therapy. Higher costs of AF management were associated with increasing age, male sex, stroke and bleeding risks, comorbidities and occurrence of events associated to AF. The sensitivity analyses conducted showed that PHC visits and hospitalizations represented the most important part of overall costs for all patients.
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Affiliation(s)
- Marc Casajuana
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gran Via de les Corts Catalanes 587, àtic, 08007, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Maria Giner-Soriano
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gran Via de les Corts Catalanes 587, àtic, 08007, Barcelona, Spain.
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.
- Institut Català de la Salut, Departament de Salut, Generalitat de Catalunya, Barcelona, Spain.
| | - Albert Roso-Llorach
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gran Via de les Corts Catalanes 587, àtic, 08007, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Cristina Vedia
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Unitat de Farmàcia, Servei d'Atenció Primària Barcelonès Nord i Maresme, Institut Català de la Salut, Badalona, Spain
| | - Concepció Violan
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gran Via de les Corts Catalanes 587, àtic, 08007, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Rosa Morros
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gran Via de les Corts Catalanes 587, àtic, 08007, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Institut Català de la Salut, Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
- UICEC IDIAP Jordi Gol, Plataforma SCReN, Barcelona, Spain
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Contreras Muruaga M, Reig G, Vivancos J, González A, Cardona P, Ramírez-Moreno J, Martí-Fábregas J, Suárez Fernández C, Pose A, Díaz JA, Rodríguez M, Pena M, Arias S, Larrosa D, González Á, Rodríguez E, González M, Fernández D, Barbagelata C, Raña N, Freire S, Cerqueiro JM, Guerrero H, Ramos L, Álvarez L, de Lis JM, Caro C, Seijo M, Mederer S, de Zarraga MA, Ferreiro J, Terrero JM, Arias M, Pérez R, Sánchez J, Maciñeiras J, Fernández J, Jaén F, Esteva D, Zamora M, Navarrete N, García J, Mérida L, Corrales MÁ, Quirós R, Cantero J, Barrero FJ, Villegas I, Castro J, Foronda J, Carrillo D, Vega J, Trujillo JA, Montero M, Jurado A, Sánchez C, Agüera-Morales E, Sánchez M, Durán P, Fernández de la Puerta R, Pérez de la Blanca M, Martínez MP, Fernández Ó, Tamayo JA, Bustamante R, Serrano PJ, Arjona A, Fernández J, Payan M, Gómez R, Peña D, Cabrerizo E, Salgado F, Ivanova Georgieva R, Gil-Núñez A, Bello E, Díaz F, Medina A, Castellano A, Miranda Y, Fabre Ó, García Polo I, Ibáñez P, Sainz C, Sierra F, Aragón E, Díaz J, Aguilar F, Ortega MÁ, Egido JA, Pontes JC, García MÁ, Cabrera F, Batalla B, Culla A, Molina C, Flores A, Seró L, Muchada M, Meler P, Boned-Riera S, Cánovas D, Estela J, Font J, Purroy F, Benabdelhak I, Sanahuja J, Roquer J, Rodríguez A, Ois Á, Cuadrado E, Jiménez J, Nogués X, Kuprinski J, German A, Irigoyen D, Cara JJ, Font MÀ, Huertas S, Martínez-Domeño A, Arroyo JA, Delgado-Mederos R, Gómez-Choco MJ, Mengual JJ, García SM, Castellanos MDM, van Eedenburg C, Cañas I, Espinosa J, Montull S, Quesada H, Ustrell X, Homedes C, Navalpotro I, Casanova J, Lago AP, Morata C, Gorriz D, Moreno I, Tembl J, Ponz A, Fonseca MJ, Chamarro R, Gil R, Oliver V, Pampliega A, Artero A, Puchades F, Landete L, Vilar C, Jiménez C, Vives B, Moragues MD, Díaz R, Tur S, Escribano JB, Lucas C, Martínez F, Pons JM, Romero A, García D, Pérez J, Villaverde R, Martínez S, Rodríguez A, Tejero C, Pérez C, Mostacero E, Fernández C, Luna A, Pérez T, González F, de Arce A, Martínez M, Díez N, Gállego J, Zandio B, Herrera M, Aymerich N, Muñoz R, Marta J, Artal J, Errea JM, Timiraos JJ, Moreno MP, Freijo M, García JM, Gil MC, Revilla MÁ, Palacio E, Vázquez JL, Bestué M, Latorre A, Calvo E, Ballester L, Serrano M, Juega JM, López MÁ, Irimia P, Imaz L, Fuentes B, Sanz BE, Beltrán L, Ruiz G, Martínez P, Sánchez D, Barroso E, Molina I, Budiño MA, Masjuan J, de Felipe A, Matute C, Tejada J, Morán A, Fernández E, Riveira MDC, Carnedo J, Manquillo A, González R, Fernández JC, Guillan M, Yebra M, Trejo JM, Saiz J, Martínez-Acitores JC, Bravo Y, Arenillas JF, Calleja A, Cortijo E, Reyes J, López L, Muñoz PL, Fidalgo MÁ, Hernández J, Gómez JC, Morán JC, Gonzalo S, Marrero J, Satué JÁ, Belinchón JC, Moniche F, Calderón E, Escudero I, de la Torre J, Casado I, Antón J, Portilla JC, Luengo J, Rosal J, Calzado E, Anglada JC, Girón J, Ramírez JM, Pijierro A, Roa A, Romero J, Aguayo M, Borrachero C, Sanz G, Gómez MJ, Rico MÁ, Cayon A, Carmona E, Cerro R, López R, Aguirre A, Lozano F, Rivera JM. Factors associated with poor anticoagulation control with vitamin K antagonists among outpatients attended in Internal Medicine and Neurology. The ALADIN study. Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2018.