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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: 7] [Impact Index Per Article: 3.5] [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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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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Loukianov MM, Martsevich SY, Andrenko EY, Yakushin SS, Vorobiev AN, Pereverzeva KG, Zagrebelny AV, Okshina ЕY, Yakusevich VV, Yakusevich VV, Pozdnyakova EM, Gomova TA, Fedotova EE, Valiakhmetov MM, Mikhin VP, Maslennikova YV, Belova EN, Klyashtorny VG, Kudryashov EV, Makoveeva AN, Tatsii JE, Boytsov SA, Drapkina OM. Combination of Atrial Fibrillation and Coronary Heart Disease in Patients in Clinical Practice: Comorbidities, Pharmacotherapy and Outcomes (Data from the REСVASA Registries). RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2021; 17:702-711. [DOI: 10.20996/1819-6446-2021-10-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2025] Open
Abstract
Aim. Assess the structure of comorbid conditions, cardiovascular pharmacotherapy and outcomes in patients with atrial fibrillation (AF) and concomitant coronary artery disease (CAD) included in the outpatient and hospital RECVASA registries.Materials and methods. 3169 patients with AF were enrolled in outpatient RECVASA (Ryazan), RECVASA AF-Yaroslavl registries and hospital RECVASA AF (Moscow, Kursk, Tula). 2497 (78.8%) registries of patients with AF had CAD and 703 (28.2%) of them had a previous myocardial infarction (MI).Results. There were 2,497 patients with a combination of AF and CAD (age was 72.2±9.9 years; 43.1% of men; CHA2DS2-VASc – 4.57±1.61 points; HAS-BLED – 1.60±0,75 points), and the group with AF without CAD included 672 patients (age was 66.0±12.3 years; 43.2% of men; CHA2DS2-VASc – 3.26±1.67 points; HAS-BLED – 1,11±0.74 points). Patients with CAD were on average 6.2 years older and had a higher risk of thromboembolic and hemorrhagic complications (p<0.05). 703 patients with a combination of AF and CAD had the previous myocardial infarction (MI; age was 72.3±9.5 years; 55.2% of men; CHA2DS2-VASc – 4.57±1.61; HAS-BLED – 1.65±0.76), and 1794 patients didn't have previous MI (age was 72.2±10.0 years; 38.4% of men; CHA2DS2-VASc – 4.30±1.50; HAS-BLED – 1.58±0.78). The proportion of men was 1.4 times higher among those with the previous MI. Patients with a combination of AF and CAD significantly more often (p <0.0001) than in the absence of CAD received a diagnosis of hypertension (93.8% and 78.6%), chronic heart failure (90.1% and 51.2%), diabetes mellitus (21.4% and 13.8%), chronic kidney disease (24.8% and 17.7%), as well as anemia (7.0% and 3.0%; p=0.001). Patients with and without the previous MI had the only significant difference in the form of a diabetes mellitus higher incidence having the previous MI (27% versus 19.2%, p=0.0008). The frequency of proper cardiovascular pharmacotherapy was insufficient, mainly in the presence of CAD (67.8%) than in its absence (74.5%), especially the prescription of anticoagulants (39.1% and 66.2%; p <0.0001), as well as in the presence of the previous MI (63.3%) than in its absence (74.3%). The presence of CAD and, in particular, the previous MI, was significantly associated with a higher risk of death (risk ratio [RR]=1.58; 95% confidence interval [CI] was 1.33-1.88; p <0.001 and RR=1.59; 95% CI was 1.33-1.90; p <0.001), as well as with a higher risk of developing a combined cardiovascular endpoint (RR=1.88; 95% CI was 1.17-3 , 00; p <0.001 and RR=1.75; 95% CI was 1.44-2.12; p<0.001, respectively).Conclusion. 78.8% of patients from AF registries in 5 regions of Russia were diagnosed with CAD, of which 28.2% had previously suffered myocardial infarction. Patients with a combination of AF and CAD more often than in the absence of CAD had hypertension, chronic heart failure, diabetes, chronic kidney disease and anemia. Patients with the previous MI had higher incidence of diabetes than those without the previous MI. The frequency of proper cardiovascular pharmacotherapy was insufficient, and to a greater extent in the presence of CAD and the previous MI than in their absence. All-cause mortality was recorded in patients with a combination of AF and CAD more often than in the absence of CAD. All-cause mortality and the incidence of nonfatal myocardial infarction were higher in patients with AF and the previous MI than in those without the previous MI. The presence of CAD and, in particular, the previous MI, was significantly associated with a higher risk of death, as well as a higher risk of developing a combined cardiovascular endpoint.
