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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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Abstract
The World Heart Federation (WHF) commenced a Roadmap initiative in 2015 to reduce the global burden of cardiovascular disease and resultant burgeoning of healthcare costs. Roadmaps provide a blueprint for implementation of priority solutions for the principal cardiovascular diseases leading to death and disability. Atrial fibrillation (AF) is one of these conditions and is an increasing problem due to ageing of the world’s population and an increase in cardiovascular risk factors that predispose to AF. The goal of the AF roadmap was to provide guidance on priority interventions that are feasible in multiple countries, and to identify roadblocks and potential strategies to overcome them. Since publication of the AF Roadmap in 2017, there have been many technological advances including devices and artificial intelligence for identification and prediction of unknown AF, better methods to achieve rhythm control, and widespread uptake of smartphones and apps that could facilitate new approaches to healthcare delivery and increasing community AF awareness. In addition, the World Health Organisation added the non-vitamin K antagonist oral anticoagulants (NOACs) to the Essential Medicines List, making it possible to increase advocacy for their widespread adoption as therapy to prevent stroke. These advances motivated the WHF to commission a 2020 AF Roadmap update. Three years after the original Roadmap publication, the identified barriers and solutions were judged still relevant, and progress has been slow. This 2020 Roadmap update reviews the significant changes since 2017 and identifies priority areas for achieving the goals of reducing death and disability related to AF, particularly targeted at low-middle income countries. These include advocacy to increase appreciation of the scope of the problem; plugging gaps in guideline management and prevention through physician education, increasing patient health literacy, and novel ways to increase access to integrated healthcare including mHealth and digital transformations; and greater emphasis on achieving practical solutions to national and regional entrenched barriers. Despite the advances reviewed in this update, the task will not be easy, but the health rewards of implementing solutions that are both innovative and practical will be great.
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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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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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Rodríguez-Capitán J, Fernández-Meseguer A, Romero-González E, Calvo-Bonacho E, Gómez-Doblas JJ, de Teresa-Galván E. Frecuencia de fibrilación auricular en una amplia muestra de adultos jóvenes extraída de la población laboral española. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.02.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Rodríguez-Capitán J, Fernández-Meseguer A, Romero-González E, Calvo-Bonacho E, Gómez-Doblas JJ, de Teresa-Galván E. Frequency of Atrial Fibrillation in a Large Sample of Young Adults Selected From the Spanish Working Population. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2018; 71:498-500. [PMID: 28528888 DOI: 10.1016/j.rec.2017.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 03/09/2017] [Indexed: 06/07/2023]
Affiliation(s)
| | | | - Eva Romero-González
- Departamento de Medicina y Dermatología, Universidad de Málaga, Málaga, Spain
| | - Eva Calvo-Bonacho
- Ibermutuamur, Mutua Colaboradora con la Seguridad Social, Madrid, Spain
| | - Juan José Gómez-Doblas
- Unidad de Gestión Clínica del Corazón, Hospital Clínico Universitario Virgen de la Victoria, Instituto Biosanitario de Málaga. (IBIMA), CIBER de Enfermedades Cardiovasculares, Universidad de Málaga, Málaga, Spain
| | - Eduardo de Teresa-Galván
- Unidad de Gestión Clínica del Corazón, Hospital Clínico Universitario Virgen de la Victoria, Instituto Biosanitario de Málaga. (IBIMA), CIBER de Enfermedades Cardiovasculares, Universidad de Málaga, Málaga, Spain
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Mora-Llabata V, Dubois-Marqués D, Roldán-Torres I, Mateu-Navarro C, Sanz-García JJ, Moreno-Ballester V, Mira-Gimeno S, Albiñana-Fernández F. Prevalencia de fibrilación auricular y características de la fibrilación auricular no valvular en la población general. Registro AFINVA. REVISTA COLOMBIANA DE CARDIOLOGÍA 2017. [DOI: 10.1016/j.rccar.2016.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Martínez-Rubio A, Alcazar MD, Cadena AS, Martínez-Torrecilla R. Using Direct Oral Anticoagulants in Patients with Atrial Fibrillation: Assessment, Monitoring and Treatment Reversal. Eur Cardiol 2016; 11:118-122. [PMID: 30310459 DOI: 10.15420/ecr.2016:30:1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
It is essential to prevent thromboembolic events in atrial fibrillation. The risks of thromboembolic and haemorrhagic events must be carefully assessed and weighed against one another, both in routine situations and in relation to invasive procedures. Vitamin K antagonists, until recently the first-line treatment for prophylaxis against thromboembolic events in patients with atrial fibrillation, have various drawbacks. Direct-acting oral anticoagulants overcome these limitations and are efficacious and safe. The recent developments of tests to monitor anticoagulant levels, and of target-specific reversal agents for these newer drugs, has facilitated their use in several situations, including emergencies. For these reasons, the European Society of Cardiology and other scientific societies now recommend direct-acting oral anticoagulants as first-line treatment for preventing thromboembolic events in atrial fibrillation.
