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Objetivos. El presente proyecto parte de la hipótesis de que un programa docente basado en la enseñanza integrada y en el aprendizaje basado en problemas constituye una forma innovadora de docencia que alcanza una mayor satisfacción en el alumnado sin disminuir el rendimiento académico. Método. Durante el curso académico 2018-19, los alumnos de cuarto curso de medicina del Campus Virgen del Rocío participaron en una implementación de una docencia integrada basada en resolución de problemas integrando tres asignaturas complementarias: patología médica de sistemas, patología quirúrgica de sistemas y diagnóstico por la imagen. Los alumnos se dividieron en dos grupos, uno sin intervención como grupo control. Tras la finalización de la asignatura, la satisfacción del alumnado fue evaluada mediante una encuesta, junto con el análisis de las calificaciones finales entre ambos grupos. Resultados. El plan docente se implementó sin grandes incidencias. La encuesta de satisfacción mostró que esta satisfacción fue elevada con un 76% de los alumnos que estaban bastante o muy satisfechos. Sin embargo, no había una aceptación uniforme para impartir la docencia exclusivamente en este formato. No hubo diferencias en las calificaciones finales entre los grupos de intervención y control Conclusiones. Los resultados avalan el uso de la enseñanza basada en resolución de problemas como método complementario la docencia tradicional sin detrimento de las calificaciones finales, Objectives. The present project is based on the hypothesis that a teaching program based on integrated teaching and problem-based learning constitutes an innovative form of teaching that achieves greater student satisfaction without reducing academic performance. Method. During the 2018-19 academic year, fourth-year medical students at the Virgen del Rocío Campus participated in an implementation of integrated teaching based on problem-solving integrating three complementary subjects: systems medical pathology, systems surgical pathology, and diagnostic imaging. The students were divided into two groups, one without intervention as a control group. After completion of the course, student satisfaction was evaluated by means of a survey, together with the analysis of final grades between the two groups. Results. The teaching plan was implemented without major incidents. The satisfaction survey showed that satisfaction was high with 76% of the students being fairly or very satisfied. However, there was no uniform acceptance for teaching exclusively in this format. There were no differences in the final ratings between the intervention and control groups. Conclusions. The results support the use of problem-based teaching as a complementary method to traditional teaching without detriment to final grades.

Background and objective Thromboembolic risk is higher in women than men with non-valvular atrial fibrillation (NVAF). Published data indicate variability in antithrombotic use by gender and region. We analyzed gender-specific antithrombotic treatment patterns in Spain and rest of Western Europe (rWE) in patients with NVAF. Methods GLORIA-AF (Phase III) is a global, prospective, observational study which enrolled newly diagnosed NVAF patients with CHA2DS2-VAScs ≥ 1 (2014–2016). Analyses were performed comparing antithrombotic treatments by gender in Spain and rWE. Results This analysis included 1163 and 7972 patients from Spain and rWE, respectively. Stroke risk was higher in women than men in both Spain and rWE. While in rWE, bleeding risk and antithrombotic treatment pattern were similar between genders, in Spain bleeding risk in women was lower and more females compared to men received OACs (95.0% versus 92.4%, d = −0.1078, respectively). Fewer Spanish patients received direct oral anticoagulants (DOACs) (women 32.1%, men 25.3%) than vitamin-K-antagonists (VKAs) (women 63.0%, men 67.1%) vs. rWE patients. In Spain women received more DOACs compared to men (56.0% versus 44.0%). Conclusions OAC rates were higher in Spain as compared to rWE. More women received OACs in Spain, while in rWE no difference by gender was observed. DOACs in rWE are the most prescribed OAC while in Spain, due to prescription barriers, its use remains low for both genders and VKAs are preferred. Spanish women received more DOACs compared to men. (NCT01468701)., Antecedentes y objetivo El riesgo tromboembólico es mayor en mujeres que en varones con fibrilación auricular no valvular (FANV). Existen diferencias en el uso de anticoagulantes (ACO) según sexo y zona geográfica. Se estudiaron los patrones de anticoagulación por sexo en España y el resto de Europa Occidental (rEO) en pacientes con FANV. Métodos GLORIA-AF es un estudio observacional prospectivo (fase III) que incluyó a pacientes con diagnóstico reciente de FANV y CHA2DS2-VASc > 1 (2014-2016). Se analizó la prescripción de anticoagulantes por sexo en España y el rEO. Resultados Se incluyó a 1.163 pacientes de España y 7.972 del rEO. El riesgo de ictus fue superior en mujeres tanto en España como en el rEO. El riesgo de hemorragia y el tratamiento antitrombótico fueron similares en ambos sexos en el rEO; en España, el riesgo de hemorragia fue menor en mujeres y estas recibieron más ACO que los varones (95,0% vs. 92,4%, d = –0,1078). En España, menos pacientes recibieron ACO directos (ACOD) (mujeres 32,1%, varones 25,3%) vs. antagonistas de la vitamina K (AVK) (mujeres 63,0%, varones 67,1%), y las mujeres recibieron más ACOD que los varones (56,0% vs. 44,0%). Conclusiones En España se emplearon más ACO que en el rEO y más mujeres fueron tratadas con ACO, mientras que en el rEO no hubo diferencias por sexo. En el rEO, los ACOD se emplearon más. En España, los ACOD se emplean menos por restricciones de prescripción y se emplean más los AVK. Las mujeres españolas reciben más ACOD que los varones. (NCT01468701).