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Affiliation(s)
- M. M. Loukianov
- National Medical Research Center for Therapy and Preventive Medicine
| | - S. Yu. Martsevich
- National Medical Research Center for Therapy and Preventive Medicine
| | - E. Yu. Andrenko
- National Medical Research Center for Therapy and Preventive Medicine
| | - S. S. Yakushin
- Ryazan State Medical University named after Academician I.P. Pavlov
| | - A. N. Vorobiev
- Ryazan State Medical University named after Academician I.P. Pavlov
| | | | - A. V. Zagrebelny
- National Medical Research Center for Therapy and Preventive Medicine
| | - Е. Yu. Okshina
- National Medical Research Center for Therapy and Preventive Medicine
| | | | | | | | | | | | | | | | | | - E. N. Belova
- National Medical Research Center for Therapy and Preventive Medicine
| | - V. G. Klyashtorny
- National Medical Research Center for Therapy and Preventive Medicine
| | - E. V. Kudryashov
- National Medical Research Center for Therapy and Preventive Medicine
| | - A. N. Makoveeva
- National Medical Research Center for Therapy and Preventive Medicine
| | - Ju. E. Tatsii
- National Medical Research Center for Therapy and Preventive Medicine
| | | | - O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
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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: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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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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Aguilera Alcaraz BM, Abellán Huerta J, Carbayo Herencia JA, Ariza Copado C, Hernández Menárguez F, Abellán Alemán J. Assessment of anticoagulation treatments in non-valvular atrial fibrillation patients diagnosed in a basic health area. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2018; 30:56-63. [PMID: 29246471 DOI: 10.1016/j.arteri.2017.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 08/12/2017] [Accepted: 08/21/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Atrial fibrillation (AF) is the most common cardiac arrhythmia. To assess the need for anticoagulation is essential for its management. Our objective was to investigate whether the indication of anticoagulation was adequate in patients diagnosed with non-valvular AF, given the CHA2-DS2-VASc scale, measuring the International Normalizad Ratio range (INR) in patients treated with anti-vitamin K drugs. METHODS This is an observational and cross sectional study. 232 patients with atrial fibrillation were included. We analyzed demographic, the CHA2-DS2-VASc and HAS-BLED variables, the treatment and INR values for 6 consequentive months. The confrontation of variables was performed using chi-square and Mantel-Haenzel test. RESULTS The prevalence of AF was 1.05%. The 88.4% had CHA2-DS2-VASc ≥ 2. The 71.1% were taking anticoagulants, of which 58.2% were under antivitamin k. The 46.7% of patients taking antivitamin K, presented inadequate range of INR. There was a greater prescription of antivitamin k in patients with persistent or permanent AF compared to the paroxysmal form (62.8 vs. 37.2% p<.001). The use of drugs that increase bleeding was associated with a worse control of INR after adjustment for the main variables of clinical relevance (odds ratio 2.17 [1.02-4.59], p=.043). CONCLUSIONS The level of anticoagulation with antivitamin K was inadequate in our sample, despite a proper follow up and adherence to treatment. Patients with paroxysmal AF received less antivitamin K than those with persistent/permanent AF.
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Affiliation(s)
| | - José Abellán Huerta
- Cátedra de Riesgo Cardiovascular, Universidad Católica San Antonio de Murcia (UCAM), Murcia, España
| | | | | | | | - José Abellán Alemán
- Cátedra de Riesgo Cardiovascular, Universidad Católica San Antonio de Murcia (UCAM), Murcia, España
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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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Escolar-Albaladejo G, Barón-Esquivias G, Zamorano JL, Betegón-Nicolás L, Canal-Fontcuberta C, de Salas-Cansado M, Rubio-Rodríguez D, Rubio-Terrés C. [Cost-effectiveness analysis of apixaban versus acetylsalicylic acid in the prevention of stroke in patients with non-valvular atrial fibrillation in Spain]. Aten Primaria 2016; 48:394-405. [PMID: 26832316 PMCID: PMC6877843 DOI: 10.1016/j.aprim.2015.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 04/14/2015] [Accepted: 04/28/2015] [Indexed: 11/21/2022] Open
Abstract
Objetivo Evaluar el coste-utilidad de apixabán frente al ácido acetilsalicílico (AAS) en la prevención del ictus en pacientes con fibrilación auricular no valvular (FANV) con contraindicación de antagonistas de la vitamina K en España. Métodos Se adaptó un modelo de Markov, simulando toda la vida del paciente. Los datos de eficacia y seguridad provienen del ensayo clínico AVERROES. Perspectivas del análisis: Sistema Nacional de Salud (SNS) y sociedad. El coste de los medicamentos se calculó según las dosis recomendadas. Los costes de las complicaciones y el manejo de la FANV proceden de fuentes españolas. Resultados Si una cohorte de 1.000 pacientes con FANV fuese tratada durante toda su vida con apixabán en lugar de AAS, se evitarían 48 ictus isquémicos, 10 embolismos sistémicos y 53 muertes relacionadas. Cada paciente tratado con apixabán obtendría más años de vida ganados (0,303 AVG) y más años de vida ajustados por calidad (0,277 AVAC ganados). Los costes para el SNS serían superiores con apixabán (1.742 € más por paciente), pero la inclusión de los costes informales generaría 2.887 € de ahorro por paciente. El resultado sería un coste por AVG y AVAC ganado de 5.749 € y 6.289 € respectivamente para el SNS, siendo apixabán dominante (más eficaz con menos costes que AAS) desde la perspectiva de la sociedad. Los análisis de sensibilidad confirmaron la estabilidad del caso base. Conclusiones Según el presente modelo, apixabán sería un tratamiento coste-efectivo en comparación con AAS en la prevención del ictus en pacientes con FANV en España.
