Introducción: La insuficiencia cardiaca en pacientes con fibrilación auricular no valvular (FANV) es de dos a tres veces más frecuente que en individuos sin FANV. Objetivo: Identificar los factores ...de riesgo cardiometabólico (FRCM) y el tratamiento antitrombótico de pacientes con FANV e insuficiencia cardiaca con fracción de expulsión reducida (IC-FEr), y determinar si existen diferencias conforme al sexo. Métodos: En forma global y de acuerdo con el sexo se analizaron FRCM, riesgo protrombótico, riesgo de sangrado y terapia antitrombótica. Resultados: De 1423 pacientes con FANV, 336 tuvieron IC-FEr. Las mujeres promediaron mayor edad que los hombres. No hubo diferencia entre los sexos respecto al tipo de FANV o uso de anticoagulantes orales directos. La hipertensión arterial sistémica fue más frecuente en mujeres. Un 3.6 % de los pacientes reportó antecedente de ataque isquémico transitorio y 10 % de evento vascular cerebral, sin diferencias en cuanto al sexo. El porcentaje de hombres con riesgo embólico elevado fue mayor, pero sin tratamiento antitrombótico, en comparación con las mujeres. Conclusiones: Se encontraron diferencias significativas de acuerdo con el sexo en pacientes con FANV e IC-FEr, tanto en FRCM y algunas comorbilidades, como en el tratamiento antitrombótico de acuerdo con el riesgo embólico y de sangrado.
Obesity increases the risk of atrial fibrillation (AF) while it may impact the outcome of patients with AF. The clinical implications of this relationship are not completely clear. We aimed to ...analyze the association of traditional anthropometric measures of excessive adiposity with 12 month case fatality rate (CFR) in patients with AF.
This was a multicenter, longitudinal, observational study on adults with documented AF, excluding records of AF secondary to reversible causes. Anthropometric variables were registered at baseline, and a central committee validated the 12 month outcomes.
We studied 1193 patients (median age: 69.14 years, 55.2% women). At baseline, rhythm control was established for 476 (39.9%) subjects, while frequency control was offered to 717 (60.1%) participants. The 12 month all-cause CFR was 8.9%. A high basal body mass index (BMI), waist-to-height ratio (WHtR) and waist circumference (WC) were associated with lower CFR in bivariate analyses. In a Cox-proportional hazards model, variables associated with 12 month all-cause CFR were BMI categories (HR: 0.736, 95% CI: 0.584–0.928), chronic heart failure (HR: 1.738, 95% CI: 1.127–2.680), chronic kidney disease (HR: 2.269, 95% CI: 1.162–4.429) and carotid stenosis >50% (HR: 5.342, 95% CI: 1.661–17.181).
The risk of death at one year in patients with AF is inversely associated with a high BMI and directly associated with the presence of chronic kidney disease, carotid stenosis, and chronic heart failure in this cohort of patients with AF. The causes and implications of this apparent obesity paradox should be addressed in the future.
Heart failure in patients with non-valvular atrial fibrillation (NVAF) is two to three times more common than in individuals without NVAF.
To identify cardiometabolic risk factors (CMRF) and ...antithrombotic treatment in patients with NVAF and heart failure with reduced ejection fraction (HFrEF), and to determine if there were differences according to gender.
CMRF, pro-thrombotic risk, bleeding risk, and antithrombotic therapy were globally analyzed and according to gender.
Out of 1,423 patients with NVAF, 336 had HFrEF. On average, females were older than males. There was no difference between genders with regard to the type of NVAF or direct oral anticoagulants use. Hypertension was more common in women. History of transient ischemic attack was reported in 3.6% of the patients and cerebrovascular event in 10%, without differences in terms of gender. The percentage of men with elevated embolic risk was higher, but without antithrombotic treatment, in comparison with women.
Significant differences were found according to gender in patients with NVAF and HFrEF, both in CMRF and some comorbidities, as well as in antithrombotic treatment according to embolic and bleeding risk.
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