ABSTRACT
BACKGROUND AND PURPOSE: Chronic kidney disease (CKD) has been related to poor anticoagulation control and an increased risk of bleeding. This study aims to evaluate the association between impaired renal function (eGFR <60 mL/min/1.73 m2 ) and anticoagulation control in patients with non-valvular atrial fibrillation (AF) on vitamin K antagonists (VKA) therapy. We also assessed whether the predictive value of the SAMe-TT2 R2 score prevailed for subgroups both with and without CKD. METHODS: This is an ancillary analysis of 1381 patients from the PAULA study, which was a cross-sectional, retrospective and nationwide multicenter study. RESULTS: A total of 370 patients had eGFR <60 mL/min/1.73 m2 . Anticoagulation control levels progressively worsened across each stage of CKD. Multiple linear regression analysis showed CKD as an independent predictor of time in therapeutic range (TTR). In the subgroup of patients with preserved renal function, female sex, diet affecting INR, polypharmacy and amiodarone were associated with poorer TTR. The SAMe-TT2 R2 score had a significant but modest predictive value for TTR<65% (AUC, area under the curve 0.558, P = .002). In the subgroup of patients with CKD, the SAMe-TT2 R2 (>2 points) showed no significant predictive capacity for TTR (AUC 0.528, P = .354). The average TTR was similar for both sexes (P = .255), but with a higher percentage of males subjects with TTR ≥65% (P = .013). CONCLUSION: Chronic kidney disease is associated with poor anticoagulation control in patients with non-valvular AF taking VKA. The SAMe-TT2 R2 score was not predictive of poor TTR in the subgroup with CKD, although a modest predictive value for poor TTR was found in those without CKD.
Subject(s)
Anticoagulants/therapeutic use , Atrial Fibrillation/drug therapy , Renal Insufficiency, Chronic/complications , Vitamin K/antagonists & inhibitors , Aged , Aged, 80 and over , Atrial Fibrillation/complications , Cross-Sectional Studies , Female , Humans , Linear Models , Logistic Models , Male , Middle Aged , Predictive Value of Tests , Renal Insufficiency, Chronic/diagnosis , Retrospective Studies , Treatment OutcomeABSTRACT
OBJECTIVE: To determine the clinical profile and blood pressure (BP) control rates of anticoagulated patients with hypertension and atrial fibrillation (AF). METHODS: The PAULA study was a multicenter cross-sectional/retrospective observational study conducted throughout Spain. The study included patients with nonvalvular AF who were receiving vitamin K antagonist therapy during the past year and were attended at primary care setting. Adequate BP control was defined according to 2013 ESC/ESH guidelines. RESULTS: A total of 1,222 hypertensive patients were included (mean age 77.9 ± 8.3 years; 51.2% women; CHADS2 2.5 ± 1.1; CHA2DS2-VASc 4.2 ± 1.4; HAS-BLED 1.6 ± 0.9). 33.5% of patients had diabetes, 24.9% heart failure and 14.0% prior stroke/transient ischemic attack. Mean BP was 131.4 ± 14.5/74.9 ± 9.8 mm Hg. With regard to antihypertensive treatment, most of patients were on combined therapy (67.9%). The commonest prescribed antihypertensive drugs were diuretics (64.4%), followed by angiotensin receptor blockers (30.1%), and beta blockers (29.4%). 75.2% of hypertensive patients achieved BP control targets; 86.6% of patients ≥80 years and 67.6% of diabetics. CONCLUSIONS: More than 75% of hypertensive patients with AF achieved BP goals, and this rate was higher in elderly. More than 2 thirds of patients were on combined therapy. BP control appears to be better in AF patients than in general hypertensive population.