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Rubio-Terrés C, Graefenhain de Codes R, Rubio-Rodríguez D, Evers T, Grau Cerrato S. Cost-effectiveness Analysis of Rivaroxaban versus Acenocoumarol in the Prevention of Stroke in Patients with Non-valvular Atrial Fibrillation in Spain. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2016; 4:19-34. [PMID: 37663009 PMCID: PMC10471359 DOI: 10.36469/9823] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Objective: The aim of this study was to evaluate, from the Spanish National Health System perspective, the cost-effectiveness of rivaroxaban (20 mg/day) versus use of acenocoumarol (5 mg/day) for the treatment of patients with non-valvular atrial fibrillation (NVAF) at moderate to high risk for stroke. Methods: A Markov model was designed and populated with local cost estimates, efficacy and safety of rivaroxaban in stroke prevention in NVAF compared with adjusted-dose warfarin clinical results from the pivotal phase III ROCKET AF trial and utility values obtained from the literature. Warfarin and acenocoumarol were assumed to have therapeutic equivalence. Results: Rivaroxaban treatment was associated with fewer ischemic strokes and systemic embolisms (0.289 vs. 0.300 events), intracranial bleeds (0.051 vs. 0.067), and myocardial infarctions (0.088 vs. 0.102) per patient compared with acenocoumarol. Over a lifetime time horizon, rivaroxaban led to a reduction of 0.041 life-threatening events per patient, and increases of 0.103 life-years and 0.155 quality-adjusted lifeyears (QALYs) versus acenocoumarol treatment. This resulted in an incremental cost-effectiveness ratio of €7045 per QALY and €10 602 per life-year gained. Sensitivity analysis indicated that these results were robust and that rivaroxaban is cost-effective compared with acenocoumarol in 89.4% of cases should a willingness-to-pay threshold of €30 000/QALY gained be considered. Conclusions: The present analysis suggests that rivaroxaban is a cost-effective alternative to acenocoumarol therapy for the prevention of stroke and systemic embolisms in patients with NVAF in the Spanish healthcare setting.
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Barón Esquivias G, Escolar Albaladejo G, Zamorano JL, Betegón Nicolás L, Canal Fontcuberta C, de Salas-Cansado M, Rubio-Rodríguez D, Rubio-Terrés C. Análisis coste-efectividad de apixabán frente a acenocumarol en la prevención del ictus en pacientes con fibrilación auricular no valvular en España. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2014.08.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Hernández Olmedo M, Suárez Fernández C. Avances en el tratamiento anticoagulante de la fibrilación auricular. Med Clin (Barc) 2015; 145:124-30. [DOI: 10.1016/j.medcli.2014.07.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 07/07/2014] [Accepted: 07/07/2014] [Indexed: 10/24/2022]
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Barón Esquivias G, Escolar Albaladejo G, Zamorano JL, Betegón Nicolás L, Canal Fontcuberta C, de Salas-Cansado M, Rubio-Rodríguez D, Rubio-Terrés C. Cost-effectiveness Analysis Comparing Apixaban and Acenocoumarol in the Prevention of Stroke in Patients With Nonvalvular Atrial Fibrillation in Spain. ACTA ACUST UNITED AC 2014; 68:680-90. [PMID: 25498373 DOI: 10.1016/j.rec.2014.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 08/04/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES Cost-effectiveness analysis of apixaban (5 mg twice daily) vs acenocoumarol (5mg/day) in the prevention of stroke in patients with nonvalvular atrial fibrillation in Spain. METHODS Markov model covering the patient's entire lifespan with 10 health states. Data on the efficacy and safety of the drugs were provided by the ARISTOTLE trial. Warfarin and acenocoumarol were assumed to have therapeutic equivalence. PERSPECTIVES The Spanish National Health System and society. Information on the cost of the drugs, complications, and the management of the disease was obtained from Spanish sources. RESULTS In a cohort of 1000 patients with nonvalvular atrial fibrillation, administration of apixaban rather than acenocoumarol would avoid 18 strokes, 71 hemorrhages (28 intracranial or major), 2 myocardial infarctions, 1 systemic embolism, and 23 related deaths. Apixaban would prolong life (by 0.187 years) and result in more quality-adjusted life years (by 0.194 years) per patient. With apixaban, the incremental costs for the Spanish National Health System and for society would be € 2,488 and € 1,826 per patient, respectively. Consequently, the costs per life year gained would be € 13,305 and € 9,765 and the costs per quality-adjusted life year gained would be € 12,825 and € 9,412 for the Spanish National Health System and for society, respectively. The stability of the baseline case was confirmed by sensitivity analyses. CONCLUSIONS According to this analysis, apixaban may be cost-effective in the prevention of stroke in patients with nonvalvular atrial fibrillation compared with acenocoumarol.
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Affiliation(s)
| | | | - José Luis Zamorano
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
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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: 1.3] [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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14
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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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15
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Formiga F, Urrutia A, Veiga F. [It is time to optimize the anticoagulant therapy in elderly patients with atrial fibrillation]. Rev Esp Geriatr Gerontol 2014; 49:201-2. [PMID: 24996967 DOI: 10.1016/j.regg.2014.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 05/16/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Francesc Formiga
- Unidad de Geriatría, Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
| | - Agustín Urrutia
- Unidad de Geriatría, Servicio de Medicina Interna, Hospital Germans Trias i Pujol, Badalona, España
| | - Fernando Veiga
- Servicio de Geriatría, Hospital Universitario Lucus Augusti, Lugo, España
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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: 15.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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17
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Hidalgo-Vega Á, Askari E, Vidal R, Aranda-Reneo I, Gonzalez-Dominguez A, Ivanova A, Ene G, Llamas P. Direct vitamin K antagonist anticoagulant treatment health care costs in patients with non-valvular atrial fibrillation. BMC Health Serv Res 2014; 14:46. [PMID: 24479444 PMCID: PMC3914362 DOI: 10.1186/1472-6963-14-46] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 01/29/2014] [Indexed: 11/12/2022] Open
Abstract
Background There is evidence suggesting that most thromboembolic complications could be prevented with adequate pharmacological anticoagulation. We estimated the direct health care costs of anticoagulant treatment with oral vitamin K antagonists in patients diagnosed with non-valvular atrial fibrillation. Methods This observational study examined the clinical records of patients diagnosed with non-valvular atrial fibrillation who received anticoagulant treatment with oral vitamin K antagonists. Data from clinical records were used in the study: international normalized ratio, number of monitoring visits, type of anticoagulant, hospital admissions from complications, and concomitant medication. Drug cost was calculated based on the official Spanish Ministry of Health price list. Monitoring expenses were included the cost of the medical supplies used in the procedures. Hospitalization costs were calculated using the Diagnosis Related Group price for each case. Hospital visits costs were calculated by one of four different scenarios, using either the invoice rates for the regional health care authority or cost per visit as established by analytical accounting methods. Results We collected data from 1,257 patients diagnosed with non-valvular atrial fibrillation who were receiving oral anticoagulant therapy. Depending on the scheme used, the direct health care costs for these patients ranged from €423,695 - €1,436,038 per annum. The average cost per patient varied between €392 - €1,341, depending on the approach used. Patients with international normalized ratio values within the therapeutic range on 25% of their visits represented an average cost between €441.70 - €1,592. Those within the therapeutic range on 25%–50% of visits had associated costs of €512.37 - €1,703.91. When international normalized ratio values were within the therapeutic range on 50% - 75% of the visits, the costs ranged between €400.80- €1,375.74. The average cost was €305.23 - €1,049.84 when the values were within the therapeutic range for over 75% of visits. Conclusions Most direct health care costs associated with the sampled patients arise from the specialist-care monitoring required for the treatment. Good monitoring is inversely related to direct health care costs.
