Revista portuguesa de cardiologia · 2018
The SAFIRA study: A reflection on the prevalence and treatment patterns of atrial fibrillation and cardiovascular risk factors in 7500 elderly subjects.
СтатьяРандомизированное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Monteiro Pedro, em nome dos investigadores do estudo Safira
Аннотация
INTRODUCTION AND AIM: Atrial fibrillation (AF) is a common arrhythmia and an important risk factor for ischemic stroke. The current ESC guidelines state that all patients aged 65 and over should be regularly screened for AF. The SAFIRA study aimed to determine the prevalence, epidemiology and clinical and therapeutic characterization of AF in the Portuguese elderly population.
METHODS: The study population (7500 subjects) were recruited from all Portuguese administrative regions. Demographic, clinical and drug treatment data were collected, risk scores were calculated, and an electrocardiogram (ECG) was performed in all subjects. In those not found to have AF on the resting ECG, a randomized subset (400 subjects) underwent 24-hour Holter monitoring and 200 subjects were fitted with an event recorder for two weeks, in order to identify patients with paroxysmal AF. The primary endpoint was AF prevalence; secondary endpoints (in the AF population) included prevalence of paroxysmal AF, mean and median CHA2DS2-VASc and HAS-BLED scores, rates of anticoagulant and antiplatelet therapy, previous stroke, previous stroke/transient ischemic attack, previous bleeding, and time in therapeutic range (if on vitamin K antagonists).
RESULTS: The prevalence of AF was 9.0%. Of these, 35.9% were unaware of the diagnosis and 18.6% had paroxysmal AF. Median CHA2DS2-VASc score was 3.5±1.2 and 56.3% of patients were not anticoagulated. In the AF subpopulation, the stroke rate was 11.2%. Overall, only 25.8% of the anticoagulated patients were considered to be adequately treated.
CONCLUSIONS: This study shows the high prevalence of AF in the elderly population, as well as suboptimal rates of diagnosis, anticoagulation and effective control of cardiovascular risk factors.
METHODS: The study population (7500 subjects) were recruited from all Portuguese administrative regions. Demographic, clinical and drug treatment data were collected, risk scores were calculated, and an electrocardiogram (ECG) was performed in all subjects. In those not found to have AF on the resting ECG, a randomized subset (400 subjects) underwent 24-hour Holter monitoring and 200 subjects were fitted with an event recorder for two weeks, in order to identify patients with paroxysmal AF. The primary endpoint was AF prevalence; secondary endpoints (in the AF population) included prevalence of paroxysmal AF, mean and median CHA2DS2-VASc and HAS-BLED scores, rates of anticoagulant and antiplatelet therapy, previous stroke, previous stroke/transient ischemic attack, previous bleeding, and time in therapeutic range (if on vitamin K antagonists).
RESULTS: The prevalence of AF was 9.0%. Of these, 35.9% were unaware of the diagnosis and 18.6% had paroxysmal AF. Median CHA2DS2-VASc score was 3.5±1.2 and 56.3% of patients were not anticoagulated. In the AF subpopulation, the stroke rate was 11.2%. Overall, only 25.8% of the anticoagulated patients were considered to be adequately treated.
CONCLUSIONS: This study shows the high prevalence of AF in the elderly population, as well as suboptimal rates of diagnosis, anticoagulation and effective control of cardiovascular risk factors.