Clinical characteristics and management of patients with atrial fibrillation treated with direct oral anticoagulants according to blood pressure control / Características clínicas y manejo de pacientes con fibrilación auricular tratados con anticoagulantes orales directos de acuerdo al control de presión arterial

Objective: To determine the clinical characteristics and management of hypertensive patients with nonvalvular atrial fibrillation (AF) treated with direct oral anticoagulants (DOACs) according to blood pressure (BP) control. Methods: For this purpose, data from two observational, cross-sectional and multicenter studies were combined. In both studies, patients on chronic treatment with anticoagulants and that were on current treatment with DOACs at least for 3 months were included. Adequate BP was defined as a systolic BP < 140 mmHg and a diastolic BP < 90 mmHg (< 140/85 mmHg if diabetes). Results: Overall, 1036 patients were included. Of these, 881 (85%) had hypertension that were finally analyzed. The presence of other risk factors and cardiovascular disease was common. Mean BP was 132.6 ± 14.3/75.2 ± 9.2 mmHg and 70.5% of patients achieved BP goals. Those patients with a poor BP control had more frequently diabetes, and a history of prior labile INR. Patients had a high thromboembolic risk, but without significant differences according to BP control. By contrast, more patients with a poor BP control had a higher bleeding risk (HAS-BLED ≥3: 24.0% vs 35.4%; P < 0.001). HAS-BLED score was an independent predictor of poor BP control (odds ratio 1.435; 95% confidence interval 1.216-1.693; P < 0.001). Satisfaction with anticoagulant treatment was independent of BP control. Conclusions: More than two thirds of our patients with hypertension and AF anticoagulated with DOACs achieve BP targets, what is clearly superior to that reported in the general hypertensive population

Objetivo: Determinar las características clínicas y el manejo de hipertensos con fibrilación auricular no valvular (FANV) tratados con anticoagulantes orales directos (ACOD) de acuerdo al control de la presión arterial (PA). Métodos: Se combinaron los datos de 2 estudios observacionales, transversales y multicéntricos. En ambos estudios se incluyeron a pacientes tratados crónicamente con anticoagulantes y que estuviesen actualmente siendo tratados con ACOD al menos durante 3 meses. Se definió como control adecuado de la PA, tener una PA sistólica < 140 mmHg y una PA diastólica < 90 mmHg (< 140/85 mmHg, si diabetes). Resultados: Se incluyeron 1.036 pacientes. De estos, 881 (85%) tenían hipertensión, que fueron finalmente analizados. La presencia de otros factores de riesgo y enfermedades cardiovasculares fue frecuente. La PA media fue de 132,6 ± 14,3/75,2 ± 9,2 mmHg; el 70,5% de los pacientes lograron los objetivos de PA. Aquellos pacientes con un pobre control de PA tuvieron más frecuentemente diabetes, y antecedentes de INR lábil. Los pacientes tenían un elevado riesgo tromboembólico, pero sin diferencias de acuerdo al control de PA. Hubo más pacientes con un pobre control de PA con un mayor riesgo de sangrado (HAS-BLED ≥3: 24,0 vs. 35,4%; p < 0,001). La puntuación HAS-BLED fue un predictor independiente de pobre control de PA (OR: 1,435; IC 95%: 1,216-1,693; p < 0,001). La satisfacción con el tratamiento anticoagulante fue independiente del control de PA. Conclusiones: Más de dos tercios de nuestros hipertensos con FANV anticoagulados con ACOD logran los objetivos de PA, lo que es claramente superior a lo reportado en la población hipertensa general

Diferencias en el manejo de los pacientes con fibrilación auricular según inicie el tratamiento con anticoagulantes orales de acción directa el médico de atención primaria o el especialista. Estudios SILVER-AP y BRONCE-AP / Differences in the management of patients with atrial fibrillation according to whether primary care or the specialist initiates treatment with direct oral anticoagulants. The SILVER-AP and BRONCE-AP studies

Objetivos: Describir las características clínicas y el manejo de pacientes con fibrilación auricular no valvular (FANV) tratados con anticoagulantes orales de acción directa (ACOD) de acuerdo a quién inicia su prescripción: el médico de atención primaria (AP) o el especialista. Material y métodos: Se compararon 2 estudios observacionales, transversales y multicéntricos. El estudio SILVER-AP se realizó en aquellas comunidades autónomas en las que el médico de AP podía prescribir ACOD y el estudio BRONCE-AP en aquellas comunidades autónomas en las que el médico de AP debía derivar al especialista para tal fin. Se incluyeron pacientes diagnosticados de FANV con riesgo de ictus o embolia sistémica que estuviesen en tratamiento crónico con anticoagulantes, que hubiesen modificado su pauta terapéutica y que actualmente estuviesen en tratamiento con un ACOD durante al menos 3meses. Resultados: Se incluyeron un total de 1.036 pacientes (790 provenientes del estudio SILVER-AP y 246 del BRONCE-AP). En comparación con el estudio BRONCE-AP, los pacientes incluidos en el SILVER-AP eran mayores, tenían más comorbilidades y el riesgo tromboembólico y hemorrágico era más elevado (CHA2DS2-VASc 4,3±1,6 vs. 3,8±1,8; p<0,001; HAS-BLED 2,1±0,8 vs. 1,8±1,0; p<0,001). El cumplimiento terapéutico fue elevado, al igual que la satisfacción con el tratamiento. Las dosis bajas de ACOD se emplearon frecuentemente, en especial con dabigatrán. Conclusiones: Los pacientes en los que el médico de AP puede prescribir ACOD tienen un peor perfil clínico, con un mayor riesgo tromboembólico y de hemorragias que aquellos casos en los que debe derivar al especialista

