Terapêutica anti trombótica no idoso com fibrilhação auricular: das guidelines à prática clínica.
Atrial fibrillation (AF) is a common medical problem with increasing prevalence among the elderly. Warfarin is effective in the prevention of AF-related-stroke but is often underutilized, especially in high-risk populations, like the elderly.To determine, in a group of elderly patients with AF, if t...
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| Format: | Article |
| Language: | English |
| Published: |
Ordem dos Médicos
2011-12-01
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| Series: | Acta Médica Portuguesa |
| Online Access: | https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/1488 |
| _version_ | 1817980170215096320 |
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| author | Elisabete Jorge Filipa Seabra Pereira Rui Baptista Pedro Monteiro Lèlita Santos Isabel Fonseca Luís A Providência M Helena Saldanha |
| author_facet | Elisabete Jorge Filipa Seabra Pereira Rui Baptista Pedro Monteiro Lèlita Santos Isabel Fonseca Luís A Providência M Helena Saldanha |
| author_sort | Elisabete Jorge |
| collection | DOAJ |
| description | Atrial fibrillation (AF) is a common medical problem with increasing prevalence among the elderly. Warfarin is effective in the prevention of AF-related-stroke but is often underutilized, especially in high-risk populations, like the elderly.To determine, in a group of elderly patients with AF, if those treated in-line with the clinical recommendations differ from patients who were not, regarding morbidity and mortality and also to determine independent predictors of mortality. A second objective was to verify if the CHADS2 score is a good predictor of thromboembolic risk in the elderly.A total of 161 consecutive elderly patients with AF admitted in a single centre were evaluated. Clinical follow-up was available for 88.4%, with a mean duration of 9 months.Mean age was 80.9 ± 6.6 years; 96.3% of the patients had permanent AF, with controlled ventricular rate in 56.4%. Previous stroke was verified in 30.4%. Only 37.3% had oral anticoagulation at hospital discharge, despite 87.6% had guideline recommendation. Cumulative mortality rate in follow-up was 48.4% and the thromboembolism rate was 8.1%. We verified that CHADS2 score was a good predictor of thromboembolic risk in this population (c-statistic=0.742). Clinical follow-up showed that patients treated according with the clinical recommendations were more likely to survive (33.33% vs 53.93%; p=0.048). Multivariate analysis showed that age >80 years, renal disease, neoplasm and neuropsychic disease as independent predictors of mortality (c-statistic=0.83).A gap of 50% existed between the guideline recommendations and actual practice. The use of risk stratification scores can help guide the decision to use anticoagulation in older patients with AF. Elderly patients treated according with the clinical recommendations had a better prognosis. |
| first_indexed | 2024-04-13T22:51:05Z |
| format | Article |
| id | doaj.art-564619a407ea41d99556638a5679c635 |
| institution | Directory Open Access Journal |
| issn | 0870-399X 1646-0758 |
| language | English |
| last_indexed | 2024-04-13T22:51:05Z |
| publishDate | 2011-12-01 |
| publisher | Ordem dos Médicos |
| record_format | Article |
| series | Acta Médica Portuguesa |
| spelling | doaj.art-564619a407ea41d99556638a5679c6352022-12-22T02:26:10ZengOrdem dos MédicosActa Médica Portuguesa0870-399X1646-07582011-12-012410.20344/amp.1488Terapêutica anti trombótica no idoso com fibrilhação auricular: das guidelines à prática clínica.Elisabete Jorge0Filipa Seabra PereiraRui BaptistaPedro MonteiroLèlita SantosIsabel FonsecaLuís A ProvidênciaM Helena SaldanhaServiço de Cardiologia, Hospitais da Universidade de Coimbra, Coimbra, Portugal.Atrial fibrillation (AF) is a common medical problem with increasing prevalence among the elderly. Warfarin is effective in the prevention of AF-related-stroke but is often underutilized, especially in high-risk populations, like the elderly.To determine, in a group of elderly patients with AF, if those treated in-line with the clinical recommendations differ from patients who were not, regarding morbidity and mortality and also to determine independent predictors of mortality. A second objective was to verify if the CHADS2 score is a good predictor of thromboembolic risk in the elderly.A total of 161 consecutive elderly patients with AF admitted in a single centre were evaluated. Clinical follow-up was available for 88.4%, with a mean duration of 9 months.Mean age was 80.9 ± 6.6 years; 96.3% of the patients had permanent AF, with controlled ventricular rate in 56.4%. Previous stroke was verified in 30.4%. Only 37.3% had oral anticoagulation at hospital discharge, despite 87.6% had guideline recommendation. Cumulative mortality rate in follow-up was 48.4% and the thromboembolism rate was 8.1%. We verified that CHADS2 score was a good predictor of thromboembolic risk in this population (c-statistic=0.742). Clinical follow-up showed that patients treated according with the clinical recommendations were more likely to survive (33.33% vs 53.93%; p=0.048). Multivariate analysis showed that age >80 years, renal disease, neoplasm and neuropsychic disease as independent predictors of mortality (c-statistic=0.83).A gap of 50% existed between the guideline recommendations and actual practice. The use of risk stratification scores can help guide the decision to use anticoagulation in older patients with AF. Elderly patients treated according with the clinical recommendations had a better prognosis.https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/1488 |
| spellingShingle | Elisabete Jorge Filipa Seabra Pereira Rui Baptista Pedro Monteiro Lèlita Santos Isabel Fonseca Luís A Providência M Helena Saldanha Terapêutica anti trombótica no idoso com fibrilhação auricular: das guidelines à prática clínica. Acta Médica Portuguesa |
| title | Terapêutica anti trombótica no idoso com fibrilhação auricular: das guidelines à prática clínica. |
| title_full | Terapêutica anti trombótica no idoso com fibrilhação auricular: das guidelines à prática clínica. |
| title_fullStr | Terapêutica anti trombótica no idoso com fibrilhação auricular: das guidelines à prática clínica. |
| title_full_unstemmed | Terapêutica anti trombótica no idoso com fibrilhação auricular: das guidelines à prática clínica. |
| title_short | Terapêutica anti trombótica no idoso com fibrilhação auricular: das guidelines à prática clínica. |
| title_sort | terapeutica anti trombotica no idoso com fibrilhacao auricular das guidelines a pratica clinica |
| url | https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/1488 |
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