Características basales, manejo de terapias antitrombóticas y pronóstico de pacientes chilenos con FA no valvular. Lecciones del Registro GARFIELD AF en Chile / Features, management and prognosis of Chilean patients with non valvular atrial fibrillation: GARFIELD AF registry

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with high rates of death, ischemic stroke and systemic embolism (SE). There is scarce information about clinical characteristics and use of anti-thrombotic therapies in Chilean patients with non-valvular AF. Aim: To describe the characteristics and 1-year outcomes of patients with recently diagnosed AF recruited in Chile into the prospective global GARFIELD-AF registry. Material and Methods: Between 2011-2016, we prospectively registered information of 971 patients recruited at 15 centers, 85% of them from the public system and 15% from the private sector. Demographics, clinical characteristics and use of antithrombotic therapies were recorded for all patients. Adverse clinical outcomes were analyzed in 711 patients with 1-year follow-up. Results: The mean age was 71.5 years (66-79), 50% were men. Mean CHAD2S2 Vasc and HAS BLED scores for stroke risk were 3.3 (2.0-4.0) and 1.5 (1.0-2.0) respectively. Oral anticoagulants were prescribed in 82% of patients. Seventy percent received Vitamin K antagonists, 10% novel direct anticoagulants or antiplatelet therapy and only 8% did not receive any antithrombotic therapy. Mean time in optimal therapeutic range (an international normalized ratio of 2 to 3), was achieved in only 40.7% (23.0-54.8) of patients receiving Vitamin K antagonists. One year rates of death, stroke/systemic embolism and bleeding were 4.75 (3.36-6.71), 2.40 (1.47-3.92) and 1.64% (0.91-2.97) per 100 person-years. Ischemic stroke occurred in 1.8% and hemorrhagic stroke in 0.8% of patients at 1-year of follow up. Conclusions: Although the use of vitamin K antagonists at baseline was high, the mean time in optimal therapeutic range was low. Mortality and stroke rates are higher than those reported in other contemporary registries.

Riesgo individual y poblacional en infarto agudo del miocardio: Estudio INTERHEART Chile / Individual and population risk in acute myocardial infarction: The Chilean INTERHEART study

Acute myocardial infarction (AMI) is the first cause of death in Chile. Aim To assess the magnitude of risk of individuals and population associated with AMI risk factors. Material and methods: Case control study with incident cases and 2 controls paired by age and gender. History of diabetes, hypertension, smoking, stress, depression, diet, weight, height, hip and waist circumference, apolipoprotein (Apo) Al and B were determined. Odds ratio (OR) and population attributable risk (PAR) were calculated with 95 percent confidence interval. Results: Three hundred thirty two cases and 672 controls were included. Mean age was 61.6±12 years and 22 percent were women. The higher individual risk was associated with smoking: OR 3.1 (2.3-4.2), hypertension: 2.9 (2.1-3.9), permanent stress: 2.2 (1,3-2,8), increased apoB/ApoAl ratio: 2.1 (1.4-3.0) and diabetes: 2.0 (1.4-2.9). A protective effect of daily consumption of vegetables and/or fruits with and OR of 0.54 (0.4-0.8), was observed. The highest PAR was due to smoking: 42 percent (33.2-51.4), increased ApoB/ApoAl ratio: 35.2 (19.0-55.8) and hypertension: 32 percent (24.5-40.8). These three factors explained 71.3 percent of the AMI risk in Chile. A moderate effect on PAR was observed for abdominal obesity: 16.6 percent (2.4-61.2), permanent stress: 12.0 percent (2.3-44.1) and diabetes: 10.8 percent (6.1-18.3). Conclusions: Known risk factors ¡ike dyslipidemia, smoking and hypertension explain most of the AMI cases in Chile. The control of these risk factors should have a major effect on morbidity and mortality due to coronary artery disease in our country.