scholarly journals Estudo FATA: Prevalência de Fibrilhação Auricular e Terapêutica Antitrombótica nos Cuidados de Saúde Primários de um Concelho do Norte de Portugal

2015 ◽  
Vol 28 (1) ◽  
pp. 35 ◽  
Author(s):  
Eva Gomes ◽  
Rui Campos ◽  
Renata Morais ◽  
Marta Fernandes
Keyword(s):  
Atrial Fibrillation ◽  
Health Care ◽  
Primary Health Care ◽  
Anticoagulant Therapy ◽  
European Society ◽  
Oral Anticoagulation ◽  
Antithrombotic Therapy ◽  
Thrombotic Risk ◽  
Primary Health ◽  
European Society Of Cardiology

<strong>Introduction:</strong> Atrial fibrillation is the most prevalent sustained arrhythmia. The efficacy of oral anticoagulation has been proved in prevention stroke in these patients. However, this seems to be an underutilized treatment.<br />Objectives: to determine the prevalence of known atrial fibrillation in a Primary Health Care population; to identify major comorbidities, current antithrombotic therapy and evaluate their suitability according to the European Society of Cardiology guidelines.<br /><strong>Material and Methods:</strong> Observational cross-sectional analytical study. Population: all patients aged 30 or above, enrolled in eight Family Health Units of Vila Nova de Gaia and diagnosed with atrial fibrillation.<br /><strong>Results:</strong> Prevalence of atrial fibrillation was 1.29% (n = 940), being higher in males (p = 0.01) and increasing with age (p &lt; 0.001). The most common comorbidities were hypertension (76.4%), heart failure (32.0%) and diabetes mellitus (28.2%). A total of 52% was performing anticoagulant therapy, 29% antiplatelet agents and 4% both therapies. Of those with low thrombotic risk, 63.6% was wrongly performing some kind of antithrombotic therapy; among patients with high risk or valvular disease 56.8% was properly undergoing anticoagulant therapy.<br /><strong>Conclusion:</strong> The prevalence of atrial fibrillation as well as the frequency of the main comorbidities associated with it are in line with the majority of studies. Although most patients are undergoing oral anticoagulation, only 56.8% of those with atrial fibrillation was performing adequate antithrombotic therapy as recommended by the European Society of Cardiology guidelines, which denote a marked underutilization of this treatment.<br /><strong>Keywords:</strong> Atrial Fibrillation; Fibrinolytic Agents; Stroke; Primary Health Care; Portugal.

scholarly journals Aspects of anticoagulant therapy in patients with atrial fibrillation in the light of updated guidelines of the European society of cardiology 2020: the position of dabigatran

2020 ◽  
pp. 17-26
Author(s):  
E. S. Kropacheva ◽  
E. P. Panchenko
Keyword(s):  
Atrial Fibrillation ◽  
Anticoagulant Therapy ◽  
European Society ◽  
Treatment Strategy ◽  
Antithrombotic Therapy ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Integrated Approach ◽  
Risk Of Bleeding ◽  
European Society Of Cardiology

This review focuses on some aspects of anticoagulant therapy in the updated clinical guidelines for atrial fibrillation of the European society of cardiology, published in 2020. Atrial fibrillation is a polymorbid continuously developing syndrome, and therefore the treatment strategy is based on a comprehensive assessment of the patient, including the risk of stroke, the presence and severity of symptoms, and an assessment of structural heart disease and comorbidities. The review describes the principles of the proposed integrated approach, abbreviated “ABC pathway”, as reflecting the three main directions of the treatment strategy. According to experts, the clinical picture of AF (i.e. first detected, paroxysmal, persistent, long-term persistent or permanent) should not determine the indications for the appointment of anticoagulant therapy. The CHA2DS2-VASc scale continues to be the basis for stratification of thromboembolic risk. The role of dabigatran in primary and secondary prevention of stroke and systemic embolism in patients with atrial fibrillation is described. Changes in the position of experts regarding the assessment of bleeding risk are highlighted in order to help identify unmodified and eliminate modifiable risk factors for bleeding, as well as to identify AF patients who are potentially at high risk of bleeding for more frequent monitoring and monitoring of their condition. Questions about the use of direct oral anticoagulants in the choice of rhythm control tactics are highlighted separately. The use of dabigatran in patients undergoing cardioversion and catheter ablation is justified. Practical questions about the continuous strategy of anticoagulant therapy during ablation are highlighted separately. Changes related to multicomponent therapy after percutaneous coronary intervention are highlighted. The main measure to improve the safety of combined antithrombotic therapy is to minimize the duration of triple therapy. The updated recommendations supportlimiting the duration of triple antithrombotic therapy to 1 month, and also provide for early discontinuation of aspirin (≤1 week) and continuation of double antithrombotic therapy in cases of uncomplicated stenting and low risk of thrombosis, or when the risk of bleeding exceeds the risk of thrombotic events.

