ABSTRACT
To analyze the clinical profile and therapeutic strategy in atrial fibrillation (AF) according to gender in a contemporaneous patient cohort a prospective, multicenter observational study was performed on consecutive patients diagnosed with AF and assessed by cardiology units in the region of Galicia (Spain). A total of 1007 patients were included, of which 32.3% were women. The mean age of the women was significantly greater than that of the men (71.6 versus 65.7 years; p < 0.001), with a higher prevalence of hypertension (HTN) and valve disease. Women more often reported symptoms related to arrhythmia (28.2% in EHRA class I versus 36.4% in men), with a poorer level of symptoms (EHRA classes IIb and III). Thromboembolic risk was significantly higher among women (CHA2DS2-VASc 3 ± 1.3 versus 2 ± 1.5), in the same way as bleeding risk (HAS-BLED 0.83 ± 0.78 versus 0.64 ± 0.78) (p < 0.001), and women more often received anticoagulation therapy (94.1% versus 87.6%; p = 0.001). Rhythm control strategies proved significantly less frequent in women (55.8% versus 66.6%; p = 0.001), with a lesser electrical cardioversion (ECV) rate (18.4% versus 27.3%; p = 0.002). Perceived health status was poorer in women. Women were older and presented greater comorbidity than men, with a greater thromboembolic and bleeding risk. Likewise, rhythm control strategies were less frequent than in men, despite the fact that women had poorer perceived quality of life and were more symptomatic.
ABSTRACT
ObjetivoDeterminar las dudas, cuántas y de qué tipo, que se plantea un facultativo de atención primaria durante su consulta ordinaria así como establecer los métodos que utiliza para resolverlas.DiseñoEstudio de prevalencia.EmplazamientoCentros de salud de las provincias de A Coruña y Lugo.ParticipantesOchenta y un médicos de atención primaria (MAP) seleccionados por muestreo aleatorizado simple. El tamaño de la muestra se calculó para localizar un total de 500 dudas. Sólo 2 facultativos rehusaron participar.MedicionesNúmero de dudas y su tipología. Sistemas utilizados para resolverlas y momento en que se efectuaron.ResultadosSe detectaron 1,7 dudas (intervalo de confianza del 95%: 1,59 a 1,82) por cada 10 pacientes. El 92% de éstas se refería a problemas clínicos. Las 12 dudas más frecuentes representaron el 75% de todas las planteadas, en las que la interpretación de un signo clínico y las indicaciones de un tratamiento fueron las más habituales. En el 51,6% de los casos se intentó resolver la duda bien durante la consulta o bien durante esa mañana. El 35,7% de éstas generó nuevas citas, bien en la propia consulta o bien como interconsulta (23%). El 81,5% de los encuestados no utilizaba nunca internet durante la consulta y sólo el 6,2% lo hacía diariamente o a menudo.ConclusionesEl número de dudas que se plantea un MAP es relativamente bajo (1,7 por cada 10 pacientes). La forma más habitual de intentar solucionarlas es realizar una interconsulta con un especialista(A)
ObjectiveTo determine the doubts, their number and type that doctors have during routine clinics in primary care, as well as establishing methods that may be used to resolve them.DesignPrevalence study.SettingHealth centres in the provinces of A Coruña and Lugo.ParticipantsA total of 81 primary care doctors, selected by simple random sampling. The sample size was calculated to obtain a total of 500 doubts. Only 2 doctors refused to take part.MeasurementsNumber and types of doubts. Systems used to resolve them and when they were carried out.ResultsA mean of 1.7 doubts were detected (95% confidence interval; 1.591.82) for every 10 patients, of which 92% were seen as clinical problems. The 12 most frequent doubts made up 75% of all those that arose, with the interpretation of a clinical sign and treatment indications being the most common. In 51.6% of cases an attempt was made to resolve the doubt either during the consultation or during that day. A total of 35.7% of the doubts led to new appointments, either in the clinic itself or as a referral (23%). A total of 81.5% of those surveyed never used the Internet during the consultation and only 6.2% did this daily or often.ConclusionsThe number of doubts that primary care doctor has is relatively small (1.7 for every 10 patients). The most common way to try to resolve them is by referral to a specialist(AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Primary Health Care , Primary Health Care/methods , Uncertainty , Referral and Consultation , 51835 , Epidemiology, Descriptive , Observational Studies as TopicABSTRACT
OBJECTIVE: To determine the doubts, their number and type that doctors have during routine clinics in primary care, as well as establishing methods that may be used to resolve them. DESIGN: Prevalence study. SETTING: Health centres in the provinces of A Coruña and Lugo. PARTICIPANTS: A total of 81 primary care doctors, selected by simple random sampling. The sample size was calculated to obtain a total of 500 doubts. Only 2 doctors refused to take part. MEASUREMENTS: Number and types of doubts. Systems used to resolve them and when they were carried out. RESULTS: A mean of 1.7 doubts were detected (95% confidence interval; 1.59-1.82) for every 10 patients, of which 92% were seen as clinical problems. The 12 most frequent doubts made up 75% of all those that arose, with the interpretation of a clinical sign and treatment indications being the most common. In 51.6% of cases an attempt was made to resolve the doubt either during the consultation or during that day. A total of 35.7% of the doubts led to new appointments, either in the clinic itself or as a referral (23%). A total of 81.5% of those surveyed never used the Internet during the consultation and only 6.2% did this daily or often. CONCLUSIONS: The number of doubts that primary care doctor has is relatively small (1.7 for every 10 patients). The most common way to try to resolve them is by referral to a specialist.