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Barrios V, Almendro-Delia M, Facila L, Garcia-Moll X, Mazón P, Camafort M, Cepeda JM, Mediavilla Garcia JD, Pose Reino A, Suarez Fernandez C. Rivaroxaban: searching the integral vascular protection. Expert Rev Clin Pharmacol 2018; 11:719-728. [PMID: 29965791 DOI: 10.1080/17512433.2018.1495559] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Residual cardiovascular risk remains high in patients with atherosclerotic cardiovascular disease despite current antithrombotic therapy. On the other hand, patients with atrial fibrillation have an increased risk of myocardial infarction and cardiovascular death. As a result, a new antithrombotic approach appears necessary to reduce this risk. Areas covered: In this article, the role of rivaroxaban on vascular protection in patients with cardiovascular disease and/or atrial fibrillation was reviewed, with a particular focus, but not limited, on clinical trials. Expert commentary: Previous data have shown that factor Xa plays a key role in the etiopathogenesis of atherothrombosis. Experimental data suggest that rivaroxaban exhibits antiinflammatory and antioxidative stress properties, and may improve endothelial dysfunction. The COMPASS trial showed that among patients with stable atherosclerotic vascular disease, the addition of rivaroxaban 2.5 mg twice daily (vascular dose) to aspirin provided a higher cardiovascular protection than aspirin alone. In ROCKET-AF trial, compared with warfarin, rivaroxaban 20 mg once daily (15 mg if moderate renal dysfunction) (anticoagulant dose) was, at least, as effective as warfarin for the prevention of stroke or systemic embolism among patients with nonvalvular atrial fibrillation, with a trend toward a reduction in the risk of cardiovascular outcomes. All these data suggest that rivaroxaban might have a vascular protective effect beyond its stroke/systemic embolism preventive activity.
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Affiliation(s)
- Vivencio Barrios
- a Cardiology Department , Hospital Ramón y Cajal , Madrid , Spain
| | | | - Lorenzo Facila
- c Cardiology Department , Consorcio Hospital General Universitario de Valencia , Valencia , Spain
| | | | - Pilar Mazón
- e Cardiology Department , Hospital Clinico Universitario de Santiago de Compostela. CIBERCV , Spain
| | - Miguel Camafort
- f Internal Medicine Department , Atrial fibrillation Unit UFA Hospital Clinic, Universitat de Barcelona , Barcelona , Spain
| | - José María Cepeda
- g Internal Medicine Department , Hospital Vega Baja , Alicante , Spain
| | | | - Antonio Pose Reino
- i Internal Medicine Department , Complexo Hospitalario Universitario de Santiago , Santiago , Spain
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Suárez Fernández C, Mostaza JM, Castilla Guerra L, Cantero Hinojosa J, Suriñach JM, Acosta de Bilbao F, Tamarit JJ, Diaz Diaz JL, Hernandez JL, Cazorla D, Ràfols C. Adherence to recommendations of the Therapeutic Positioning Report about treatment with oral anticoagulants in elderly patients with atrial fibrillation. The ESPARTA study. Med Clin (Barc) 2018; 151:8-15. [PMID: 28992980 DOI: 10.1016/j.medcli.2017.07.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/19/2017] [Accepted: 07/27/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the adherence to the recommendations in clinical practice performed by the Therapeutic Positioning Report (TPR) of the Spanish Agency of Medicines and Sanitary Products about the treatment with oral anticoagulants in patients aged≥75 years old with nonvalvular atrial fibrillation (NVAF) treated in Internal Medicine departments in Spain. PATIENTS AND METHODS Observational, cross-sectional and multicenter study in which 837 patients aged≥75 years old with NVAF, with stable treatment with oral anticoagulants at least 3 months before inclusion, and that had started treatment with oral anticoagulants before the inclusion period were included. RESULTS Mean age was 83.0±5.0 years old, mean CHADS2 score 3.2±1.2, mean CHA2DS2-VASc score 5.0±1.4, and mean HAS-BLED score 2.1±0.9. A percentage of 70.8 of patients were treated with vitamin K antagonists (VKA) and the rest of patients with direct oral anticoagulants (DOACs). A percentage of 65.6 of patients treated with VKA did not follow the recommendations made by the TPR compared with 43.0% of patients treated with DOACs (P<.0001). In the case of VKA, the main reason for being considered as not appropriate according to the TPR was having poor control of anticoagulation and not switching to DOACs, whereas in the case of DOACs, it was not receiving the adequate dose according to the TPR. CONCLUSIONS In a high proportion of anticoagulated elderly patients with NVAF in Spain, the recommendations performed by the TPR are not followed, particularly with VKA, since patients are not switched to DOACs despite time in therapeutic range.