scholarly journals Prevalence of atrial fibrillation in a primary health care centre in Fars Province, Islamic Republic of Iran

2004 ◽  
Vol 10 (1-2) ◽  
pp. 147-151
Author(s):  
F. Habibzadeh ◽  
M. Yadollahie ◽  
M. Roshanipoor ◽  
A. Boroomand Haghighi
Keyword(s):  
Atrial Fibrillation ◽  
Health Care ◽  
Primary Health Care ◽  
Primary Health Care Centre ◽  
Fars Province ◽  
Care Centre ◽  
Islamic Republic ◽  
Health Care Centre ◽  
Primary Health ◽  
Islamic Republic Of Iran

This study determined the prevalence of atrial fibrillation at a primary health care centre in Fars province of the Islamic Republic of Iran. All ambulatory people aged > or = 50 years visiting the centre between April and October 2001 were screened for atrial fibrillation using a st and ard 12-lead ECG. The mean +/- SD age of participants was 64.0 +/- 8.9 years. Of 463 participants aged 50-79 years, 13 [2.8%] had atrial fibrillation [median age 74 years], significantly more women [10/230] than men [3/233]. Unlike previous studies in industrialized countries, the prevalence tripled with each decade of life and increased significantly from 0.6% in the 50-59 years to 6.4% in the 70-79 years age group. With increasing longevity in some developing countries, atrial fibrillation and consequently stroke may become major health problems

scholarly journals Warfarin treatment and risk of myocardial infarction — A cohort study of patients with atrial fibrillation treated in primary health care

2016 ◽  
Vol 221 ◽  
pp. 789-793 ◽  
Author(s):  
Per Wändell ◽  
Axel C. Carlsson ◽  
Martin J. Holzmann ◽  
Johan Ärnlöv ◽  
Sven-Erik Johansson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Health Care ◽  
Cohort Study ◽  
Primary Health Care ◽  
Primary Health ◽  
Warfarin Treatment

scholarly journals Primary Prevention of First-Ever Stroke in Primary Health Care: A Clinical Practice Study Based on Medical Register Data in Sweden

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
Ylva Skånér ◽  
Gunnar H. Nilsson ◽  
Ingvar Krakau ◽  
Ejda Hassler ◽  
Kristina Sundquist
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Health Care ◽  
Primary Health Care ◽  
Primary Prevention ◽  
Health Care Professionals ◽  
Care Needs ◽  
The Public ◽  
Primary Health ◽  
Related Risk

Background. The aim of this study was to investigate whether established risk factors for stroke in patients admitted to health care for first-ever stroke had been detected and treated in primary health care.Methods. In a retrospective study in Nacka municipality, Stockholm County, Sweden, with about 70 000 inhabitants, we included all men and women admitted to health care due to first-ever stroke between October 1999 and March 2001. Data on 187 such patients, with a mean age of 75 years, were obtained from medical registers. Main outcome measures were detection and treatment of risk factors for stroke including hypertension, diabetes, atrial fibrillation, smoking, alcohol abuse, and overweight/obesity.Results. In a majority of patients seen in primary health care with hypertension and diabetes, those risk factors were detected and treated (75.6% and 75.0%, resp.). Fewer patients with atrial fibrillation received treatment (60.9%). Treatment of lifestyle factors was difficult to assess because of lack of data in the medical records.Conclusions. Primary prevention of stroke in primary health care needs to be improved, especially when atrial fibrillation and lifestyle-related risk factors are present. Health policies need to target not only the public, but also general practitioners and other health care professionals.