Background and objective Thromboembolic risk is higher in women than men with non-valvular atrial fibrillation (NVAF). Published data indicate variability in antithrombotic use by gender and region. We analyzed gender-specific antithrombotic treatment patterns in Spain and rest of Western Europe (rWE) in patients with NVAF. Methods GLORIA-AF (Phase III) is a global, prospective, observational study which enrolled newly diagnosed NVAF patients with CHA2DS2-VAScs ≥ 1 (2014–2016). Analyses were performed comparing antithrombotic treatments by gender in Spain and rWE. Results This analysis included 1163 and 7972 patients from Spain and rWE, respectively. Stroke risk was higher in women than men in both Spain and rWE. While in rWE, bleeding risk and antithrombotic treatment pattern were similar between genders, in Spain bleeding risk in women was lower and more females compared to men received OACs (95.0% versus 92.4%, d = −0.1078, respectively). Fewer Spanish patients received direct oral anticoagulants (DOACs) (women 32.1%, men 25.3%) than vitamin-K-antagonists (VKAs) (women 63.0%, men 67.1%) vs. rWE patients. In Spain women received more DOACs compared to men (56.0% versus 44.0%). Conclusions OAC rates were higher in Spain as compared to rWE. More women received OACs in Spain, while in rWE no difference by gender was observed. DOACs in rWE are the most prescribed OAC while in Spain, due to prescription barriers, its use remains low for both genders and VKAs are preferred. Spanish women received more DOACs compared to men. (NCT01468701)., Antecedentes y objetivo El riesgo tromboembólico es mayor en mujeres que en varones con fibrilación auricular no valvular (FANV). Existen diferencias en el uso de anticoagulantes (ACO) según sexo y zona geográfica. Se estudiaron los patrones de anticoagulación por sexo en España y el resto de Europa Occidental (rEO) en pacientes con FANV. Métodos GLORIA-AF es un estudio observacional prospectivo (fase III) que incluyó a pacientes con diagnóstico reciente de FANV y CHA2DS2-VASc > 1 (2014-2016). Se analizó la prescripción de anticoagulantes por sexo en España y el rEO. Resultados Se incluyó a 1.163 pacientes de España y 7.972 del rEO. El riesgo de ictus fue superior en mujeres tanto en España como en el rEO. El riesgo de hemorragia y el tratamiento antitrombótico fueron similares en ambos sexos en el rEO; en España, el riesgo de hemorragia fue menor en mujeres y estas recibieron más ACO que los varones (95,0% vs. 92,4%, d = –0,1078). En España, menos pacientes recibieron ACO directos (ACOD) (mujeres 32,1%, varones 25,3%) vs. antagonistas de la vitamina K (AVK) (mujeres 63,0%, varones 67,1%), y las mujeres recibieron más ACOD que los varones (56,0% vs. 44,0%). Conclusiones En España se emplearon más ACO que en el rEO y más mujeres fueron tratadas con ACO, mientras que en el rEO no hubo diferencias por sexo. En el rEO, los ACOD se emplearon más. En España, los ACOD se emplean menos por restricciones de prescripción y se emplean más los AVK. Las mujeres españolas reciben más ACOD que los varones. (NCT01468701).

Background: The aim of this study was to analyze the impact of the presence of heart failure (HF) on the clinical profile and outcomes in patients with atrial fibrillation (AF) anticoagulated with rivaroxaban. Methods: Observational and non-interventional study that included AF adults recruited from 79 Spanish centers, anticoagulated with rivaroxaban ≥ 6 months before inclusion. Data were analyzed according to baseline HF status. Results: Out of 1,433 patients, 326 (22.7%) had HF at baseline. Compared to patients without HF, HF patients were older (75.3 ± 9.9 vs. 73.8 ± 9.6 years; p = 0.01), had more diabetes (36.5% vs. 24.3%; p < 0.01), coronary artery disease (28.2% vs. 12.9%; p < 0.01), renal insufficiency (31.7% vs. 22.6%; p = 0.01), higher CHA2DS2-VASc (4.5 ± 1.6 vs. 3.2 ± 1.4; p < 0.01) and HAS-BLED (1.8 ± 1.1 vs. 1.5 ± 1.0; p < 0.01). After a median follow-up of 2.5 years, among HF patients, annual rates of stroke/ /systemic embolism/transient ischemic attack, major adverse cardiovascular events (MACE) (non-fatal myocardial infarction, revascularization and cardiovascular death), cardiovascular death, and major bleeding were 1.2%, 3.0%, 2.0%, and 1.4%, respectively. Compared to those patients without HF, HF patients had greater annual rates of MACE (3.0% vs. 0.5%; p < 0.01) and cardiovascular death (2.0% vs. 0.2%; p < 0.01), without significant differences regarding other outcomes, including thromboembolic or bleeding events. Previous HF was an independent predictor of MACE (odds ratio 3.4; 95% confidence interval 1.6–7.3; p = 0.002) but not for thromboembolic events or major bleeding. Conclusions: Among AF patients anticoagulated with rivaroxaban, HF patients had a worse clinical profile and a higher MACE risk and cardiovascular mortality. HF was independently associated with the development of MACE, but not with thromboembolic events or major bleeding. (Cardiol J 2022; 29, 6: 936–947).

