Anticoagulation in elderly patients with atrial fibrillation: from the guidelines to the daily medical practice.
Autor(a) principal: | |
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Data de Publicação: | 2011 |
Outros Autores: | , , , , , , |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/1488 |
Resumo: | 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. |
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Anticoagulation in elderly patients with atrial fibrillation: from the guidelines to the daily medical practice.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 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.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.Ordem dos Médicos2011-12-29info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/1488oai:ojs.www.actamedicaportuguesa.com:article/1488Acta Médica Portuguesa; Vol. 24 (2011): Suplemento 2; 293-300Acta Médica Portuguesa; Vol. 24 (2011): Suplemento 2; 293-3001646-07580870-399Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPporhttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/1488https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/1488/1074Jorge, ElisabetePereira, Filipa SeabraBaptista, RuiMonteiro, PedroSantos, LèlitaFonseca, IsabelProvidência, Luís ASaldanha, M Helenainfo:eu-repo/semantics/openAccess2022-12-20T10:57:57Zoai:ojs.www.actamedicaportuguesa.com:article/1488Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T16:17:11.126954Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Anticoagulation in elderly patients with atrial fibrillation: from the guidelines to the daily medical practice. Terapêutica anti trombótica no idoso com fibrilhação auricular: das guidelines à prática clínica. |
title |
Anticoagulation in elderly patients with atrial fibrillation: from the guidelines to the daily medical practice. |
spellingShingle |
Anticoagulation in elderly patients with atrial fibrillation: from the guidelines to the daily medical practice. Jorge, Elisabete |
title_short |
Anticoagulation in elderly patients with atrial fibrillation: from the guidelines to the daily medical practice. |
title_full |
Anticoagulation in elderly patients with atrial fibrillation: from the guidelines to the daily medical practice. |
title_fullStr |
Anticoagulation in elderly patients with atrial fibrillation: from the guidelines to the daily medical practice. |
title_full_unstemmed |
Anticoagulation in elderly patients with atrial fibrillation: from the guidelines to the daily medical practice. |
title_sort |
Anticoagulation in elderly patients with atrial fibrillation: from the guidelines to the daily medical practice. |
author |
Jorge, Elisabete |
author_facet |
Jorge, Elisabete Pereira, Filipa Seabra Baptista, Rui Monteiro, Pedro Santos, Lèlita Fonseca, Isabel Providência, Luís A Saldanha, M Helena |
author_role |
author |
author2 |
Pereira, Filipa Seabra Baptista, Rui Monteiro, Pedro Santos, Lèlita Fonseca, Isabel Providência, Luís A Saldanha, M Helena |
author2_role |
author author author author author author author |
dc.contributor.author.fl_str_mv |
Jorge, Elisabete Pereira, Filipa Seabra Baptista, Rui Monteiro, Pedro Santos, Lèlita Fonseca, Isabel Providência, Luís A Saldanha, M Helena |
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. |
publishDate |
2011 |
dc.date.none.fl_str_mv |
2011-12-29 |
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info:eu-repo/semantics/publishedVersion |
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info:eu-repo/semantics/article |
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publishedVersion |
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https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/1488 oai:ojs.www.actamedicaportuguesa.com:article/1488 |
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https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/1488 |
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oai:ojs.www.actamedicaportuguesa.com:article/1488 |
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https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/1488 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/1488/1074 |
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Ordem dos Médicos |
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Ordem dos Médicos |
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Acta Médica Portuguesa; Vol. 24 (2011): Suplemento 2; 293-300 Acta Médica Portuguesa; Vol. 24 (2011): Suplemento 2; 293-300 1646-0758 0870-399X reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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