Outcomes of a contemporary sample of patients with atrial fibrillation taking digoxin: results from the AFBAR study.

INTRODUCTION AND OBJECTIVES: We aimed to assess and compare the effect of digoxin on clinical outcomes in patients with atrial fibrillation vs those under beta-blockers or none of these drugs. METHODS: AFBAR is a prospective registry study carried out by a team of primary care physicians (n=777 patients). Primary endpoints were survival, survival free of admission due to any cause, and survival free of admission due to cardiovascular causes. The mean follow up was 2.9 years. Four groups were analyzed: patients receiving digoxin, beta-blockers, or digoxin plus beta-blockers, and patients receiving none of these drugs. RESULTS: Overall, 212 patients (27.28%) received digoxin as the only heart control strategy, 184 received beta-blockers (23.68%), 58 (7.46%) were administered both, and 323 (41.57%) received none of these drugs. Digoxin was not associated with all-cause mortality (estimated hazard ratio=1.42; 95% confidence interval, 0.77-2.60; P=.2), admission due to any cause (estimated hazard ratio=1.03; 95% confidence interval, 0.710-1.498; P=.8), or admission due to cardiovascular causes (estimated hazard ratio=1.193; 95% confidence interval, 0.725-1.965; P=.4). No association was found between digoxin use and all-cause mortality, admission due to any cause, or admission due to cardiovascular causes in patients without heart failure. There was no interaction between digoxin use and sex in all-cause mortality or in survival free of admission due to any cause. However, an association was found between sex and admission due to cardiovascular causes. CONCLUSIONS: Digoxin was not associated with increased all-cause mortality, survival free of admission due to any cause, or admission due to cardiovascular causes, regardless of underlying heart failure.

Seguimiento clínico de una muestra contemporánea de pacientes con fibrilación auricular en tratamiento con digoxina: resultados del estudio AFBAR / Outcomes of a contemporary sample of patients with atrial fibrillation taking digoxin: results from the AFBAR study

Introducción y objetivos: Evaluar el efecto de la digoxina en los resultados clínicos de los pacientes con fibrilación auricular con y sin tratamiento con bloqueadores beta. Métodos El AFBAR es un registro prospectivo llevado a cabo por un equipo de médicos de atención primaria (n = 777 pacientes). Los objetivos principales fueron la supervivencia, la supervivencia libre de hospitalización por cualquier causa y la supervivencia libre de hospitalización por causas cardiovasculares. La media de seguimiento fue 2,9 años. Se analizaron cuatro grupos: pacientes tratados con digoxina, bloqueadores beta o digoxina más bloqueadores beta, y pacientes que no recibían ninguno de estos fármacos. Resultados En total, 212 pacientes (27,28%) recibieron digoxina como única estrategia de control de frecuencia; 184 recibieron bloqueadores beta (23,68%); 58 (7,46%), ambos fármacos y 323 (41,57%), ninguno de ellos. El tratamiento con digoxina no se asoció a la mortalidad por todas las causas (razón de riesgos estimada = 1,42; intervalo de confianza del 95%, 0,710-1,498; p = 0,2), la hospitalización por todas las causas (razón de riesgos estimada = 1,03; intervalo de confianza del 95%, 0,71-1,49; p = 0,8) ni la hospitalización por causas cardiovasculares (razón de riesgos estimada = 1,193; intervalo de confianza del 95%, 0,725-1,965; p = 0,4). No se observó asociación entre el empleo de digoxina y la mortalidad por cualquier causa, la hospitalización por cualquier causa o la hospitalización por causas cardiovasculares en los pacientes sin insuficiencia cardiaca. No hubo interacción entre el uso de digoxina y el sexo en cuanto a la mortalidad por todas las causas o la supervivencia sin hospitalización por todas las causas. Sin embargo, sí se observó una asociación entre el sexo y la hospitalización por causa cardiovascular. Conclusiones: La digoxina no se asoció a un aumento de la mortalidad por cualquier causa, la supervivencia libre de hospitalización por cualquier causa ni la supervivencia libre de hospitalización por causas cardiovasculares, con independencia de la presencia de insuficiencia cardiaca subyacente (AU)

