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1.
Med Clin (Barc) ; 163(4): 167-174, 2024 Aug 30.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-38821830

RESUMO

BACKGROUND: Coronary heart disease is the leading cause of heart failure (HF), and tools are needed to identify patients with a higher probability of developing HF after an acute coronary syndrome (ACS). Artificial intelligence (AI) has proven to be useful in identifying variables related to the development of cardiovascular complications. METHODS: We included all consecutive patients discharged after ACS in two Spanish centers between 2006 and 2017. Clinical data were collected and patients were followed up for a median of 53months. Decision tree models were created by the model-based recursive partitioning algorithm. RESULTS: The cohort consisted of 7,097 patients with a median follow-up of 53months (interquartile range: 18-77). The readmission rate for HF was 13.6% (964 patients). Eight relevant variables were identified to predict HF hospitalization time: HF at index hospitalization, diabetes, atrial fibrillation, glomerular filtration rate, age, Charlson index, hemoglobin, and left ventricular ejection fraction. The decision tree model provided 15 clinical risk patterns with significantly different HF readmission rates. CONCLUSIONS: The decision tree model, obtained by AI, identified 8 leading variables capable of predicting HF and generated 15 differentiated clinical patterns with respect to the probability of being hospitalized for HF. An electronic application was created and made available for free.


Assuntos
Síndrome Coronariana Aguda , Inteligência Artificial , Árvores de Decisões , Insuficiência Cardíaca , Readmissão do Paciente , Humanos , Síndrome Coronariana Aguda/diagnóstico , Feminino , Masculino , Idoso , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Medição de Risco/métodos , Seguimentos , Fatores de Risco , Algoritmos , Espanha
2.
Rev. costarric. cardiol ; 21(1): 37-40, ene.-jun. 2019. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1042862

RESUMO

Resumen La seguridad y eficacia de los anticoagulantes directos se ha demostrado como alternativas al tratamiento con antagonistas de la vitamina K en pacientes con fibrilación auricular (FA), permitiendo realizar una cardioversión precoz, especialmente en los pacientes tratados con Rivaroxabán y Edoxabán. Los pacientes con FA presentan un riesgo tromboembólico elevado, que varía según el número de factores de riesgo asociados. Además de esas características intrínsecas de cada individuo, el procedimiento de ablación puede presentar un incremento de eventos, en relación a la introducción y manipulación de catéteres, la presencia de introductores dentro de la aurícula izquierda y las lesiones endocárdicas producidas por la ablación. Por lo que es fundamental mantener la anticoagulación durante este procedimiento. Un tercer aspecto importante a tener en cuenta es el manejo perioperatorio de estos casos. El tiempo previo para suspender la terapia anticoagulante depende de cada fármaco, no se requiere puente con heparinas de bajo peso molecular y para el manejo de posibles sangrados existen algoritmos que analizaremos.


Abstract The safety and efficacy of direct anticoagulants has been demonstrated as alternatives to treatment with vitamin K antagonists in patients with atrial fibrillation (FA), allowing early cardioversion, especially in patients treated with Rivaroxaban and Edoxaban. Patients with AF have a high thromboembolic risk, which varies according to the number of associated risk factors. In addition to the intrinsic risk of each individual, the ablation procedure presents an increased risk of events, in relation to the introduction and manipulation of catheters, the presence of sheaths inside the left atrium and the endocardial lesions produced by ablation. For this reason, it is essential to maintain anticoagulation during this procedure. Finally, we present some aspects about the management in the perioperative period in this patients.


Assuntos
Humanos , Fibrilação Atrial , Espanha , Cardioversão Elétrica , Ablação por Cateter , Rivaroxabana , Anticoagulantes
3.
Rev. costarric. cardiol ; 19(1/2): 5-8, ene.-dic. 2017. graf
Artigo em Espanhol | LILACS | ID: biblio-900879

RESUMO

Resumen La fibrilación auricular es una de las cardiopatías con mayor prevalencia. Para escoger la terapia ideal se debe evaluar el riesgo hemorrágico con la escala de HASBLED y el riesgo de sufrir un evento cerebrovascular con la escala del CHADS VASC. Se recomienda utilizar el algoritmo de las guías ESC 2016 para prevención de un ictus por fibrilación auricular, donde los NOAC deben preferirse a los antagonistas de la vitamina K


Abstract Anticoagulation in patients with atrial fibrillation. What do clinical practice recommendations guidelines say? Atrial fibrillation is one of the most prevalent heart disease. In order to choose the ideal therapy, the risk of hemorrhagic risk should be evaluated with the HASBLED score and the risk of suffering a cerebrovascular event with the CHADSVASC score. It is recommended to use the algorithm of ESC 2016 guidelines for the prevention of stroke in atrial fibrillation, where NOAC should be preferred to vitamin K antagonists.


Assuntos
Humanos , Fibrilação Atrial , Varfarina/uso terapêutico , Guia de Prática Clínica , Cardiopatias , Insuficiência Cardíaca , Anticoagulantes
4.
Rev. costarric. cardiol ; 19(1/2): 9-11, ene.-dic. 2017. graf
Artigo em Espanhol | LILACS | ID: biblio-900880

RESUMO

Resumen Los resultados de los ensayos clínicos con los anticoagulantes directos en pacientes con fibrilación auricular demuestra mayor eficacia en la prevención del ictus versus warfarina. Las guías de práctica clínica recomiendan que estos fármacos deberían preferirse a los antagonistas de la vitamina K para anticoagular los pacientes con fibrilación auricular no valvular.


Abstract Direct anticoagulants in patients with atrial fibrillation. From clinical trials to real-world records The results of clinical trials with direct anticoagulants in patients with atrial fibrillation show greater efficacy in the prevention of stroke versus warfarin. Clinical practice guidelines recommend that these drugs should be preferred to vitamin K antagonists to anticoagulate patients with non-valvular atrial fibrillation.


Assuntos
Humanos , Fibrilação Atrial , Varfarina/uso terapêutico , Rivaroxabana/uso terapêutico , Dabigatrana/uso terapêutico , Anticoagulantes/uso terapêutico
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