medigraphic.com
SPANISH

Revista Cubana de Medicina General Integral

ISSN 1561-3038 (Print)
  • Contents
  • View Archive
  • Information
    • General Information        
    • Directory
  • Publish
    • Instructions for authors        
  • medigraphic.com
    • Home
    • Journals index            
    • Register / Login
  • Mi perfil

2022, Number 1

<< Back Next >>

Rev Cubana Med Gen Integr 2022; 38 (1)

Atrial Fibrillation in Primary Healthcare

Herrera VJL, Peña BM
Full text How to cite this article

Language: Spanish
References: 24
Page: 1-15
PDF size: 560.86 Kb.


Key words:

atrial fibrillation, antiarrhythmic, municipal intensive unit.

ABSTRACT

Introduction: Atrial fibrillation is an important health concerns, due to its increasing incidence with aging and association with other diseases. Patients with atrial fibrillation have 4-5 times the risk of stroke and about twice the risk of death in relation to those without atrial fibrillation.
Objective: To characterize patients with atrial fibrillation treated at Guanabo outpatient Polyclinic.
Methods: A retrospective, descriptive and cross-sectional study was carried out with all the patients admitted, with the aforementioned arrhythmia, in the municipal intensive care unit of Guanabo (eastern Havana, Cuba). Twenty-four months were reviewed (10 from 2017 and 2018, and the first four-month period of 2019). The variables studied were main diagnosis at admission, hemodynamic status, lethality, therapeutic strategy, and final behavior.
Results: Regarding their main diagnosis on admission, fibrillation accounted for 52% of cases, another entity plus electrocardiographic findings accounted for the rest; 6.5% arrived with hemodynamic instability. Two cases died, which resulted in a case fatality rate of 2.2%. Pharmacological cardioversion was used in 68 cases (75%). The most commonly used drugs were amiodarone, atenolol and digoxin. Electrical cardioversion was applied in only four of the six unstable cases. Fifty-eight percent were discharged home, 39% were remitted, and 70% had a stay between two and three hours.
Conclusions: The main diagnosis at admission was atrial fibrillation, with hemodynamic stability and low lethality. The therapeutic strategy consisted of amiodarone, atenolol and digoxin. The service showed high solving capacity. The average length of stay was two to three hours.


REFERENCES

  1. Lip GYH, Tse H-F. Management of atrial fibrillation. Lancet. 2007;1:604-18.

  2. Fuster V, Ryde´n LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, et al. ACC/ AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation-executive summary: a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation). J Am Coll Cardiol. 2006;48:854-906. DOI: https://doi.org/10.1016/j.jacc.2006.07.009

  3. Benjamin EJ, Levy D, Vaziri SM, D'Agostino RB, Belanger AJ, Wolf PA. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA. 1994;271:840-4.

  4. Wolf PA, Dawber TR, Thomas HE Jr, Kannel WB. Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham study. Neurology. 1978;28(10):973-77.

  5. Seguel EM. ¿Es posible prevenir la fibrilación auricular y sus complicaciones? Rev Med Clin Condes. 2012 [acceso: 10/12/2017];23(6):732-41. Disponible en: https://www.clinicalascondes.cl

  6. Declaración de Helsinki de la asociación médica mundial. Principios éticos para las investigaciones médicas en seres humanos. Adoptada por la 18ª Asamblea Médica Mundial Helsinki, Finlandia. 1964 [acceso: 28/11/2000]. Disponible en: http://www.wma.net/s/helsinki.html

  7. Fabritz L, Guasch E, Antoniades C. Defining the major health modifiers causing atrial fibrillation: a roadmap to underpin personalized prevention and treatment. Nat Rev Cardiol. 2016;13:230-7. DOI: https://doi.org/10.1038/nrcardio.2015.194

  8. Benjamin EJ, Levy D, Vaziri SM, D'Agostino RB, Belanger AJ, Wolf PA. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA. 1994;271:840-4.

  9. Naqash JS, Feinberg J, Nielsen EE, Sanam S, Gluud C, Jakobsen JC, et al. The effect of rhythm control strategies versus rate control strategies for atrial fibrillation and atrial flutter: A systematic review with meta-analysis and trial sequential analysis. PloS one. 2017 [acceso: 26/10/2017];12(10):eo186856. Disponible en: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0186856

  10. Pluymaekers N, Dudink E, Luermans J, Meeder JG, Lenderink T, Widdershoven J, et al. Early or delayed cardioversion in recent-onset atrial fibrillation. N Engl J Med. 2019 [acceso: 26/01/2020];380:1499-508. Disponible en: https://pubmed.ncbi.nlm.nih.gov/30883054/