atrial fibrillation (AF) treated with rivaroxaban and to improve the accuracy of 2MACE. Methods: This was a post-authorization and observational study of AF adults treated with rivaroxaban for ≥ 6 months. The primary endpoint was any of the major adverse cardiac events (MACE), namely, cardiovas cular death, non-fatal myocardial infarction, and myocardial revascularization. The area under the curve (AUC) was calculated to evaluate the performance of 2MACE, and a new score, 2MACER to predict MACE. Results: A total of 1433 patients were included (74.2 ± 9.7 years, CHA2DS2-VASc 3.5 ± 1.5, 26.9% 2MACE ≥ 3). The annual event rates (follow-up 2.5 years) were 1.07% for MACE, 0.66% for throm boembolic events and 1.04% for major bleeding. Patients with 2MACE ≥ 3 (vs. < 3) had higher risk of stroke/systemic embolism/transient ischemic attack (odds ratio [OR] 5.270; 95% confidence interval [CI] 2.216–12.532), major bleeding (OR 4.624; 95% CI 2.163–9.882), MACE (OR 3.202; 95% CI 1.548–6.626) and cardiovascular death (OR 3.395; 95% CI 1.396–8.259). 2MACE was recalcu lated giving 1 more point to patients with baseline a glomerular filtration rate < 50 mL/min/1.73 m2 (2MACER); (2MACER vs. 2MACE: IDI 0.1%, p = 0.126; NRI 23.9%, p = 0.125; AUC: 0.651 [95% CI 0.547–0.755] vs. 0.638 [95% CI 0.534–0.742], respectively; p = 0.361). Conclusions: In clinical practice, AF patients anticoagulated with rivaroxaban exhibit a low risk of events. 2MACE score acts as a modest predictor of a higher risk of adverse outcomes in this population. 2MACER did not significantly increase the ability of 2MACE to predict MACE. (Cardiol J 2022; 29, 4: 601–609)

atrial fibrillation (AF) treated with rivaroxaban and to improve the accuracy of 2MACE. Methods: This was a post-authorization and observational study of AF adults treated with rivaroxaban for ≥ 6 months. The primary endpoint was any of the major adverse cardiac events (MACE), namely, cardiovas cular death, non-fatal myocardial infarction, and myocardial revascularization. The area under the curve (AUC) was calculated to evaluate the performance of 2MACE, and a new score, 2MACER to predict MACE. Results: A total of 1433 patients were included (74.2 ± 9.7 years, CHA2DS2-VASc 3.5 ± 1.5, 26.9% 2MACE ≥ 3). The annual event rates (follow-up 2.5 years) were 1.07% for MACE, 0.66% for throm boembolic events and 1.04% for major bleeding. Patients with 2MACE ≥ 3 (vs. < 3) had higher risk of stroke/systemic embolism/transient ischemic attack (odds ratio [OR] 5.270; 95% confidence interval [CI] 2.216–12.532), major bleeding (OR 4.624; 95% CI 2.163–9.882), MACE (OR 3.202; 95% CI 1.548–6.626) and cardiovascular death (OR 3.395; 95% CI 1.396–8.259). 2MACE was recalcu lated giving 1 more point to patients with baseline a glomerular filtration rate < 50 mL/min/1.73 m2 (2MACER); (2MACER vs. 2MACE: IDI 0.1%, p = 0.126; NRI 23.9%, p = 0.125; AUC: 0.651 [95% CI 0.547–0.755] vs. 0.638 [95% CI 0.534–0.742], respectively; p = 0.361). Conclusions: In clinical practice, AF patients anticoagulated with rivaroxaban exhibit a low risk of events. 2MACE score acts as a modest predictor of a higher risk of adverse outcomes in this population. 2MACER did not significantly increase the ability of 2MACE to predict MACE. (Cardiol J 2022; 29, 4: 601–609)

Background: The aim of this study was to analyze the impact of the presence of heart failure (HF) on the clinical profile and outcomes in patients with atrial fibrillation (AF) anticoagulated with rivaroxaban. Methods: Observational and non-interventional study that included AF adults recruited from 79 Spanish centers, anticoagulated with rivaroxaban ≥ 6 months before inclusion. Data were analyzed according to baseline HF status. Results: Out of 1,433 patients, 326 (22.7%) had HF at baseline. Compared to patients without HF, HF patients were older (75.3 ± 9.9 vs. 73.8 ± 9.6 years; p = 0.01), had more diabetes (36.5% vs. 24.3%; p < 0.01), coronary artery disease (28.2% vs. 12.9%; p < 0.01), renal insufficiency (31.7% vs. 22.6%; p = 0.01), higher CHA2DS2-VASc (4.5 ± 1.6 vs. 3.2 ± 1.4; p < 0.01) and HAS-BLED (1.8 ± 1.1 vs. 1.5 ± 1.0; p < 0.01). After a median follow-up of 2.5 years, among HF patients, annual rates of stroke/ /systemic embolism/transient ischemic attack, major adverse cardiovascular events (MACE) (non-fatal myocardial infarction, revascularization and cardiovascular death), cardiovascular death, and major bleeding were 1.2%, 3.0%, 2.0%, and 1.4%, respectively. Compared to those patients without HF, HF patients had greater annual rates of MACE (3.0% vs. 0.5%; p < 0.01) and cardiovascular death (2.0% vs. 0.2%; p < 0.01), without significant differences regarding other outcomes, including thromboembolic or bleeding events. Previous HF was an independent predictor of MACE (odds ratio 3.4; 95% confidence interval 1.6–7.3; p = 0.002) but not for thromboembolic events or major bleeding. Conclusions: Among AF patients anticoagulated with rivaroxaban, HF patients had a worse clinical profile and a higher MACE risk and cardiovascular mortality. HF was independently associated with the development of MACE, but not with thromboembolic events or major bleeding. (Cardiol J 2022; 29, 6: 936–947).

