RESUMEN
To analyze the clinical profile and therapeutic strategy in atrial fibrillation (AF) according to gender in a contemporaneous patient cohort a prospective, multicenter observational study was performed on consecutive patients diagnosed with AF and assessed by cardiology units in the region of Galicia (Spain). A total of 1007 patients were included, of which 32.3% were women. The mean age of the women was significantly greater than that of the men (71.6 versus 65.7 years; p < 0.001), with a higher prevalence of hypertension (HTN) and valve disease. Women more often reported symptoms related to arrhythmia (28.2% in EHRA class I versus 36.4% in men), with a poorer level of symptoms (EHRA classes IIb and III). Thromboembolic risk was significantly higher among women (CHA2DS2-VASc 3 ± 1.3 versus 2 ± 1.5), in the same way as bleeding risk (HAS-BLED 0.83 ± 0.78 versus 0.64 ± 0.78) (p < 0.001), and women more often received anticoagulation therapy (94.1% versus 87.6%; p = 0.001). Rhythm control strategies proved significantly less frequent in women (55.8% versus 66.6%; p = 0.001), with a lesser electrical cardioversion (ECV) rate (18.4% versus 27.3%; p = 0.002). Perceived health status was poorer in women. Women were older and presented greater comorbidity than men, with a greater thromboembolic and bleeding risk. Likewise, rhythm control strategies were less frequent than in men, despite the fact that women had poorer perceived quality of life and were more symptomatic.
RESUMEN
OBJECTIVE: To determine the doubts, their number and type that doctors have during routine clinics in primary care, as well as establishing methods that may be used to resolve them. DESIGN: Prevalence study. SETTING: Health centres in the provinces of A Coruña and Lugo. PARTICIPANTS: A total of 81 primary care doctors, selected by simple random sampling. The sample size was calculated to obtain a total of 500 doubts. Only 2 doctors refused to take part. MEASUREMENTS: Number and types of doubts. Systems used to resolve them and when they were carried out. RESULTS: A mean of 1.7 doubts were detected (95% confidence interval; 1.59-1.82) for every 10 patients, of which 92% were seen as clinical problems. The 12 most frequent doubts made up 75% of all those that arose, with the interpretation of a clinical sign and treatment indications being the most common. In 51.6% of cases an attempt was made to resolve the doubt either during the consultation or during that day. A total of 35.7% of the doubts led to new appointments, either in the clinic itself or as a referral (23%). A total of 81.5% of those surveyed never used the Internet during the consultation and only 6.2% did this daily or often. CONCLUSIONS: The number of doubts that primary care doctor has is relatively small (1.7 for every 10 patients). The most common way to try to resolve them is by referral to a specialist.