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1.
Arq. bras. cardiol ; 117(3): 426-434, Sept. 2021. tab
Article in English, Portuguese | LILACS | ID: biblio-1339193

ABSTRACT

Resumo Fundamento: A fibrilação ou flutter atrial (FFA) é a arritmia cardíaca sustentada mais comum. Existem poucos dados sobre a epidemiologia da FFA na América do Sul. Objetivo: O presente estudo procurou descrever a epidemiologia clínica da FFA e o uso de anticoagulantes na avaliação da linha de base do Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil). Métodos: Foram analisados dados de 13.260 participantes do ELSA-Brasil. A FFA foi definida pelo eletrocardiograma ou por autorrelato. Modelos de regressão logística foram construídos para analisar fatores associados à FFA. Este estudo também analisou se idade e sexo estavam associados ao uso de anticoagulantes para evitar acidente vascular cerebral. O nível de significância foi de 5%. Resultados: A idade mediana foi de 51 anos, e 7.213 (54,4%) participantes eram mulheres. A FFA foi detectada em 333 (2,5%) participantes. O aumento da idade (razão de chances [RC]:1,05; intervalo de confiança de 95% [IC95%]: 1,04-1,07), hipertensão (RC:1,44; IC95%:1,14-1,81) coronariopatia (RC: 5,11; IC95%:3,85-6,79), insuficiência cardíaca (RC:7,37; IC95%:5,00-10,87) e febre reumática (RC:3,38; IC95%:2,28-5,02) foram associadas à FFA. Dos 185 participantes com FFA e pontuação no CHA2DS2-VASc≥2, apenas 20 (10,8%) usavam anticoagulantes (50,0% entre aqueles com FFA no eletrocardiograma de linha de base). O uso de anticoagulantes nesse grupo foi associado a maior idade (1,8% vs 17,7% naqueles com idade ≤ 54 e ≥ 65 anos, respectivamente; p=0,013). Observou-se uma tendência ao menor uso de anticoagulantes em mulheres (7,1% vs. 16,4% em mulheres e homens, respectivamente; p=0,055). Conclusões: No recrutamento do ELSA-Brasil, 2,5% dos participantes tinham FFA. O baixo uso de anticoagulantes era comum, o que representa um desafio para os cuidados de saúde nesse cenário.


Abstract Background: Atrial fibrillation or flutter (AFF) is the most common sustained cardiac arrhythmia. Limited data can be found on AFF epidemiology in South America. Objective: The present study sought to describe the clinical epidemiology of AFF and the use of stroke prevention medication in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline assessment. Methods: This study analyzed data from 13,260 ELSA-Brasil participants. AFF was defined according to ECG recording or by self-report. Logistic regression models were built to analyze factors associated with AFF. This study also analyzed if age and sex were associated with anticoagulant use for stroke prevention. Significance level was set at 5%. Results: Median age was 51 years and 7,213 (54.4%) participants were women. AFF was present in 333 (2.5%) participants. Increasing age (odds ratio [OR]:1.05; 95% confidence interval [95%CI]: 1.04-1.07), hypertension (OR:1.44; 95%CI: 1.14-1.81), coronary heart disease (OR: 5.11; 95%CI: 3.85-6.79), heart failure (OR:7.37; 95%CI: 5.00-10.87), and rheumatic fever (OR:3.38; 95%CI: 2.28-5.02) were associated with AFF. From 185 participants with AFF and a CHA2DS2-VASc score ≥2, only 20 (10.8%) used anticoagulants (50.0% among those with AFF in the baseline ECG). Stroke prevention in this group was associated with a higher age (1.8% vs 17.7% in those aged ≤ 54 and ≥ 65 years, respectively; p=0.013). A trend towards a reduced anticoagulant use was observed in women (7.1% vs. 16.4% in women and men, respectively; p=0.055). Conclusions: At the ELSA-Brasil baseline, 2.5% of the participants had AFF. The lack of stroke prevention was common, which is an especially challenging point for healthcare in this setting.


