Diferencias en el manejo de los pacientes con fibrilación auricular según inicie el tratamiento con anticoagulantes orales de acción directa el médico de atención primaria o el especialista. Estudios SILVER-AP y BRONCE-AP

  1. M. de la Figuera 1
  2. M.A. Prieto 2
  3. Marín, Nuria
  4. I. Egocheaga 3
  5. S. Cinza 4
  1. 1 CAP Sardenya, Barcelona, España
  2. 2 C.S. Vallobín-La Florida, Oviedo, España
  3. 3 Centro Salud Isla de Oza, Madrid, España
  4. 4 C.S. Porto do Son, Santiago de Compostela, La Coruña, España
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Journal:
Semergen: revista española de medicina de familia

ISSN: 1138-3593

Year of publication: 2018

Issue: 5

Pages: 323-334

Type: Article

DOI: 10.1016/J.SEMERG.2017.09.005 DIALNET GOOGLE SCHOLAR

More publications in: Semergen: revista española de medicina de familia

Sustainable development goals

Abstract

Objectives To determine the clinical characteristics and management of patients with non-valvular atrial fibrillation (NVAF) treated with direct oral anticoagulants (DOAC) according to who initiates their prescription, the Primary Care (PC) physician or referring the patient to a specialist. Material and methods Two observational, cross-sectional and multicentre studies were compared for this purpose. The SILVER-AP study was performed in those autonomous communities in which the PC physician can prescribe DOAC directly, and the BRONCE-AP study in those autonomous communities in which the PC physician has to refer the patient to the specialist to start treatment with DOAC. Patients on chronic treatment with anticoagulants, in whom therapy was changed, and those that were on current treatment with DOAC for at least 3months, were included. Results A total of 1,036 patients (790 from SILVER-AP study and 246 from BRONCE-AP study) were included. Compared with the BRONCE-AP study, those patients included in SILVER-AP were older and had more comorbidities, as well as a higher thromboembolic and haemorrhagic risk (CHA2DS2-VASc 4.3±1.6 vs. 3.8±1.8; P<.001; HAS-BLED 2.1±0.8 vs. 1.8±1.0; P<.001). Therapeutic adherence and satisfaction with treatment were high. Low doses of DOAC were frequently prescribed, particularly with dabigatran. Conclusions Those patients in whom the PC physician can prescribe DOAC directly have a worse clinical profile, as well as a higher thromboembolic and haemorrhagic risk than those patients in whom the PC physician has to refer to the specialist.

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Data source: Dialnet