Estadísticas

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      "titulo" => "El cambio de paradigma en la prevención de ictus en la fibrilación auricular. Retos y oportunidades emergentes para el médico de familia"
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          "autoresLista" => "José Carlos del Castillo Rodríguez, Ignacio Fernández Lozano"
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    "titulo" => "Fibrilación auricular: de la detección al tratamiento. Papel del médico de familia, del cardiólogo y de otros especialistas. Nuevos modelos de gestión clínica"
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        "titulo" => "Atrial fibrillation&#58; from detection to treatment&#46; Role of the family physician&#44; cardiologist and other specialists&#46; New models of clinical management"
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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Se estima que la prevalencia en adultos de fibrilaci&#243;n auricular &#40;FA&#41; en Espa&#241;a es del 4&#44;4&#37; de la poblaci&#243;n &#62;<span class="elsevierStyleHsp" style=""></span>40 a&#241;os&#44; lo que corresponder&#237;a a una media de 30 a 40 pacientes por cada m&#233;dico de familia&#46; La importancia de esta frecuente arritmia radica&#44; sobre todo&#44; en su estrecha relaci&#243;n con el ictus u otras embolias sist&#233;micas por delante de otras posibles complicaciones&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El diagn&#243;stico de FA es su registro electrocardiogr&#225;fico&#44; por lo que est&#225; al alcance del m&#233;dico de familia&#44; que debe evaluar al paciente de forma global&#44; incluyendo los factores de riesgo&#44; la comorbilidad&#44; el tipo de FA y la valoraci&#243;n de los riesgos emb&#243;lico y hemorr&#225;gico&#46; La decisi&#243;n de anticoagular o no se debe tomar pronto&#44; en funci&#243;n del riesgo emb&#243;lico del paciente y no del tipo de arritmia&#46; Por otra parte se debe decidir&#44; junto con el cardi&#243;logo de referencia&#44; la mejor estrategia terap&#233;utica para cada paciente individual&#58; control de ritmo &#40;intentar recuperar y mantener el ritmo sinusal&#41; o control de frecuencia &#40;mantener la frecuencia card&#237;aca en l&#237;mites aceptables&#41;&#46; En ambas estrategias debe estar presente el tratamiento antitromb&#243;tico de base&#44; ya que la complicaci&#243;n m&#225;s grave&#44; frecuente y de mayor repercusi&#243;n en morbilidad y mortalidad es el ictus&#46; Adem&#225;s&#44; los ictus cardioemb&#243;licos &#40;hasta 1 de cada 4 ictus&#41; son especialmente devastadores&#44; con mayor letalidad&#44; consumo de recursos hospitalarios y sociales&#44; y discapacidad asociada&#46; El control de la FA y&#44; en particular&#44; la prevenci&#243;n continuada del ictus a trav&#233;s de una adecuada anticoagulaci&#243;n deben realizarse primordialmente en atenci&#243;n primaria&#46; No obstante&#44; el manejo multidisciplinar se impone en una mayor&#237;a de pacientes&#44; donde debe establecerse una buena coordinaci&#243;n entre AP y especializada&#44; en especial cardiolog&#237;a&#44; hematolog&#237;a y neurolog&#237;a &#40;en pacientes que ya presentaron un ictus&#41;&#46;</p>"
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        "resumen" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The prevalence of atrial fibrillation &#40;AF&#41; in adults in Spain is estimated to be 4&#46;4&#37; of the population aged 40 years or more&#44; corresponding to a mean of 30 to 40 patients per family physician&#46; The importance of this common arrhythmia lies&#44; above all&#44; in its close association with stroke and other systemic embolisms&#44; among other possible complications&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Diagnosis of AF is based on electrocardiographic recording and can consequently be made by the family physician&#44; who should make an overall assessment of the patient&#39;s health&#44; including risk factors&#44; comorbidity and type of AF and evaluate embolic and hemorrhagic risk&#46; The decision to prescribe anticoagulation therapy or not should be taken promptly and should be based on the patient&#39;s embolic risk and not on the type of arrhythmia&#46; In addition&#44; the family physician&#44; together with the treating cardiologist&#44; should decide on the most appropriate therapeutic strategy for each individual patient&#58; a rhythm control strategy &#40;attempting to recover and maintain sinus rhythm&#41; or a rate control strategy &#40;maintaining heart rate within acceptable limits&#41;&#46; Antithrombotic treatment should form part of both strategies&#44; since stroke is the most serious and common complication of AF and also has the greatest effects on morbidity and mortality&#46; Moreover&#44; cardioembolic strokes &#40;accounting for one out of every four strokes&#41; are especially devastating&#44; with the highest fatality&#44; hospital and social resource use&#44; and associated disability&#46; Control of AF and particularly stroke prevention with adequate anticoagulation should be carried out mainly in primary care&#46; Nevertheless&#44; multidisciplinary management is required in most patients&#44; which requires effective coordination between primary and specialized care&#44; especially cardiology&#44; hematology and neurology &#40;in patients who have already had a stroke&#41;&#46;</p>"
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