Introduction and objectives We aimed to assess and compare the effect of digoxin on clinical outcomes in patients with atrial fibrillation vs those under beta-blockers or none of these drugs. We compared the incidence of ventricular arrhythmias in patients who were undergoing cardiac resynchronization therapy with an implantable cardioverter-defibrillator in terms of the degree of echocardiographic response to resynchronization. Patients were classified in 3 subgroups; super-responders, responders, and nonresponders. Methods AFBAR is a prospective registry study carried out by a team of primary care physicians (n = 777 patients). Primary endpoints were survival, survival free of admission due to any cause, and survival free of admission due to cardiovascular causes. The mean follow up was 2.9 years. Four groups were analyzed: patients receiving digoxin, beta-blockers, or digoxin plus beta-blockers, and patients receiving none of these drugs. Conclusions Digox in was not associated with increased all-cause mortality, survival free of admission due to any cause, or admission due to cardiovascular causes, regardless of underlying heart failure(AU)

Prevalence of carotid stenosis and silent myocardial ischemia in asymptomatic subjects with a low ankle-brachial index.

OBJECTIVE: Subjects with symptomatic peripheral artery disease (PAD) have an elevated prevalence of carotid stenosis and of silent myocardial ischaemia. As such, clinical guidelines advocate the detection of sub-clinical vascular disease in this population. However, the prevalence of occult vascular disease in asymptomatic patients with a low ankle-brachial index (ABI) has not been previously evaluated. METHODS: Cross-sectional study in five primary care centres for patients' selection and two University Hospitals for further assessment. Subjects were 1070 asymptomatic individuals between 60 and 80 years of age with at least two cardiovascular risk factors, selected for ankle-brachial index measurement. Eighty five subjects with an ABI <0.9 and an equal number of controls, matched for age, gender, diabetes, and smoking habit, and with a normal ABI, were referred to the Hospital for carotid ultrasound and exercise stress tests (EST). Main outcome measures were prevalence of a carotid stenosis >50% and an abnormal EST. RESULTS: The prevalence of a low ABI in the overall population was 9.1%. A carotid stenosis >50% was detected in 14.3% of the subjects with a low ABI and in 4.7% of the control subjects (Odds Ratio [OR]: 3.37; 95% Confidence Interval [CI]: 1.04-10.93, P = .033). The prevalence of a positive EST test was 16.2% in those with a low ABI and 10.5% in control subjects (OR: 1.65; 95% CI: 0.63-4.29, P = .309). These prevalences were higher in older subjects, in those with hypertension or diabetes, or in those with dyslipidemia. CONCLUSION: Our results indicate that in high-risk asymptomatic subjects >60 years of age, the presence of an ABI <0.9 identifies a subgroup of the population with an increased prevalence of carotid stenosis and of silent myocardial ischemia and, as such, are candidates for closer follow-up.

Morbidity and mortality among heart failure patients in Galicia, N.W. Spain: the GALICAP Study.

OBJECTIVE: Characterization of current morbidity and mortality among heart failure (HF) outpatients in Galicia (N.W. Spain), together with their main determinants. DESIGN: Prospective multicentre study involving 149 primary care physicians. SETTING: Primary care physicians selected randomly from among all (1959) primary care physicians in Galicia. PATIENTS: Clinical and epidemiological information for 1195 outpatients with HF were collected in 2006, with a mean follow-up of 6.5+/-1.5 months. MAIN OUTCOME MEASURES: Survival rates were calculated by Cox's proportional hazard model. RESULTS: Mean patient age was 76 years, 48% were male, 82% had a history of arterial hypertension, and 32% ischaemic cardiopathy. Echocardiography had been performed in 67%, showing preserved systolic function in 61%. Ninety-two (8%) died during follow-up [74 (80%) of them from cardiac causes], and 313 (29%) were re-admitted to hospital [230 (73%) of them for cardiac reasons]. Multivariate analysis identified the following independent predictors of cardiovascular death and/or readmission: ischaemic cardiopathy [hazard ratio (HR) 1.76, 95% confidence interval (CI) 1.29-4.40], stroke (HR 1.79, CI 1.18-2.73), oedema (HR 1.49, CI 1.10-2.03), anaemia (HR 1.66, CI 1.21-2.27), deteriorated systolic function (HR 1.62, CI 1.19-2.20), and previous cardiovascular admissions (HR 2.33, CI 1.67-3.24). Residence in the Barbanza district was identified as an independent predictor of survival free from cardiovascular admission (HR 0.56, CI 0.37-0.86). CONCLUSION: Morbidity and mortality are currently high among Galician HF patients, and their best single predictor is previous hospitalization for cardiovascular reasons.

[Galician study of heart failure in primary care (GALICAP Study)]. / Estudio gallego de insuficiencia cardiaca en atención primaria (estudio GALICAP).