Background: Primary percutaneous coronary intervention (PPCI) in patients with ST-segment elevation myocardial infarction (STEMI) improves the survival of patients; nevertheless, some patients develop left ventricular adverse remodeling (LVAR) a few months after the intervention. The main objective of this study was to characterize the role of pro-inflammatory cell populations, related cytokines, and microRNAs (miRNAs) released after PPCI as reliable prognostic biomarkers for LVAR in patients with STEMI. Methods: We evaluated the level of pro-inflammatory subsets, before and after revascularization, 1 and 6 months after PPCI, using flow cytometry. We also performed a miRNA microarray in isolated peripheral blood mononuclear cells (PBMCs) and examined the levels of 27 cytokines in patients’ serum of patients by multiplex ELISA. Results: We observed that the levels of classical and intermediate monocytes increased 6 h after PPCI in patients who developed LVAR later. Multivariate regression analysis and ROC curves indicated that intermediate monocytes, after PPCI, were the best monocyte subset that correlated with LVAR. Within the 27 evaluated cytokines evaluated, we found that the increase in the level of vascular endothelial growth factor (VEGF) correlated with LVAR. Furthermore, the microarray analysis of PBMCs determined that up to 1,209 miRNAs were differentially expressed 6 h after PPCI in LVAR patients, compared with those who did not develop LVAR. Using RT-qPCR we confirmed a significant increase in miR-16, miR-21-5p, and miR-29a-3p, suggested to modulate the expression of different cytokines, 6 h post-PPCI in LVAR patients. Interestingly, we determined that the combined analysis of the levels of the intermediate monocyte subpopulation, VEGF, and miRNAs gave a better association with LVAR appearance. Similarly, combined ROC analysis provided high accurate specificity and sensibility to identify STEMI patients who will develop LVAR. Conclusion: Our data suggest

Background and objective Thromboembolic risk is higher in women than men with non-valvular atrial fibrillation (NVAF). Published data indicate variability in antithrombotic use by gender and region. We analyzed gender-specific antithrombotic treatment patterns in Spain and rest of Western Europe (rWE) in patients with NVAF. Methods GLORIA-AF (Phase III) is a global, prospective, observational study which enrolled newly diagnosed NVAF patients with CHA2DS2-VAScs ≥ 1 (2014–2016). Analyses were performed comparing antithrombotic treatments by gender in Spain and rWE. Results This analysis included 1163 and 7972 patients from Spain and rWE, respectively. Stroke risk was higher in women than men in both Spain and rWE. While in rWE, bleeding risk and antithrombotic treatment pattern were similar between genders, in Spain bleeding risk in women was lower and more females compared to men received OACs (95.0% versus 92.4%, d = −0.1078, respectively). Fewer Spanish patients received direct oral anticoagulants (DOACs) (women 32.1%, men 25.3%) than vitamin-K-antagonists (VKAs) (women 63.0%, men 67.1%) vs. rWE patients. In Spain women received more DOACs compared to men (56.0% versus 44.0%). Conclusions OAC rates were higher in Spain as compared to rWE. More women received OACs in Spain, while in rWE no difference by gender was observed. DOACs in rWE are the most prescribed OAC while in Spain, due to prescription barriers, its use remains low for both genders and VKAs are preferred. Spanish women received more DOACs compared to men. (NCT01468701)., Antecedentes y objetivo El riesgo tromboembólico es mayor en mujeres que en varones con fibrilación auricular no valvular (FANV). Existen diferencias en el uso de anticoagulantes (ACO) según sexo y zona geográfica. Se estudiaron los patrones de anticoagulación por sexo en España y el resto de Europa Occidental (rEO) en pacientes con FANV. Métodos GLORIA-AF es un estudio observacional prospectivo (fase III) que incluyó a pacientes con diagnóstico reciente de FANV y CHA2DS2-VASc > 1 (2014-2016). Se analizó la prescripción de anticoagulantes por sexo en España y el rEO. Resultados Se incluyó a 1.163 pacientes de España y 7.972 del rEO. El riesgo de ictus fue superior en mujeres tanto en España como en el rEO. El riesgo de hemorragia y el tratamiento antitrombótico fueron similares en ambos sexos en el rEO; en España, el riesgo de hemorragia fue menor en mujeres y estas recibieron más ACO que los varones (95,0% vs. 92,4%, d = –0,1078). En España, menos pacientes recibieron ACO directos (ACOD) (mujeres 32,1%, varones 25,3%) vs. antagonistas de la vitamina K (AVK) (mujeres 63,0%, varones 67,1%), y las mujeres recibieron más ACOD que los varones (56,0% vs. 44,0%). Conclusiones En España se emplearon más ACO que en el rEO y más mujeres fueron tratadas con ACO, mientras que en el rEO no hubo diferencias por sexo. En el rEO, los ACOD se emplearon más. En España, los ACOD se emplean menos por restricciones de prescripción y se emplean más los AVK. Las mujeres españolas reciben más ACOD que los varones. (NCT01468701).

