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Resumen Introduccion y objetivos La prevalencia y la incidencia de la fibrilacion auricular (FA), un importante factor de riesgo de ictus cardioembolico, han aumentado sustancialmente en los ultimos anos. Sin embargo, varios estudios europeos han observado una disminucion en la tasa de ictus cardioembolico asociada con un aumento de la penetracion de los anticoagulantes orales de accion directa (ACOD). Este estudio ecologico evalua la asociacion entre la penetracion de los ACOD y la tasa de incidencia de ictus cardioembolicos en Espana. Metodos Los datos se obtuvieron del Registro de Actividad Sanitaria Especializada del Ministerio de Sanidad de Espana (RAE-CMBD). Los ictus cardioembolicos se identificaron mediante codigos ICD. Las tasas de incidencia se estandarizaron por edad y se ajustaron a la poblacion estandar europea de 2013. Se utilizaron modelos de regresion de Poisson para estimar la asociacion entre la penetracion de los ACOD y la tasa de ictus cardioembolico en pacientes de 65 o mas anos. Resultados La tasa de incidencia ajustada (TI) del ictus cardioembolico aumento desde 2005 (2,20/100.000 personas/ano) hasta 2012 (2,67). A partir de 2012, tras la introduccion de los ACOD para la prevencion del ictus cardioembolico en Espana, la TI se ha mantenido constante o ha disminuido ligeramente (en 2018, 2,66). Los resultados del modelo de regresion de Poisson indican que la penetracion de los ACOD tiene una influencia estadisticamente significativa en la tasa de ictus cardioembolicos de los mayores de 65 anos (RDI = 0,995; IC95%, 0,995-0,996). Conclusiones Los resultados de este estudio muestran una asociacion entre la penetracion de los ACOD y una menor incidencia de ictus cardioembolicos. A pesar de que esta asociacion no implica causalidad, indica que una mayor penetracion de los ACOD podria llevar a un mayor beneficio clinico para los pacientes con FA en Espana.

La fibrilación auricular aumenta hasta en 5 veces el riesgo de ictus. Los ictus cardioembólicos habitualmente son más graves y tienen altas tasas de recurrencias y discapacidad permanente en comparación con los ictus de otras etiologías. En consecuencia, la reducción del riesgo de ictus mediante una adecuada anticoagulación es uno de los principales objetivos en el tratamiento de los pacientes con fibrilación auricular. Los antagonistas de la vitamina K han sido ampliamente superados por los anticoagulantes orales de acción directa, ya que tanto los resultados de los ensayos clínicos como los de los estudios de práctica clínica y, últimamente, estudios poblacionales han demostrado que los anticoagulantes orales de acción directa tienen mayores eficacia (menos ictus y muerte) y seguridad (menos hemorragias intracraneales) que los antagonistas de la vitamina K. Además, durante la pandemia de COVID-19, el empleo preferente de anticoagulantes orales de acción directa frente a los antagonistas de la vitamina K constituye una estrategia clave para garantizar una calidad óptima de la anticoagulación y una mejor protección del paciente contra el SARS-CoV-2, al no precisarse control de la razón internacional normalizada.

The increased availability of new cancer treatments in recent years has led to improved prognosis and increased life expectancy for cancer patients, but at the expense of increased cardiovascular risk. For this reason, multidisciplinary teams need to be formed for the joint evaluation of these patients to optimise the cardiovascular health and overall survival of these patients and minimise interruptions to onco-haematological treatments. A wide range of cardiovascular toxicities are associated with the various cancer treatments. The structured control of cardiovascular risk before, during and after oncological treatment will enable strategies for the prevention, early detection and early treatment of cardiotoxicities.

Objective: To analyze impact of implementation of an oral anticoagulation self-monitoring and self-management program among patients with mechanical valve prosthesis. Materials & methods: Observational and retrospective study performed in Hospital Moises Broggi, Barcelona, Spain. The program started on June 2019. The study compared 6-month period before and after the implementation of the program. Results: The study included 44 patients. There was a numerical increase of time in therapeutic range from 53.6 ± 21.3% to 57.1 ± 15.7% (p = 0.30). Proportion of patients with international normalized ratio (INR) >5 significantly decreased from 3.9 to 2.0% (p = 0.04). No significant differences were observed in thromboembolic or bleeding complications. Visits to emergency department decreased from (29.5 to 22.7%; p = 0.41). Conclusion: Oral anticoagulation self-monitoring and self-management program seems an appropriate approach that could provide additional benefits in selected patients with mechanical valve prosthesis.

To analyze the temporal trends of atrial fibrillation (AF)-related ischemic stroke (IS) and their relationship with the prescription patterns of antithrombotic treatment from 2013 to 2019 in the Health Assistance Area of a regional hospital.First, a retrospective ecological study of aggregate data to analyze the annual incidence of IS between 2013 and 2019 was performed. Second, we selected those patients diagnosed with AF between 2013 and 2019 and performed a retrospective longitudinal study to assess the role of antithrombotic therapy in the development of AF-related IS.During this period, whereas the annual incidence of IS remained stable (from 1.3 in 2013 to 1.2 cases per 1000 inhabitants in 2019; adjustedThe prescription of oral anticoagulants, particularly direct oral anticoagulants, has increased from 2013 to 2019 in our Health Assistance Area. This increase might partially explain the reduction in AF-related IS.