Subject(s)
Humans , Male , Female , Adult , Aged , Atrial Fibrillation/diagnosis , Atrial Fibrillation/epidemiology , Stroke/diagnosis , Stroke/prevention & control , Stroke/epidemiology , Cross-Sectional Studies , Risk Factors , Longitudinal Studies , Risk Assessment , Electrocardiography , Self Report , Middle Aged , Anticoagulants/therapeutic use
2.
Rev. argent. cardiol ; 88(4): 290-296, jul. 2020. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1250990

ABSTRACT

RESUMEN Introducción: El GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) es un registro internacional, prospectivo, en tres fases, para determinar la seguridad y eficacia del dabigatrán en pacientes con fibrilación auricular no valvular recientemente diagnosticada, en riesgo de stroke. La fase II empezó cuando el dabigatrán, el primer anticoagulante oral no antagonista de la vitamina K (NOAC) estuvo disponible. Objetivos: Describir los datos clínicos basales de la fase II en la población general y el seguimiento a 2 años de aquellos que recibieron dabigatrán. Material y Métodos: Se reclutaron un total de 15 644 pacientes, de los cuales 15 308 fueron elegibles y 4873 recibieron dabigatrán. Se analizaron las características de la fibrilación auricular, los hallazgos en el seguimiento y las enfermedades concomitantes. Los datos fueron analizados usando estadísticas descriptivas. Resultados: Del total de pacientes elegibles, el 45,5% eran mujeres, con una edad promedio de 71 (rango intercuartilo: 64-78) años. Los pacientes eran de Europa (47,9%), América del Norte (22,2%), Asia (20,1%), América Latina (6,0%) y Medio Oriente/ África (3,9%). La mayoría se encontraba en alto riesgo de stroke (CHA2DS2-VASc score >2; 86,1%); un 13,9% tuvieron riesgo moderado (CHA2DS2-VASc score >1). El 80,3% recibieron anticoagulantes orales; de ellos, el 47,9% recibieron NOAC y el 32,4%, antagonistas de la vitamina K (VKA); 12,0% recibieron agentes antiagregantes plaquetarios y el 7,6% no recibieron tratamiento antitrombótico. A 2 años de seguimiento, el 70,5% permanecieron en dabigatrán. Conclusiones: Los datos de la fase II del registro GLORIA-AF demostraron que, en FA no valvular, los NOAC han sido ampliamente adoptados en la práctica clínica y fueron más frecuentemente prescriptos que los VKA. No obstante, una gran proporción de pacientes en todo el mundo permanecieron sin tratamiento.


ABSTRACT Background: GLORIA-AF is a prospective, global, 3-phase registry program to determine the safety and effectiveness of dabigatran in patients with newly diagnosed non-valvular atrial fibrillation at risk of stroke. Phase II began when dabigatran, the first non-vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives: To describe phase II baseline clinical data in the general population and 2-year follow-up of those patients treated with dabigatran. Methods: A total of 15,644 patients were enrolled, 15,308 of whom were eligible and 4,873 received dabigatran. Atrial fibrillation disease characteristics, follow-up findings and concomitant diseases were collected. Data were analyzed using descriptive statistics. Results: Of the total eligible patients, 45.5% were female; median age was 71.0 (interquartile range: 64, 78) years. Patients were from Europe (47.9%), North America (22.2%), Asia (20.1%), Latin America (6.0%), and the Middle East/Africa (3.9%). Most had high stroke risk (CHA2DS2-VASc score ≥2; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc =1). Overall, 80.3% received oral anticoagulants, of whom 47.9% received NOACs and 32.4% vitamin K antagonists (VKA); 12.0% received anti-platelet agents; and 7.6% received no antithrombotic treatment. At 2-year follow-up, 70.5% remained on dabigatran. Conclusions: Data from GLORIA-AF phase II showed that in non-valvular AF, NOACs have been highly adopted in clinical practice, becoming more frequently prescribed than VKAs. Worldwide, however, a large proportion of patients remain undertreated.