Aim The SAMe-TT2R2 score helps identify patients with atrial fibrillation (AF) likely to have poor anticoagulation control during anticoagulation with vitamin K antagonists (VKA) and those with scores >2 might be better managed with a target-specific oral anticoagulant (NOAC). We hypothesized that in clinical practice, VKAs may be prescribed less frequently to patients with AF and SAMe-TT2R2 scores >2 than to patients with lower scores. Methods and results We analyzed the Phase III dataset of the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF), a large, global, prospective global registry of patients with newly diagnosed AF and ≥1 stroke risk factor. We compared baseline clinical characteristics and antithrombotic prescriptions to determine the probability of the VKA prescription among anticoagulated patients with the baseline SAMe-TT2R2 score >2 and ≤ 2. Among 17,465 anticoagulated patients with AF, 4,828 (27.6%) patients were prescribed VKA and 12,637 (72.4%) patients an NOAC: 11,884 (68.0%) patients had SAMe-TT2R2 scores 0-2 and 5,581 (32.0%) patients had scores >2. The proportion of patients prescribed VKA was 28.0% among patients with SAMe-TT2R2 scores >2 and 27.5% in those with scores ≤2. Conclusions The lack of a clear association between the SAMe-TT2R2 score and anticoagulant selection may be attributed to the relative efficacy and safety profiles between NOACs and VKAs as well as to the absence of trial evidence that an SAMe-TT2R2-guided strategy for the selection of the type of anticoagulation in NVAF patients has an impact on clinical outcomes of efficacy and safety. The latter hypothesis is currently being tested in a randomized controlled trial.

Introducción y objetivos: La coexistencia de la fibrilación auricular y la diabetes mellitus es frecuente. Nuestro objetivo es analizar la manera como los cardiólogos tratamos a los pacientes que padecen ambas enfermedades en 2019. Métodos: Dise ̃namos un registro multicéntrico y prospectivo en el que incluimos todos los pacientes atendidos en consultas externas en los que coexistían ambas entidades. Se recogen parámetros clínicos, electrocardiográficos, ecocardiográficos y analíticos, el tratamiento que venían tomando los pacientes y la actitud terapéutica de los cardiólogos. Resultados: Durante 11 meses incluimos 658 pacientes, 55% mujeres, de 73,8 ± 8,5 a ̃nos de edad. Encontra- mos una elevadísima prevalencia de otros factores de riesgo con diferencias significativas entre géneros. No se utiliza el ácido acetilsalicílico y se anticoagula al 96% de aquellos que lo precisan según las guías. Aquellos que siguen tratados con antivitamina K tienen un tiempo en rango terapéutico de Rosendaal de 59,8 ± 31, pero solo se optimiza el tratamiento en el 57,4% (rango de variabilidad entre cardiólogos 10-93%, p = 0,001) de los que tenían un tiempo en rango terapéutico < 65%. La hemoglobina glucosilada era de 7 ± 1,2, y el 37,5% presentaban cifras de hemoglobina glucosilada ≥ 7. Los cardiólogos optimizaron el tratamiento en el 35,2% de ellos (rango de variabilidad entre cardiólogos 6,3-93%, p = 0,0001). Si esta era ≥ 7,5, se optimizaba en el 46,3% y si era ≥ 9 en el 63,2%. Conclusiones: La coexistencia de fibrilación auricular y diabetes mellitus define una población de ele- vadísimo riesgo cardiovascular. La intervención del cardiólogo en el tratamiento anticoagulante y antidiabético es buena, pero mejorable, y hay gran variabilidad entre profesionales., Introduction and objectives: The coexistence of atrial fibrillation and diabetes mellitus is frequent. Our goal was to analyse how cardiologists treated patients with both pathologies in 2019. Methods: We designed a prospective, multicentre registry in which we included all the patients in whom both pathologies coexisted. Clinical, analytical, electrocardiographic, and echocardiographic parameters were collected. In addition, we collected the treatment that patients had been taking and the attitude of cardiologists. Results: Over 11 months we included 658 patients, 55% women, 73.8 ± 8.5 years. We found an extremely high prevalence of other risk factors with significant differences between genders. Acetylsalicylic acid was not used and 96% of those who required it were anticoagulated according to the guidelines. Those who were treated with aVK had a Rosendaal’s time in therapeutic range of 59.8 ± 31, but treatment was only optimized in 57.4% (range of variability between cardiologists 10%-93%, P = .001) of which < 65% had time in therapeutic range. Glycated haemoglobin was 7.0 ± 1.2, and 37.5% had glycated hemoglobin levels ≥ 7.0. Cardiologists optimized treatment in 35.2% of them (range of variability between cardiologists 6.3%-93%, P = .0001). If it was ≥ 7.5, it was optimized in 46.3% and if it was ≥ 9 in 63.2%. Conclusions: The coexistence of atrial fibrillation and diabetes mellitus defines a population with a very high cardiovascular risk. The intervention of the cardiologist in anticoagulant and antidiabetic treatment is good, but it can be improved, and there is great variability among professionals.

