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Tortosa, Spain

Panisello-Tafalla A.,Institute Catala Salut | Clua-Espuny J.L.,Institute Catala Salut | Gil-Guillen V.F.,University Miguel Hernandez | Gonzalez-Henares A.,Institute Catala Salut | And 7 more authors.
BioMed Research International | Year: 2015

Objective. This study aimed to examine the effectiveness of the use of oral anticoagulation (OAC) medication, recommended by national guidelines for stroke prevention but reportedly underused in AF patients with moderate to high stroke risk. Method. A multicentre and cross-sectional study of undiagnosed AF among out-of-hospital patients over 60 years old was carried out, visiting 3,638 patients at primary health centres or at home for AF diagnosis using the IDC-10 classification. The main outcome measures were CHA2DS2VASC, HAS-BLED scores, cardiovascular comorbidity, pharmacological information, TTR, and SAMe-TT2R2 scores. Results. The main findings were undiagnosed AF in 26.44% of cases; 31.04% registered with AF but not using OAC despite 95.6% having a CHA2DS2VASC≥2 score; a risk of bleeding in important subgroups using OAC without indication (37.50% CHA2DS2VASC<2 score); the use of OAC with TTR < 60% (33.1%), of whom 47.6% had a HAS-BLED score ≥3. Thus, 35.4% of the expected AF prevalence achieved an optimal time in the therapeutic range. Conclusions. The expected AF prevalence was 10.9% (n 5267), but the registered prevalence was 7.5% (n 3638). Only 35.04% (CI = 95%, 33.7-36.3) of AF patients treated with vitamin K antagonists (VKAs) achieve the goal of TTR > 60%. © 2015 Anna Panisello-Tafalla et al. Source

Clua-Espuny J.L.,Institute Catala Salut | Ripolles-Vicente R.,Institute Catala Salut | Lopez-Pablo C.,Area de Biologia Molecular i Recerca | Panisello-Tafalla A.,SAP | And 4 more authors.
Atencion Primaria | Year: 2015

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. © 2013 Elsevier España, S.L.U. All rights reserved. Source

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