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Affiliation(s)
| | | | | | - Isaac Aranda-Reneo
- Department of Economic and Financial Analysis, Faculty of Social Sciences, University of Castilla-La Mancha, Mancha, Avda Real Fábrica de Seda s/n, 45600 Talavera de la Reina Toledo, Spain.
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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: 32] [Impact Index Per Article: 2.7] [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: 2.8] [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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Clua-Espuny JL, Lechuga-Duran I, Bosch-Princep R, Roso-Llorach A, Panisello-Tafalla A, Lucas-Noll J, López-Pablo C, Queralt-Tomas L, Giménez-Garcia E, González-Rojas N, Gallofré López M. Prevalencia de la fibrilación auricular desconocida y la no tratada con anticoagulantes. Estudio AFABE. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2013.03.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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22
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Llisterri Caro J, Vera García S, Precioso Costa J, Silvero Y. Aspectos epidemiológicos y diagnósticos de la fibrilación auricular. Semergen 2013. [DOI: 10.1016/s1138-3593(13)74375-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Prieto-Díaz M. Evidencias sobre el coste económico de los nuevos anticoagulantes. Semergen 2013. [DOI: 10.1016/s1138-3593(13)74379-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Prevalence of undiagnosed atrial fibrillation and of that not being treated with anticoagulant drugs: the AFABE study. ACTA ACUST UNITED AC 2013; 66:545-52. [PMID: 24776203 DOI: 10.1016/j.rec.2013.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 03/01/2013] [Indexed: 11/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES Atrial fibrillation constitutes a serious public health problem because it can lead to complications. Thus, the management of this arrhythmia must include not only its treatment, but antithrombotic therapy as well. The main goal is to determine the proportion of cases of undiagnosed atrial fibrillation and the proportion of patients not being treated with oral anticoagulants. METHODS A multicenter, population-based, retrospective, cross-sectional, observational study. In all, 1043 participants over 60 years of age were randomly selected to undergo an electrocardiogram in a prearranged appointment. Demographic data, CHA2DS2-VASc and HAS-BLED scores, international normalized ratio results, and reasons for not receiving oral anticoagulant therapy were recorded. RESULTS The overall prevalence of atrial fibrillation was 10.9% (95% confidence interval, 9.1%-12.8%), 20.1% of which had not been diagnosed previously. In the group with known atrial fibrillation, 23.5% of those with CHA2DS2-VASc≥2 were not receiving oral anticoagulant therapy, and 47.9% had a HAS-BLED score≥3. The odds ratio for not being treated with oral anticoagulation was 2.04 (95% confidence interval, 1.11-3.77) for women, 1.10 (95% confidence interval, 1.05-1.15) for more advanced age at diagnosis, and 8.61 (95% confidence interval 2.38-31.0) for a CHA2DS2-VASc score<2. Cognitive impairment (15.2%) was the main reason for not receiving oral anticoagulant therapy. CONCLUSIONS The prevalence of previously undiagnosed atrial fibrillation in individuals over 60 years of age is 20.1%, and 23.5% of those who have been diagnosed receive no treatment with oral anticoagulants.
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Key Words
- AF
- Anticoagulation for atrial fibrillation
- Atrial fibrillation
- CHA(2)DS(2)-VASc
- Estudio de base poblacional
- Fibrilación auricular
- HAS-BLED
- INR
- OAT
- Population-based study
- Prevalence
- Prevalencia
- Tratamiento anticoagulante
- atrial fibrillation
- congestive heart failure, hypertension, age≥75 (doubled), diabetes, stroke (doubled)-vascular disease and sex category (female)
- hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly (>65 years), drugs/alcohol concomitantly
- international normalized ratio
- oral anticoagulant therapy
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Fácila L, Pallarés V, Morillas P, Cordero A, Llisterri JL, Sánchis C, Gorriz JL, Castillo J, Gil V, Redon J. Gender differences related to the presence of atrial fibrillation in older hypertensive patients. World J Cardiol 2013; 5:124-131. [PMID: 23710299 PMCID: PMC3663126 DOI: 10.4330/wjc.v5.i5.124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 03/17/2013] [Accepted: 04/29/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine whether there are gender differences in the epidemiological profile of atrial fibrillation (AF) and to characterise the clinical, biochemical, and therapeutic factors associated with AF.
