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1.
Emergencias ; 31(4): 227-233, 2019.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-31347801

RESUMO

OBJECTIVES: To analyze heart rate control in hospital emergency departments and outcomes in patients with recent onset atrial fibrillation (AF) so that targets for improvement can be identified. MATERIAL AND METHODS: Multicenter, prospective observational cross-sectional study in a representative sample of 124 hospitals of the Spanish health services, based on records in the HERMES-AF database (Hospital Emergency Department Management Strategies for AF) for May 23 to June 5, 2011. Patients with symptomatic AF within 48 hours of onset were enrolled when the decision was made to attempt restoration of sinus rhythm. RESULTS: We included 337 patients. Chemical cardioversion was used in 311 (92.3%) and electrical cardioversion in 52 (15%), after drugs had failed in half the cases. Sinus rhythm was restored in 278 patients (82.5%), and symptoms resolved in 94%. Adverse effects were recorded in 0.9% but none were serious. Amiodarone was independently associated with a lower rate of restored sinus rhythm (odds ratio [OR], 0.442; 95% CI, 0.238-0.823; P=.01) than electrical cardioversion (OR, 4.0; 95% CI, 1.2-13.3; P=.024). The use of class Ic antiarrhythmic agents was associated with a higher percentage of discharges in less than 6 hours (OR, 2.6; 95% CI, 1.6-4.3; P< .001), and amiodarone was associated with hospital stays longer than 24 hours (OR, 2.7; 95% CI, 1.5-4.8; P< .003). CONCLUSION: Emergency department restoration of sinus rhythm in patients with AF is safe, effective, and associated with clinical benefits. Quality of care could be improved by replacing the use of amiodarone with faster and more effective treatments such as electrical cardioversion or the use of class Ic agents.

2.
Acad Emerg Med ; 26(9): 1034-1043, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30703274

RESUMO

BACKGROUND: Although rhythm control has failed to demonstrate long-term benefits over rate control in longstanding episodes of atrial fibrillation (AF), there is little evidence concerning recent-onset ones. We analyzed the benefits of rhythm and rate control in terms of symptoms alleviation and need for hospital admission in patients with recent-onset AF. METHODS: This was a multicenter, observational, cross-sectional study with prospective standardized data collection carried out in 124 emergency departments (EDs). Clinical variables, treatment effectiveness, and outcomes (control of symptoms, final disposition) were analyzed in stable patients with recent-onset AF consulting for AF-related symptoms. RESULTS: Of 421 patients included, rhythm control was chosen in 352 patients (83.6%), a global effectiveness of 84%. Rate control was performed in 69 patients (16.4%) and was achieved in 67 (97%) of them. Control of symptoms was achieved in 396 (94.1%) patients and was associated with a heart rate after treatment ≤ 110 beats/min (odds ratio [OR] = 14.346, 95% confidence interval [CI] = 3.90 to 52.70, p < 0.001) and a rhythm control strategy (OR = 2.78, 95% CI = 1.02 to 7.61, p = 0.046). Sixty patients (14.2%) were admitted: discharge was associated with a rhythm control strategy (OR = 2.22, 95% CI = 1.20-4.60, p = 0.031) and admission was associated with a heart rate > 110 beats/min after treatment (OR = 29.71, 95% CI = 7.19 to 123.07, p < 0.001) and acute heart failure (OR = 9.45, 95% CI = 2.91 to 30.65, p < 0.001). CONCLUSION: In our study, recent-onset AF patients in whom rhythm control was attempted in the ED had a high rate of symptoms' alleviation and a reduced rate of hospital admissions.

