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Baños-González MA, González-Hermosillo A, Guevara-Valtier ME, Vázquez-Acosta JA, de los Ríos-Ibarra MO, Aguilar-Linares JA, Cantú-Brito C, Leiva-Pons JL, Pozas-Garza G, Favela-Pérez EA, Molina L, Magaña-Magaña R, Camacho-Casillas R, Chuquiure-Valenzuela E, Manzano-Cabada J, Márquez-Murillo MF. Factores de riesgo cardiometabólico y tratamiento antitrombótico en población mexicana con fibrilación auricular e insuficiencia cardiaca con fracción de expulsión reducida. GAC MED MEX 2023. [DOI: 10.24875/gmm.22000285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
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Baños-González MA, González-Hermosillo A, Guevara-Valdivia ME, Vázquez-Acosta JA, de Los Ríos-Ibarra MO, Aguilar-Linares JA, Cantú-Brito C, Leiva-Pons JL, Pozas-Garza G, Favela-Pérez EA, Molina L, Magaña-Magaña R, Camacho-Casillas R, Chuquiure-Valenzuela E, Manzano-Cabada J, Márquez-Murillo MF. Cardiometabolic risk factors and antithrombotic treatment in a Mexican population with atrial fibrillation and heart failure with reduced ejection fraction. GAC MED MEX 2023; 159:24-31. [PMID: 36930551 DOI: 10.24875/gmm.m22000738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
INTRODUCTION Heart failure in patients with non-valvular atrial fibrillation (NVAF) is two to three times more common than in individuals without NVAF. OBJECTIVE To identify cardiometabolic risk factors (CMRF) and antithrombotic treatment in patients with NVAF and heart failure with reduced ejection fraction (HFrEF), and to determine if there were differences according to gender. METHODS CMRF, pro-thrombotic risk, bleeding risk, and antithrombotic therapy were globally analyzed and according to gender. RESULTS Out of 1,423 patients with NVAF, 336 had HFrEF. On average, females were older than males. There was no difference between genders with regard to the type of NVAF or direct oral anticoagulants use. Hypertension was more common in women. History of transient ischemic attack was reported in 3.6% of the patients and cerebrovascular event in 10%, without differences in terms of gender. The percentage of men with elevated embolic risk was higher, but without antithrombotic treatment, in comparison with women. CONCLUSIONS Significant differences were found according to gender in patients with NVAF and HFrEF, both in CMRF and some comorbidities, as well as in antithrombotic treatment according to embolic and bleeding risk.
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Affiliation(s)
- Manuel A Baños-González
- Center of Research and Post-degree, Health Sciences Academic Division, Universidad Juárez Autónoma de Tabasco, Tabasco
| | | | - Milton E Guevara-Valdivia
- Hospital de Especialidades "Dr. Antonio Fraga Mouret", Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City
| | | | | | | | - Carlos Cantú-Brito
- Neurology Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City
| | | | | | | | - Luis Molina
- Hospital General de México, Universidad Nacional Autónoma de México, Mexico City
| | | | | | | | - Janneth Manzano-Cabada
- Electrocardiology Department, Instituto Nacional de Cardiología "Ignacio Chávez", Mexico City. Mexico
| | - Manlio F Márquez-Murillo
- Electrocardiology Department, Instituto Nacional de Cardiología "Ignacio Chávez", Mexico City. Mexico
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Rodríguez-Diez G, Márquez MF, Iturralde-Torres P, Molina-Fernández de L LG, Pozas-Garza G, Cordero-Cabra A, Rojel-Martínez U. Joint Mexican position document on the treatment of atrial fibrillation. Arch Cardiol Mex 2020; 90:69-76. [PMID: 31996856 DOI: 10.24875/acm.19000323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Atrial fibrillation (AF) is a frequent arrhythmia; its prevalence is near 2% in the general population; in Mexico, more than one-half million people are affected. AF needs to be considered as a public health problem. Because AF is an independent risk factor associated with mortality, due to embolic events, heart failure, or sudden death; early diagnosis is of utmost importance. In unstable patients with a recent onset of AF, electrical cardioversion should be practiced. In stable patients, once thromboembolic measures have been taken, it is necessary to assess whether it is reasonable to administer an antiarrhythmic drug to restore sinus rhythm or performed electrical cardioversion. For recidivating cases of paroxysmal and persistent presentation, the most effective strategy is performed pulmonary vein isolation with either radiofrequency or cryoballoon energy. Permanent AF is that in which recovery of sinus rhythm is not possible, the distinguishing feature of this phase is the uncontrollable variability of the ventricular frequency and could be treated pharmacologically with atrioventricular (AV) nodal blockers or with a VVIR pacemaker plus AV nodal ablation. The presence of AF has long been associated with the development of cerebral and systemic (pulmonary, limb, coronary, renal, and visceral) embolism. The prevention of embolisms in "valvular" AF should perform with Vitamin K antagonists (VKA). For patients with AF not associated with mitral stenosis or a mechanical valve prosthesis, a choice can be made between anticoagulant drugs, VKA, or direct oral anticoagulants. Antiplatelet agents have the weakest effect in preventing embolism.