INTRODUCTION AND OBJECTIVES: Heart failure (HF) is an important public health concern. Our aim was to evaluate the characteristics of HF patients in Galicia, Spain. METHODS: This descriptive, cross-sectional, multicenter study involved 149 primary care physicians and recorded the characteristics of 1195 patients diagnosed with HF. RESULTS: Some 48% of patients were male, and their mean age was 76 years, though women were older (P<.001). Disease history included hypertension in 82%, hyperlipidemia in 47%, diabetes in 31%, atrial fibrillation in 49%, valvular disease in 35%, and ischemic heart disease in 32%. Mean systolic and diastolic blood pressures were 131 mm Hg and 76 mm Hg, respectively. Pressure was controlled (

Estudio gallego de insuficiencia cardiaca en atención primaria (estudio GALICAP) / Galician study of heart failure in primary care (GALICAP study)

Introducción y objetivos. La insuficiencia cardiaca (IC) es un importante problema de salud en nuestro medio. Pretendemos conocer las características de estos pacientes en Galicia. Métodos. Estudio descriptivo, transversal, multicéntrico con la participación de 149 médicos de atención primaria, en el que se registraron las características de 1.195 pacientes diagnosticados de IC. Resultados. Un 48% de los pacientes eran varones con una edad media de 76 años, mayor en mujeres (p < 0,001). Presentaba antecedentes de hipertensión el 82%, de dislipidemia el 47%, de diabetes el 31%, de fibrilación auricular el 49%, de valvulopatía el 35% y de cardiopatía isquémica el 32%. Los valores medios de presión arterial sistólica y diastólica fueron, respectivamente, 131 y 76 mmHg, y estaban controlados (≤ 130/80 mmHg) en el 43% de pacientes. El 67% tiene un ecocardiograma, el 61% de ellos con una función sistólica preservada. Al 47% de los pacientes con IC se les realizó una coronariografía, porcentaje superior (p < 0,001) en varones. Los fármacos más prescritos fueron diuréticos (82%), inhibidores de la enzima de conversión de la angiotensina (IECA) (48%), antagonistas de los receptores de la angiotensina II (29%) y bloqueadores beta (27%). En los pacientes con función sistólica deprimida se prescriben más bloqueadores beta (p < 0,001), IECA (p < 0,01) y antialdosterónicos (p < 0,05). Durante el último año, el 57% de los pacientes estuvieron ingresados, el 45% de ellos por causa cardiovascular. Conclusiones. La IC con función sistólica preservada es la forma más prevalente en Galicia, que está mayoritariamente asociada con una presión arterial elevada siendo, su control limitado. En pacientes con cardiopatía isquémica, el sexo influye en la realización de coronariografía. La prescripción de fármacos no es óptima. Es necesario promover estrategias para mejorar el cuidado de estos pacientes (AU)

Introduction and objectives. Heart failure (HF) is an important public health concern. Our aim was to evaluate the characteristics of HF patients in Galicia, Spain. Methods. This descriptive, cross-sectional, multicenter study involved 149 primary care physicians and recorded the characteristics of 1195 patients diagnosed with HF. Results. Some 48% of patients were male, and their mean age was 76 years, though women were older (P<.001). Disease history included hypertension in 82%, hyperlipidemia in 47%, diabetes in 31%, atrial fibrillation in 49%, valvular disease in 35%, and ischemic heart disease in 32%. Mean systolic and diastolic blood pressures were 131 mm Hg and 76 mm Hg, respectively. Pressure was controlled (≤ 130/80 mm Hg) in 43% of patients. Overall, 67% underwent echocardiography, of whom 61% had preserved systolic function. Coronary angiography was performed in 47% of patients with ischemic heart disease, more frequently in males than females (P<.001). The most commonly prescribed drugs were diuretics (82%), angiotensin-converting enzyme (ACE) inhibitors (48%), angiotensin II receptor antagonists (29%), and beta-blockers (27%). Patients with depressed systolic function were more frequently prescribed beta-blockers (P<.001), ACE inhibitors (P<.01), and antialdosterones (P<.05). During the last year, 57% of patients had been admitted to hospital, of whom 45% were admitted for cardiovascular reasons. Conclusions. The most prevalent form of HF in Galicia was HF with preserved systolic function, which was mostly associated with high blood pressure due to poor control. In patients with ischemic heart disease, the use of coronary angiography was influenced by sex. Drug treatment was suboptimal. Intervention programs are required to improve care in these patients (AU)