3.
Stroke ; 48(5): 1344-1352, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28389612

RESUMO

BACKGROUND AND PURPOSE: Long-term benefits of initiating stroke prophylaxis in the emergency department (ED) are unknown. We analyzed the long-term safety and benefits of ED prescription of anticoagulation in atrial fibrillation patients. METHODS: Prospective, multicenter, observational cohort of consecutive atrial fibrillation patients was performed in 62 Spanish EDs. Clinical variables and thromboprophylaxis prescribed at discharge were collected at inclusion. Follow-up at 1 year post-discharge included data about thromboprophylaxis and its complications, major bleeding, and death; risk was assessed with univariate and bivariate logistic regression models. RESULTS: We enrolled 1162 patients, 1024 (88.1%) at high risk according to CHA2DS2-VASc score. At ED discharge, 935 patients (80.5%) were receiving anticoagulant therapy, de novo in 237 patients (55.2% of 429 not previously treated). At 1 year, 48 (4.1%) patients presented major bleeding events, and 151 (12.9%) had died. Anticoagulation first prescribed in the ED was not related to major bleeding (hazard ratio, 0.976; 95% confidence interval, 0.294-3.236) and was associated with a decrease in mortality (hazard ratio, 0.398; 95% confidence interval, 0.231-0.686). Adjusting by the main clinical and sociodemographic characteristics, concomitant antiplatelet treatment, or destination (discharge or admission) did not affect the results. CONCLUSIONS: Prescription of anticoagulation in the ED does not increase bleeding risk in atrial fibrillation patients at high risk of stroke and contributes to decreased mortality.


Assuntos
Anticoagulantes/farmacologia , Fibrilação Atrial/terapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Acidente Vascular Cerebral/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Fibrilação Atrial/mortalidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Espanha/epidemiologia , Acidente Vascular Cerebral/mortalidade
4.
Eur Heart J ; 38(17): 1329-1335, 2017 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-27354046

RESUMO

Aims: Intravenous procainamide and amiodarone are drugs of choice for well-tolerated ventricular tachycardia. However, the choice between them, even according to Guidelines, is unclear. We performed a multicentre randomized open-labelled study to determine the safety and efficacy of intravenous procainamide and amiodarone for the acute treatment of tolerated wide QRS complex (probably ventricular) tachycardia. Methods and results: Patients were randomly assigned to receive intravenous procainamide (10 mg/kg/20 min) or amiodarone (5 mg/kg/20 min). The primary endpoint was the incidence of major predefined cardiac adverse events within 40 min after infusion initiation. Of 74 patients included, 62 could be analysed. The primary endpoint occurred in 3 of 33 (9%) procainamide and 12 of 29 (41%) amiodarone patients (odd ratio, OR = 0.1; 95% confidence interval, CI 0.03-0.6; P = 0.006). Tachycardia terminated within 40 min in 22 (67%) procainamide and 11 (38%) amiodarone patients (OR = 3.3; 95% CI 1.2-9.3; P = 0.026). In the following 24 h, adverse events occurred in 18% procainamide and 31% amiodarone patients (OR: 0.49; 95% CI: 0.15-1.61; P: 0.24). Among 49 patients with structural heart disease, the primary endpoint was less common in procainamide patients (3 [11%] vs. 10 [43%]; OR: 0.17; 95% CI: 0.04-0.73, P = 0.017). Conclusions: This study compares for the first time in a randomized design intravenous procainamide and amiodarone for the treatment of the acute episode of sustained monomorphic well-tolerated (probably) ventricular tachycardia. Procainamide therapy was associated with less major cardiac adverse events and a higher proportion of tachycardia termination within 40 min.


Assuntos
Amiodarona/administração & dosagem , Antiarrítmicos/administração & dosagem , Procainamida/administração & dosagem , Taquicardia Ventricular/tratamento farmacológico , Idoso , Amiodarona/efeitos adversos , Antiarrítmicos/efeitos adversos , Cardiomiopatias/complicações , Esquema de Medicação , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Procainamida/efeitos adversos , Resultado do Tratamento
6.
Ann Emerg Med ; 65(1): 1-12, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25182543