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Affiliation(s)
| | | | - Luis Castilla Guerra
- Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, España
| | | | | | - Fernando Acosta de Bilbao
- Servicio de Medicina Interna, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Las Palmas, España
| | - Juan José Tamarit
- Servicio de Medicina Interna, Hospital General de Valencia, Valencia, España
| | - José Luis Diaz Diaz
- Servicio de Medicina Interna, Complejo Universitario Hospitalario de A Coruña, La Coruña, España
| | - Jose Luis Hernandez
- Servicio de Medicina Interna, Hospital Marqués de Valdecilla, Universidad de Cantabria, Santander, España
| | - Daniel Cazorla
- Departamento Médico, Bayer Hispania S. L., Barcelona, España
| | - Carles Ràfols
- Departamento Médico, Bayer Hispania S. L., Barcelona, España
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Contreras Muruaga MM, Reig G, Vivancos J, González A, Cardona P, Ramírez-Moreno JM, Martí-Fábregas J, Suárez Fernández C. Factors associated with poor anticoagulation control with vitaminK antagonists among outpatients attended in Internal Medicine and Neurology. The ALADIN study. Rev Clin Esp 2018; 218:327-335. [PMID: 29983190 DOI: 10.1016/j.rce.2018.04.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 04/24/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To identify factors associated with poor anticoagulation control with vitaminK antagonists (VKA) among outpatients with nonvalvular atrial fibrillation (NVAF) attended in Neurology and Internal Medicine in Spain. METHODS Cross-sectional and multicenter study, from the ALADIN database, of outpatients with NVAF treated with VKA and attended in Internal Medicine and Neurology in Spain. Rates of anticoagulation control were determined with the direct and Rosendaal methods, considering data from the 6months before the inclusion. RESULTS Out of 1,337 patients included in the ALADIN study, 750 were taking VKA, and complete information about INR values in the last 6months was available in 383 patients. Mean scores of Charlson Index, CHADS2, CHA2DS2-VASc and HAS-BLED were 1.94±1.54; 3.10±1.26; 4.63±1.54, and 2.20±0.90, respectively. 46.2% and 47.0% of patients had an adequate anticoagulation control according to the direct and Rosendaal methods, respectively. Inadequate anticoagulation control according to the direct method was associated with diabetes (OR: 2.511; 95%CI: 1.144-5.659), prior labile INR (OR: 35.371; 95%CI: 15.058-83.083) and the determination of >6INR controls in the last 6months (OR: 4.747; 95%CI: 2.094-10.759), and according to the Rosendaal method, with prior labile INR (P<.001) and HAS-BLED score (OR: 3.991; 95%CI: 2.520-6.319). CONCLUSIONS Despite the high thromboembolic risk, only a little more than a half of patients were well controlled. Factors associated with poor anticoagulation control were diabetes, labile INR, >6INR controls and HAS-BLED.