Objectives: To determine the clinical characteristics and management of patients with non-valvular atrial fibrillation (NVAF) treated with direct oral anticoagulants (DOAC) according to who initiates their prescription, the Primary Care (PC) physician or referring the patient to a specialist. Material and methods: Two observational, cross-sectional and multicentre studies were compared for this purpose. The SILVER-AP study was performed in those autonomous communities in which the PC physician can prescribe DOAC directly, and the BRONCE-AP study in those autonomous communities in which the PC physician has to refer the patient to the specialist to start treatment with DOAC. Patients on chronic treatment with anticoagulants, in whom therapy was changed, and those that were on current treatment with DOAC for at least 3months, were included. Results: A total of 1,036 patients (790 from SILVER-AP study and 246 from BRONCE-AP study) were included. Compared with the BRONCE-AP study, those patients included in SILVER-AP were older and had more comorbidities, as well as a higher thromboembolic and haemorrhagic risk (CHA2DS2-VASc 4.3±1.6 vs. 3.8±1.8; P<.001; HAS-BLED 2.1±0.8 vs. 1.8±1.0; P<.001). Therapeutic adherence and satisfaction with treatment were high. Low doses of DOAC were frequently prescribed, particularly with dabigatran. Conclusions: Those patients in whom the PC physician can prescribe DOAC directly have a worse clinical profile, as well as a higher thromboembolic and haemorrhagic risk than those patients in whom the PC physician has to refer to the specialist

Clinical characteristics and management of patients with atrial fibrillation treated with direct oral anticoagulants according to blood pressure control.

OBJECTIVE: To determine the clinical characteristics and management of hypertensive patients with nonvalvular atrial fibrillation (AF) treated with direct oral anticoagulants (DOACs) according to blood pressure (BP) control. METHODS: For this purpose, data from two observational, cross-sectional and multicenter studies were combined. In both studies, patients on chronic treatment with anticoagulants and that were on current treatment with DOACs at least for 3 months were included. Adequate BP was defined as a systolic BP<140mmHg and a diastolic BP<90mmHg (<140/85mmHg if diabetes). RESULTS: Overall, 1036 patients were included. Of these, 881 (85%) had hypertension that were finally analyzed. The presence of other risk factors and cardiovascular disease was common. Mean BP was 132.6±14.3/75.2±9.2mmHg and 70.5% of patients achieved BP goals. Those patients with a poor BP control had more frequently diabetes, and a history of prior labile INR. Patients had a high thromboembolic risk, but without significant differences according to BP control. By contrast, more patients with a poor BP control had a higher bleeding risk (HAS-BLED ≥3: 24.0% vs 35.4%; P<0.001). HAS-BLED score was an independent predictor of poor BP control (odds ratio 1.435; 95% confidence interval 1.216-1.693; P<0.001). Satisfaction with anticoagulant treatment was independent of BP control. CONCLUSIONS: More than two thirds of our patients with hypertension and AF anticoagulated with DOACs achieve BP targets, what is clearly superior to that reported in the general hypertensive population.

[Differences in the management of patients with atrial fibrillation according to whether primary care or the specialist initiates treatment with direct oral anticoagulants. The SILVER-AP and BRONCE-AP studies]. / Diferencias en el manejo de los pacientes con fibrilación auricular según inicie el tratamiento con anticoagulantes orales de acción directa el médico de atención primaria o el especialista. Estudios SILVER-AP y BRONCE-AP.

OBJECTIVES: To determine the clinical characteristics and management of patients with non-valvular atrial fibrillation (NVAF) treated with direct oral anticoagulants (DOAC) according to who initiates their prescription, the Primary Care (PC) physician or referring the patient to a specialist. MATERIAL AND METHODS: Two observational, cross-sectional and multicentre studies were compared for this purpose. The SILVER-AP study was performed in those autonomous communities in which the PC physician can prescribe DOAC directly, and the BRONCE-AP study in those autonomous communities in which the PC physician has to refer the patient to the specialist to start treatment with DOAC. Patients on chronic treatment with anticoagulants, in whom therapy was changed, and those that were on current treatment with DOAC for at least 3months, were included. RESULTS: A total of 1,036 patients (790 from SILVER-AP study and 246 from BRONCE-AP study) were included. Compared with the BRONCE-AP study, those patients included in SILVER-AP were older and had more comorbidities, as well as a higher thromboembolic and haemorrhagic risk (CHA2DS2-VASc 4.3±1.6 vs. 3.8±1.8; P<.001; HAS-BLED 2.1±0.8 vs. 1.8±1.0; P<.001). Therapeutic adherence and satisfaction with treatment were high. Low doses of DOAC were frequently prescribed, particularly with dabigatran. CONCLUSIONS: Those patients in whom the PC physician can prescribe DOAC directly have a worse clinical profile, as well as a higher thromboembolic and haemorrhagic risk than those patients in whom the PC physician has to refer to the specialist.