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Affiliation(s)
- Antoni Martínez-Rubio
- Department of Cardiology, University Hospital Sabadell, Autonomous University of Barcelona, Barcelona, Spain and the International Society of Cardiovascular Pharmacotherapy
| | - Mario DiazNuila Alcazar
- Department of Cardiology, University Hospital Sabadell, Autonomous University of Barcelona, Barcelona, Spain and the International Society of Cardiovascular Pharmacotherapy
| | - Anna Soria Cadena
- Department of Cardiology, University Hospital Sabadell, Autonomous University of Barcelona, Barcelona, Spain and the International Society of Cardiovascular Pharmacotherapy
| | - Roger Martínez-Torrecilla
- Department of Cardiology, University Hospital Sabadell, Autonomous University of Barcelona, Barcelona, Spain and the International Society of Cardiovascular Pharmacotherapy
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Baena-Díez J, Grau M, Forés R, Fernández-Bergés D, Elosua R, Sorribes M, Félix-Redondo F, Segura A, Rigo F, Cabrera de León A, Sanz H, Marrugat J, Sala J. Prevalencia de fibrilación auricular y factores asociados en España, análisis de seis estudios de base poblacional. Estudio DARIOS. Rev Clin Esp 2014; 214:505-12. [DOI: 10.1016/j.rce.2014.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 04/26/2014] [Accepted: 06/09/2014] [Indexed: 02/05/2023]
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11
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Prevalence of atrial fibrillation and its associated factors in Spain: An analysis of six population-based studies. DARIOS Study. Rev Clin Esp 2014. [DOI: 10.1016/j.rceng.2014.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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12
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Gómez-Doblas JJ, Muñiz J, Martin JJA, Rodríguez-Roca G, Lobos JM, Awamleh P, Permanyer-Miralda G, Chorro FJ, Anguita M, Roig E. Prevalencia de fibrilación auricular en España. Resultados del estudio OFRECE. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.07.015] [Citation(s) in RCA: 173] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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13
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Gómez-Doblas JJ, Muñiz J, Martin JJA, Rodríguez-Roca G, Lobos JM, Awamleh P, Permanyer-Miralda G, Chorro FJ, Anguita M, Roig E. Prevalence of atrial fibrillation in Spain. OFRECE study results. ACTA ACUST UNITED AC 2013; 67:259-69. [PMID: 24774588 DOI: 10.1016/j.rec.2013.07.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 07/19/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND OBJECTIVES Atrial fibrillation is associated with substantial morbidity and mortality and both its incidence and prevalence are high. Nevertheless, comprehensive data on this condition in Spain are lacking. The aim of this study was to estimate the prevalence of atrial fibrillation in Spain. METHODS A cross-sectional study was conducted in the general Spanish population older than 40 years. Two-stage random sampling was used, in which first-stage units were primary care physicians randomly selected in every Spanish province and second-stage units were 20 randomly selected persons drawn from each participating physician's assigned population. The reported prevalence was standardized for the age and sex distribution of the Spanish population. The electrocardiogram recordings were read centrally. RESULTS Overall, 8343 individuals were evaluated. The mean age was 59.2 years (95% confidence interval, 58.6-59.8 years), and 52.4% of the participants were female. The overall age-adjusted prevalence of atrial fibrillation was 4.4% (95% confidence interval, 3.8-5.1). Prevalence was similar in both sexes, men 4.4% (3.6-5.2) and women 4.5% (3.6-5.3), rising with increasing age older than 60 years. In patients older than 80 years, the prevalence was 17.7% (14.1-21.3). In 10% of patients an unknown atrial fibrillation was diagnosed. CONCLUSIONS The prevalence of atrial fibrillation in the general Spanish population older than 40 years is high, at 4.4%. The prevalence is similar in both sexes and rises steeply above 60 years of age. It is estimated that there are over 1 million patients with atrial fibrillation in the Spanish population, of whom over 90,000 are undiagnosed.
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Affiliation(s)
- Juan José Gómez-Doblas
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain.
| | - Javier Muñiz
- Instituto Universitario de Ciencias de la Salud, Universidad de A Coruña, A Coruña, Spain
| | | | | | | | - Paula Awamleh
- Servicio de Cardiología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | | | | | - Manuel Anguita
- Servicio de Cardiología, Hospital Reina Sofía, Córdoba, Spain
| | - Eulalia Roig
- Servicio de Cardiología, Hospital de Sant Pau, Barcelona, Spain
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Pérez-Villacastín J, Pérez Castellano N, Moreno Planas J. Epidemiología de la fibrilación auricular en España en los últimos 20 años. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2013.02.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Pérez-Villacastín J, Pérez Castellano N, Moreno Planas J. Epidemiology of atrial fibrillation in Spain in the past 20 years. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2013; 66:561-5. [PMID: 24776206 DOI: 10.1016/j.rec.2013.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 02/04/2013] [Indexed: 11/30/2022]
Abstract
Atrial fibrillation is the most common sustained arrhythmia. Because of its potentially serious clinical consequences (heart failure, stroke, and cognitive impairment), atrial fibrillation has important socioeconomic and health implications. This article reviews the major studies on the epidemiology of atrial fibrillation in Spain. Recent data suggest that in people older than 40 years, the prevalence of atrial fibrillation may be more than 4%. Given the current Spanish demography, these data would imply that more than 1 million people in Spain have atrial fibrillation.