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Affiliation(s)
- M M Contreras Muruaga
- Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, España.
| | - G Reig
- Servicio de Neurología, Hospital Universitario de La Princesa, Madrid, España
| | - J Vivancos
- Servicio de Neurología, Hospital Universitario de La Princesa, Madrid, España
| | - A González
- Servicio de Neurología y Neurofisiología Clínica, Hospital San Roque Las Palmas, Las Palmas, España
| | - P Cardona
- Servicio de Neurología, Hospital Universitario de Bellvitge (HUB), Hospitalet de Llobregat, Barcelona, España
| | - J M Ramírez-Moreno
- Unidad de Ictus, Servicio de Neurología, Departamento de Ciencias Biomédicas, Hospital Universitario Infanta Cristina, Badajoz, España
| | - J Martí-Fábregas
- Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, España
| | - C Suárez Fernández
- Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, España
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Diferencias en el manejo de los pacientes con fibrilación auricular según inicie el tratamiento con anticoagulantes orales de acción directa el médico de atención primaria o el especialista. Estudios SILVER-AP y BRONCE-AP. Semergen 2018; 44:323-334. [DOI: 10.1016/j.semerg.2017.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/23/2017] [Accepted: 09/12/2017] [Indexed: 12/31/2022]
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Suárez Fernández C, Mostaza JM, Castilla Guerra L, Cantero Hinojosa J, Suriñach JM, Acosta de Bilbao F, Tamarit JJ, Diaz Diaz JL, Hernandez JL, Cazorla D, Ràfols C. Adherence to recommendations of the Therapeutic Positioning Report about treatment with oral anticoagulants in elderly patients with atrial fibrillation. The ESPARTA study. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.medcle.2018.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Uso de anticoagulantes orales en situaciones clínicas complejas con fibrilación auricular. Med Clin (Barc) 2018; 150 Suppl 1:8-24. [DOI: 10.1016/s0025-7753(18)30666-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Escobar Cervantes C. Rivaroxaban: from ROCKET-AF trial to routine practice in Spain. Future Cardiol 2018; 14:1-2. [PMID: 29848088 DOI: 10.2217/fca-2018-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Pacientes con fibrilación auricular atendidos en consulta de atención primaria de una institución de alta complejidad. REVISTA COLOMBIANA DE CARDIOLOGÍA 2018. [DOI: 10.1016/j.rccar.2017.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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de la Figuera M, Cinza S, Egocheaga I, Marín N, Prieto MA. Clinical characteristics and management of patients with atrial fibrillation treated with direct oral anticoagulants according to blood pressure control. HIPERTENSION Y RIESGO VASCULAR 2018; 35:e1-e9. [PMID: 29454558 DOI: 10.1016/j.hipert.2018.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 01/10/2018] [Accepted: 01/12/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the clinical characteristics and management of hypertensive patients with nonvalvular atrial fibrillation (AF) treated with direct oral anticoagulants (DOACs) according to blood pressure (BP) control. METHODS For this purpose, data from two observational, cross-sectional and multicenter studies were combined. In both studies, patients on chronic treatment with anticoagulants and that were on current treatment with DOACs at least for 3 months were included. Adequate BP was defined as a systolic BP<140mmHg and a diastolic BP<90mmHg (<140/85mmHg if diabetes). RESULTS Overall, 1036 patients were included. Of these, 881 (85%) had hypertension that were finally analyzed. The presence of other risk factors and cardiovascular disease was common. Mean BP was 132.6±14.3/75.2±9.2mmHg and 70.5% of patients achieved BP goals. Those patients with a poor BP control had more frequently diabetes, and a history of prior labile INR. Patients had a high thromboembolic risk, but without significant differences according to BP control. By contrast, more patients with a poor BP control had a higher bleeding risk (HAS-BLED ≥3: 24.0% vs 35.4%; P<0.001). HAS-BLED score was an independent predictor of poor BP control (odds ratio 1.435; 95% confidence interval 1.216-1.693; P<0.001). Satisfaction with anticoagulant treatment was independent of BP control. CONCLUSIONS More than two thirds of our patients with hypertension and AF anticoagulated with DOACs achieve BP targets, what is clearly superior to that reported in the general hypertensive population.
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Affiliation(s)
| | - S Cinza
- CS Porto do Son, Santiago de Compostela, Spain
| | | | - N Marín
- Bayer Hispania S.L., General Medicine CV, Barcelona, Spain.
