ABSTRACT
Fundamento y objetivo: Evaluar en la práctica clínica el cumplimiento de las recomendaciones del Informe de Posicionamiento Terapéutico (IPT) de la Agencia Española de Medicamentos y Productos Sanitarios sobre el tratamiento con anticoagulantes orales en pacientes≥75 años con fibrilación auricular no valvular (FANV) atendidos en unidades de Medicina Interna en España. Pacientes y métodos: Estudio observacional, transversal y multicéntrico, en el que se incluyeron 837 pacientes≥75 años con FANV en tratamiento estable con anticoagulantes orales durante los 3 meses previos a la inclusión y que hubiesen iniciado dicho tratamiento antes de comenzar el período de inclusión. Resultados: La edad media fue de 83,0±5,0 años, el CHADS2 medio 3,2±1,2, el CHA2DS2-VASc 5,0±1,4 y el HAS-BLED 2,1±0,9. El 70,8% de los pacientes estaba en tratamiento con antagonistas de la vitamina K (AVK) y el resto con anticoagulantes orales de acción directa (ACOD). El 65,6% de los pacientes con AVK no siguieron las recomendaciones del IPT frente al 43,0% de los pacientes con ACOD (p<0,0001). En el caso de los pacientes con AVK, el motivo principal para ser considerado como no adecuado fue presentar un mal control de la anticoagulación y no cambiar a un ACOD, mientras que en el caso de los ACOD fue recibir una dosis inadecuada según el IPT. Conclusiones: En un porcentaje elevado de pacientes ancianos con FANV anticoagulados en España no se siguen las recomendaciones realizadas por el IPT, especialmente con los AVK, al no realizarse el cambio a ACOD a pesar de un tiempo en rango terapéutico inadecuado
Background and objective: To evaluate the adherence to the recommendations in clinical practice performed by the Therapeutic Positioning Report (TPR) of the Spanish Agency of Medicines and Sanitary Products about the treatment with oral anticoagulants in patients aged≥75 years old with nonvalvular atrial fibrillation (NVAF) treated in Internal Medicine departments in Spain. Patients and methods: Observational, cross-sectional and multicenter study in which 837 patients aged≥75 years old with NVAF, with stable treatment with oral anticoagulants at least 3 months before inclusion, and that had started treatment with oral anticoagulants before the inclusion period were included. Results: Mean age was 83.0±5.0 years old, mean CHADS2 score 3.2±1.2, mean CHA2DS2-VASc score 5.0±1.4, and mean HAS-BLED score 2.1±0.9. A percentage of 70.8 of patients were treated with vitamin K antagonists (VKA) and the rest of patients with direct oral anticoagulants (DOACs). A percentage of 65.6 of patients treated with VKA did not follow the recommendations made by the TPR compared with 43.0% of patients treated with DOACs (P<.0001). In the case of VKA, the main reason for being considered as not appropriate according to the TPR was having poor control of anticoagulation and not switching to DOACs, whereas in the case of DOACs, it was not receiving the adequate dose according to the TPR. Conclusions: In a high proportion of anticoagulated elderly patients with NVAF in Spain, the recommendations performed by the TPR are not followed, particularly with VKA, since patients are not switched to DOACs despite time in therapeutic range
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Vitamin K/antagonists & inhibitors , Antifibrinolytic Agents/therapeutic use , Atrial Fibrillation/drug therapy , Observational Study , Cross-Sectional Studies , Anticoagulants/therapeutic use , Anticoagulants/administration & dosage , AgedABSTRACT
BACKGROUND AND OBJECTIVE: To evaluate the adherence to the recommendations in clinical practice performed by the Therapeutic Positioning Report (TPR) of the Spanish Agency of Medicines and Sanitary Products about the treatment with oral anticoagulants in patients aged≥75 years old with nonvalvular atrial fibrillation (NVAF) treated in Internal Medicine departments in Spain. PATIENTS AND METHODS: Observational, cross-sectional and multicenter study in which 837 patients aged≥75 years old with NVAF, with stable treatment with oral anticoagulants at least 3 months before inclusion, and that had started treatment with oral anticoagulants before the inclusion period were included. RESULTS: Mean age was 83.0±5.0 years old, mean CHADS2 score 3.2±1.2, mean CHA2DS2-VASc score 5.0±1.4, and mean HAS-BLED score 2.1±0.9. A percentage of 70.8 of patients were treated with vitamin K antagonists (VKA) and the rest of patients with direct oral anticoagulants (DOACs). A percentage of 65.6 of patients treated with VKA did not follow the recommendations made by the TPR compared with 43.0% of patients treated with DOACs (P<.0001). In the case of VKA, the main reason for being considered as not appropriate according to the TPR was having poor control of anticoagulation and not switching to DOACs, whereas in the case of DOACs, it was not receiving the adequate dose according to the TPR. CONCLUSIONS: In a high proportion of anticoagulated elderly patients with NVAF in Spain, the recommendations performed by the TPR are not followed, particularly with VKA, since patients are not switched to DOACs despite time in therapeutic range.