METHODS: Each investigator (primary care physicians or physicians based in hospital units for hypertension treatment) recruited the first 3 patients with an age of ≥ 65 years and a clinical diagnosis of hypertension (ambulatory blood pressure monitoring and an electrocardiogram, were performed) on the first working day of the week for 5 wk and identified those individuals with atrial fibrillation. A binary logistic regression was performed, including all of the variables that were significant in the univariate analysis, to establish the variables that were associated with the presence of arrhythmia.
RESULTS: A total of 1028 patients were included in the study, with a mean age of 72.8 ± 5.8 years. Of these patients, 47.3% were male, 9% were smokers, 27.6% were diabetics, 48.3% had dyslipidaemia, 10.9% had angina, and 6.5% had experienced a myocardial infarction. Regarding gender differences, the men exhibited a larger waist circumference, a lower body mass index, less obesity, and a more extensive history of diabetes, smoking, ischaemic heart disease, kidney failure, peripheral arterial disease and carotid disease than the women. There were no differences, however, in the prevalence of AF between the men and the women (11.5% vs 9.2%, respectively; P = no significant). Regarding treatment, the women received antiplatelet agents and diuretics less frequently, but there were no other differences in the use of antihypertensive and antithrombotic therapies. In the multivariate analysis, AF in the total study population was associated with age, alcohol consumption, the presence of heart disease, and decreased glomerular filtration. In the women, AF was associated with all of the factors included in the overall analysis, as well as the presence of left ventricle hypertrophy. In contrast, in the men, the only risk factors associated with AF were age, the presence of heart disease and alcohol consumption.
CONCLUSION: In patients with hypertension over 65 years of age, there are relevant gender differences in the factors associated with AF.
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Rodríguez-Mañero M, Bertomeu-González V, Cordero A, Moreno-Arribas J, Mazón P, Fácila L, Cosín J, Galve E, Lekuona I, González-Juanatey JR, Bertomeu-Martínez V. Trends in clinical profile and medical treatments of atrial fibrillation patients over the last 10 years. Rev Port Cardiol 2013; 32:103-9. [DOI: 10.1016/j.repc.2012.06.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Accepted: 06/04/2012] [Indexed: 11/29/2022] Open
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27
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Rodríguez-Mañero M, Bertomeu-González V, Cordero A, Moreno-Arribas J, Mazón P, Fácila L, Cosín J, Galve E, Lekuona I, González-Juanatey JR, Bertomeu-Martínez V. Trends in clinical profile and medical treatments of atrial fibrillation patients over the last 10 years. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.repce.2013.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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28
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Blanch Gracia P, Freixa Pamias R, Codinach Huix P, Martin Baranera M, Armario García P. Predictores electrocardiográficos y ecocardiográficos de fibrilación auricular en pacientes hipertensos. HIPERTENSION Y RIESGO VASCULAR 2013. [DOI: 10.1016/j.hipert.2012.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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29
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González-Juanatey JR, Álvarez-Sabin J, Lobos JM, Martínez-Rubio A, Reverter JC, Oyagüez I, González-Rojas N, Becerra V. Cost-effectiveness of dabigatran for stroke prevention in non-valvular atrial fibrillation in Spain. Rev Esp Cardiol 2012; 65:901-10. [PMID: 22958943 DOI: 10.1016/j.recesp.2012.06.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 06/06/2012] [Indexed: 01/22/2023]
Abstract
INTRODUCTION AND OBJECTIVES Assessment of the cost-effectiveness of dabigatran for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation in Spain, from the perspective of the National Health System. METHODS Adaptation of a Markov chain model that simulates the natural history of the disease over the lifetime of a cohort of 10,000 patients with non-valvular atrial fibrillation. Model comparators were warfarin in a first scenario, and a real world prescribing pattern in a second scenario, in which 60% of the patients were treated with vitamin K antagonists, 30% with acetylsalicylic acid, and 10% received no treatment. Deterministic and probabilistic sensitivity analyses were performed. RESULTS Dabigatran reduced the occurrence of clinical events in both scenarios, providing gains in quantity and quality of life. The incremental cost-effectiveness ratio for dabigatran compared to warfarin was 17,581 euros/quality-adjusted life year gained and 14,118 euros/quality-adjusted life year gained when compared to the real world prescribing pattern. Efficiency in subgroups was demonstrated. When the social costs were incorporated into the analysis, dabigatran was found to be a dominant strategy (ie, more effective and less costly). The model proved to be robust. CONCLUSIONS From the perspective of the Spanish National Health System, dabigatran is an efficient strategy for the prevention of stroke in patients with non-valvular atrial fibrillation compared to warfarin and to the real-world prescribing pattern; incremental cost-effectiveness ratios were below the 30,000 euros/quality-adjusted life year threshold in both scenarios. Dabigatran would also be a dominant strategy from the societal perspective, providing society with a more effective therapy at a lower cost compared to the other 2 alternatives. Full English text available from:www.revespcardiol.org.
