Login
Search
Search
0 Dates
2024
2023
2022
2021
2020
2019
2018
0 Events
CPC 2018
CPC 2019
Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
CPC 2020
CPC 2021
CPC 2022
CPC 2023
CPC 2024
0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
G. Aortic Disease, Peripheral Vascular Disease, Stroke
H. Interventional Cardiology and Cardiovascular Surgery
I. Hypertension
J. Preventive Cardiology
K. Cardiovascular Disease In Special Populations
L. Cardiovascular Pharmacology
M. Cardiovascular Nursing
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
O. Basic Science
P. Other
0 Themes
01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
37. Miscellanea
0 Resources
Abstract
Slides
Vídeo
Report
CLEAR FILTERS
Very fragile patients with atrial fibrillation: to anticoagulate or not is the question!
Session:
Painel 12 -Cardio-Oncologia / Farmacologia 1
Speaker:
Sofia S. Martinho
Congress:
CPC 2020
Topic:
K. Cardiovascular Disease In Special Populations
Theme:
30. Cardiovascular Disease in Special Populations
Subtheme:
30.6 Cardio-Oncology
Session Type:
Posters
FP Number:
---
Authors:
Sofia S. Martinho; José Almeida; Adriana Girão; Flávio André Freitas; Catia Ferreira; James Milner; João André Ferreira; Fátima Franco Silva; Rui Baptista; Lino Gonçalves
Abstract
<p>BACKGROUND: In the setting of patients with atrial fibrillation (AF), older age and frailty increase the risk of both thromboembolic and haemorrhagic complications. One tool to evaluate frailty is through the Katz Index of activities of daily living (KI). We hypothesized that among a frail population, non-necessarily an elderly one, the net clinical benefit of anticoagulation persists.</p> <p>METHODS: We conducted a retrospective, observational study of 800 patients with AF admitted to an Internal Medicine ward and grouped the population according to the KI: KI=0 (totally dependent: n=293, 39%) and KI>0 (non-totally dependent: n=455, 61%). Patients were stratified whether they were adequately anticoagulated [with low molecular weight heparin, warfarin or direct oral anticoagulant (DOAC) at correct dose] or inadequately anticoagulated (discharged with no anticoagulant or anticoagulant at an incorrect dose). Finally, we assessed the incidence of 1-year adverse outcomes (cardiovascular death, ischemic or haemorrhagic stroke and major bleeding).</p> <p>RESULTS: Patients with KI=0 were slightly older (86±7 vs 81±8, p<0.001) than patients with KI>0, with a similar gender distribution (57% women). A KI=0 conferred a 3-fold higher risk of dying than a KI>0 (p<0.01). There was a significant interaction between anticoagulation adequacy and mortality: inadequately anticoagulated patients with KI=0 had a 1.6-fold higher mortality compared to those adequately anticoagulated, after adjusting for age and sex (63% vs 47%), HR 1.60 (95% CI 1.05-2.45, Log Rank p=0.026). Conversely, no interaction was found between the adequacy of anticoagulation and the risk of events in KI=0 patients (ischemic stroke n=1, 2.3%; haemorrhagic stroke n=4, 0.6% major bleeding n=6, 3.5% in inadequately anticoagulated).</p> <p>CONCLUSIONS: Although we cannot exclude prescription bias, in extremely frail, totally dependent patients a benefit was found from an adequate anticoagulation strategy, if the focus is cardiovascular mortality. The ischemic and hemorrhagic event rate was similar among groups, eventually due to underreporting. Thus, we want to reinforce the importance of evaluating variables other than fragility, like cognitive function at the time of the decision to anticoagulate a extremely frail patient.</p>
Slides
Our mission: To reduce the burden of cardiovascular disease
Visit our site