Publication: Situación del riesgo de embolia y de hemorragia según las escalas CHADS₂, CHA₂DS₂-VASc y HAS-BLED en pacientes con diagnóstico de fibrilación auricular crónica, en un centro de salud de Madrid
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2016-08-26
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Universidad Complutense de Madrid
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Abstract
La fibrilación auricular (FA) es la arritmia sostenida más frecuente en la práctica clínica, consistente en la desorganización total de la actividad eléctrica de la aurícula y ausencia de contracción auricular ordenada. Las últimas guías americanas AHA/ACC/HRS del 2014 definen “fibrilación auricular no valvular” (FANV) como aquella que aparece en ausencia de estenosis mitral reumática, prótesis valvular cardíaca o reparación valvular mitral, que en la FA en la que basamos este trabajo. La prevalencia estimada de fibrilación auricular en el mundo desarrollado es de un 1,5-2%, cuya incidencia aumenta escalonadamente en función de las décadas de la vida, siendo la edad media presentación entre los 75 y los 85 años. En España se estima que la FA afecta a un 8,5% de la población mayor de 60 años, es decir que existen más de 1 millón de personas con FA, de los cuales más de 90.000 se encuentran sin diagnosticar. La FA puede aparecer como consecuencia de una cardiopatía estructural, aunque otras enfermedades extracardíacas también se asocian a la FA, por mecanismos hemodinámicos, como la embolia pulmonar, EPOC, SAOS, o bien por la modulación del SNA, como en el caso del hipertiroidismo. La importancia de la FA radica en su creciente prevalencia, así como por la importante carga de morbilidad y mortalidad que genera. La FA está asociada a una tasa aumentada de muerte, ACV y otros episodios tromboembólicos, insuficiencia cardiaca y hospitalizaciones, pérdida de calidad de vida, deterioro cognitivo, capacidad reducida para el ejercicio y disfunción ventricular izquierda. El riesgo de muerte es el doble que el de la población sin dicha patología. Y el riesgo de ictus es de 3-5 veces mayor...
Atrial fibrillation (AF) is the most common type of arrhythmia in the clinical practice, characterized by uncoordinated atrial contraction due to a disorganized electrical signals leading in an irregular heart contraction and therefore heartbeat. The current guidelines for the management of patients with AF, AHA/ACC/HRS 2014, define AF as “nonvalvular atrial fibrillation“ (NVAF) like the one which appear in the absence of major valve diseases as rheumatic mitral stenosis, heart valve replacement or mitral valve restoration. This study is just focus on NVAF. The prevalence of AF in developed countries has been estimated between 1.5-2%, with a growing incidence with the aging, being between 75 to 85 years the mean age at presentation. The estimated prevalence of AF in Spain is 8.5% in a population over 60 years, so 1 million of Spaniards has AF, and 90,000 of them are undiagnosed. AF used to be a consequence of some structural hearth abnormalities, but other non-cardiac diseases can lead ini AF by hemodynamic mechanism as pulmonary embolism, chronic obstructive pulmonary disease (COPD), sleep apnoea, or by sympathetic stimulation as hyperthyroidism. AF is a global health problem, because is associated with several complications, as stroke, thromboembolism, congestive heart failure, and hospital admission and therefore losses on the quality of life, cognitive impairment, reduction of exercise capacity and left ventricular dysfunction. It has been estimated that AF alone increases 2-fold the risk of death, and between 3 and 5 fold of ischaemic stroke. Several scores has been developed to stratify the cardiovascular risk to help in the decision of choosing the antithrombotic treatment. These scores as well analyse cost-effectiveness of antithrombotic therapies in order to avoid AF complications...
Atrial fibrillation (AF) is the most common type of arrhythmia in the clinical practice, characterized by uncoordinated atrial contraction due to a disorganized electrical signals leading in an irregular heart contraction and therefore heartbeat. The current guidelines for the management of patients with AF, AHA/ACC/HRS 2014, define AF as “nonvalvular atrial fibrillation“ (NVAF) like the one which appear in the absence of major valve diseases as rheumatic mitral stenosis, heart valve replacement or mitral valve restoration. This study is just focus on NVAF. The prevalence of AF in developed countries has been estimated between 1.5-2%, with a growing incidence with the aging, being between 75 to 85 years the mean age at presentation. The estimated prevalence of AF in Spain is 8.5% in a population over 60 years, so 1 million of Spaniards has AF, and 90,000 of them are undiagnosed. AF used to be a consequence of some structural hearth abnormalities, but other non-cardiac diseases can lead ini AF by hemodynamic mechanism as pulmonary embolism, chronic obstructive pulmonary disease (COPD), sleep apnoea, or by sympathetic stimulation as hyperthyroidism. AF is a global health problem, because is associated with several complications, as stroke, thromboembolism, congestive heart failure, and hospital admission and therefore losses on the quality of life, cognitive impairment, reduction of exercise capacity and left ventricular dysfunction. It has been estimated that AF alone increases 2-fold the risk of death, and between 3 and 5 fold of ischaemic stroke. Several scores has been developed to stratify the cardiovascular risk to help in the decision of choosing the antithrombotic treatment. These scores as well analyse cost-effectiveness of antithrombotic therapies in order to avoid AF complications...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina Interna, leída el 08-02-2016