RESUMO

STUDY OBJECTIVE: We determine the prevalence of stroke prophylaxis prescription in emergency department (ED) patients with atrial fibrillation and the factors associated with a lack of prescription of anticoagulation in high-risk patients without contraindications. METHODS: This was a multicenter, observational, cross-sectional study with prospective standardized data collection carried out in 124 Spanish EDs. Clinical variables, risk factors for stroke, type of prophylaxis prescribed, and reasons for not prescribing anticoagulation in high-risk patients (congestive heart failure/left ventricular dysfunction, hypertension, age >75 years, diabetes and previous stroke/transient ischemic attack/systemic embolism [CHADS2] score ≥2 and the congestive heart failure/left ventricular dysfunction, hypertension, age >75 years, diabetes, previous stroke/transient ischemic attack/systemic embolism, vascular disease age 65 to 74 years and sex category [CHA2DS2-VASc] score ≥2) without contraindications were collected. RESULTS: Of 3,276 patients enrolled, 71.5% were at high risk according to CHADS2; 89.7% according to CHA2DS2-VASc. At discharge from the ED, 2,255 patients (68.8%) were receiving anticoagulants, 1,691 of whom (75%) were high-risk patients. Of the 1,931 patients discharged home, anticoagulation was prescribed for 384 patients (19.9%) de novo and for 932 patients (48.3%) previously receiving anticoagulation. The main reasons for not prescribing anticoagulation to eligible patients were considering antiplatelet therapy as adequate prophylaxis (33.1%), advanced age (15%), and considering stroke risk as low (8.3%). Advanced age (odds ratio 0.46; 95% confidence interval 0.30 to 0.69) and female sex (odds ratio 0.50; 95% confidence interval 0.36 to 0.71) were significantly associated with the lack of prescription of anticoagulation to eligible patients. CONCLUSION: In Spain, most patients with atrial fibrillation treated in EDs who do not receive anticoagulation are at high risk of stroke, with relevant differences with regard to the risk stratification scheme used. Anticoagulation is underused, mainly because the risk of stroke is underestimated by the treating physicians and the benefits of antiplatelets are overrated, principally in female patients and the elderly. Efforts to increase the prescription of anticoagulation in these patients appear warranted.


Assuntos
Fibrilação Atrial/complicações , Serviço Hospitalar de Emergência , Acidente Vascular Cerebral/prevenção & controle , Fatores Etários , Idoso , Anticoagulantes/uso terapêutico , Estudos Transversais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Padrões de Prática Médica/estatística & dados numéricos , Medição de Risco , Fatores de Risco , Fatores Sexuais , Espanha/epidemiologia
7.
Heart Rhythm ; 11(11): 2035-44, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24993462

RESUMO

BACKGROUND: The Group for Syncope Study in the Emergency Room (GESINUR) was a Spanish multicenter, prospective, observational study that evaluated the clinical presentation and acute management of loss of consciousness in Spain. Several studies have shown that an abnormal ECG is a poor prognostic factor in patients with syncope. However, the prognostic significance of each ECG abnormality is not well known. OBJECTIVE: The purpose of this study was to study the association between specific ECG abnormalities and mortality in patients with syncope from the GESINUR study. METHODS: All patients in the GESINUR study who had syncope and had available, readable ECG and 12-month follow-up data were included in this retrospective observational study (n = 524, age 57 ± 22 years, 50.6% male). ECG abnormalities were analyzed and assessed to evaluate whether an association with all-cause mortality existed at 12 months. RESULTS: ECGs were classified as abnormal in 344 patients (65.6%). Thirty-three patients died during follow-up (6.3%), but only 1 due to sudden cardiovascular death. Atrial fibrillation (odds ratio [OR] 6.8, 95% confidence interval [CI] 2.8-16.3, P <.001), intraventricular conduction disturbances (OR 3.8, 95% CI 1.7-8.3, P = .001), left ventricular hypertrophy ECG criteria (OR 6.3, 95% CI 1.5-26.3, P = .011), and ventricular pacing (OR 21.8, 95% CI 4.1-115.3, P <.001) were the only independent ECG predictors of all-cause mortality. CONCLUSION: Although an abnormal ECG in patients with syncope is a common finding, only the presence of atrial fibrillation, intraventricular conduction disturbances, left ventricular hypertrophy ECG criteria, and ventricular pacing is associated with 1-year all-cause mortality.