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Affiliation(s)
- Gerardo Rodríguez-Diez
- Unidad de Arritmias y Estimulación Cardiaca, Centro Médico Nacional Siglo XXI, Instituto de Seguridad Social y Servicios Sociales de los Trabajadores del Estado, Ciudad de México
| | - Manlio F Márquez
- Servicio de Electrocardiología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México
| | - Pedro Iturralde-Torres
- Servicio de Electrocardiología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México
| | | | - Gerardo Pozas-Garza
- Instituto de Cardiología y Medicina Vascular, Hospital Zambrano Hellion TEC-Salud, Nuevo Léon
| | - Alejandro Cordero-Cabra
- Servicio de Electrofisiología, Centro Médico Nacional de Occidente-Hospital de Especialidad, Instituto de Seguridad Social y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Guadalajara
| | - Ulises Rojel-Martínez
- Unidad de Arritmias y Estimulación Cardiaca, Centro Médico Sur de los Servicios Médicos de Salud de Puebla, Puebla, Mexico
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Antonio González-Hermosillo J, Baños-González MA, Guevara-Valdivia ME, Vázquez-Acosta JA, de Los Ríos Ibarra MO, Aguilar-Linares KA, Cantú-Brito C, Leiva-Pons JL, Pozas-Garza G, Favela-Pérez EA, Márquez MF. Gender differences and management of stroke risk of nonvalvular atrial fibrillation in an upper middle-income country: Insights from the CARMEN-AF registry. Int J Cardiol Heart Vasc 2019; 22:117-122. [PMID: 30705937 PMCID: PMC6349010 DOI: 10.1016/j.ijcha.2018.12.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 12/28/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Atrial Fibrillation (AF) is associated with an increased risk of stroke and systemic embolism. Several studies have suggested that female AF patients could have a greater risk for stroke. There is scarce information about clinical characteristics and use of antithrombotic therapies in Latin American patients with nonvalvular AF. OBJECTIVE To describe the gender differences in clinical characteristics, thromboembolic risk, and antithrombotic therapy of patients with nonvalvular AF recruited in Mexico, an upper middle-income country, into the prospective national CARMEN-AF Registry. METHODS A total of 1423 consecutive patients, with at least one thromboembolic risk factor were enrolled in CARMEN-AF Registry during a three-year period (2014-2017). They were categorized according to Gender. RESULTS Overall, 48.6% were women, mean age 70 ± 12 years. Diabetes, smoking, alcoholism, non-ischemic cardiomyopathy, coronary artery disease, and obstructive sleep apnea were higher in men. Most women were found with paroxysmal AF (40.6%), and most men with permanent AF (44.0%). No gender differences were found in the use of vitamin K antagonists (VKA) (30.5% in women vs. 28.0% in men). No gender differences were found in the use of direct oral anticoagulants (DOAC) (33.8% women vs 35.4% men). CONCLUSIONS CARMEN-AF Registry demonstrates that in Mexico, regardless of gender, a large proportion of patients remain undertreated. No gender differences were found in the use of VKA or DOAC.
