Different Types of Statins and All-Cause Mortality during Anticoagulation for Venous Thromboembolism: Validation Study from RIETE Registry.

Introduction We previously reported that during the course of anticoagulation for venous thromboembolism (VTE) patients using statins were at a lower risk to die than nonusers. Methods We used the R egistro I nformatizado E nfermedad T rombo E mbólica (RIETE) registry to validate our previous findings in a subsequent cohort of patients and to compare the risk of death according to the use of different types of statins. Results From January 2018 to December 2019, 19,557 patients with VTE were recruited in RIETE. Of them, 4,065 (21%) were using statins (simvastatin, 1,406; atorvastatin, 1,328; rosuvastatin, 246; and others, 1,085). During anticoagulation (192 vs.182 days, for statin and no statin users respectively), 500 patients developed a VTE recurrence, 519 suffered major bleeding, and 1,632 died (fatal pulmonary embolism [PE], 88 and fatal bleeding, 78). On multivariable analysis, statin users were at a lower risk to die (hazard ratio [HR] = 0.68; 95% confidence interval [CI]: 0.59-0.79) than nonusers. When separately analyzing the drugs, on multivariable analysis, patients using simvastatin (HR = 0.64; 95% CI: 0.52-0.80), atorvastatin (HR 0.72; 95% CI: 0.58-0.89), or other statins (HR = 0.67; 95% CI: 0.52-0.87) were at a lower risk to die than nonusers. For those using rosuvastatin, difference was not statistically significant (HR = 0.77; 95% CI: 0.50-1.19), maybe due to the sample size. Conclusion Our data validate previous findings and confirm that VTE patients using statins at baseline are at a lower risk to die than nonusers. No statistically differences were found according to type of statins.

[Patterns of clinical presentation of atrial fibrillation in hospitalized patients]. / Patrones clínicos de presentación de la fibrilación auricular en los pacientes hospitalizados.

INTRODUCTION AND OBJECTIVES: The ACC/AHA/ESC 2001 guidelines for the management of atrial fibrillation (AF) establish 4 categories: first episode, paroxysmal, persistent and permanent. The aim of this study was to analyze the frequency of the different clinical patterns of presentation of AF in hospitalized patients. PATIENTS AND METHOD: We analyzed the pattern of AF in 300 hospitalized patients, 200 of whom were admitted to the cardiology and 100 to the internal medicine department. We determined the clinical profile and evaluated the factors influencing therapeutic management. RESULTS: The permanent form was present in 30% of the patients admitted to the cardiology department and in 51% if those admitted to the internal medicine department. The first episode pattern was the most frequent in cardiology department patients (41%). In patients hospitalized the in cardiology the percentage use of anticoagulants (57.9% vs. 41%; p < 0.01) and beta blockers was greater than in internal medicine patients, and digitalis use was lower. In the multivariate analysis, admission to the cardiology department was an independent predictor of treatment with beta blockers (OR = 3.8; 95% CI, 1.3-11.1; p < 0.05), and discharge from the hospital with AF was a predictor of anticoagulant prescription (OR = 4.8; 95% CI, 2.5-9.2; p < 0.001). CONCLUSIONS: a) Atrial fibrillation is an arrhythmia with a heterogeneous clinical pattern that varies depending on the type of care provided; b) on admission to cardiology, only 30% of the patients present with permanent arrhythmia, and the most frequent clinical pattern is first episode; and c) discharge from the hospital with AF was the principal determinant of therapeutic management.

Patrones clínicos de presentación de la fibrilación auricular en los pacientes hospitalizados / Patterns of clinical presentation of atrial fibrillation in hospitalized patients

Introducción y objetivos. La guía ACC/AHA/ESC 2001 para el tratamiento de la fibrilación auricular (FA) establece 4 categorías: primer episodio, paroxística, persistente y permanente. El objetivo es analizar la frecuencia de los distintos patrones clínicos de presentación de FA en los pacientes hospitalizados. Pacientes y método. Analizamos el patrón de la FA en 300 pacientes hospitalizados, 200 de ellos en el servicio de cardiología y 100 en el de medicina interna. Determinamos su perfil clínico y valoramos los factores que condicionaron el tratamiento terapéutico. Resultados. La forma permanente sólo estuvo presente en el 30 por ciento de los pacientes hospitalizados en el servicio de cardiología y en el 51 por ciento de los ingresados en el servicio de medicina interna. El patrón de primer episodio fue el más frecuente en los pacientes de cardiología (41 por ciento). En éstos hubo un mayor porcentaje de utilización de anticoagulantes que entre los ingresados en medicina interna (57,9 frente a 41 por ciento; p < 0,01), así como de bloqueadores beta, y un menor uso de digital, si bien en el análisis multivariable el ingreso en cardiología sólo se comportó como un factor predictor independiente de mayor probabilidad de ser tratado con bloqueadores beta (odds ratio [OR] = 3,8; intervalo de confianza [IC] del 95 por ciento, 1,3-11,1; p < 0,05), y el mayor condicionante del uso de anticoagulantes fue haber sido dado de alta en FA (OR = 4,8; IC del 95 por ciento, 2,5-9,2; p < 0,001). Conclusiones. a) La FA es una arritmia con un patrón clínico heterogéneo y diferente según el nivel asistencial en el que se analice; b) entre los pacientes hospitalizados en el servicio de cardiología, sólo el 30 por ciento presenta la arritmia de forma permanente y el primer episodio es el patrón clínico más frecuente, y c) ser dado de alta en FA se ha comportado como el principal determinante del tratamiento terapéutico (AU)