Outcomes of a contemporary sample of patients with atrial fibrillation taking digoxin: results from the AFBAR study.

INTRODUCTION AND OBJECTIVES: We aimed to assess and compare the effect of digoxin on clinical outcomes in patients with atrial fibrillation vs those under beta-blockers or none of these drugs. METHODS: AFBAR is a prospective registry study carried out by a team of primary care physicians (n=777 patients). Primary endpoints were survival, survival free of admission due to any cause, and survival free of admission due to cardiovascular causes. The mean follow up was 2.9 years. Four groups were analyzed: patients receiving digoxin, beta-blockers, or digoxin plus beta-blockers, and patients receiving none of these drugs. RESULTS: Overall, 212 patients (27.28%) received digoxin as the only heart control strategy, 184 received beta-blockers (23.68%), 58 (7.46%) were administered both, and 323 (41.57%) received none of these drugs. Digoxin was not associated with all-cause mortality (estimated hazard ratio=1.42; 95% confidence interval, 0.77-2.60; P=.2), admission due to any cause (estimated hazard ratio=1.03; 95% confidence interval, 0.710-1.498; P=.8), or admission due to cardiovascular causes (estimated hazard ratio=1.193; 95% confidence interval, 0.725-1.965; P=.4). No association was found between digoxin use and all-cause mortality, admission due to any cause, or admission due to cardiovascular causes in patients without heart failure. There was no interaction between digoxin use and sex in all-cause mortality or in survival free of admission due to any cause. However, an association was found between sex and admission due to cardiovascular causes. CONCLUSIONS: Digoxin was not associated with increased all-cause mortality, survival free of admission due to any cause, or admission due to cardiovascular causes, regardless of underlying heart failure.

Seguimiento clínico de una muestra contemporánea de pacientes con fibrilación auricular en tratamiento con digoxina: resultados del estudio AFBAR / Outcomes of a contemporary sample of patients with atrial fibrillation taking digoxin: results from the AFBAR study

Introducción y objetivos: Evaluar el efecto de la digoxina en los resultados clínicos de los pacientes con fibrilación auricular con y sin tratamiento con bloqueadores beta. Métodos El AFBAR es un registro prospectivo llevado a cabo por un equipo de médicos de atención primaria (n = 777 pacientes). Los objetivos principales fueron la supervivencia, la supervivencia libre de hospitalización por cualquier causa y la supervivencia libre de hospitalización por causas cardiovasculares. La media de seguimiento fue 2,9 años. Se analizaron cuatro grupos: pacientes tratados con digoxina, bloqueadores beta o digoxina más bloqueadores beta, y pacientes que no recibían ninguno de estos fármacos. Resultados En total, 212 pacientes (27,28%) recibieron digoxina como única estrategia de control de frecuencia; 184 recibieron bloqueadores beta (23,68%); 58 (7,46%), ambos fármacos y 323 (41,57%), ninguno de ellos. El tratamiento con digoxina no se asoció a la mortalidad por todas las causas (razón de riesgos estimada = 1,42; intervalo de confianza del 95%, 0,710-1,498; p = 0,2), la hospitalización por todas las causas (razón de riesgos estimada = 1,03; intervalo de confianza del 95%, 0,71-1,49; p = 0,8) ni la hospitalización por causas cardiovasculares (razón de riesgos estimada = 1,193; intervalo de confianza del 95%, 0,725-1,965; p = 0,4). No se observó asociación entre el empleo de digoxina y la mortalidad por cualquier causa, la hospitalización por cualquier causa o la hospitalización por causas cardiovasculares en los pacientes sin insuficiencia cardiaca. No hubo interacción entre el uso de digoxina y el sexo en cuanto a la mortalidad por todas las causas o la supervivencia sin hospitalización por todas las causas. Sin embargo, sí se observó una asociación entre el sexo y la hospitalización por causa cardiovascular. Conclusiones: La digoxina no se asoció a un aumento de la mortalidad por cualquier causa, la supervivencia libre de hospitalización por cualquier causa ni la supervivencia libre de hospitalización por causas cardiovasculares, con independencia de la presencia de insuficiencia cardiaca subyacente (AU)

