Prevalence and clinical-therapeutic profile of atrial fibrillation in private cardiology offices in northeast Mexico

Introduction: The prevalence of atrial fibrillation (AF) in Mexico is unknown. Objectives: To document AF prevalence and a clinical-therapeutic profile. Methods: Cross-sectional study in three private cardiology offices in Northeast Mexico; in 337 patients from 8,999 clinical records, AF was documented. Results: AF prevalence was 3.74%, permanent 56.0%, paroxistic 28.4%, persistent 15.7%; non valvular atrial fibrillation (NVAF) 94.06%. Age 74 ± 12.89 years, women 52.22%, hypertension, 74.18%, smoking, 36.79%, alcoholism 35.01% and type 2 diabetes, 30.56%. The CHA2DS2-VASc ≥ 2 group vs 0-1, received more anticoagulant (OAC) (31.88 vs 8.33%) and new oral anticoagulant (NOAC) (53.31 vs 13.33%) p < 0.01 for both. In ages 60-75, the CHA2DS2VASc ≥ 2 group vs 0-1, received more OAC (34.89 vs 6.25%) p = 0.0004, and NOAC (54.16 vs 0%) p < 0.01. The CHADS group ≥ 2 vs 0-1, used more OAC (33.6 vs 18.8%) and NOAC (55.17 vs 34.11%) p < 0.01 for both and vitamin K antagonist (VKA) (12.06 vs 3.5%) p = 0.004. The CHA2DS2VASc group ≥ 2 vs 0-1, had more women than men (95.03% versus 85.9%), received more diuretics (57.49 vs 13.33), mineralocorticoid receptor antagonist (MRA) (27.52 vs 0%) and angiotensin receptor blockers (ARB) (55.40 vs 16.66%) p < 0.01 for all. Conclusion: In our patients, AF is characterized by having a clinical profile of high cardiovascular risk, alcoholism, senility and predominance of women, with a prevalence (3.74%) similar to that of other western countries. RESUMEN Introducción: La prevalencia de fibrilación auricular (FA) en México es desconocida. Objetivos: Documentar la prevalencia de FA y su perfil clínico-terapéutico. Métodos: Estudio transversal, en tres consultorios privados de cardiología; en 337 de 8,999 expedientes clínicos, la FA fue documentada. Resultados: Prevalencia de FA, 3.74%; permanente 56.0%, paroxística 28.4%, persistente 15.7%. FANV 94.06%. Edad, 74 ± 12.89 años, mujeres 52.22%, hipertensión, 74.18%, tabaquismo, 36.79%, alcoholismo 35.01%, diabetes tipo 2, 30.56%. El grupo CHA2DS2-VASc ≥ 2, comparado al 0-1, recibió más anticoagulación oral ACO (31.88 vs 8.333%) y nuevos anticoagulantes orales (NAO) (53.31 vs 13.33%) p < 0.01 para ambos. En pacientes de 60-75 años, se utilizaron más ACO en el grupo CHA2DS2-VASc ≥ 2 respecto al 0-1 (34.89 vs 6.25%) p = 0.0004 y NOA (54.16 vs 0%) p < 0.01. El grupo CHADS ≥ 2 comparado al 0-1, utilizó más ACO (33.6 vs 18.8%) NAO (55.17 vs 34.11%) p < 0.01 para ambos y antagonistas de la vitamina K (AVK) (12.06 vs 3.5%) p = 0.004. El grupo CHA2DS2-VASc ≥ 2 vs 0-1 tuvo más mujeres que hombres (95.03 vs 85.9%), recibió más diuréticos (57.49 vs 13.33%), antagonistas de los receptores de mineralocorticoides (ARM) (27.52 vs 0%) y bloqueadores de los receptores de angiotensina 2 (BRA 2) (55.40 vs 16.66%) p < 0.01 para todos. Conclusión: En nuestros pacientes la FA se caracteriza por tener un perfil de alto riesgo cardiovascular, alcoholismo, senilidad y predominio de mujeres, con una prevalencia (3.74%) similar a la de otros países occidentales. the most frequent in cardiological practice, is of special importance because it increases the risk of dementia, heart failure (HF) and embolic cerebrovascular disease (ECVD). 1 In addition to causing a deterioration in the quality of life, it increases hospital mortality and health care costs. INTRODUCTION W the increase in the life expectancy of the population, in the last 20 years there has also been a notable increase in the diagnosis of atrial fibrillation (AF). This arrhythmia, www.medigraphic. org.mx 41 Solís OCA et al. Prevalence and clinical-therapeutic profile of atrial fibrillation in private cardiology offices in northeast Mexico www.medigraphic. com/cms Cardiovasc Metab Sci 2020; 31 (2): 40-48 The prevalence of AF in western countries is 1.9 to 3.0% in the general population, predominates in men and increases in frequency of onset with advancing age, in both sexes.2 The evidence about the prevalence and consequences of AF, comes from studies conducted in Europe and North America, whose data contrast with those provided by studies conducted in African-American and Indo-Asian populations, observing significant differences between these ethnic groups and the population white, as reported in the Indo-Asian population of the United Kingdom, with a very low prevalence of AF of 0.6%. 3,4 We do not know if these ethnic epidemiological differences also occur in Hispanic patients, since the epidemiology of AF is scarce in Latin America and Mexico. The results of the CARMEN AF study (in process)5 will surely expand this information. On the other hand, given the known difficulties in achieving optimal oral with vitamin K antagonists (VKA), a new oral anticoagulants (NOAC), of simple dosage and predictable pharmacokinetics appeared a decade ago, observing a progressive increases in their prescription and actually are currently the firstline oral anticoagulant (OAC) in the cardiological guidelines, with similar efficacy or higher to VKA in the prevention of ECVD, in patients with non-valvular atrial fibrillation (NVAF). 6 Despite this, some experts have pointed out that these OAC are still underutilized, considering suboptimal percentages of utilization less than 70% observed in countries like Mexico, Germany, United Kingdom, Canada and even in the health system of France, with 66.3%. 7 The present work reviews the experience in the care of Mexican patients with AF, from a group of private cardiologists in Northeast Mexico, seeking to document their clinical-therapeutic profile, with special focus on the frequency of use of OAC. Objectives: Primary objective: to document the prevalence of AF in Mexican patients treated in private cardiology offices in Northeast Mexico. Secondary objective: to establish a clinical-therapeutic profile. MATERIAL AND METHODS Cross-sectional and observational study of patients treated during the last 5 years in 3 private cardiology offices. Two of the offices were located in the State of Nuevo León (one in the city of Monterrey and another in San Nicolás de los Garza) and the other in the city of Tampico, Tamaulipas. From 8,999 clinical records, 337 were diagnosed with AF. Inclusion criteria: both sexes, any age and etiology, NVAF and valve (VAF), regardless of their duration. Exclusion criteria: undocumented AF. Qualitative and quantitative variables of interest were obtained, such as main clinical history, etiologies, left ventricular ejection fraction (LVEF) and pharmacotherapy. The CHADS and CHA2DS2VASc scales were used to calculate embolic risk. The paroxysmal AF was identified by its sudden onset and spontaneous end, within 7 days of initiation. The persistent form was defined as one in wich the episode last more than 7 days. This includes cases that could stop spontaneously and those that end with pharmacologicalor electrical cardioversion. The permanent AF was defined as one that is decided not to revert to sinus rhythm. Statistic analysis: Descriptive statistics. Continuous variables expressed as mean ± standard deviation; categorical variables as percentages. For the association of 2 categorical variables, T of proportions was used. Statistical analyzes were performed using the SPSS software. The tentative level of significance was 0.05.