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Affiliation(s)
- J Antonio González-Hermosillo
- Instituto Nacional de Cardiología "Ignacio Chávez", Juan Badiano 1, Belisario Domínguez XVI, Tlalpan, Mexico City P. C. 14080, Mexico
| | - Manuel A Baños-González
- Centro de Investigación y Posgrado, División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco (UJAT), Avenida Gregorio Méndez Magaña 2836 A, Tamulte, Villahermosa, Tabasco P. C. 86150, Mexico
| | - Milton E Guevara-Valdivia
- Unidad Médica de Alta Especialidad del Hospital de Especialidades "Dr. Antonio Fraga Mouret", Centro Médico Nacional "La Raza", Instituto Mexicano del Seguro Social, Seris esquina Zaachila, La Raza, Azcapotzalco, Mexico City P. C. 02990, Mexico
| | - Jorge A Vázquez-Acosta
- Hospital Regional de PEMEX Ciudad Madero, 20 de noviembre, Jardín, Madero P. C. 89440, Tamaulipas, Mexico
| | - Manuel Odín de Los Ríos Ibarra
- SINACOR, Centro para el Desarrollo de la Medicina y de Asistencia Médica Especializada S.C., Río Choix 922, Antonio Rosales, Culiacán, Sinaloa P. C. 80230, Mexico
| | - Kulio A Aguilar-Linares
- Hospital Regional No. 1 Tijuana, Instituto Mexicano del Seguro Social, Canadá 16801, Río Tijuana Tercera Etapa, Tijuana, Baja California P. C. 22226, Mexico
| | - Carlos Cantú-Brito
- Departament of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco de Quiroga 15, Belisario Domínguez, Tlalpan, Mexico City P. C. 14080, Mexico
| | - José L Leiva-Pons
- Hospital Central "Dr. Ignacio Morones Prieto", Av. Venustiano Carranza 2395, Zona Universitaria, San Luis Potosí, San Luis Potosí P. C. 78216, Mexico
| | - Gerardo Pozas-Garza
- Instituto de Cardiología y Medicina Vascular Hospital Zambrano, Tec Salud, Batallón San Patricio 112, Real de San Agustín, San Pedro Garza García, Nuevo León P. C. 66278, Mexico
| | - Eddie A Favela-Pérez
- Star Medica Mérida, Calle 26 199, Altabrisa, Mérida, Yucatán P. C. 97133, Mexico
| | - Manlio F Márquez
- Instituto Nacional de Cardiología "Ignacio Chávez", Juan Badiano 1, Belisario Domínguez XVI, Tlalpan, Mexico City P. C. 14080, Mexico
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Rodríguez-Reyes H, Arauz-Góngora A, Asensio-Lafuente E, Celaya-Cota MDJ, Cordero-Cabra A, Guevara-Valdivia M, Izaguirre-Avila R, Lara-Vaca S, Mariona-Moreno V, Martínez-Flores E, Nava-Townsend S, Pozas-Garza G, Rodríguez-Diez G. [Multidisciplinary meeting about the use of direct oral anticoagulants in nonvalvular atrial fibrillation]. Arch Cardiol Mex 2016; 87:124-143. [PMID: 27578566 DOI: 10.1016/j.acmx.2016.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 06/17/2016] [Accepted: 06/21/2016] [Indexed: 11/27/2022] Open
Abstract
Knowing the real impact of atrial fibrillation in the stroke, the Sociedad Mexicana of Electrofisiología y Estimulación Cardiaca (SOMEEC) had the initiative to develop a multidisciplinary meeting of experts the with the purpose to update the available scientific evidence from clinical practice guidelines, meta-analyses, controlled clinical trials, and complementing with the experience and views of a group of experts. To meet this goal, SOMEEC gathered a group of specialists in the area of cardiology, electrophysiology, neurology and hematology that given their experience in certain areas, they share the scientific evidence with the panel of experts to leave open a discussion about the information presented in this article. This document brings together the best scientific evidence available and aims to be a useful tool in the decision to use of new oral anticoagulants in nonvalvular atrial fibrillation and ischemic heart disease, or relating to the management of patients with stroke or renal failure, and even those that will be submitted to elective surgery and invasive procedures. In the same, they handled comparative schemes of follow-up and treatment which simplifies the decision making by the specialists participants.
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Affiliation(s)
| | - Antonio Arauz-Góngora
- Clínica de Enfermedad Vascular Cerebral, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
| | | | | | | | - Milton Guevara-Valdivia
- UMAE Hospital de Especialidades «Dr. Antonio Fraga Mouret», Centro Médico Nacional La Raza, Ciudad de México, México
| | - Raúl Izaguirre-Avila
- Departamento de Hematología, Clínica de anticoagulantes, Instituto Nacional de Cardiología «Ignacio Chávez», Ciudad de México, México
| | - Susano Lara-Vaca
- Servicio de Arritmias, Centro Médico IMSS, León Guanajuato, México
| | | | | | - Santiago Nava-Townsend
- Departamento de Electrocardiología, Instituto Nacional de Cardiología «Ignacio Chávez», Ciudad de México, México
| | - Gerardo Pozas-Garza
- Instituto de Cardiología y Medicina vascular del TEC de Monterrey, Monterrey, México
| | - Gerardo Rodríguez-Diez
- Departamento de Electrofisiología, Centro Médico Nacional 20 de Noviembre, Ciudad de México, México
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