Aim The SAMe-TT2R2 score helps identify patients with atrial fibrillation (AF) likely to have poor anticoagulation control during anticoagulation with vitamin K antagonists (VKA) and those with scores >2 might be better managed with a target-specific oral anticoagulant (NOAC). We hypothesized that in clinical practice, VKAs may be prescribed less frequently to patients with AF and SAMe-TT2R2 scores >2 than to patients with lower scores. Methods and results We analyzed the Phase III dataset of the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF), a large, global, prospective global registry of patients with newly diagnosed AF and ≥1 stroke risk factor. We compared baseline clinical characteristics and antithrombotic prescriptions to determine the probability of the VKA prescription among anticoagulated patients with the baseline SAMe-TT2R2 score >2 and ≤ 2. Among 17,465 anticoagulated patients with AF, 4,828 (27.6%) patients were prescribed VKA and 12,637 (72.4%) patients an NOAC: 11,884 (68.0%) patients had SAMe-TT2R2 scores 0-2 and 5,581 (32.0%) patients had scores >2. The proportion of patients prescribed VKA was 28.0% among patients with SAMe-TT2R2 scores >2 and 27.5% in those with scores ≤2. Conclusions The lack of a clear association between the SAMe-TT2R2 score and anticoagulant selection may be attributed to the relative efficacy and safety profiles between NOACs and VKAs as well as to the absence of trial evidence that an SAMe-TT2R2-guided strategy for the selection of the type of anticoagulation in NVAF patients has an impact on clinical outcomes of efficacy and safety. The latter hypothesis is currently being tested in a randomized controlled trial.

Introducción y objetivos: La coexistencia de la fibrilación auricular y la diabetes mellitus es frecuente. Nuestro objetivo es analizar la manera como los cardiólogos tratamos a los pacientes que padecen ambas enfermedades en 2019. Métodos: Dise ̃namos un registro multicéntrico y prospectivo en el que incluimos todos los pacientes atendidos en consultas externas en los que coexistían ambas entidades. Se recogen parámetros clínicos, electrocardiográficos, ecocardiográficos y analíticos, el tratamiento que venían tomando los pacientes y la actitud terapéutica de los cardiólogos. Resultados: Durante 11 meses incluimos 658 pacientes, 55% mujeres, de 73,8 ± 8,5 a ̃nos de edad. Encontra- mos una elevadísima prevalencia de otros factores de riesgo con diferencias significativas entre géneros. No se utiliza el ácido acetilsalicílico y se anticoagula al 96% de aquellos que lo precisan según las guías. Aquellos que siguen tratados con antivitamina K tienen un tiempo en rango terapéutico de Rosendaal de 59,8 ± 31, pero solo se optimiza el tratamiento en el 57,4% (rango de variabilidad entre cardiólogos 10-93%, p = 0,001) de los que tenían un tiempo en rango terapéutico < 65%. La hemoglobina glucosilada era de 7 ± 1,2, y el 37,5% presentaban cifras de hemoglobina glucosilada ≥ 7. Los cardiólogos optimizaron el tratamiento en el 35,2% de ellos (rango de variabilidad entre cardiólogos 6,3-93%, p = 0,0001). Si esta era ≥ 7,5, se optimizaba en el 46,3% y si era ≥ 9 en el 63,2%. Conclusiones: La coexistencia de fibrilación auricular y diabetes mellitus define una población de ele- vadísimo riesgo cardiovascular. La intervención del cardiólogo en el tratamiento anticoagulante y antidiabético es buena, pero mejorable, y hay gran variabilidad entre profesionales., Introduction and objectives: The coexistence of atrial fibrillation and diabetes mellitus is frequent. Our goal was to analyse how cardiologists treated patients with both pathologies in 2019. Methods: We designed a prospective, multicentre registry in which we included all the patients in whom both pathologies coexisted. Clinical, analytical, electrocardiographic, and echocardiographic parameters were collected. In addition, we collected the treatment that patients had been taking and the attitude of cardiologists. Results: Over 11 months we included 658 patients, 55% women, 73.8 ± 8.5 years. We found an extremely high prevalence of other risk factors with significant differences between genders. Acetylsalicylic acid was not used and 96% of those who required it were anticoagulated according to the guidelines. Those who were treated with aVK had a Rosendaal’s time in therapeutic range of 59.8 ± 31, but treatment was only optimized in 57.4% (range of variability between cardiologists 10%-93%, P = .001) of which < 65% had time in therapeutic range. Glycated haemoglobin was 7.0 ± 1.2, and 37.5% had glycated hemoglobin levels ≥ 7.0. Cardiologists optimized treatment in 35.2% of them (range of variability between cardiologists 6.3%-93%, P = .0001). If it was ≥ 7.5, it was optimized in 46.3% and if it was ≥ 9 in 63.2%. Conclusions: The coexistence of atrial fibrillation and diabetes mellitus defines a population with a very high cardiovascular risk. The intervention of the cardiologist in anticoagulant and antidiabetic treatment is good, but it can be improved, and there is great variability among professionals.