  11. Baugh CW, Clark CL, Wilson JW, Stiell IG, Kocheril AG Luck KK, et al. Creation and implementation of an outpatient pathway for atrial Fibrillation in the emergency department setting: results of an expert panel. Acad Emerg Med. 2018; 25:1065-75. Disponible en: https://baugh.bwh.harvard.edu/publications

  12. Wyse DG, Waldo AL, DiMarco JP, Domanski MJ, Rosenberg Y, Schron EB, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002;347:1825-33. DOI: https://www.nejm.org/doi/full/10.1056/NEJMoa021328

  13. Nikki AHA. Pluymaekers MD, Elton AMP, Dudink MD, Justin GLM, Luermans MD, et al. Fuente: NEJM Early or Delayed Cardioversion in Recent-Onset Atrial Fibrillation. (Financiado por la Organización de los Países Bajos para la Investigación y el Desarrollo de la Salud y otros; RACE 7 ACWAS ClinicalTrials.gov, número NCT02248753. DOI: https://doi.org/10.1056/NEJMoa1900353

  14. Vinson DR, Hoehn T, Graber DJ, Williams TM. Managing emergency department patients with recent onset atrial fibrillation. J Emerg Med. 2012 [acceso: 26/10/2014];42:139-48. Disponible en: https://www.medscape.com/viewarticle/813618_3

  15. Pluymaekers N, Dudink E, Luermans J, Meeder JG, Lenderink T, Widdershoven J, et al. Early or delayed cardioversion in recent-onset atrial fibrillation. N Engl J Med. 2019;380:1499-508. DOI: https://www.nejm.org/doi/10.1056/NEJMoa1900353

  16. Jennifer L. White, Judd E. Hollander. Rapid atrial fibrillation, rapid cardioversion, rapid return home. Emergencias. 2019;31:223-4. Disponible en: https://dialnet.unirioja.es/servlet/articulo?codigo=6981119

  17. Coll-Vinent B, Fuenzalida C, García A, Martín A, Miró Ò, et al. Management of acute atrial fibrillation in the emergency department: a systematic review of recent studies. Eur J Emerg Med. 2013 [acceso: 26/10/2017];20:151-9. Disponible en https://journals.lww.com/euroemergencymed/Abstract/2013/06000/Management_of_acute_atrial_fibrillation_in_the.2.aspx

  18. Fernández de Simón A, Coll-Vinent B, Martín A, Suero C, Sánchez J, Varona M, et al, en representación de los investigadores del estudio HERMES-AF. Metanálisis de estudios antitrombótico. 2011 [acceso: 26/10/2017]. Disponible en: https://titulomasterentrombosis.com/asignatura-4/

  19. Ballard DW, Reed ME, Singh N, Rauchwerger AS, Hamity CA, Warton EM, et al. Emergency department management of atrial fibrillation and flutter and patient quality of life at one-month post visit. Ann Emerg Med. 2015;66:646-54. DOI: https://doi.org/10.1016/j.annemergmed.2015.04.011

  20. Sandhu RK, Smigorowsky M, Lockwood E. Impact of electrical cardioversion on quality of life for the treatment of atrial fibrillation. Can J Cardiol. 2017;33:450-5. DOI: https://doi.org/10.1016/j.cjca.2016.11.013

  21. Lip GYH, Nieuwlaat R, Pisters R, Lane DA, Crijns HJGM. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest. 2010 [acceso: 26/10/2017];137(2):263-72. Disponible en: https://journal.chestnet.org/article/S0012-3692(10)60067-0/fulltext

  22. Craig TJ, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC Jr., et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2019;74(1):104-132. DOI: https://doi.org/10.1016/j.jacc.2019.01.011

  23. Lopes RD, Rordorf R, De Ferrari GM, Leonardi S, Laine T, Wojdyla DM, et al. For the ARISTOTLE Committees and Investigators. Digoxin and Mortality in Patients with Atrial Fibrillation. Journal of the American College of Cardiology. Elsevier. 2018 [acceso: 26/10/2019];71(10). Disponible en: https://www.jacc.org/doi/10.1016/j.jacc.2017.12.060?utm_campaign=toc&utm_medium=email_newsletter&utm_content=20180305&utm_source=jacc&sso=1&rss=1&sso_redirect_count=4&access_token=

  24. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. Guía ESC 2016 sobre el diagnóstico y tratamiento de la fibrilación auricular, desarrollada en colaboración con la EACTS. DOI: https://doi.org/10.1016/j.recesp.2016.11.014




2020     |     www.medigraphic.com

Mi perfil

C?MO CITAR (Vancouver)

Rev Cubana Med Gen Integr. 2022;38