3.
Arq. bras. cardiol ; 107(6): 576-589, Dec. 2016. tab, graf
Article in English | LILACS | ID: biblio-838661

ABSTRACT

Abstract Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, with an estimated prevalence of 1-2% in North America and Europe. The increased prevalence of AF in Latin America is associated with an ageing general population, along with poor control of key risk factors, including hypertension. As a result, stroke prevalence and associated mortality have increased dramatically in the region. Therefore, the need for effective anticoagulation strategies in Latin America is clear. The aim of this review is to provide a contemporary overview of anticoagulants for stroke prevention. The use of vitamin K antagonists (VKAs, eg, warfarin) and aspirin in the prevention of stroke in patients with AF in Latin America remains common, although around one fifth of all AF patients receive no anticoagulation. Warfarin use is complicated by a lack of access to effective monitoring services coupled with an unpredictable pharmacokinetic profile. The overuse of aspirin is associated with significant bleeding risks and reduced efficacy for stroke prevention in this patient group. The non-VKA oral anticoagulants (NOACbs) represent a potential means of overcoming many limitations associated with VKA and aspirin use, including a reduction in the need for monitoring and a reduced risk of hemorrhagic events. The ultimate decision of which anticoagulant drug to utilize in AF patients depends on a multitude of factors. More research is needed to appreciate the impact of these factors in the Latin American population and thereby reduce the burden of AF-associated stroke in this region.


Resumo A fibrilação atrial (FA) é a arritmia cardíaca sustentada mais comum, com uma prevalência estimada de 1-2% na América do Norte e Europa. O aumento da prevalência da FA na América Latina está associado com o envelhecimento da população geral, juntamente com um mal controle dos principais fatores de risco, incluindo a hipertensão arterial. Como resultado, a prevalência do acidente vascular cerebral (AVC) e a mortalidade associada a ele aumentou dramaticamente na região. Há, portanto, uma clara necessidade de estratégias efetivas de anticoagulação na América Latina. O objetivo desta revisão é oferecer uma visão atual da anticoagulação na prevenção do AVC. O uso de antagonistas da vitamina K (AVKs, ex.: varfarina) e ácido acetilsalicílico (AAS) na prevenção do AVC em pacientes com FA na América Latina permanece frequente, apesar de cerca de um quinto de todos os pacientes com FA não receberem anticoagulação. O uso da varfarina é complicado pela falta de acesso a serviços de monitoramento eficazes, juntamente com um perfil farmacocinético imprevisível. A utilização excessiva do AAS está associada com riscos significativos de sangramento e eficácia reduzida na prevenção do AVC neste grupo de pacientes. Os novos anticoagulantes orais não AVK (NOACs) representam um meio potencial de superar muitas limitações associadas ao uso dos AVKs e do AAS, incluindo uma redução na necessidade de monitoramento e risco reduzido de eventos hemorrágicos. A decisão final sobre qual anticoagulante utilizar em pacientes com FA depende de diversos fatores. Pesquisas adicionais são necessárias para avaliar o impacto desses fatores na população latino-americana e, assim, reduzir o ônus do AVC associado à FA nesta região.


Subject(s)
Humans , Male , Female , Atrial Fibrillation/prevention & control , Warfarin/therapeutic use , Stroke/prevention & control , Anticoagulants/therapeutic use , Platelet Aggregation Inhibitors/therapeutic use , Risk Factors , Practice Guidelines as Topic , Risk Assessment , Latin America
4.
Rev. urug. cardiol ; 30(3): 371-384, dic. 2015. ilus, tab
Article in Spanish | LILACS-Express | LILACS | ID: lil-774666

ABSTRACT

Los NOAC (No antivitamina K AntiCoagulantes) representan una opción atractiva para numerosos pacientes con fibrilación auricular (FA). Los diversos NOAC tienen propiedades levemente diferentes, por lo que su prescripción debe realizarse en base a las características del paciente. Frente a la necesidad de elegir entre varios NOAC, este artículo ofrece un enfoque centrado en el paciente para seleccionar el mejor NOAC en aquellos con FA no valvular.


A non-Vitamin K antagonist oral anticoagulant (NOAC) is an attractive option for many patients with atrial fibrillation (AF). The various NOACs have slightly different properties, and thus prescribing NOACs should be based on patient characteristics. With several NOACs to choose from, this article offers a patient-centred approach in choosing the best choice of NOACs for non-valvular AF patients.