Aim The SAMe-TT2R2 score helps identify patients with atrial fibrillation (AF) likely to have poor anticoagulation control during anticoagulation with vitamin K antagonists (VKA) and those with scores >2 might be better managed with a target-specific oral anticoagulant (NOAC). We hypothesized that in clinical practice, VKAs may be prescribed less frequently to patients with AF and SAMe-TT2R2 scores >2 than to patients with lower scores. Methods and results We analyzed the Phase III dataset of the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF), a large, global, prospective global registry of patients with newly diagnosed AF and ≥1 stroke risk factor. We compared baseline clinical characteristics and antithrombotic prescriptions to determine the probability of the VKA prescription among anticoagulated patients with the baseline SAMe-TT2R2 score >2 and ≤ 2. Among 17,465 anticoagulated patients with AF, 4,828 (27.6%) patients were prescribed VKA and 12,637 (72.4%) patients an NOAC: 11,884 (68.0%) patients had SAMe-TT2R2 scores 0-2 and 5,581 (32.0%) patients had scores >2. The proportion of patients prescribed VKA was 28.0% among patients with SAMe-TT2R2 scores >2 and 27.5% in those with scores ≤2. Conclusions The lack of a clear association between the SAMe-TT2R2 score and anticoagulant selection may be attributed to the relative efficacy and safety profiles between NOACs and VKAs as well as to the absence of trial evidence that an SAMe-TT2R2-guided strategy for the selection of the type of anticoagulation in NVAF patients has an impact on clinical outcomes of efficacy and safety. The latter hypothesis is currently being tested in a randomized controlled trial.

Introducción y objetivos: La coexistencia de la fibrilación auricular y la diabetes mellitus es frecuente. Nuestro objetivo es analizar la manera como los cardiólogos tratamos a los pacientes que padecen ambas enfermedades en 2019. Métodos: Dise ̃namos un registro multicéntrico y prospectivo en el que incluimos todos los pacientes atendidos en consultas externas en los que coexistían ambas entidades. Se recogen parámetros clínicos, electrocardiográficos, ecocardiográficos y analíticos, el tratamiento que venían tomando los pacientes y la actitud terapéutica de los cardiólogos. Resultados: Durante 11 meses incluimos 658 pacientes, 55% mujeres, de 73,8 ± 8,5 a ̃nos de edad. Encontra- mos una elevadísima prevalencia de otros factores de riesgo con diferencias significativas entre géneros. No se utiliza el ácido acetilsalicílico y se anticoagula al 96% de aquellos que lo precisan según las guías. Aquellos que siguen tratados con antivitamina K tienen un tiempo en rango terapéutico de Rosendaal de 59,8 ± 31, pero solo se optimiza el tratamiento en el 57,4% (rango de variabilidad entre cardiólogos 10-93%, p = 0,001) de los que tenían un tiempo en rango terapéutico < 65%. La hemoglobina glucosilada era de 7 ± 1,2, y el 37,5% presentaban cifras de hemoglobina glucosilada ≥ 7. Los cardiólogos optimizaron el tratamiento en el 35,2% de ellos (rango de variabilidad entre cardiólogos 6,3-93%, p = 0,0001). Si esta era ≥ 7,5, se optimizaba en el 46,3% y si era ≥ 9 en el 63,2%. Conclusiones: La coexistencia de fibrilación auricular y diabetes mellitus define una población de ele- vadísimo riesgo cardiovascular. La intervención del cardiólogo en el tratamiento anticoagulante y antidiabético es buena, pero mejorable, y hay gran variabilidad entre profesionales., Introduction and objectives: The coexistence of atrial fibrillation and diabetes mellitus is frequent. Our goal was to analyse how cardiologists treated patients with both pathologies in 2019. Methods: We designed a prospective, multicentre registry in which we included all the patients in whom both pathologies coexisted. Clinical, analytical, electrocardiographic, and echocardiographic parameters were collected. In addition, we collected the treatment that patients had been taking and the attitude of cardiologists. Results: Over 11 months we included 658 patients, 55% women, 73.8 ± 8.5 years. We found an extremely high prevalence of other risk factors with significant differences between genders. Acetylsalicylic acid was not used and 96% of those who required it were anticoagulated according to the guidelines. Those who were treated with aVK had a Rosendaal’s time in therapeutic range of 59.8 ± 31, but treatment was only optimized in 57.4% (range of variability between cardiologists 10%-93%, P = .001) of which < 65% had time in therapeutic range. Glycated haemoglobin was 7.0 ± 1.2, and 37.5% had glycated hemoglobin levels ≥ 7.0. Cardiologists optimized treatment in 35.2% of them (range of variability between cardiologists 6.3%-93%, P = .0001). If it was ≥ 7.5, it was optimized in 46.3% and if it was ≥ 9 in 63.2%. Conclusions: The coexistence of atrial fibrillation and diabetes mellitus defines a population with a very high cardiovascular risk. The intervention of the cardiologist in anticoagulant and antidiabetic treatment is good, but it can be improved, and there is great variability among professionals.

One in three vasovagal syncope (VVS) patients has syncopal recurrence after diagnosis, despite the standard recommendations for the avoidance of a recurrence, and one in five patients has more than one syncopal recurrence in the medium term. Given the high prevalence of VVS, there is a large population that continues to need effective treatment. There are numerous studies that use the implantable loop recorder (ILR) to document a cardioinhibitory response during VVS, with one study, ISSUE-3, demonstrating the efficacy of pacing using the rate-drop-response algorithm to trigger pacing and prevent syncopal recurrence in this population. There are more uncertainties in the studies that have used head-up tilt test (HUT) to select the population for pacing. We have recently performed the SPAIN randomized, controlled clinical trial using HUT to select the patients for pacing. The conclusion of the study was that, with the closed-loop system to introduce pacing, there was a significant reduction in the burden of syncope and a seven-fold increase in the time to first recurrence of syncope, which was greater than in the ISSUE-3 study. Since the completion of the SPAIN trial and its inclusion in the European guidelines, in our daily clinical practice, the use of this therapy is still recommended with caution in the context of the available literature, but it has increased our confidence in so doing. One in five patients with VVS needs treatment because of a high syncopal load. If an ILR is used to select the patients for pacing, the rate-drop-response algorithm can be recommended. In patients who have asystole on HUT, pacing with the closed-loop system has higher success and must now be considered as a tenable option for VVS patients.