Assuntos
Eletrocardiografia/classificação , Serviço Hospitalar de Emergência , Síncope/fisiopatologia , Causas de Morte , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Fatores de Risco , Espanha , Inquéritos e Questionários , Síncope/mortalidade
8.
Europace ; 12(6): 869-76, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20215367

RESUMO

AIMS: To assess the clinical presentation and acute management of patients with transient loss of consciousness (T-LOC) in the emergency department (ED). METHODS AND RESULTS: A multi-centre prospective observational study was carried out in 19 Spanish hospitals over 1 month. The patients included were > or =14 years old and were admitted to the ED because of an episode of T-LOC. Questionnaires and corresponding electrocardiograms (ECGs) were reviewed by a Steering Committee (SC) to unify diagnostic criteria, evaluate adherence to guidelines, and diagnose correctly the ECGs. We included 1419 patients (prevalence, 1.14%). ECG was performed in 1335 patients (94%) in the ED: 498 (37.3%) ECGs were classified as abnormal. The positive diagnostic yield ranged from 0% for the chest X-ray to 12% for the orthostatic test. In the ED, 1217 (86%) patients received a final diagnosis of syncope, whereas the remaining 202 (14%) were diagnosed of non-syncopal transient loss of consciousness (NST-LOC). After final review by the SC, 1080 patients (76%) were diagnosed of syncope, whereas 339 (24%) were diagnosed of NST-LOC (P < 0.001). Syncope was diagnosed correctly in 84% of patients. Only 25% of patients with T-LOC were admitted to hospitals. CONCLUSION: Adherence to clinical guidelines for syncope management was low; many diagnostic tests were performed with low diagnostic yield. Important differences were observed between syncope diagnoses at the ED and by SC decision.


Assuntos
Serviços Médicos de Emergência/normas , Serviço Hospitalar de Emergência/normas , Fidelidade a Diretrizes , Inconsciência/diagnóstico , Inconsciência/epidemiologia , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Eletrocardiografia , Serviços Médicos de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Prevalência , Estudos Prospectivos , Distribuição por Sexo , Espanha/epidemiologia , Inquéritos e Questionários
9.
Liberabit ; 12(12): 33-40, 2006.
Artigo em Espanhol | PERNAL | ID: pnc-11171

RESUMO

Se hace una revisión general de la Psicología Política como marco especializado de la psicología científica actual, sus fines y alcances así como sus niveles y perspectivas (Montero,1999), ubicando el tema de la conciencia política como aspecto clave para el desarrollo del liderazgo. En tal sentido se presenta los antecedentes de este constructo en referencia a las competencias socio-emocionales que permiten su manifestación adaptativa, así como sus efectos e implicancias como habilidad social para la práctica de un liderazgo transformador (Burns, 1978; Bennis, 1993), tan necesario en la actualidad en el manejo de organizaciones y grupos sociales, ya que la misma es imprescindible en el comportamiento del líder efectivo, tal como se sustenta en este trabajo en el análisis de diversos enfoques y por su contribución para la construcción de una definición más amplia sobre el liderazgo político. (AU)


It is done a general inspection of the Political Psychology as a specialized frame of the present Scientific Psychology, its aims and reaches as well as its levels or perspectives (Montero, 1999); locating the subject of the political conscience as key aspect in the leadership development. In such sense, the antecedents of this construct are presented in reference to the socio-emotional competences that allow their adaptive manifestation, as well as their effects and implications like the social ability for the practice of a transforming leadership. (Burns, 1978; Bennis, 1993); it is so necessary at the present time in the handling of organizations and social groups since the same is essential in the effective leaders behavior, as it is sustained in this contribution throughout the analysis of diverse approaches in the contribution for the construction of a wider range of definitions about the political leadership. (AU)


Assuntos
Psicologia , Política , Liderança
10.
Ann Emerg Med ; 46(5): 424-30, 2005 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-16271674