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Affiliation(s)
- José R González-Juanatey
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, España
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30
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Urrutia A, Santesmases J. Fibrilación auricular en el anciano. Ese largo camino…. Med Clin (Barc) 2012; 138:246-8. [DOI: 10.1016/j.medcli.2011.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 06/21/2011] [Indexed: 10/17/2022]
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Barrios V, Calderón A, Escobar C, de la Figuera M. Pacientes con fibrilación auricular asistidos en consultas de atención primaria. Estudio Val-FAAP. Rev Esp Cardiol 2012; 65:47-53. [DOI: 10.1016/j.recesp.2011.08.008] [Citation(s) in RCA: 157] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 08/11/2011] [Indexed: 11/29/2022]
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López Soto A, Formiga F, Bosch X, García Alegría J. [Prevalence of atrial fibrillation and related factors in hospitalized old patients: ESFINGE study]. Med Clin (Barc) 2011; 138:231-7. [PMID: 21940001 DOI: 10.1016/j.medcli.2011.05.023] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 05/14/2011] [Accepted: 05/17/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Atrial fibrillation (AF) is the commonest rhythm abnormality and it increases with ageing. The main objective of this study was to assess the prevalence of AF in hospitalized old patients as well as its characteristics and related clinical and therapeutic factors. PATIENTS AND METHODS Prospective, multicenter, observational study in patients aged ≥ 70 years with AF, who had been hospitalized in Internal Medicine or Geriatrics wards. All variables studied were obtained from the patients' clinical records. RESULTS Out of 3,319 evaluable patients, 922 had an AF, which represents a prevalence of 31.3% (CI 95%; 29.7-32.9). The mean age was 82 years (6.1; 69.9-101.8) and 57% were women. 88.7% of patients (818 p) had an AF before admission. AF was long-standing persistent or permanent in 728 cases (89.1%) and it was the first episode (paroxysmal or persistent) in 51 patients (6.2%). There was a clear etiology of AF in only 4.1% cases. Congestive heart failure was the commonest reason for hospitalization in our patients. Regarding the cardiovascular risk factors, 80.3% patients were hypertensive, 36.4% had dyslipemia, 38.2% had diabetes and 5% were active smokers. Associated diseases included renal insufficiency (38.1%) and chronic obstructive pulmonary disease (38.2%); in addition, 188 patients (20.4%) had suffered from cerebrovascular accidents. Finally, 67.4% patients had received antiarrhythmic drugs for their FA. Although 86.1% had received thromboembolic prevention therapy, only 54.1% were under oral anticoagulation. Finally, 6.9% patients had antiarrhythmic drugs-related side effects. CONCLUSIONS Over one third of hospitalized patients older than 70 years have AF, which is generally relapsing and permanent. Heart failure is the commonest reason for hospitalization in these patients and about 40% have an associated disease.
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Affiliation(s)
- Alfonso López Soto
- Servicio de Medicina Interna, Instituto Clínico de Medicina y Dermatología, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, España.
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Rodríguez-Mañero M, Cordero A, Bertomeu-González V, Moreno-Arribas J, Bertomeu-Martínez V, Mazón P, Fácila L, Cosín J, Lekuona I, Galve E, González-Juanatey JR. Impact of new criteria for anticoagulant treatment in atrial fibrillation. Rev Esp Cardiol 2011; 64:649-53. [PMID: 21652133 DOI: 10.1016/j.recesp.2011.03.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2010] [Accepted: 03/07/2011] [Indexed: 01/16/2023]
Abstract
INTRODUCTION AND OBJECTIVES The guidelines for the management of atrial fibrillation (AF) incorporate new risk factors for thromboembolism, trying to de-emphasize the use of the 'low', 'moderate', and 'high' risk categories. The objective of this study was to determine the impact of the new scheme CHA₂DS₂-VASc and of the new recommendations for oral anticoagulation (OAC) in a contemporary sample of patients with AF seen by primary physicians and cardiologists. METHODS Multicenter, observational, cross-sectional study on the epidemiology of hypertension and its control, designed by the arterial hypertension department. Each researcher enrolled the first 6 consenting patients who came for examination during a 5-day period. RESULTS Of 25 137 individuals recruited, 1544 were diagnosed with AF. The vast majority of the sample had a CHADS₂ score ≥2 (77.3%). Individuals with a risk score lower than 2 were categorized according to the CHA₂DS₂-VASc score: 14.4% were aged 75 years or older (CHA₂DS₂-VASc=2). Of those younger than 75, 42.3% had a CHA₂DS₂-VASc=2; 23.7% CHA₂DS₂-VASc=3, and 1.1% CHA₂DS₂-VASc=4. This means that the 85.1% of the patients with a CHADS₂ score <2 and no contraindications are indicated for OAC. CONCLUSIONS The new recommendations will result in a significant increase in patients with indications for OAC, at the expense of those previously characterized as low-to-moderate risk. Therefore, patients at risk of thromboembolic events must be identified, although an evaluation of bleeding risk should be part of the patient assessment before starting anticoagulation.
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Sex differences in the treatment of patients with atrial fibrillation: population-based study in a local health district. Rev Esp Cardiol 2011; 64:233-6. [PMID: 21324575 DOI: 10.1016/j.recesp.2010.04.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Accepted: 04/27/2010] [Indexed: 12/12/2022]
Abstract
Differences in the treatment of atrial fibrillation between men and women were investigated by using patients in a local health district as a reference population. The study included 688 patients (359 female) who presented with atrial fibrillation. Women were older, more frequently had heart failure, and were more often functionally dependent than men. With regards to the management of atrial fibrillation, women were prescribed digoxin more frequently than men, but underwent electrical cardioversion less often, were less frequently seen by a cardiologist, and understood less about their treatment. After stratifying the findings by age and adjusting for heart failure and the degree of functional dependence, it was observed that women aged over 85 years were prescribed digoxin more often than men, while women aged under 65 years underwent cardioversion less often than men. In conclusion, gender differences observed in the treatment of atrial fibrillation cannot be fully explained by differences in clinical characteristics between men and women in the population.