Introduction and objectives We aimed to assess and compare the effect of digoxin on clinical outcomes in patients with atrial fibrillation vs those under beta-blockers or none of these drugs. We compared the incidence of ventricular arrhythmias in patients who were undergoing cardiac resynchronization therapy with an implantable cardioverter-defibrillator in terms of the degree of echocardiographic response to resynchronization. Patients were classified in 3 subgroups; super-responders, responders, and nonresponders. Methods AFBAR is a prospective registry study carried out by a team of primary care physicians (n = 777 patients). Primary endpoints were survival, survival free of admission due to any cause, and survival free of admission due to cardiovascular causes. The mean follow up was 2.9 years. Four groups were analyzed: patients receiving digoxin, beta-blockers, or digoxin plus beta-blockers, and patients receiving none of these drugs. Conclusions Digox in was not associated with increased all-cause mortality, survival free of admission due to any cause, or admission due to cardiovascular causes, regardless of underlying heart failure(AU)

Nuevos datos sobre fibrilación auricular, observaciones al estudio OFRECE / New Data About Atrial Fibrillation, Comment to the OFRECE Study

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Exploring The Obesity Paradox In Atrial Fibrillation. AFBAR (Atrial Fibrillation Barbanza Area) Registry Results.

INTRODUCTION AND OBJECTIVES: Previous studies have described an inverse relationship between obesity and adverse events in a variety of conditions. Our aim was to investigate the relationship between obesity and prognosis in patients with atrial fibrillation. METHODS: We studied 746 patients who were prospectively included, between January and April 2008, in the AFBAR (Atrial Fibrillation in BARbanza area) registry. Patients were categorized into 3 body mass index groups using baseline measurements: normal (< 25 kg/m2), overweight (25-30 kg/m2), and obese (≥30 kg/m2). Survival free from the composite endpoint hospitalization for cardiovascular causes or all-cause mortality was compared across the 3 body mass index groups. A multivariable Cox proportional hazard regression was also performed to determine the independent effect of obesity as well as overweight, with respect to normal body mass index as a reference category, regarding the study endpoint. Median follow-up time was 36 (28-36) months. RESULTS: 49.3% were obese and 38.2% had overweight. The composite endpoint rate was 70.9%, 67.5%, and 57.6% for obese, overweight, and normal weight patients, respectively (log rank test; p=0.02). An inverse association of obesity with a favorable prognosis persisted even after multivariable adjustment: hazard ratio 0.668; 95% confidence interval 0.449-0.995; p=0.047. Hazard ratio of overweight, however, was 0.741; 95% confidence interval: 0.500-1.098; p=0.096. CONCLUSIONS: Obesity, defined as a body mass index ≥ 30 kg/m2, is associated with better prognosis in a community-based cohort of patients with atrial fibrillation.

The change in the atrial fibrillation type as a prognosis marker in a community study: long-term data from AFBAR (Atrial Fibrillation in the BARbanza) study.

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.

Determinants of cardiovascular mortality in a cohort of primary care patients with chronic ischemic heart disease. BARBANZA Ischemic Heart Disease (BARIHD) study.

BACKGROUND: Prognosis of chronic patients with established ischemic heart disease (IHD) is not fully understood. The objective was to determine which factors are related to cardiovascular death and hospitalizations in patients with IHD within a primary care network. MATERIALS AND METHODS: A cohort study was carried out by 69 primary care providers in Spain in 2007. Participants were followed up for a mean of 2.2 ± 0.3 years. 1095 patients were recruited if they had established (at least 1 year of known disease) IHD (myocardial infarction or and stable or unstable angina). Several hypothesized determinants of cardiovascular mortality were studied, using Cox proportional hazard regression models. Subgroup analysis was also performed for participants without cardiovascular admissions within the last year. RESULTS: Mean time since first IHD diagnosis was 7.6 ± 6.0 years. Annual all-cause mortality rate was 3.25%, with 44 cardiovascular deaths and 119 cardiovascular admissions. The main prognostic factor for cardiovascular death was previous heart failure (hazard ratio [HR] 4.32, 95% confidence interval [CI] 2.30 to 8.11, p<0.001). Recent cardiovascular admission doubled the risk for death (HR 2.01, CI 1.06 to 3.81, p=0.031). Results showed that use of beta blockers and increased physical activity were the main protective factors. Patients without a recent cardiovascular admission showed previous heart failure as the main significant factor for cardiovascular death. CONCLUSIONS: Patients with chronic IHD in a primary care setting may need a closer follow-up in the presence of previous conditions such as heart failure. Physical activity and treatment with beta blockers were the factors giving these patients the greatest protection.