Subject(s)
Anticoagulants/therapeutic use , Antihypertensive Agents/therapeutic use , Atrial Fibrillation/complications , Atrial Fibrillation/drug therapy , Hypertension/complications , Hypertension/drug therapy , Aged , Aged, 80 and over , Atrial Fibrillation/epidemiology , Atrial Fibrillation/physiopathology , Blood Pressure/drug effects , Cross-Sectional Studies , Female , Humans , Hypertension/epidemiology , Hypertension/physiopathology , Male , Retrospective Studies , Spain/epidemiologyABSTRACT
OBJECTIVE: To assess the major clinical factors affecting the quality of anticoagulation and evaluate the predictive value of the SAMe-TT2R2 score to identify patients who will achieve a high average time in therapeutic range (T.T.R.) with vitamin K antagonist (V.K.A.) treatment. RESEARCH DESIGN AND METHODS: This observational, cross-sectional, retrospective and nationwide multicenter study included 1524 patients from the primary care setting with non-valvular atrial fibrillation receiving V.K.A. (≥12 months). We performed a bivariate analysis to identify factors individually associated with the T.T.R. and a multiple regression analysis to identify the independent predictive factors. For the validation of the SAMe-TT2R2 score, the receiver operating characteristic (R.O.C.) curve was calculated and the Hosmer-Lemeshow test was used to test calibration. RESULTS: A total of 94.8% of patients received acenocumarol (4.8% warfarin). A progressive decrease in mean T.T.R. was found when the SAMe-TT2R2 score increased from 0 points (72.1 ± 17.1%) to 4 points (64.1 ± 23.2%), p < 0.001. Other risk scores (CHADS2 and CHA2DS2-VASc, HAS-BLED) were also associated with the mean T.T.R. We found a significant association between low T.T.R. and the following clinical factors: female sex, three or more comorbidities, amiodarone treatment, dietary habits, bleeding history and the intake of ≥7 tablets per day besides V.K.A. (p < 0.01). Regarding SAMe-TT2R2 score validation, the R.O.C. curve showed significant capability, although not high, of discriminating good anticoagulation control (T.T.R. ≥65%) with an area under the curve of 0.562 (95% C.I. 0.533-0.592, p < 0.001) which increased, remaining modest, to 0.594 (95% C.I. 0.564-0.624, p < 0.001) when the factors not included in SAMe-TT2R2 score were added. CONCLUSION: In this cohort, the SAMe-TT2R2 score had a significant, although modest, ability to assess the likelihood of good international normalized ration (I.N.R.) control, and its predictive value might slightly improve by adding other simple clinical factors. Further research is needed to refine the predictive scales.
Subject(s)
Anticoagulants/therapeutic use , Atrial Fibrillation/drug therapy , Atrial Fibrillation/epidemiology , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Humans , Male , ROC Curve , Retrospective Studies , Spain/epidemiology , Warfarin/therapeutic useABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Societies, Medical/legislation & jurisprudence , Societies, Medical/statistics & numerical data , Societies, Medical/trends , Stroke/epidemiology , Stroke/prevention & control , Societies, Medical/organization & administration , Societies, Medical/standards , Societies, Medical , Primary Health Care/methods , Primary Health Care/trends , Primary Health CareABSTRACT
La neumonía adquirida en la comunidad (NAC) es una enfermedadinfecciosa respiratoria aguda que tiene una incidenciade 3 - 8 casos/1.000 habitantes, y aumenta con la edad y lascomorbilidades. El neumococo es el microorganismo más frecuentementeimplicado en la NAC en los adultos (30 - 35%).El 40% de los pacientes con NAC requieren ingreso hospitalarioy alrededor del 10% necesitan ser admitidos en una unidadde cuidados intensivos (UCI). Las formas más graves de infecciónneumocócica se incluyen en la enfermedad neumocócicainvasiva (ENI), que agrupa a los casos de bacteriemia (asociadaso no a neumonía), meningitis, pleuritis, artritis, peritonitisprimaria y pericarditis.En la actualidad, el mayor problema con el neumococo es laaparición de resistencias a los agentes antimicrobianos y suelevada morbimortalidad, a pesar del uso de antibióticos apropiadosy de un tratamiento médico correcto. Ciertas condicionesmédicas subyacentes aumentan el riesgo de ENI y de suscomplicaciones, destacando, desde el punto de vista neumoló-gico, el tabaquismo y las enfermedades respiratorias crónicas La enfermedad neumocócica, según la OMS, es la primeracausa de muerte prevenible en el mundo en niños y adultos.Entre las estrategias para prevenir la ENI se encuentra la vacunación.La OMS considera esencial y prioritaria su introduccióne implementación considera esencial y prioritaria su intro-ducción e implementación frente al neumococo, de forma universal, en todos los países. Actualmente disponemos de 2 vacunas antineumocócicas para el adulto: la polisacárida de 23 serotipos (VNP23) y la conjugada de 13 serotipos (VNC13).Las sociedades científicas aquí representadas han trabajado para elaborar unas recomendaciones, basadas en la evidencia científica actual, respecto a la vacunación antineumocócica en el adulto inmunocompetente con enfermedad respiratoria crónica y en fumadores con riesgo de padecer ENI
Subject(s)
Humans , Pneumococcal Infections/prevention & control , Pneumonia, Pneumococcal/prevention & control , Pneumococcal Vaccines/administration & dosage , /prevention & control , Streptococcus pneumoniae/pathogenicity , Community-Acquired Infections/prevention & control , Respiratory Tract Diseases , Chronic Disease , Pulmonary Disease, Chronic Obstructive , Asthma , SmokingSubject(s)
Humans , Anticoagulants/therapeutic use , Family Practice/methods , Family Practice/trends , Primary Health Care/methods , Primary Health Care/trends , Primary Health Care , Family Practice , Family Practice/standards , Primary Health Care/organization & administration , Primary Health Care/standards , Societies, Medical/organization & administration , Societies, Medical/standards , Societies, MedicalABSTRACT
No disponible