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Morillas P, Pallarés V, Llisterri JL, Sanchis C, Sánchez T, Fácila L, Pérez-Alonso M, Castillo J, Redón J, Bertomeu V. Prevalence of atrial fibrillation and use of antithrombotics in hypertensive patients aged >or=65 years. The FAPRES trial. Rev Esp Cardiol 2011; 63:943-50. [PMID: 20738939 DOI: 10.1016/s0300-8932(10)70206-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2009] [Accepted: 02/22/2010] [Indexed: 12/11/2022]
Abstract
INTRODUCTION AND OBJECTIVES Age and arterial hypertension are two of the main factors associated with atrial fibrillation and an increased risk of embolism. The objective of this study was to determine the prevalence of atrial fibrillation and the extent of antithrombotic use in hypertensive patients aged >or=65 years in the Spanish region of Valencia. METHODS Each study investigator enrolled the first three hypertensive patients aged >or=65 years who came for a consultation on the first day of each week for 5 weeks. Each patient's risk factors, history of cardiovascular disease, CHADS2 score and medical treatment were noted and an ECG was recorded. Data were analyzed centrally. A patient was regarded as having atrial fibrillation if it was observable on the ECG or reported in medical records. RESULTS The study included 1,028 hypertensive patients with a mean age of 72.8 years. Overall, 10.3% had atrial fibrillation: in 6.7%, it was observable on the ECG while 3.6% were in sinus rhythm but had a history of the condition. Factors associated with atrial fibrillation were age, alcohol intake, structural heart disease and glomerular filtration rate. In total, 76.2% of patients with ECG evidence of atrial fibrillation and a CHADS2 score >1 were taking anticoagulants compared with 41.7% of those who had a history of the condition but were currently in sinus rhythm. CONCLUSIONS The prevalence of atrial fibrillation in our group of hypertensives was 10.3%; in 1.7%, it was previously undiagnosed. Antithrombotic use was high in patients with current atrial fibrillation, but lower in those who had experienced an episode previously.
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Affiliation(s)
- Pedro Morillas
- Servicio de Cardiología, Hospital Universitario de San Juan, Sant Joan d'Alacant, Alicante, España.
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Morillas P, Pallarés V, Llisterri JL, Sanchis C, Sánchez T, Fácila L, Pérez-Alonso M, Castillo J, Redón J, Bertomeu V. Prevalence of atrial fibrillation and use of antithrombotics in hypertensive patients aged >or=65 years. The FAPRES trial. Rev Esp Cardiol 2011; 63:943-50. [PMID: 20738939 DOI: 10.1016/s1885-5857(10)70188-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION AND OBJECTIVES Age and arterial hypertension are two of the main factors associated with atrial fibrillation and an increased risk of embolism. The objective of this study was to determine the prevalence of atrial fibrillation and the extent of antithrombotic use in hypertensive patients aged >or=65 years in the Spanish region of Valencia. METHODS Each study investigator enrolled the first three hypertensive patients aged >or=65 years who came for a consultation on the first day of each week for 5 weeks. Each patient's risk factors, history of cardiovascular disease, CHADS2 score and medical treatment were noted and an ECG was recorded. Data were analyzed centrally. A patient was regarded as having atrial fibrillation if it was observable on the ECG or reported in medical records. RESULTS The study included 1,028 hypertensive patients with a mean age of 72.8 years. Overall, 10.3% had atrial fibrillation: in 6.7%, it was observable on the ECG while 3.6% were in sinus rhythm but had a history of the condition. Factors associated with atrial fibrillation were age, alcohol intake, structural heart disease and glomerular filtration rate. In total, 76.2% of patients with ECG evidence of atrial fibrillation and a CHADS2 score >1 were taking anticoagulants compared with 41.7% of those who had a history of the condition but were currently in sinus rhythm. CONCLUSIONS The prevalence of atrial fibrillation in our group of hypertensives was 10.3%; in 1.7%, it was previously undiagnosed. Antithrombotic use was high in patients with current atrial fibrillation, but lower in those who had experienced an episode previously.
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Affiliation(s)
- Pedro Morillas
- Servicio de Cardiología, Hospital Universitario de San Juan, Sant Joan d'Alacant, Alicante, España.
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Castaño M, Gil-Jaurena JM, Conejo L, Gualis J. Epidemiología de las taquiarritmias preoperatorias en la cirugía cardíaca. CIRUGIA CARDIOVASCULAR 2010. [DOI: 10.1016/s1134-0096(10)70108-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Moro Serrano C, Hernández-Madrid A. [Atrial fibrillation: are we faced with an epidemic? ]. Rev Esp Cardiol 2009; 62:10-4. [PMID: 19150009 DOI: 10.1016/s0300-8932(09)70015-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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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: 5.8] [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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Coll-Vinent B, Junyent M, Orús J, Villarroel C, Casademont J, Miró O, Magriñà J, Obach V, Sánchez M, Sitges M, Bragulat E, Jiménez S, Pacheco G, Brugada J, Mont L. Tratamiento de la fibrilación auricular en los distintos niveles asistenciales de un área sanitaria. Med Clin (Barc) 2007; 128:125-9. [PMID: 17288932 DOI: 10.1157/13098018] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Atrial fibrillation is managed in multiple settings by different specialists. We sought to analyze treatment and compliance of the prevailing guidelines of patients with atrial fibrillation attended at different levels of health care and to quantify interventions to correct treatment inadequacies. PATIENTS AND METHOD We included all adult patients with atrial fibrillation who presented during a 14 day-period to different levels of health care of a tertiary hospital and a related primary care clinic (family physician, cardiologist, emergency department, hospitalization). In all of them, clinical and epidemiological data in relation to atrial fibrillation, and all data referring to treatment and compliance of guidelines, were recorded prospectively. RESULTS 293 patients were included. Clinical and epidemiological data were similar in the different settings. A great diversity in atrial fibrillation treatment was observed. In 30 and 33% of the patients, antiarrhythmic and antithrombotic treatment, respectively, did not meet the recommendations of the prevailing guidelines. The adequacy was inferior in primary care. The adequacy percentages increased slightly after the medical attention (2 and 3% respectively, p non significant) with no differences in this increase between the different settings. CONCLUSIONS There are no epidemiological differences between patients with atrial fibrillation treated at different levels of health care. An important number of patients do not follow the recommendations of the prevailing guidelines. There is a clear medical abstention in incorrectly treated cases.