Background: Real-world data from different regions are needed to support the external validity of con trolled trials and assess the impact of new oral anticoagulants (NOAC) in clinical practice. Methods: ‘‘GLORIA-AF” is a large, ongoing, multicenter, global, prospective registry program in patients with newly diagnosed non-valvular atrial fibrillation (NVAF) at risk of stroke. Newly diagnosed patients with NVAF (within 4.5 months) and a CHA2DS2-VASc score 1 were consecutively enrolled. The study objective was to estimate the incidence rate of stroke and major bleeding after a two year follow up of patients on dabigatran that participated in the ‘‘GLORIA-AF” study (Phase II) in Latin America. Results: Latin America included 378 eligible patients that received dabigatran in eight countries (Argentina, Brazil, Chile, Colombia, Ecuador, Mexico, Perú, and Venezuela): 56.3% were male; mean age was 70.3 ± 10.8 years; 43.4% had paroxysmal AF; 36.0% persistent AF and 20.6% permanent AF. Mean CHA2DS2-VASc score was 3.2 ± 1.4; mean HAS-BLED score was 1.2 ± 0.8. Incidence rates for clinical events after 2-years of follow-up per 100 patient-years were as follows: stroke 0.33 (95% CI: 0.04–1.17), major bleeding 0.49 (95% CI: 0.10–1.42) and all-cause death 4.06 (95% CI: 2.63–6.00). Persistence with dabiga tran at 6, 12 and 24 months was 91%, 86%, and 80%, respectively. Conclusion: These regional data shows the sustained safety and effectiveness of dabigatran over two years of follow-up, consistent with already available evidence. An increase in accessibility and incorpo ration of NOAC to anticoagulant treatment strategies could potentially have a positive impact on AF stroke prevention in Latin America.

One in three vasovagal syncope (VVS) patients has syncopal recurrence after diagnosis, despite the standard recommendations for the avoidance of a recurrence, and one in five patients has more than one syncopal recurrence in the medium term. Given the high prevalence of VVS, there is a large population that continues to need effective treatment. There are numerous studies that use the implantable loop recorder (ILR) to document a cardioinhibitory response during VVS, with one study, ISSUE-3, demonstrating the efficacy of pacing using the rate-drop-response algorithm to trigger pacing and prevent syncopal recurrence in this population. There are more uncertainties in the studies that have used head-up tilt test (HUT) to select the population for pacing. We have recently performed the SPAIN randomized, controlled clinical trial using HUT to select the patients for pacing. The conclusion of the study was that, with the closed-loop system to introduce pacing, there was a significant reduction in the burden of syncope and a seven-fold increase in the time to first recurrence of syncope, which was greater than in the ISSUE-3 study. Since the completion of the SPAIN trial and its inclusion in the European guidelines, in our daily clinical practice, the use of this therapy is still recommended with caution in the context of the available literature, but it has increased our confidence in so doing. One in five patients with VVS needs treatment because of a high syncopal load. If an ILR is used to select the patients for pacing, the rate-drop-response algorithm can be recommended. In patients who have asystole on HUT, pacing with the closed-loop system has higher success and must now be considered as a tenable option for VVS patients.

Background: Real-world data from different regions are needed to support the external validity of con trolled trials and assess the impact of new oral anticoagulants (NOAC) in clinical practice. Methods: ‘‘GLORIA-AF” is a large, ongoing, multicenter, global, prospective registry program in patients with newly diagnosed non-valvular atrial fibrillation (NVAF) at risk of stroke. Newly diagnosed patients with NVAF (within 4.5 months) and a CHA2DS2-VASc score 1 were consecutively enrolled. The study objective was to estimate the incidence rate of stroke and major bleeding after a two year follow up of patients on dabigatran that participated in the ‘‘GLORIA-AF” study (Phase II) in Latin America. Results: Latin America included 378 eligible patients that received dabigatran in eight countries (Argentina, Brazil, Chile, Colombia, Ecuador, Mexico, Perú, and Venezuela): 56.3% were male; mean age was 70.3 ± 10.8 years; 43.4% had paroxysmal AF; 36.0% persistent AF and 20.6% permanent AF. Mean CHA2DS2-VASc score was 3.2 ± 1.4; mean HAS-BLED score was 1.2 ± 0.8. Incidence rates for clinical events after 2-years of follow-up per 100 patient-years were as follows: stroke 0.33 (95% CI: 0.04–1.17), major bleeding 0.49 (95% CI: 0.10–1.42) and all-cause death 4.06 (95% CI: 2.63–6.00). Persistence with dabiga tran at 6, 12 and 24 months was 91%, 86%, and 80%, respectively. Conclusion: These regional data shows the sustained safety and effectiveness of dabigatran over two years of follow-up, consistent with already available evidence. An increase in accessibility and incorpo ration of NOAC to anticoagulant treatment strategies could potentially have a positive impact on AF stroke prevention in Latin America.