RESUMO

STUDY OBJECTIVE: Limited information relative to the management of atrial fibrillation in the emergency department (ED) daily practice is available. This study evaluates current management of atrial fibrillation in this setting to identify areas for practice improvement. METHODS: This was a prospective multicenter observational study carried out in 12 EDs. Adults in whom atrial fibrillation was demonstrated in an ECG obtained in the ED were included. Clinical variables and atrial fibrillation management in the ED were prospectively collected by the treating physicians using a standardized questionnaire. Patients with rapid ventricular response (>100 beats/min) were considered eligible for rate control, and patients with recent-onset episodes (<48 hours) were eligible for rhythm control. RESULTS: Of 1,178 patients, 41% presented with a rapid ventricular response and 21% had recent-onset episodes. Rhythm control was attempted in 42% of eligible patients, with antiarrhythmic drugs in 88% of cases (I-C drugs in 44% of patients; amiodarone in 43% of patients). Overall effectiveness of pharmacologic cardioversion was 63% (amiodarone 54.5%, flecainide 93%), whereas electrocardioversion was effective in 87.5% of cases. Rate control was performed in 68.3% of eligible patients (overall effectiveness 47.8%); digoxin was used in 67% of cases (effectiveness 45%). Both strategies were selected in 4.5% of cases, whereas no treatment for atrial fibrillation was performed in 60% of patients. CONCLUSION: In our ED population, rate-control effectiveness is poor and rhythm control is not attempted in most recent-onset episodes. Methods to improve rate-control effectiveness, the selection of patients for rhythm control, and the use of electrocardioversion appear warranted.


Assuntos
Fibrilação Atrial/terapia , Medicina de Emergência/métodos , Medicina de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Adulto , Idoso , Antiarrítmicos/uso terapêutico , Cardioversão Elétrica/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Espanha , Resultado do Tratamento
11.
Acad Emerg Med ; 12(9): 828-34, 2005 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16141016

RESUMO

BACKGROUND: Several clinical classification schemes (CCSs) for predicting stroke in nonvalvular atrial fibrillation (NVAF) have been developed to help identify patients eligible for anticoagulation. OBJECTIVES: To estimate the agreement in predicting the risk of stroke among four widespread CCSs, and to determine their implications for thromboprophylaxis in clinical practice. METHODS: The authors conducted a prospective, multicenter, observational study of adults with NVAF in 12 emergency departments (EDs) in July 2000 and February 2001. The proportions of patients classified as having high, moderate, and low risk of stroke among the following CCSs were compared: the Atrial Fibrillation Investigators (AFI), the Stroke Prevention in Atrial Fibrillation (SPAF), the CHADS(2) (an acronym for congestive heart failure, hypertension, age >75 years, diabetes mellitus, and prior stroke or transient ischemic attack), and the American College of Chest Physicians (ACCP). RESULTS: One thousand two hundred twenty patients were included. The proportions of patients stratified as having high/moderate/low risk of stroke according to each CCS were: 70%/22%/8% (AFI), 38%/41%/21% (SPAF), 13%/45%/42% (CHADS(2)), and 86%/7%/7% (ACCP). The agreement was medium between AFI and ACCP (kappa = 0.52) and poor among the rest of them (AFI/SPAF, kappa = 0.01; AFI/CHADS(2), kappa = 0.02; SPAF/CHADS(2), kappa = 0.18; SPAF/ACCP, kappa = 0.11; CHADS(2)/ACCP, kappa = 0.03). The agreements in selecting patients as eligible for antiplatelet therapy or anticoagulation were: AFI/SPAF, kappa = 0.45; AFI/CHADS(2), kappa = 0.22; AFI/ACCP, kappa = 0.91; SPAF/CHADS(2), kappa = 0.47; SPAF/ACCP, kappa = 0.11; CHADS(2)/ACCP, kappa = 0.03. CONCLUSIONS: In the ED population studied, these CCSs showed relevant differences in the risk of stroke stratification and, therefore, in the identification of patients with NVAF eligible for anticoagulation.