scholarly journals Oral anticoagulation in patients with non-valvular atrial fibrillation and a CHA2DS2-VASc score of 1: a current opinion of the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy and European Society of Cardiology Council on Stroke

2019 ◽  
Vol 5 (3) ◽  
pp. 171-180 ◽  
Author(s):  
Patrick Sulzgruber ◽  
Sven Wassmann ◽  
Anne Grete Semb ◽  
Wolfram Doehner ◽  
Petr Widimsky ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
European Society ◽  
Oral Anticoagulation ◽  
Working Group ◽  
Thromboembolic Risk ◽  
Current Opinion ◽  
Cardiovascular Pharmacotherapy ◽  
Therapeutic Decisions ◽  
The Individual ◽  
European Society Of Cardiology

Abstract Oral anticoagulation in patients presenting with non-valvular atrial fibrillation and a CHA2DS2-VASc score of 1 (CHA2DS2-VASc of 2 in women) remains a challenging approach in clinical practice. Therapeutic decisions need to balance the individual benefit of reducing thromboembolic risk against the potential harm due to an increase in bleeding risk in this intermediate risk patient population. Within the current opinion statement of the European Society of Cardiology working group of cardiovascular pharmacotherapy and the European Society of Cardiology council on stroke the currently available evidence on the anti-thrombotic management in patients presenting with a CHA2DS2-VASc of 1 is summarized. Easily applicable tools for a personalized refinement of the individual thromboembolic risk in patients with atrial fibrillation and a CHA2DS2-VASc score of 1 that guide clinicians through the question whether to anticoagulate or not are provided.

scholarly journals The Quality of Anticoagulation Therapy among Warfarin-Treated Patients with Atrial Fibrillation in a Primary Health Care Setting

Medicina ◽  
2019 ◽  
Vol 55 (1) ◽  
pp. 15 ◽  
Author(s):  
Gediminas Urbonas ◽  
Leonas Valius ◽  
Gintarė Šakalytė ◽  
Kęstutis Petniūnas ◽  
Inesa Petniūnienė
Keyword(s):  
Atrial Fibrillation ◽  
Health Care ◽  
Primary Health Care ◽  
Anticoagulation Therapy ◽  
Warfarin Dose ◽  
Median Number ◽  
Target Range ◽  
Primary Health ◽  
Anticoagulation Control

Background and objectives: Long-term therapy with oral anticoagulants is recommended for stroke prevention in patients with atrial fibrillation (AF). This study evaluated the quality of anticoagulation therapy among warfarin-treated AF patients in selected primary health care centres in Lithuania. Materials and Methods: This was a retrospective study conducted in nine primary health care centres in Lithuania. Existing medical records of randomly selected adult patients with AF who were treated with warfarin for at least 12 months were reviewed and analysed. Physicians’ decisions to adjust warfarin dose were considered as consistent with the approved warfarin posology if warfarin dose was increased in case of international normalized ratio (INR) <2.0, decreased in case of INR >3.0 or unchanged in case of INR within 2.0 to 3.0. Results: The study population included 406 patients. The mean duration of treatment with warfarin was 5.4 years. The median number of INR measurements per patient per year was 8.0. More than half (57.3%) of available INR values were outside the target range, with 13.6% INR values being above 3.0 and 43.7% INR values—below 2.0. The median time in therapeutic range (TTR) was 40.0%; only 20% of patients had TTR of ≥65%. In about 40% of the cases with INR values outside the target range, no dose corrections were implemented. About 27% of decisions on warfarin dose adjustment were not consistent with the recommended warfarin posology. The median number of INR measurements was lower among patients living in urban areas, while the median TTR was significantly higher in urban patients than in rural patients. In the multivariate regression model, gender, HAS-BLED score and warfarin treatment duration were associated with a TTR of ≥65%. Conclusions: Anticoagulation control is suboptimal in routine clinical practice with a median TTR of 40%. Our findings suggest that there might be a room for improvement of anticoagulation control in primary care.

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