Factores de riesgo de enfermedad cerebrovascular en pacientes con fibrilación auricular hospitalizados en el Hospital Alcívar
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2021
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
La enfermedad cerebrovascular es la tercera causa de mortalidad en el mundo y la principal causa de incapacidad o perdida funcional de tipo neurológico y va a afectar por lo general a adultos de mediana edad y a ancianos. La Fibrilación auricular es la arritmia más frecuente en la población general con una prevalencia del 0.4 % al 8 % en los pacientes mayores de 80 años.
Antecedentes. En nuestro medio la fibrilación auricular afecta al 1 % de la población adulta mayor de 50 años y su presencia se asocia a un aumento de 5 veces del riesgo de accidente cerebrovascular y un aumento al doble de mortalidad lo que motiva a hacer su diagnóstico temprano y tratamiento inmediato.
Objetivo. Determinar la frecuencia de accidente cerebrovascular en los pacientes con fibrilación auricular y la relación con los factores de riesgo.
Metodología. Se realizó un estudio de tipo analítico, observacional de corte transversal. Se analizó 460 historias clínicas de pacientes con diagnóstico de ECV isquémico y FA admitidos en el
Hospital Alcívar en el Período entre enero 2020 y enero 2021. Se analizó la frecuencia de los factores de riesgo y se los relacionó con la presencia de ECV isquémico en los pacientes de riesgo que no presentaron terapéutica anticoagulante adecuada.
Resultados. Se realizó el análisis de 458 pacientes de los cuales 94 pacientes (20%) presentan Fibrilación auricular y que fueron incluidos en el estudio, de los cuales 87 casos no presentaron ECV (93%) y solo 7 casos (7%) con FA desarrollaron ECV, 64 pacientes(68%) con FA no se encontraban anticoagulados previo a su ingreso y 30 pacientes (32%) se inició anticoagulación. Los factores de riesgo que más se relacionaron con el desarrollo de ECV fueron edad, Diabetes Mellitus, Hipertensión arterial, tabaquismo, ECV previo, cardiopatía previa, valvulopatía. De los 94 pacientes 26 casos (28%) se encontraban en escala CHAD2S2VASC alto con puntaje > 3, y en 9 casos (10%) se encontraban en escala HAS BLED alto con puntaje > 3.
Conclusiones. La asociación de fibrilación auricular y evento cerebrovascular es frecuente en nuestro medio y en la población en general además existen varios factores a que se asocian a
morbimortalidad por lo cual es importante su intervención temprana. Con los resultados obtenidos se concluye que pese a las escalas de riesgo de ictus establecidas se anticoagula poco a nuestros pacientes con fibrilación auricular no valvular previo a su ingreso hospitalario.
Cerebrovascular disease is the third leading cause of mortality in the world and the leading cause of neurological disability or functional loss and will generally affect middle-aged and elderly adults. Atrial fibrillation is the most frequent arrhythmia in the general population with a prevalence of 0.4% to 8% in patients older than 80 years. Background In our environment, atrial fibrillation affects 1% of the adult population over 50 years of age and its presence is associated with a 5-fold increase in the risk of cerebrovascular accident and a doubling of mortality, which motivates an early diagnosis and immediate treatment. Objective.To determine the frequency of stroke in patients with atrial fibrillation and the relationship with risk factors. Methodology An analytical, observational, cross-sectional study was carried out. 460 medical records of patients with a diagnosis of ischemic CVD and AF admitted to the Alcívar Hospital in the period between January 2020 and January 2021 were analyzed. The frequency of risk factors was analyzed and related to the presence of ischemic CVD in patients with risk that did not present adequate anticoagulant therapy. Results The analysis of 458 patients was carried out, of which 94 patients (20%) had atrial fibrillation and who were included in the study, of which 87 cases did not present CVD (93%) and only 7 cases (7%) with AF developed CVD, 64 patients (68%) with AF were not anticoagulated prior to admission and 30 patients (32%) started anticoagulation. The risk factors most related to the development of CVD were age, diabetes mellitus, hypertension, smoking, previous CVD, previous heart disease, and valvular heart disease. Of the 94 patients, 26 cases (28%) had a high CHAD2S2VASC scale with a score> 3, and in 9 cases (10%) they had a high HAS BLED scale with a score> 3. Conclusions The association of atrial fibrillation and cerebrovascular event is frequent in our environment and in the general population, there are also several factors that are associated with morbidity and mortality, which is why early intervention is important. With the results obtained, it is concluded that despite the established stroke risk scales, our patients with nonvalvular atrial fibrillation are poorly anticoagulated prior to hospital admission.
Cerebrovascular disease is the third leading cause of mortality in the world and the leading cause of neurological disability or functional loss and will generally affect middle-aged and elderly adults. Atrial fibrillation is the most frequent arrhythmia in the general population with a prevalence of 0.4% to 8% in patients older than 80 years. Background In our environment, atrial fibrillation affects 1% of the adult population over 50 years of age and its presence is associated with a 5-fold increase in the risk of cerebrovascular accident and a doubling of mortality, which motivates an early diagnosis and immediate treatment. Objective.To determine the frequency of stroke in patients with atrial fibrillation and the relationship with risk factors. Methodology An analytical, observational, cross-sectional study was carried out. 460 medical records of patients with a diagnosis of ischemic CVD and AF admitted to the Alcívar Hospital in the period between January 2020 and January 2021 were analyzed. The frequency of risk factors was analyzed and related to the presence of ischemic CVD in patients with risk that did not present adequate anticoagulant therapy. Results The analysis of 458 patients was carried out, of which 94 patients (20%) had atrial fibrillation and who were included in the study, of which 87 cases did not present CVD (93%) and only 7 cases (7%) with AF developed CVD, 64 patients (68%) with AF were not anticoagulated prior to admission and 30 patients (32%) started anticoagulation. The risk factors most related to the development of CVD were age, diabetes mellitus, hypertension, smoking, previous CVD, previous heart disease, and valvular heart disease. Of the 94 patients, 26 cases (28%) had a high CHAD2S2VASC scale with a score> 3, and in 9 cases (10%) they had a high HAS BLED scale with a score> 3. Conclusions The association of atrial fibrillation and cerebrovascular event is frequent in our environment and in the general population, there are also several factors that are associated with morbidity and mortality, which is why early intervention is important. With the results obtained, it is concluded that despite the established stroke risk scales, our patients with nonvalvular atrial fibrillation are poorly anticoagulated prior to hospital admission.
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ENFERMEDAD CEREBROVASCULAR, FIBRILACION ATRIAL, HOSPITALIZACION, REGISTROS MEDICOS, HOSPITAL ALCIVAR, CANTON GUAYAQUIL, ECUADOR