Subject(s)
Anticoagulants/therapeutic use , Atrial Fibrillation/drug therapy , Guideline Adherence/statistics & numerical data , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Humans , Male , Practice Guidelines as Topic , SpainABSTRACT
Fundamento y objetivo: Validar el cuestionario de satisfacción Anti-Clot Treatment Scale (ACTS) en pacientes con fibrilación auricular no valvular (FANV) en tratamiento con anticoagulantes orales atendidos en consultas de Medicina Interna y Neurología de España. Métodos: Estudio transversal, multicéntrico, en el que se incluyeron 1.337 sujetos ≥ 18 años con FANV, en tratamiento con anticoagulantes orales ≥ 3 meses, atendidos en consultas de Medicina Interna o Neurología en España. Los pacientes completaron los cuestionarios ACTS, Self-Assessment of Treatment Questionnaire (SAT-Q) y EuroQol-5 dimensions (5Q-5D). La escala ACTS es un instrumento de satisfacción específico para la evaluación de la carga (mayor puntuación, menor carga) y beneficios (mayor puntuación, mayor beneficio) con el tratamiento anticoagulante. Se evaluaron las propiedades psicométricas del cuestionario de acuerdo con la teoría clásica de los test. Resultados: El tiempo medio en cumplimentar el cuestionario fue 8,99 ± 6,06min y el 63,70% de los pacientes precisaron ayuda para la cumplimentación del mismo. Existió una elevada concordancia entre las puntuaciones del test y el retest. La fiabilidad total (alfa de Cronbach) fue 0,95 en la escala Carga y 0,82 en la escala Beneficio. El modelo factorial resultó pertinente. Todas las correlaciones con el cuestionario SAT-Q fueron positivas, moderadas y estadísticamente significativas. Con respecto al cuestionario EQ-5D-3L, estas fueron positivas, bajas y estadísticamente significativas. La satisfacción de los pacientes fue mayor cuando estaban siendo tratados con anticoagulantes orales de acción directa. Conclusiones: En pacientes con FANV en tratamiento con anticoagulantes orales, la versión en español del cuestionario ACTS fue fiable, válida y factible (AU)
Background and objective: To validate the satisfaction questionnaire Anti-Clot-Treatment Scale (ACTS) in outpatients with nonvalvular atrial fibrillation (NVAF) treated with oral anticoagulants attended in Internal Medicine and Neurology departments in Spain. Methods: In this cross-sectional and multicentrer study, 1,337 outpatients aged ≥ 18 years, with NVAF, treated with oral anticoagulants ≥ 3 months, attended in Internal Medicine and Neurology departments in Spain were analyzed. The patients completed ACTS, Self-Assessment of Treatment Questionnaire (SAT-Q) and EuroQol-5 dimensions (EQ-5D) questionnaires. ACTS is a satisfaction tool that specifically analyzes burdens (higher score, lesser burden) and benefits (higher score, higher benefit) with anticoagulant treatment. The psychometric properties of the questionnaire were evaluated according to the classical test theory. Results: The average time to complete the questionnaire was 8.99 ± 6.06min and 63.70% of patients needed assistance to complete it. There was a high concordance between test and retest scores. Total reliability (Cronbach's alpha) was 0.95 in the ACTS Burdens scale and 0.82 in the ACTS Benefits scale. The factorial model was pertinent. All correlations with the SAT-Q questionnaire were positive, moderate and statistically significant. With regard to the EQ-5D-3L questionnaire, correlations were positive, low and statistically significant. Patient satisfaction was higher in the individuals being treated with new direct oral anticoagulants. Conclusions: In patients with NVAF treated with oral anticoagulants, the Spanish version of ACTS questionnaire was reliable, valid and feasible (AU)
Subject(s)