Resumen La fibrilacion auricular aumenta de manera marcada el riesgo de ictus. Multiples ensayos clinicos y estudios en practica clinica han demostrado que el tratamiento anticoagulante disminuye el riesgo de complicaciones tromboembolicas. Para este tratamiento, los anticoagulantes orales de accion directa (ACOD) ofrecen un mejor perfil de eficacia y seguridad que los antagonistas de la vitamina K. Estudios realizados en paises de nuestro entorno han objetivado en los ultimos anos una reduccion en la incidencia de ictus isquemico, lo que podria estar en relacion con una mayor prescripcion de anticoagulantes orales, sobre todo ACOD. En Espana hay muy poca informacion sobre este tema. Sin embargo, los datos disponibles indican que parece que tambien la mayor prescripcion de anticoagulantes orales, sobre todo ACOD, se asociaria con una significativa reduccion de las incidencias tanto de ictus isquemico como de hemorragias intracraneales. En consecuencia, se deberia recomendar un mayor empleo de los ACOD para los pacientes con fibrilacion auricular, lo que contribuiria no solo a reducir la incidencia de ictus isquemico y de hemorragias intracraneales, sino tambien la carga economica que esto conlleva.

Aims: The role of non‐invasive telemedicine (TM) combining telemonitoring and teleintervention by videoconference (VC) in patients recently admitted due to heart failure (HF) (‘vulnerable phase’ HF patients) is not well established. The aim of the Heart failure Events reduction with Remote Monitoring and eHealth Support (HERMeS) trial is to assess the impact on clinical outcomes of implementing a TM service based on mobile health (mHealth), which includes remote daily monitoring of biometric data and symptom reporting (telemonitoring) combined with VC structured, nurse‐based follow‐up (teleintervention). The results will be compared with those of the comprehensive HF usual care (UC) strategy based on face‐to‐face on‐site visits at the vulnerable post‐discharge phase. Methods and results: We designed a 24 week nationwide, multicentre, randomized, controlled, open‐label, blinded endpoint adjudication trial to assess the effect on cardiovascular (CV) mortality and non‐fatal HF events of a TM‐based comprehensive management programme, based on mHealth, for patients with chronic HF. Approximately 508 patients with a recent hospital admission due to HF decompensation will be randomized (1:1) to either structured follow‐up based on face‐to‐face appointments (UC group) or the delivery of health care using TM. The primary outcome will be a composite of death from CV causes or non‐fatal HF events (first and recurrent) at the end of a 6 month follow‐up period. Key secondary endpoints will include components of the primary event analysis, recurrent event analysis, and patient‐reported outcomes. Conclusions: The HERMeS trial will assess the efficacy of a TM‐based follow‐up strategy for real‐world ‘vulnerable phase’ HF patients combining telemonitoring and teleintervention. info:eu-repo/semantics/publishedVersion

Introduction and objectives The incidence and prevalence of atrial fibrillation (AF), a major risk factor for stroke, has increased substantially in the past few years. However, several studies have reported a decline in AF-related stroke rates associated with higher uptake of direct oral anticoagulants (DOACs). This ecological study evaluated the association between DOAC uptake in Spain and the incidence rate (IR) of AF-related ischemic stroke. Methods Data were obtained from the Registry of Activity of Specialized Healthcare of the Spanish Ministry of Health (RAE-MDS). AF-related ischemic strokes were identified using International Classification of Diseases codes. IR were age-standardized and adjusted to the 2013 European standard population. Poisson regression models were used to identify the association between DOAC uptake and AF-related ischemic stroke in patients aged ≥ 65 years. Results Before the use of DOACs, the adjusted IR of AF-related ischemic stroke increased steadily from 2005 (IR = 2.20 per 100 000 person/y) to 2012 (IR = 2.67). Upon DOAC uptake in Spain from 2012 onwards for AF-related ischemic stroke prevention, the IR remained constant or decreased slightly (IR in 2018 = 2.66). Poisson regression showed that DOAC uptake was a significant predictor for the rate of AF-related ischemic stroke in patients older than 65 years (IRR = 0.995; 95%CI, 0.995-0.996). Conclusions This study shows an association between DOAC use and a reduced incidence of AF-related ischemic stroke. While this association is based on aggregate data and cannot demonstrate causality, these findings suggest that higher DOAC uptake could improve health outcomes in AF patients in Spain.

Aim: To analyze the impact of implementing a program integrating cardiology and primary care in clinical practice. Methods: In the integrated care model, every cardiologist was assigned to each primary care center. Results & conclusion: The implementation of the new care model was associated with a significant reduction of 31.2% in requests of first visits. In addition, the delay to the cardiologist consultation significantly decreased by 54.5% for the first visits, and by 57.1% for the follow-up visits. The proportion of patients that achieved recommended low density lipoprotein-cholesterol goals significantly increased from 20.8 to 29.6%. The proportion of patients submitted to anticoagulant therapy significantly increased from 69.3 to 74.2%, as well as the proportion of patients taking direct oral anticoagulants (from 7.9 to 28.4%).