Calidad de vida, adherencia y satisfacción en pacientes con fibrilación auricular tratados con dabigatrán o antagonistas de la vitamina K / Quality of life, adherence and satisfaction of patients with auricular fibrillation treated with dabigatran or vitamin K antagonists

Objetivo: Analizar la calidad de vida, la adherencia y la percepción del grado de satisfacción del tratamiento con dabigatrán frente a antagonistas de vitamina K (AVK) en pacientes con fibrilación auricular no valvular (FANV) atendidos en consultas de cardiología en España. Métodos: Estudio observacional, comparativo, prospectivo y multicéntrico en pacientes con FANV atendidos en Cardiología, que iniciaron tratamiento con dabigatrán o AVK en el mes previo a la visita basal. El seguimiento fue de 6 meses. Se analizaron la calidad de vida mediante el cuestionario validado AF-QoL 18 (0: mínimo; 100: máximo), la adherencia mediante el test de Morisky-Green y la percepción del cardiólogo mediante un cuestionario específico (0: completamente insatisfecho; 10: totalmente satisfecho). Resultados: Se analizó a 1.015 pacientes (73,3+/- 9,4 años; 57% varones; CHA2DS2VASc: 3,4+/- 1,5; HAS-BLED: 1,5+/- 1,0), tratados con dabigatrán (74,7%) o con AVK (25,3%). Las puntuaciones totales de calidad de vida se mantuvieron constantes durante el seguimiento (47,9+/- 23,5 basalmente vs. 48,6+/- 24,4 a los 6 meses; p=NS), pero superiores a los 6 meses en el grupo de dabigatrán (50,6+/- 24,7 vs. 42,8+/- 22,5; p<0,001). La adherencia al tratamiento fue elevada durante el estudio, pero superior con dabigatrán a los 6 meses (89,2% vs. 81,1%; p=0,001). Existió una mejor percepción del cardiólogo sobre la satisfacción de los pacientes tratados con dabigatrán a los 6 meses (9,0+/-1,2 vs. 6,6+/-2,2; p<0,001). Conclusiones: En pacientes con FANV y alto riesgo tromboembólico atendidos en consultas de Cardiología, tanto la adherencia como la satisfacción y la calidad de vida fueron superiores en los pacientes tratados con dabigatrán que con AVK

Objective: To analyse the quality of life, adherence and satisfaction of patients with nonvalvular auricular fibrillation (NVAF) treated with dabigatran versus vitamin K antagonists (VKA) in cardiology consultations in Spain. Methods: We conducted an observational, comparative, prospective and multicentre study of patients with NVAF treated in cardiology departments, who started treatment with dabigatran or VKA in the month prior to the baseline visit. The follow-up lasted 6 months. We analysed quality of life (using the validated AF-QoL 18 questionnaire [0, minimum; 100, maximum]), adherence (using the Morisky-Green test) and the cardiologist's perception (using a specific questionnaire [0, completely dissatisfied; 10, completely satisfied]). Results: We analysed 1015 patients (mean age, 73.3+/-9.4 years; 57% men; CHA2DS2VASc, 3.4+/-1.5; HAS-BLED, 1.5+/-1.0) who were treated with dabigatran (74.7%) or with VKA (25.3%). The total quality-of-life scores remained constant throughout the follow-up (47.9+/-23.5 and 48.6+/-24.4 at baseline and at 6 months, respectively; P=NS) but were higher at 6 months for the dabigatran group (50.6+/-24.7 vs. 42.8+/-22.5; P<.001). Treatment adherence was high during the study but greater with dabigatran at 6 months (89.2% vs. 81.1%; P=.001). There was a better perception of the cardiologist regarding the satisfaction of the patients treated with dabigatran at 6 months (9.0+/-1.2 vs. 6.6+/-2.2; P<.001). Conclusions: For patients with NVAF and high thromboembolic risk treated in cardiology consultations, the adherence, satisfaction and quality of life were higher for the patients treated with dabigatran than for those treated with VKA

Quality of life, adherence and satisfaction of patients with auricular fibrillation treated with dabigatran or vitamin K antagonists. / Calidad de vida, adherencia y satisfacción en pacientes con fibrilación auricular tratados con dabigatrán o antagonistas de la vitamina K.

OBJECTIVE: To analyse the quality of life, adherence and satisfaction of patients with nonvalvular auricular fibrillation (NVAF) treated with dabigatran versus vitamin K antagonists (VKA) in cardiology consultations in Spain. METHODS: We conducted an observational, comparative, prospective and multicentre study of patients with NVAF treated in cardiology departments, who started treatment with dabigatran or VKA in the month prior to the baseline visit. The follow-up lasted 6 months. We analysed quality of life (using the validated AF-QoL 18 questionnaire [0, minimum; 100, maximum]), adherence (using the Morisky-Green test) and the cardiologist's perception (using a specific questionnaire [0, completely dissatisfied; 10, completely satisfied]). RESULTS: We analysed 1015 patients (mean age, 73.3±9.4 years; 57% men; CHA2DS2VASc, 3.4±1.5; HAS-BLED, 1.5±1.0) who were treated with dabigatran (74.7%) or with VKA (25.3%). The total quality-of-life scores remained constant throughout the follow-up (47.9±23.5 and 48.6±24.4 at baseline and at 6 months, respectively; P=NS) but were higher at 6 months for the dabigatran group (50.6±24.7 vs. 42.8±22.5; P<.001). Treatment adherence was high during the study but greater with dabigatran at 6 months (89.2% vs. 81.1%; P=.001). There was a better perception of the cardiologist regarding the satisfaction of the patients treated with dabigatran at 6 months (9.0±1.2 vs. 6.6±2.2; P<.001). CONCLUSIONS: For patients with NVAF and high thromboembolic risk treated in cardiology consultations, the adherence, satisfaction and quality of life were higher for the patients treated with dabigatran than for those treated with VKA.

[The use of the average activity contained in the circular areas of interest on the polar map in identifying affected coronary arteries]. / Aplicación de la actividad media contenida en regiones de interés circulares del mapa polar en la identificación de arterias coronarias lesionadas.

INTRODUCTION AND OBJECTIVES: We studied the feasibility to identify coronary lesions of the average regional activity obtained by regions of interest displayed on the three main coronary territories from the polar map (left anterior descending artery, circumflex and right coronary artery). METHODS: In 125 patients with angiographic diagnosis of coronary artery disease, were made tomographic studies with technetium-99m isonitrile to analyze the average regional activity, in rest and stress. RESULTS: According to the stepwise logistic regression test, the stress average regional activity is significant and independent correlated with the stenosis rate (r = -0.60, -0.67 and -0.67 for left anterior descending artery, right coronary artery and circumflex). The thresholds values of the stress average regional activity (percentage of peak activity) with the best assessment of the significant lesions (> 70%) are: less than 70% for left anterior descending artery and circumflex, and less than 60% for the right coronary artery. Using those diagnostic criteria, this quantitative method has a high diagnostic accuracy: Sensitivity/specificity to identify significant lesion of: 0.86/0.93 for left anterior descending artery, 0.85/0.83 for right coronary artery and 0.80/0.90 for circumflex. Significant coincidence with the angiographic diagnosis of the number of diseased vessels (Kappa coefficient 9.62). CONCLUSION: The assessment of the stress average regional activity by circular regions of interest is an easy method, with a high diagnostic accuracy to identify diseased coronary arteries.