Cardiopatía isquémica en la mujer. Datos del estudio CIBAR / Ischemic heart disease in women. Data from BARIHD study

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Cardiopatía isquémica y mujer: son necesarias más respuestas. Respuesta / Ischemic heart disease and women: more answers are needed. Response

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El cambio de tipo de fibrilación auricular, observaciones al registro Val-FAAP / Change in atrial fibrillation status, comments to Val-FAAP registry

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Definición y control de factores de riesgo en el superviviente a un ictus. Réplica / No disponible

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Una oportunidad para conocer la hipertensión arterial refractaria en nuestro medio / An opportunity to know about resistant hypertension in our area

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[Clinical features and prognosis of patients with chronic cerebrovascular disease (ICBAR study)]. / Características clínicas y pronóstico de pacientes con enfermedad cerebrovascular crónica (estudio ICBAR).

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.

Desigualdades para las que no tenemos explicación, un fenómeno reproducible en distintas áreas poblacionales / Inequalities for which we have no explanation, a reproducible phenomenon in different local health districts

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Prognostic impact of atrial fibrillation progression in a community study: AFBAR Study (Atrial Fibrillation in the Barbanza Area Study).

INTRODUCTION: The aim of the study is to describe the natural history of an unselected population of patients with atrial fibrillation (AF) currently attending primary care services in a single health-service area in Galicia, north-western Spain. METHODS: AFBAR is a transverse prospective study in which 35 general practitioners within one health-service area have enrolled patients diagnosed with AF who presented at their clinics during a three-month recruiting period. Primary endpoints are mortality or hospital admission. Here we report the results of the first 7-month follow-up period. RESULTS: 798 patients (421 male) were recruited; mean age of cohort was 75 years old. Hypertension was the most prevalent risk factor (77%). 87% of the patients were both overweight and obese. Permanent AF was diagnosed in 549 patients (69%). In the follow-up period, 16.4% of the patients underwent a primary endpoint and the overall survival was 98%. The following independent determinants of primary endpoint were identified: change in AF status (Hazard Ratio (HR) 2.89 (95% confidence interval (CI) 1.28-6.55); p=0.011); ischemic heart disease (IHD) (HR 2.78 (95% CI 1.51-5.13); p=0.001); pre-recruitment hospital admission (HR 2.22 (95% CI 1.18-4.19); p=0.013); left ventricular systolic dysfunction (HR 2.19 (95% CI 1.11-4.32); p=0.023); or AF-related complications (HR 1.98 (95% CI 1.10-3.56); p=0.022). CONCLUSIONS: In the first 7-month follow-up period of patients with AF in a primary care setting the study identified several independent risk factors for mortality or hospital admission, i.e. change in AF status, ischemic heart disease, left ventricular systolic dysfunction, previous AF-related complications and hospital admission.

Effect of diabetes on the clinical characteristics and prognosis of patients with chronic ischemic heart disease. The CIBAR study.

The aim of this study was to evaluate the effect of diabetes mellitus on the prognosis of patients with chronic ischemic heart disease. The multicenter prospective cohort study involved 1108 outpatients with ischemic heart disease whose clinical characteristics were recorded by 69 primary care physicians. Morbidity and mortality were recorded during a mean follow-up period of 6.9 months. Overall, 29% of patients were diabetic; they were older than non-diabetics, presented with more risk factors, had poorer blood pressure control, and had more comorbid conditions. In addition, diabetics were more likely to be prescribed renin-angiotensin system blockers, calcium channel blockers, diuretics and lipid-lowering drugs. Cardiovascular mortality and hospitalization rates were higher in diabetics. On multivariate analysis, diabetes was found to be an independent predictor of a cardiovascular event (hazard ratio=1.81; 95% confidence interval, 1.17-2.82). Prognosis in chronic ischemic heart disease is relatively good, although it is worse in diabetics, which means that treatment and disease controls targets must be more rigorously applied in these patients.