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Ibáñez Pérez de Viñaspre JA, Gómez Bitrian J, Royo Hernández R, de Azúa Jiménez M, Marco López C, Urieta González L. [Oral anticoagulation in atrial fibrillation: What is the guideline for using new drugs?]. Semergen 2017; 44:297-303. [PMID: 28867369 DOI: 10.1016/j.semerg.2017.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/22/2017] [Accepted: 06/02/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To assess whether there are differences between atrial fibrillation (AF) patients initiating new direct-acting oral anticoagulants (DOAC) therapy and vitamin K antagonist (VKA) therapy in an emergency service. METHODS Descriptive, observational, prospective study. We enrolled patients with AF who were visited in a hospital emergency service over one year. RESULTS This study included 492 patients with AF, and 189 subjects received anticoagulant therapy, 104 with VKA (55%), and 85 with DOAC (45%). The VKA group: mean age 76.1 years, male 50.9% and female 49.1%, CHA2DS2-VASc mean 3.2±1.3 points, and a HAS-BLED mean of 1.9±0.8 points. The DOAC group: mean age 73.4 years, male 37.6% and female 63.3%, CHA2DS2-VASc mean 3.1±1.6 points, and a HAS-BLED mean of 1.7±0.8 points. On analysing the medical history, 17.3% of patients in the VKA group had a previous stroke, and 13.5% significant valve disease, as well as 7.1 and 1.2% of patients, respectively, in the DOAC group. In the analysis of the DOAC types, 24.2% of patients in the dabigatran group had a previous stroke, 22.7% in the rivaroxaban group had ischaemic heart disease. CONCLUSIONS Patients with AF who start on treatment in emergency services with VKA or with DOAC show a similar profile of age, gender, CHA2DS2-VASc score, and HAS-BLED score. The patients with a history of valvular or ischaemic heart disease received more VKA than DOAC. When the patient has a history of stroke, the DOAC more used is dabigatran, and in patients with ischaemic heart disease it is preferred to give rivaroxaban.
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Affiliation(s)
| | - J Gómez Bitrian
- Servicio de Urgencias, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - R Royo Hernández
- Servicio de Urgencias, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - M de Azúa Jiménez
- Servicio de Urgencias, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - C Marco López
- Servicio de Urgencias, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - L Urieta González
- Servicio de Urgencias, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
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Serrano-Sánchez V, Ripollés-de Ramón J, Collado-Yurrita L, Vaello-Checa I, Colmenero-Ruiz C, Helm A, Ciudad-Cabañas MJ, Serrano-Cuenca V. New horizons in anticoagulation: Direct oral anticoagulants and their implications in oral surgery. Med Oral Patol Oral Cir Bucal 2017; 22:e601-e608. [PMID: 28809374 PMCID: PMC5694183 DOI: 10.4317/medoral.21862] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 05/14/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Thrombotic disorders remain a leading cause of death in the Western World. For decades, vitamin K antagonists used in the prevention of this pathology, such as warfarin or sintrom, were the only oral agents available for long-term anticoagulation, in spite of their disadvantages. MATERIAL AND METHODS An electronic database search was carried out on MedLine and The Cochrane Library Plus, without restrictions on the type of study nor dates, in English and Spanish. Abstracts were reviewed, and complete articles if necessary, considering all articles that included recommendations on DOACs and oral surgery. RESULTS In recent years, the so-called "new oral anticoagulants" have been introduced in clinical practice to treat those patients whose medical conditions require long-term anticoagulant treatment, replacing traditional oral anticoagulants. CONCLUSIONS The new oral anticoagulants represent new therapeutic options, with a number of advantages such as poor interaction with food, minor drug interactions, and do not require periodic dose adjustments or routine controls. The purpose of this review is to establish an update on the new oral anticoagulants: Dabigatran, Rivarozaban, Apixaban and Edoxaban.
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Características y patrón temporal de reingresos de los pacientes con fibrilación auricular hospitalizados en servicios médicos. Rev Clin Esp 2017; 217:309-314. [PMID: 28460719 DOI: 10.1016/j.rce.2017.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 01/27/2017] [Accepted: 03/07/2017] [Indexed: 11/21/2022]
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Iñiguez Vázquez I, Monte Secades R, Matesanz Fernández M, Romay Lema E, Rubal Bran D, Casariego Vales E. Characteristics and temporal pattern of readmissions of patients with atrial fibrillation hospitalized in medical departments. Rev Clin Esp 2017. [DOI: 10.1016/j.rceng.2017.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Barrios V, Egocheaga-Cabello M, Gállego-Culleré J, Ignacio-García E, Manzano-Espinosa L, Martín-Martínez A, Mateo-Arranz J, Polo-García J, Vargas-Ortega D. Healthcare resources and needs in anticoagulant therapy for patients with nonvalvular atrial fibrillation. SAMOA Study. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.rceng.2016.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Polo García J, Barrios Alonso V, Escobar Cervantes C, Prieto Valiente L, Lobos Bejarano J, Vargas Ortega D, Prieto Díaz M, Alonso Moreno F, Barquilla García A. Control de la anticoagulación en pacientes con fibrilación auricular no valvular en práctica clínica de atención primaria en las diferentes comunidades autónomas. Estudio PAULA. Semergen 2017; 43:207-215. [DOI: 10.1016/j.semerg.2016.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 05/10/2016] [Indexed: 11/24/2022]
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