ABSTRACT
BACKGROUND: The aim is to describe the prognosis role of the change in the atrial fibrillation (AF) type in an unselected population of patients with AF currently attending primary care in a single health-service area in Galicia, north-western Spain. METHODS: AFBAR is a cohort study that was carried out by 35 primary care providers in 2008. Participants were followed up for a mean of 2.8 ± 0.7 years. 798 patients with the diagnosis of AF who presented at their clinics during a three-month period were recruited. Primary endpoint was mortality or hospital admission. RESULTS: 778 patients (413 male) were analyzed; mean age 74.8 years old. Hypertension was the most prevalent risk factor (76.5%). Permanent AF was diagnosed in 529 patients (68.0%). Change of AF status occurred in 76 patients (9.8%). During follow-up 52.1% of the patients underwent a primary endpoint and the overall survival was 83.4%. The following independent determinants of primary endpoint were identified: change in AF status (Hazard Ratio (HR) 1.41 (95%-confidence interval (CI) 1.04-1.92); p=0.026); previous heart failure (HR 1.28 (95%-CI 1.00-1.65); p=0.050); previous cardiovascular admission (HR 1.54 (95%-CI 1.16-2.03); p=0.002); stroke (HR 2.02 (95%-CI 1.35-3.03); p=0.001);ischemic heart disease (HR 1.28 (95%-CI 1.00-1.65); p=0.050); chronic obstructive pulmonary disease (HR 1.28 (95%-CI 1.00-1.64);p=0.042); anemia (HR 1.37 (95% CI 1.08-1.75); p=0.010); or AF-related complications (HR 1.45 (95%-CI 1.18-1.78); p<0.001). CONCLUSIONS: The change in AF status showed to be an important prognosis marker for death or hospital admissions in a primary care cohort.
Subject(s)
Atrial Fibrillation/epidemiology , Hospitalization/trends , Risk Assessment/methods , Aged , Aged, 80 and over , Atrial Fibrillation/physiopathology , Disease Progression , Female , Follow-Up Studies , Humans , Incidence , Male , Middle Aged , Prognosis , Prospective Studies , Risk Factors , Spain/epidemiology , Time FactorsABSTRACT
INTRODUCTION: Patients with cerebrovascular disease (CVD) are a group with a very high cardiovascular risk, in addition to that arising from their own vascular pathology, probably due to an inadequate control of risk factors and owing to the presence of comorbidities. PATIENTS AND METHODS: This research consisted in a multi-centre study involving the collaboration of 34 primary care physicians and recording of the features of 473 patients with a previous history of a CVD event that required hospitalisation. After a clinical follow-up of the cohort, hospital readmissions, mortality and causes were analysed. RESULTS: The mean age of patients (52% males) was 75 ± 10 years and the most prevalent risk factors were arterial hypertension (79%), dyslipidaemia (66%), obesity (43%) and diabetes (29%). Sixty-eight per cent of patients had been diagnosed with stroke and 32% with transient ischaemic attack. The mean amount of time elapsed since the first CVD event was 6.6 ± 5.5 years. Twenty-nine per cent of patients had a situation of dependence and only one third showed good blood pressure and lipid control. During a follow-up lasting 8.2 ± 2.3 months, 7.2% of patients suffered some kind of cardio-vascular event (death or hospitalisation), which independent determinants were found to be previous heart failure (hazard ratio, HR = 2.74; 95% confidence interval, CI 95% = 1.3-5.9); cardiomyopathy (HR = 3.32; CI 95% = 1.4-8.2); anaemia (HR = 3.09; CI 95% = 1.6-6.2); renal failure (HR = 2.4; CI 95% = 1.0-5.6); the situation of dependence (HR = 2.57; CI 95% = 1.3-5.7) and cardiovascular admissions over the past year (HR = 3.05; CI 95% = 1.5-5.6). CONCLUSIONS: Patients with CVD followed up in the area of primary care present a high prevalence of arterial hypertension and little is done to control it. Their prognosis is conditioned by cardiovascular comorbidities and sequelae of their cerebro-vascular disease.