Humans , Male , Female , Aged , Patient Satisfaction/statistics & numerical data , Atrial Fibrillation/epidemiology , Atrial Fibrillation/therapy , Anticoagulants/therapeutic use , Psychometrics/methods , Psychometrics/organization & administration , Patient Acceptance of Health Care/statistics & numerical data , Surveys and Questionnaires , Internal Medicine/statistics & numerical data , Neurology/statistics & numerical data , Spain/epidemiology , Cross-Sectional Studies/methods , 28599 , Comorbidity , Reproducibility of ResultsABSTRACT
BACKGROUND AND OBJECTIVE: To validate the satisfaction questionnaire Anti-Clot-Treatment Scale (ACTS) in outpatients with nonvalvular atrial fibrillation (NVAF) treated with oral anticoagulants attended in Internal Medicine and Neurology departments in Spain. METHODS: In this cross-sectional and multicentrer study, 1,337 outpatients aged≥18 years, with NVAF, treated with oral anticoagulants≥3 months, attended in Internal Medicine and Neurology departments in Spain were analyzed. The patients completed ACTS, Self-Assessment of Treatment Questionnaire (SAT-Q) and EuroQol-5 dimensions (EQ-5D) questionnaires. ACTS is a satisfaction tool that specifically analyzes burdens (higher score, lesser burden) and benefits (higher score, higher benefit) with anticoagulant treatment. The psychometric properties of the questionnaire were evaluated according to the classical test theory. RESULTS: The average time to complete the questionnaire was 8.99±6.06min and 63.70% of patients needed assistance to complete it. There was a high concordance between test and retest scores. Total reliability (Cronbach's alpha) was 0.95 in the ACTS Burdens scale and 0.82 in the ACTS Benefits scale. The factorial model was pertinent. All correlations with the SAT-Q questionnaire were positive, moderate and statistically significant. With regard to the EQ-5D-3L questionnaire, correlations were positive, low and statistically significant. Patient satisfaction was higher in the individuals being treated with new direct oral anticoagulants. CONCLUSIONS: In patients with NVAF treated with oral anticoagulants, the Spanish version of ACTS questionnaire was reliable, valid and feasible.
Subject(s)
Anticoagulants/therapeutic use , Atrial Fibrillation/drug therapy , Patient Satisfaction , Surveys and Questionnaires , Administration, Oral , Adolescent , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Psychometrics , Reproducibility of Results , Spain , Young AdultABSTRACT
Peptide display on solvent-exposed surfaces of engineered enzymes allows them to respond to anti-peptide antibodies by detectable changes in their enzymatic activity, offering a new principle for biosensor development. In this work, we show that multiple peptide insertion in the vicinity of the Escherichia coli beta-galactosidase active site dramatically increases the enzyme responsiveness to specific anti-peptide antibodies. The modified enzymes HD7872A and HT7278CA, carrying eight and 12 copies respectively of a foot-and-mouth disease peptide per enzyme molecule, show antibody-mediated activation factors higher than those previously observed in the first generation enzymatic sensors, for HT7278CA being close to 400%. The analysis of the signal transduction process with multiple inserted proteins strongly suggests a new, non-exclusive mechanism of enzymatic regulation in which the target proteins might be stabilised by the bound antibody, extending the enzyme half-life and consequently enhancing the signal-background ratio. In addition, the tested sensors are differently responsive to sera from immune farm animals, depending on the antigenic similarity between the B-cell epitopes in the immunising virus and those in the peptide used as sensing element on the enzyme surface. Altogether, these results point out the utility of these enzymatic biosensors for a simple diagnosis of foot-and-mouth disease in an extremely fast homogeneous assay.