5.
Rev. urug. cardiol ; 28(1): 99-109, abr. 2013. graf, tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-962310

ABSTRACT

Resumen Objetivos: establecer la prevalencia de la fibrilación auricular (FA) en la población general en el Reino Unido y en los individuos con factores de riesgo. Método y resultados: se estableció la prevalencia de la FA electrocardiográfica en grupos seleccionados de forma prospectiva; se seleccionaron aleatoriamente 3.960 individuos de la población, mayores de 45 años; 782 tenían diagnóstico previo de insuficiencia cardíaca y 1.062 con antecedente de infarto de miocardio, hipertensión, angina de pecho o diabetes. Los pacientes también fueron evaluados clínicamente y mediante ecocardiografía. Se hizo un seguimiento de la mortalidad durante ocho años. Se encontró FA en 78 de la muestra aleatoria de la población (2,0%). La prevalencia fue de 1,6% en las mujeres y de 2,4% en los hombres, aumentando con la edad, yendo desde 0,2% en los sujetos de entre 45 y 54 años, hasta 8,0% en los de 75 años o mayores. La mitad de todos los casos eran en pacientes de 75 años o mayores. Solo 23 de los 78 (29,5%) con diagnóstico de FA estaban recibiendo warfarina. De los 782 pacientes, 175 (22,4%) con diagnóstico de insuficiencia cardíaca presentaban FA, y 95 (54,3%) de ellos tenían una función ventricular izquierda normal. Se constató FA en 14 de los 244 (5,7%) pacientes con antecedentes de infarto de miocardio; en 15 de los 388 (3,9%) pacientes con hipertensión; en 15 de los 321 (4,7%) pacientes con angina, y en 11 de los 208 (5,3%) pacientes diabéticos. Ajustando por edad y sexo, la mortalidad fue 1,57 veces mayor en quienes presentaban FA. Conclusión: la FA es frecuente en ancianos y en personas con factores de riesgo clínico. Un tamizaje de estos grupos permitiría identificar a muchos individuos con FA. El uso de anticoagulación era bajo en la época en que se hizo la evaluación inicial, a fines de los años 90, pero la práctica puede haber cambiado en los últimos tiempos.


Summary Aim: To establish the prevalence of atrial fibrillation (AF) in the general population in the UK, and in those with risk factors. Methods and results: The prevalence of AF on electrocardiography was established in prospectively selected groups: 3960 randomly selected from the population, aged 45+; 782 with a previous diagnosis of heart failure; and 1062 with a record of myocardial infarction, hypertension, angina, or diabetes. Patients were also assessed clinically and with echocardiography. Mortality was tracked for 8 years. Atrial fibrillation was found in 78 of the random population sample (2.0%). Prevalence was 1.6% in women and 2.4% in men, rising with age from 0.2% in those aged 45-54 to 8.0% in those aged 75 and older. Half of all cases were in patients aged 75 and older. Only 23 of the 78 (29.5%) of those in AF took warfarin. Of the 782 patients, 175 (22.4%) with a diagnosis of heart failure were in AF, with normal left ventricular function in 95 (54.3%) of these. Atrial fibrillation was found in 14 of the 244 (5.7%) of those with a history of myocardial infarction, 15 of the 388 (3.9%) of those with hypertension, 15 of the 321 (4.7%) of those with angina, and 11 of the 208 (5.3%) of diabetics. Adjusting for age and sex, mortality was 1.57 times higher for those in AF. Conclusion: Atrial fibrillation is common in the elderly and those with clinical risk factors. Screening these groups would identify many with AF. Use of anticoagulation was low at the time of the initial assessments in the late 1990s; practice may have changed recently

6.
Rev. bras. hipertens ; 13(1): 8-13, jan.-mar. 2006. graf
Article in English | LILACS | ID: lil-427055

ABSTRACT

The prevalence of both hypertension and type II diabetes mellitus are increasing in industrialised countries. These diseases are very closely related and associated with a high incidence of cardiovascular, cerebrovascular and renovascular complications. Effective management of hypertension in type II diabetes reduces the associated morbidity and mortality. The target blood pressure in patients with type II diabetes mellitus is less than 130/80 mm Hg, with a lower levei of less than 120/80 mm Hg being recommended in the context of renal impairment or proteinuria. Ali groups of antihypertensive drugs are effective in reducing hypertension in diabetics with the individual agent, or combination of agents, used dictated by patient characteristics, including age and ethnicity, in addition to co-morbidities. Often, an ACE inhibitor or an angiotensin II receptor blocker, usually combined with a diuretic, would be first line therapy. A calcium-channel blocker, beta-blocker, or alpha-blocker may be used as additional therapy if required


Subject(s)
Humans , Antihypertensive Agents , Arterial Pressure , Cardiovascular Diseases , Hypertension , Hypertension/drug therapy
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