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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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Martínez-Brotóns AM, Ruiz-Granell R, Morell S, Plancha E, Ferrero A, Roselló A, Llácer A, García-Civera R. [Therapeutic success of a prospective cardioversion protocol for persistent atrial fibrillation]. Rev Esp Cardiol 2006; 59:1038-46. [PMID: 17125714 DOI: 10.1157/13093981] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES The best therapeutic approach for persistent atrial fibrillation has yet to be defined. Our aim was to investigate the effects of cardioversion in unselected patients with persistent atrial fibrillation who were treated according to a strict protocol involving pretreatment, cardioversion, and follow-up. METHODS Consecutive patients with persistent atrial fibrillation of at least 1 months' duration were included prospectively in a cardioversion protocol that involved standard antiarrhythmic pretreatment, with amiodarone being offered first, and follow-up. RESULTS The study included 295 patients, 87.5% of whom were taking the antiarrhythmic drug amiodarone. Sinus rhythm was restored in 92.5%, with pharmacologic cardioversion occurring in 9.5%. The recurrence rate was 33.5% in the first month and 54.9% by month 12. Antiarrhythmic treatment had to be modified in 10.8% of patients. Independent risk factors for recurrence during the first year after cardioversion were an atrial fibrillation duration greater than one year, previous cardioversion, and left ventricular dilatation. A simple risk scoring system was able to differentiate between subgroups of patients with a low, intermediate or high risk of recurrence in the first year after cardioversion. CONCLUSIONS Sinus rhythm was maintained for 1 year after effective cardioversion in 45.1% of patients who received homogeneous antiarrhythmic pretreatment. There were few side effects. Recurrence can be predicted using clinical variables such as left ventricular dilatation, arrhythmia duration, and previous cardioversion.
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González-Juanatey JR, Conthe P. [Cardiovascular disease and hypertensive cardiomyopathy. Beyond heart]. Med Clin (Barc) 2006; 126:99-100. [PMID: 16472484 DOI: 10.1157/13083889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Robledo Martín E, González Lorente P, Brugos Larumbe A, García Zufiaurre R, Barasoain Lecumberri P, Lorenzo Veloso A. Estudio de prevalencia de la fibrilación auricular en la población de 65 años o más. Validez de la toma de pulso radial como cribado de fibrilación auricular. Semergen 2005. [DOI: 10.1016/s1138-3593(05)72947-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Estudio de prevalencia de la fibrilación auricular en la población de 65 años o más. Validez de la toma de pulso radial como cribado de fibrilación auricular. Semergen 2005. [DOI: 10.1016/s1138-3593(05)72936-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ruiz Ortiz M, Romo Peñas E, Franco Zapata M, Mesa Rubio D, Anguita Sánchez M, López Granados A, Arizón del Prado JM, Vallés Belsué F. Un protocolo prospectivo permite incrementar la utilización de anticoagulación oral en pacientes con fibrilación auricular crónica no valvular. Rev Esp Cardiol 2003; 56:971-7. [PMID: 14563291 DOI: 10.1016/s0300-8932(03)76994-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES Observational studies have shown that oral anticoagulants (OAC) prescription is suboptimal in patients with nonvalvular atrial fibrillation (NVAF). Our objective was to evaluate the usefulness of a prospective protocol for increasing OAC usage in these patients. PATIENTS AND METHOD From 1 February 2000 until 31 October 2002 we enrolled all patients with chronic NVAF seen in two outpatient cardiology clinics, excluding candidates for cardioversion. Each patient was studied to identify cardioembolic risk factors (CERF) and contraindications for OAC. Anticoagulation was suggested to all patients with > or =2 CERF and without contraindications for OAC. The decision to prescribe OAC was made by the physician in charge when there was only one CERF. RESULTS 721 patients fulfilled the inclusion criteria. Mean age was 73 +/- 8 years; 44% were men. In most cases NVAF was related with hypertension (57%), followed by no structural heart disease (25%) or ischemic heart disease (9%). The most frequent CERFs were hypertension (66%), age > or =75 years (45%) and diabetes (24%). A total of 663 patients had > or =1 CERF (92%), and 125 (19%) of these presented at least one contraindication for OAC. Of the 538 remaining patients (90%), 485 (67% of the whole series) were treated with anticoagulation. Of the patients with > or =2 CERF and without contraindications for OAC, 95% were treated. CONCLUSIONS A prospective protocol for use in the outpatient cardiology clinic allows to prescribe OAC in a large percentage of patients with NVAF.
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