RESUMO
INTRODUCTION: Atrial fibrillation (AF) cannot be considered an isolated disease. Patients with AF should be managed using a comprehensive approach that is not limited to stroke prevention. AREAS COVERED: In this manuscript, the potential role of AF as a vascular disease that is managed as part of a holistic approach was reviewed. EXPERT OPINION: The residual risk of stroke in patients with AF reaches 1-2% annually, despite appropriate anticoagulation therapy. Additionally, patients with AF may develop cognitive impairment through stroke-independent pathways. Furthermore, patients with AF may have a higher risk of developing atherosclerotic vascular disease in various vascular beds and chronic kidney disease; conversely, patients with atherosclerotic disease may have an increased risk of developing AF. AF should be considered a truly systemic vascular disease, since it brings together several hemodynamic and systemic changes, including inflammation, oxidative stress, activation of the renin-angiotensin-aldosterone and sympathetic systems, as well as a prothrombotic state and endothelial dysfunction. In this regard, patients with AF should be treated based on a holistic approach that is not limited to oral anticoagulation but includes complete vascular protection.
Assuntos
Aterosclerose , Fibrilação Atrial , Acidente Vascular Cerebral , Humanos , Fibrilação Atrial/complicações , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Aterosclerose/complicações , Fatores de Risco , Anticoagulantes/uso terapêuticoRESUMO
AIM: To analyze the impact of implementing a program integrating cardiology and primary care in clinical practice. METHODS: In the integrated care model, every cardiologist was assigned to each primary care center. RESULTS & CONCLUSION: The implementation of the new care model was associated with a significant reduction of 31.2% in requests of first visits. In addition, the delay to the cardiologist consultation significantly decreased by 54.5% for the first visits, and by 57.1% for the follow-up visits. The proportion of patients that achieved recommended low density lipoprotein-cholesterol goals significantly increased from 20.8 to 29.6%. The proportion of patients submitted to anticoagulant therapy significantly increased from 69.3 to 74.2%, as well as the proportion of patients taking direct oral anticoagulants (from 7.9 to 28.4%).