Características clínicas basales y manejo de los pacientes incluidos en el estudio IBERICAN / Baseline clinical characteristics and management of patients included in IBERICAN study

Objetivos. Determinar la prevalencia e incidencia de los factores de riesgo y eventos cardiovasculares en España, así como la calidad de su seguimiento en la práctica clínica. En este artículo se presentan los datos correspondientes a los primeros 830 pacientes incluidos en el IBERICAN. Metodología. IBERICAN es un estudio longitudinal, observacional y multicéntrico en el que se están incluyendo pacientes atendidos en las consultas de atención primaria en España. El estudio está abierto a sujetos entre 18 y 85 años, seleccionados de manera consecutiva en las consultas de atención primaria. El tratamiento de los pacientes se realizará de acuerdo a los criterios clínicos del médico investigador sin ninguna intervención por parte del estudio. Se han considerado como criterios de adecuado control de hipertensión arterial los de las guías europeas de 2013, para el control del colesterol LDL los de las guías europeas de prevención cardiovascular de 2012, y para la diabetes una HbA1c < 7%. Resultados. La edad media fue de 57,9 ± 14,1 años. El 54,1% tenían dislipidemia; el 47,5% hipertensión arterial; el 17,7% diabetes; y el 10,8% ya presentaban historia de cardiopatía isquémica. Respecto a la prescripción de fármacos, el 55% de los hipertensos tomaba ≥ 2 fármacos antihipertensivos pero solo el 59,9% lograron los objetivos. Entre los hiperlipidémicos, el 65,7% tomaban estatinas pero solo el 35,6% estaban controlados. Entre los diabéticos, únicamente el 51,4% conseguían los niveles de HbA1c recomendados. Conclusiones. Los sujetos atendidos en atención primaria muestran una elevada prevalencia de factores de riesgo y un pobre control de los mismos (AU)

Aims. To determine the prevalence and incidence of cardiovascular risk factors and cardiovascular events in Spain, as well as the quality of the follow-up in clinical practice. In this study the baseline data of the first interim analysis of IBERICAN are shown (n = 830). Methods. IBERICAN is a multicenter, longitudinal and observational population-based study of patients daily attended in primary care setting according to clinical practice in Spain. Subjects between 18 and 85 years daily attended in primary care setting are being included consecutively. Treatment of patients will be performed according only to clinical criteria of investigators. Blood pressure control was defined according to 2013 European guidelines of hypertension; LDL-cholesterol control was defined according to 2012 European guidelines of cardiovascular prevention; diabetes control was defined as HbA1c < 7%. Results. Mean age was 57.9 ± 14.1 years. 54.1% of patients had dyslipidemia, 47.5% hypertension, 17.7% diabetes, and 10.8% history of ischemic heart disease. Regarding drugs, despite 55% of hypertensive patients were taking ≥ 2 antihypertensive agents, only 59.9% achieved blood pressure targets; 65.7% of patients with dyslipidemia were taking statins, but only 35.6% attained LDL-cholesterol goals. Only 51.4% of diabetics achieved HbA1c goals. Conclusions. Subjects attended in primary care showed a high prevalence of cardiovascular risk factors with a poor control (AU)

[Baseline clinical characteristics and management of patients included in IBERICAN study]. / Características clínicas basales y manejo de los pacientes incluidos en el estudio IBERICAN.

AIMS: To determine the prevalence and incidence of cardiovascular risk factors and cardiovascular events in Spain, as well as the quality of the follow-up in clinical practice. In this study the baseline data of the first interim analysis of IBERICAN are shown (n=830). METHODS: IBERICAN is a multicenter, longitudinal and observational population-based study of patients daily attended in primary care setting according to clinical practice in Spain. Subjects between 18 and 85 years daily attended in primary care setting are being included consecutively. Treatment of patients will be performed according only to clinical criteria of investigators. Blood pressure control was defined according to 2013 European guidelines of hypertension; LDL-cholesterol control was defined according to 2012 European guidelines of cardiovascular prevention; diabetes control was defined as HbA1c<7%. RESULTS: Mean age was 57.9±14.1 years. 54.1% of patients had dyslipidemia, 47.5% hypertension, 17.7% diabetes, and 10.8% history of ischemic heart disease. Regarding drugs, despite 55% of hypertensive patients were taking≥2 antihypertensive agents, only 59.9% achieved blood pressure targets; 65.7% of patients with dyslipidemia were taking statins, but only 35.6% attained LDL-cholesterol goals. Only 51.4% of diabetics achieved HbA1c goals. CONCLUSIONS: Subjects attended in primary care showed a high prevalence of cardiovascular risk factors with a poor control.