[Auricular fibrillation as a risk factor of cerebrovascular events in the over-65s. Is clinical practice in anticoagulant prophylaxis adequate?]. / Fibrilación auricular como factor de riesgo de acontecimientos cerebrovasculares en personas mayores de 65 años: es adecuada la práctica clínica en profilaxis anticoagulante?

AIM: To describe the clinical practice in antithrombotic therapy to prevent stroke in older patients with atrial fibrillation (AF). DESIGN: Cross-sectional study. SETTING: Ourense's area with 95,840 inhabitants over 65 years. PARTICIPANTS: Patients over 65 with non rheumatic AF, chronic or paroxistic; 411 cases, 69.6% older than 75 year. MAIN MEASUREMENTS: Demographic characteristics, personal history, stroke risk, diagnostic characteristics of AF, antithrombotic treatment, and its adequacy. RESULTS: Only 33% high risk patients received oral anticoagulation (OCA) with warfarin at diagnosis. Some features were found to be significant independent risk factors for OCA: age (older than 75 vs 65-74 years; odds ratio =0.32; 95% confidence interval, 0.18-0.59), and prior stroke (odds ratio =2.02; 95% confidence interval, 1.16-3.55). CONCLUSIONS: Warfarin prophylactic is insufficiently prescribed, especially in older than 75 years (with high baseline risk of stroke and no counter-indications). There was inadequate prescription in 73.4% cases.

Fibrilación auricular como factor de riesgo de acontecimientos cerebrovasculares en personas mayores de 65 años: ¿es adecuada la práctica clínica en profilaxis anticoagulante? / Auricular fibrillation as a risk factor of cerebrovascular events in the over-65s. Is clinical practice in anticoagulant prophylaxis adequate?

Objetivo. Analizar las pautas de profilaxis antitrombótica en pacientes con fibrilación auricular (FA) mayores de 65 años y su adecuación a la evidencia. Diseño. Estudio transversal. Emplazamiento. Área de salud de Ourense, con 95.840 habitantes mayores de 65 años. Participantes. Personas mayores de 65 años con FA no reumática, crónica o paroxística (411 casos; un 69,6% mayor de 75 años). Mediciones principales. a) Variables sociodemográficas, antecedentes personales y riesgo de accidente cerebrovascular (ACV), y b) características diagnósticas de la FA, tratamiento antitrombótico prescrito y adecuación a la evidencia científica. Resultados. En el momento del diagnóstico se prescribió anticoagulación oral (ACO) al 33% de los casos con riesgo alto. La probabilidad de recibir ACO se modificó por la edad (mayores de 75 años frente al grupo de 65-75 años; odds ratio, 0,32; intervalo de confianza del 95%, 0,18-0,59) y por la presencia de ACV previo (odds ratio, 2,02; intervalo de confianza del 95%, 1,16-3,55). Conclusiones. Resulta insuficiente la prescripción de ACO profiláctica, sobre todo en los mayores de 75 años con riesgo alto de ACV y baja frecuencia de contraindicaciones; el porcentaje de inadecuación es del 73,4% en este grupo

Aim. To describe the clinical practice in antithrombotic therapy to prevent stroke in older patients with atrial fibrillation (AF). Design. Cross-sectional study. Setting. Ourense's area with 95 840 inhabitants over 65 years. Participants. Patients over 65 with non rheumatic AF, chronic or paroxistic; 411 cases, 69.6% older than 75 year. Main measurements. Demographic characteristics, personal history, stroke risk, diagnostic characteristics of AF, antithrombotic treatment, and its adequacy. Results. Only 33% high risk patients received oral anticoagulation (OCA) with warfarin at diagnosis. Some features were found to be significant independent risk factors for OCA: age (older than 75 vs 65-74 years; odds ratio =0.32; 95% confidence interval, 0.18-0.59), and prior stroke (odds ratio =2.02; 95% confidence interval, 1,16-3,55). Conclusions. Warfarin prophylactic is insufficiently prescribed, especially in older than 75 years (with high baseline risk of stroke and no counter-indications). There was inadequate prescription in 73.4% cases