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Cea-Calvo L, Redón J, Lozano JV, Fernández-Pérez C, Martí-Canales JC, Llisterri JL, González-Esteban J, Aznar J. [Prevalence of atrial fibrillation in the Spanish population aged 60 years or more. The PREV-ICTUS study]. Rev Esp Cardiol 2007; 60:616-24. [PMID: 17580050 DOI: 10.1157/13107118] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION AND OBJECTIVES The aims of this study were to determine the prevalence of atrial fibrillation in individuals aged 60 years or more in Spain using a random sample of the population and to identify associated factors. METHODS An analysis of the PREV-ICTUS study, a randomized cross-sectional population-based study of individuals aged 60 years or more, was carried out. Data on demographic variables, cardiovascular risk factors, and cardiovascular disease were obtained from medical records. The diagnosis of atrial fibrillation was based on the patient's medical history and an electrocardiogram performed during the study. RESULTS In the 7108 individuals studied (mean age 71.9 [7.1] years, 53.6% female), the prevalence of atrial fibrillation was 8.5% (95% confidence interval [CI] 7.9-9.2%). It was higher in males (9.3% vs 7.9% in females; P=.036) and increased from 4.2% in individuals aged 60-64 years to 16.5% in those aged 85 years or more (chi-squared test for linear trend, P< .001). Multivariate analysis showed that existing cardiovascular disease, hypertension, age, and left ventricular hypertrophy had the strongest associations with atrial fibrillation. Although there was a strong relationship between hypertension and atrial fibrillation (odds ratio 2.53, 95% CI, 1.60-4.01), no association was found between poor blood pressure control and atrial fibrillation. A weak association with diabetes mellitus was found only when arterial pressure was included in the model, but not when a diagnosis of hypertension was included. CONCLUSIONS In this cross-sectional population-based study of elderly individuals, the prevalence of atrial fibrillation was 8.5%, and was strongly associated with existing cardiovascular disease, hypertension, age and left ventricular hypertrophy.
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Affiliation(s)
- Luis Cea-Calvo
- Departamento de Investigación Clínica, Merck Sharp and Dohme de España, Madrid, Spain
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Barrios Alonso V, de la Figuera von Wichmann M, Coca Payeras A. Prevención de la fibrilación auricular en el paciente hipertenso. Med Clin (Barc) 2007; 128:148-54. [PMID: 17288938 DOI: 10.1157/13098021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A large percentage of patients with hypertension suffer from atrial fibrillation (AF). The presence of hypertension increases the risk of AF, which in turn aggravates hypertension. The ability of drugs to interfere with specific signal transduction pathways easing the presence of AF in hypertensive patients is promising. To date, the most effective mechanism appears to be the inhibition of the renin-angiotensin-aldosterone system with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin-II receptor blockers (ARBs). This approach is under active investigation. Several trials have assessed the effectiveness of these drugs in the prevention of AF. Data show that both, ACEIs and ARBs, appear effective to prevent AF. However, a lack of prospective randomized double-blind trials data limits their application in absence of any other indication.
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Valencia Martín J, Climent Payá VE, Marín Ortuño F, Monmeneu Menadas JV, Martínez Martínez JG, García Martínez M, Ibáñez Criado A, García De Burgos Rico F, Sogorb Garri F. [The efficacy of scheduled cardioversion in atrial fibrillation. Comparison of two schemes of treatment: electrical versus pharmacological cardioversion]. Rev Esp Cardiol 2002; 55:113-20. [PMID: 11852022 DOI: 10.1016/s0300-8932(02)76570-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES Atrial fibrillation is an arrhythmia with high morbidity and mortality. Restoring sinus rhythm is one of the principle objectives in its management. The present study aimed to assess the efficacy of scheduled cardioversion on atrial fibrillation by comparing two different therapeutic approaches: electrical vs. pharmacological cardioversion. PATIENTS AND METHOD Two hundred thirty patients with atrial fibrillation of more than 48 hours duration and requiring sinus rhythm restoration were included. One hundred forty-four patients underwent external electrical cardioversion and 86 patients received quinidine. We analyzed the rate of success, duration of hospital stay, complications and clinical and echocardiographic variable that might predict success. RESULTS Sinus rhythm was restored in 181 of 230 patients (79%). The rate of success was 77% (111/144 patients) in the electrical group and 81% (70 of 86 patients) in the pharmacological group (ns). In 13 pharmacological group patients for whom the first attempt failed attempt, a second attempt with electrical cardioversion was made and was successful in 8 patients (61%). No embolic complication was recorded and only two electrical disturbances were seen. Only atrial fibrillation lasting less than 8 weeks was associated with a higher success rate (p < 0.01). CONCLUSIONS Scheduled cardioversion in atrial fibrillation is an effective technique with a high success rate and a very low rate of complication. Electrical cardioversion and pharmacological cardioversion with quinidine are similarly effective, although the latter involves a longer hospital stay.
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