Assuntos
Fibrilação Atrial/complicações , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Idoso , Anticoagulantes/uso terapêutico , Estudos de Coortes , Medicina de Emergência/métodos , Feminino , Humanos , Masculino , Padrões de Prática Médica , Estudos Prospectivos , Medição de Risco/métodos , Fatores de Risco , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica
12.
Liberabit ; 11(11): 63-74, 2005. tab
Artigo em Espanhol | PERNAL | ID: pnc-11163

RESUMO

La investigación que se presenta tuvo como objetivo principal establecer la relación entre las habilidades sociales y el clima social familiar con el rendimiento académico en un grupo de estudiantes universitarios de Lima Metropolitana. Para su realización se evaluó a 205 estudiantes, de ambos sexos, mayores de 16 años, que cursaban el I ciclo de estudios en Psicología, procedentes de Universidad Particular de San Martín de Porres y de Universidad Nacional Mayor de San Marcos, a quienes se aplicó la Lista de Chequeo de Habilidades Sociales de Goldstein, traducida y adaptada a nuestro país por Ambrosio Tomás entre 1994 95 y la escala de clima social en la familia de Moos y Trickett estandarizada en el Perú por Ruiz y Guerra en 1993. Los resultados de la investigación fueron procesados por el coeficiente de correlación de pearson, prueba chi cuadrado, media y desviación estándar, el coeficiente alfa de cronbach. Los resultados arrojaron una correlación positiva y significativa entre habilidades sociales y el clima social en la familia, encontrándose también que no existe estadísticamente una correlación significativa entre habilidades sociales y clima social en la familia con el rendimiento académico; se encontró además que en relación con las variables habilidades sociales y clima social en la familia más del 50% de los alumnos de la muestra total se ubicaron en el nivel promedio (65.9% y 62.7% respectivamente) y en rendimiento académico solo un porcentaje bajo de alumnos (9.8%) obtuvo notas desaprobatorias. (AU)


The research that here it is presented had as main objective to establish the relationship between the social skills and the family social climate with the academic yield in a group of university students from Metropolitan Lima. For its performance, 205 students were evaluated, from both sexes, older than 16 years, who studied in the I cycle of studies in Psychology, coming from San Martin of Porres University and San Marcos National University to whom the List of Checkup of Social Abilities of Goldstein was applied, translated and adapted to our country by Ambrosio Tomás between 1994 - 95 and the scale of social climate in the family of Moos and Trickett standardized in Peru by Ruiz y Guerra in 1993. The results of this research were processed by Pearson correlation, square chi test, arithmetic mean and standard deviation, the coefficient Cronbach alpha. The results showed a positive and significant correlation between social abilities and the social climate in the family, being also that it doesnt exist a significant correlation statistically between social abilities and social climate in the family with the academic yield; also it was found that in connection with social skills and social climate in the family, more than 50% of the students of the total sample was located in the average level (65.9 % and 62.7 % respectively), and in academic yield only a small percentage of students (9.8%) obtained bad notes. (AU)


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Aptidão , Desejabilidade Social , Família , Estudantes , Epidemiologia Descritiva
13.
Ann Emerg Med ; 44(1): 3-11, 2004 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-15226703

RESUMO

STUDY OBJECTIVES: We determine the risk for stroke of patients with atrial fibrillation in the emergency department (ED) and analyze the use of stroke prophylaxis in this setting. METHODS: This was a cross-sectional study carried out in 12 EDs. Clinical variables, risk factors for stroke, the prophylaxis prescribed, and the reasons for not initiating anticoagulation were collected. Risk factors and indications for therapy were evaluated according to the American College of Chest Physicians' 1998 recommendations. RESULTS: Of 1,178 patients included, 69% were not taking anticoagulants. Of the latter, 89% patients had indications for anticoagulation (age >75 years 59%, hypertension 56%, cardiac disorders 29%, heart failure 22%, diabetes 22%, previous embolism 14%), and 63% of the patients had 2 or more risk factors. Anticoagulation was prescribed in the ED to 27% of patients (67% with warfarin, 33% low-weight heparin plus warfarin), antiplatelets to 20% of patients, and no thromboprophylaxis to 53% of these eligible patients. Anticoagulants were prescribed in only 9% of patients with risk factors and current prophylaxis with antiplatelet agents. The main reasons for not prescribing anticoagulation in the presence of risk factors were advanced age (11%), contraindication for anticoagulation (27%), or because it was not considered to be indicated by the physicians (23%). CONCLUSION: Most patients seen in the ED with atrial fibrillation are at high risk of stroke. Despite this risk, anticoagulation is underused in this setting, mainly because of the influence of advanced age on medical decisions and the reluctance to change current antiplatelet therapy.


Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Uso de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Acidente Vascular Cerebral/prevenção & controle , Idoso , Contraindicações , Estudos Transversais , Serviço Hospitalar de Emergência , Feminino , Fidelidade a Diretrizes , Humanos , Masculino , Guias de Prática Clínica como Assunto , Fatores de Risco , Espanha , Acidente Vascular Cerebral/etiologia
14.
Blood Press Monit ; 8(6): 267-70, 2003 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-14688558

RESUMO

AIM: To assess the agreement between the clinical information provided by the ambulatory daytime average and 24 h average blood pressure value for diagnosing hypertension and assessing the effects of antihypertensive treatment. METHODS: We analysed 261 24 h ambulatory monitoring records (SpaceLabs 90207, SpaceLabs, Redmond, Washington, USA) obtained from hypertensives over 18 years of age (mean age 55.8 years) in order to make a diagnosis of hypertension or assess its control in response to treatment. Recording was programmed to occur every 20 min during waking periods and every 30 min during sleep, daily activity also being registered. The criteria compared in the diagnosis of hypertension were: (1) the evaluation criterion: an average blood pressure for the activity period of less than 135/85 mmHg (Joint National Committee VI); (2) the gold standard: an average blood pressure over 24 h of less than 125/80 mmHg (World Health Organization-International Society of Hypertension, 1999). RESULTS: In 90% of the records, there was agreement between both criteria. In 7.2%, the awake blood pressure average was normal and the 24 h average high. Values obtained were: sensitivity, 89% (95% confidence interval 84-89%); specificity, 92% (95% CI 88-95%); positive predictive value, 95.6% (95% CI 93-98%); negative predictive value, 81% (95% CI 75-85%); pretest probability, 66% (95% CI 60-72%); positive likelihood ratio, 11; and negative likelihood ratio, 0.3. There were no significant differences in age, gender or percentage of treated subjects between the groups with and without agreement. CONCLUSIONS: Daytime and 24 h average blood pressure may indeed carry similar information for diagnosing hypertension and assessing the effects of antihypertensive treatment in clinical practice. Ambulatory blood pressure monitoring used only during the daytime period could be better tolerated and agreed to by patients than 24 h monitoring.


Assuntos
Monitorização Ambulatorial da Pressão Arterial/métodos , Hipertensão/fisiopatologia , Sono/fisiologia , Vigília/fisiologia , Adulto , Idoso , Pressão Sanguínea/fisiologia , Humanos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade
15.
Rev Esp Cardiol ; 56(8): 801-16, 2003 Aug.
Artigo em Espanhol | MEDLINE | ID: mdl-12892626

RESUMO

Atrial fibrillation (AF) is the most prevalent arrhythmia in hospital emergency departments and is a serious disease associated with a twofold increase in morbidity and a high mortality rate. However, the management of AF in this scenario is variable and frequently inadequate. This is probably a consequence of the diverse clinical aspects and therapeutic options to consider in the management of patients with AF. Therefore, implementation of specific, coordinated management strategies by the different care providers involved is needed to improve the quality of care and optimize the use of human and material resources. This document presents the guidelines recommended by the Spanish Society of Cardiology (SEC) and the Spanish Society of Emergency Medicine (SEMES) for the management of AF in hospital emergency departments. These guidelines are based on published scientific evidence and are applicable to most emergency departments in Spain. Specific management strategies are proposed for the conversion and maintenance of sinus rhythm, heart rate control during AF, prophylaxis for thrombi and emboli, and hospital admission and discharge protocols.


Assuntos
Fibrilação Atrial/terapia , Fibrilação Atrial/complicações , Fibrilação Atrial/fisiopatologia , Serviço Hospitalar de Emergência , Humanos , Tromboembolia/etiologia , Tromboembolia/prevenção & controle , Função Ventricular
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