Diferencias en la supervivencia después de un episodio de ictus tratado con fibrinólisis. Estudio Ebrictus / Differences in the survival after an episode of stroke treated with thrombolytic therapy. Study Ebrictus

OBJETIVO: Investigar la relación entre género y supervivencia después de un episodio de ictus tratado con fibrinólisis. DISEÑO: Estudio de cohortes. Emplazamiento: Atención primaria. PARTICIPANTES: Los casos tratados con fibrinólisis por un ictus agudo desde el 1 de abril de 2006 al 13 de septiembre de 2013. INTERVENCIONES: Seguimiento del estado vital. MEDICIONES PRINCIPALES: Riesgos vasculares: escala Framingham, REGICOR, CHA2DS2-VASc, Essen, NIHSS, índice Barthel; densidad de incidencia; análisis de supervivencia por Kaplan-Meier; bivariado entre supervivientes y fallecidos; y multivariante de Cox. RESULTADOS: Noventa y un pacientes con edad media 68,02 ± 11,9 años. Los hombres tienen mayor riesgo cardiovascular basal. El tiempo medio de seguimiento fue de 2,95 ± 2,33 años. La razón de tasa de incidencias mostró un mayor riesgo en los hombres respecto a las mujeres IR = 3,2 (IC 95%: 1,2-8,0). Los fallecidos en relación con los supervivientes son mayores (p = 0,032); mayor riesgo cardiovascular basal (p = 0,040) y de recidiva de ictus (p < 0,001); mayor severidad del episodio (p = 0,002); y una mayor caída en la puntuación Barthel un año después del ictus (p = 0,016). El porcentaje de muertes es significativamente más alto cuando el paciente es derivado a centros de agudos o de larga estancia (p = 0,006) que cuando se deriva al domicilio, pero solo el género (HR: 1,12; IC 95%: 1,05-1,20) y la prevención cardiovascular secundaria (HR: 0,13; IC 95%: 0,06-0,28) se asociaron con la mortalidad de los pacientes. CONCLUSIONES: Después de un episodio de ictus tratado con fibrinólisis los hombres tienen un 12% más de riesgo de morir que las mujeres, y la ausencia de prevención cardiovascular secundaria aumenta 7,7 veces el riesgo de mortalidad

OBJECTIVE: To seek if there is gender survival difference among patients treated with thrombolytic therapy. DESIGN: Cohort study. LOCATION: Community based register. PARTICIPANTS: 91 subjects with an episode of stroke collected since April 2006 up to September 2013 and treated with thrombolytic therapy. INTERVENTIONS: Monitoring of vital status. Measurements: We collected baseline characteristics in Framingham, Regicor, CHA2DS2-VASc, Essen, NIHSS, Barthel scales and outcomes according to gender; person-time incidence rate; survival analysis by Kaplan-Meier's curves, bivariate analysis between survivors and deaths, and Cox multivariate. RESULTS: 91 patients with middle age 68.02 ± 11.9 years. The men have higher cardiovascular basal risk. The average time of follow-up was 2.95 ± 2.33 years. Incidence rate ratio (IR) shown higher risk in men than in women IR = 3.2 (CI 95% 1.2-8.0). The dead cases were older (P = .032); with higher cardiovascular basal risk (P = .040) and more risk of stroke recurrence (P = < .001), with cardiovascular pathology before the stroke (P = .005); more stroke severity (P = .002); and a major fall in the score Barthel one year after the episode (P = .016). The percentage of deaths is significantly higher when the patient is referred by complications to other centres (P = .006) in relation to those referred to home, but just the gender (HR: 1,12; IC 95%: 1,05-1,20) and secondary cardiovascular prevention (HR: 0,13; IC 95%: 0,06-0,28) were associated with higher risk of mortality. CONCLUSIONS: After stroke episode treated with thrombolytic therapy, men have 12% higher risk of dying than women and don't be treated with secondary cardiovascular prevention rise 7.7 times the mortality risk

[Differences in the survival after an episode of stroke treated with thrombolytic therapy. Study Ebrictus]. / Diferencias en la supervivencia después de un episodio de ictus tratado con fibrinólisis. Estudio Ebrictus.

OBJECTIVE: To seek if there is gender survival difference among patients treated with thrombolytic therapy. DESIGN: Cohort study. LOCATION: Community based register. PARTICIPANTS: 91 subjects with an episode of stroke collected since April 2006 up to September 2013 and treated with thrombolytic therapy. INTERVENTIONS: Monitoring of vital status. MEASUREMENTS: We collected baseline characteristics in Framingham, Regicor, CHA2DS2-VASc, Essen, NIHSS, Barthel scales and outcomes according to gender; person-time incidence rate; survival analysis by Kaplan-Meier's curves, bivariate analysis between survivors and deaths, and Cox multivariate. RESULTS: 91 patients with middle age 68.02±11.9 years. The men have higher cardiovascular basal risk. The average time of follow-up was 2.95±2.33 years. Incidence rate ratio (IR) shown higher risk in men than in women IR=3.2 (CI 95% 1.2-8.0). The dead cases were older (P=.032); with higher cardiovascular basal risk (P=.040) and more risk of stroke recurrence (P=<.001), with cardiovascular pathology before the stroke (P=.005); more stroke severity (P=.002); and a major fall in the score Barthel one year after the episode (P=.016). The percentage of deaths is significantly higher when the patient is referred by complications to other centres (P=.006) in relation to those referred to home, but just the gender (HR: 1,12; IC 95%: 1,05-1,20) and secondary cardiovascular prevention (HR: 0,13; IC 95%: 0,06-0,28) were associated with higher risk of mortality. CONCLUSIONS: After stroke episode treated with thrombolytic therapy, men have 12% higher risk of dying than women and don't be treated with secondary cardiovascular prevention rise 7.7 times the mortality risk.

Atrial Fibrillation and Cardiovascular Comorbidities, Survival and Mortality: A Real-Life Observational Study.

BACKGROUND: Atrial fibrillation (AF) is the most common cardiac tachyarrhythmia encountered in clinical practice affecting up to 10% of the population over 60 years old and its prevalence rises with age. The main goals were to characterize the AF patient population after the initial diagnosis of AF and to determine overall survival. METHODS: It is a real-life observational study of 269 subjects with an AF diagnosis over 60 years old randomly selected. The collected variables were: sociodemographic, cardiovascular complications/comorbidities (CVCs) included in the CHA2DS2-VASc and HAS_BLED scores, drug assigned as clinical treatment, mean range INR and CVCs and death dates (all-cause mortality). The survival curve and the risk of death were assessed using Kaplan-Meier survival curve and comparisons with log-rank. RESULTS: The average following time was 6.2 ± 3.7 years (0.2-20.4). Eleven point five percent died. Sixty-five point four percent had some CVCs. There were no differences in the overall incidence of CVCs by gender. The survival probability was 0.86 ± DE 0.03 among men and 0.90 ± DE 0.04 among women without differences. Thirty-six point eight percent (95% CI: 30.8 - 42.7) were diagnosed vascular complications before AF diagnosis, being ischemic cardiopathy (24.2%) and ischemic stroke (23.2%) the most frequent. The mortality is higher (P < 0.036) among those who suffered ≥ 3 vascular complications and significantly lower among those treated with statins (P = 0.032). After AF diagnosis, the most frequent was the cardiac heart failure (46.7%), significantly higher among women (P = 0.037). The mortality is significantly lower in those treated with OAC (P = 0.003). CONCLUSIONS: AF is associated with ischemic heart disease, ischemic stroke and congestive heart failure, but the average mortality age is not different from the global population in Spain and Catalonia.