Factores asociados con la adherencia al tratamiento anticoagulante oral de pacientes con fibrilación auricular no valvular mayores de 65 años

La fibrilación auricular no valvular (FANV) es la arrimia cardiaca más frecuente y su prevalencia aumenta proporcionalmente con la edad. Esta se relaciona con desenlances desfavorables como muerte, accidentes cerebrovasculares (ACV) y discapacidad. Aproximadamente el 80% de los ACV se pueden preveni...

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Autores:
Rodríguez Rocha, Wiston Alberto
Tipo de recurso:
Fecha de publicación:
2020
Institución:
Universidad Autónoma de Bucaramanga - UNAB
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Repositorio UNAB
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spa
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oai:repository.unab.edu.co:20.500.12749/7196
Acceso en línea:
http://hdl.handle.net/20.500.12749/7196
Palabra clave:
Embolia pulmonar
Cardiopatías
Geriatría
Internal medicine
Medicine
Medical sciences
Health sciences
Atrial fibrillation
Anticoagulants
Therapeutic adherence
Fragility
Pulmonary embolism
Heart diseases
Geriatrics
Medicina interna
Medicina
Ciencias médicas
Ciencias de la salud
Fibrilación auricular
Anticoagulantes
Adherencia terapéutica
Fragilidad
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http://creativecommons.org/licenses/by-nc-nd/2.5/co/
id UNAB2_24d3100a75bfe3329ef7bef4a7755f30
oai_identifier_str oai:repository.unab.edu.co:20.500.12749/7196
network_acronym_str UNAB2
network_name_str Repositorio UNAB
repository_id_str
dc.title.spa.fl_str_mv Factores asociados con la adherencia al tratamiento anticoagulante oral de pacientes con fibrilación auricular no valvular mayores de 65 años
dc.title.translated.eng.fl_str_mv Factors associated with adherence to oral anticoagulant treatment in patients with nonvalvular atrial fibrillation over 65 years of age
title Factores asociados con la adherencia al tratamiento anticoagulante oral de pacientes con fibrilación auricular no valvular mayores de 65 años
spellingShingle Factores asociados con la adherencia al tratamiento anticoagulante oral de pacientes con fibrilación auricular no valvular mayores de 65 años
Embolia pulmonar
Cardiopatías
Geriatría
Internal medicine
Medicine
Medical sciences
Health sciences
Atrial fibrillation
Anticoagulants
Therapeutic adherence
Fragility
Pulmonary embolism
Heart diseases
Geriatrics
Medicina interna
Medicina
Ciencias médicas
Ciencias de la salud
Fibrilación auricular
Anticoagulantes
Adherencia terapéutica
Fragilidad
title_short Factores asociados con la adherencia al tratamiento anticoagulante oral de pacientes con fibrilación auricular no valvular mayores de 65 años
title_full Factores asociados con la adherencia al tratamiento anticoagulante oral de pacientes con fibrilación auricular no valvular mayores de 65 años
title_fullStr Factores asociados con la adherencia al tratamiento anticoagulante oral de pacientes con fibrilación auricular no valvular mayores de 65 años
title_full_unstemmed Factores asociados con la adherencia al tratamiento anticoagulante oral de pacientes con fibrilación auricular no valvular mayores de 65 años
title_sort Factores asociados con la adherencia al tratamiento anticoagulante oral de pacientes con fibrilación auricular no valvular mayores de 65 años
dc.creator.fl_str_mv Rodríguez Rocha, Wiston Alberto
dc.contributor.advisor.spa.fl_str_mv Cadena Sanabria, Miguel Oswaldo
Ochoa Vera, Miguel Enrique
dc.contributor.author.spa.fl_str_mv Rodríguez Rocha, Wiston Alberto
dc.contributor.cvlac.*.fl_str_mv https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0001339250
https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000898465
dc.contributor.googlescholar.*.fl_str_mv https://scholar.google.es/citations?hl=es&user=8fdkkOoAAAAJ
https://scholar.google.es/citations?hl=es&user=jQUx5WcAAAAJ
dc.contributor.orcid.*.fl_str_mv https://orcid.org/0000-0001-9807-3029
https://orcid.org/0000-0002-4552-3388
dc.contributor.scopus.*.fl_str_mv https://www.scopus.com/authid/detail.uri?authorId=56437735000
https://www.scopus.com/authid/detail.uri?authorId=36987156500
dc.contributor.researchgate.*.fl_str_mv https://www.researchgate.net/profile/Miguel_Cadena-Sanabria
https://www.researchgate.net/profile/Miguel_Ochoa7
dc.subject.mesh.spa.fl_str_mv Embolia pulmonar
Cardiopatías
Geriatría
topic Embolia pulmonar
Cardiopatías
Geriatría
Internal medicine
Medicine
Medical sciences
Health sciences
Atrial fibrillation
Anticoagulants
Therapeutic adherence
Fragility
Pulmonary embolism
Heart diseases
Geriatrics
Medicina interna
Medicina
Ciencias médicas
Ciencias de la salud
Fibrilación auricular
Anticoagulantes
Adherencia terapéutica
Fragilidad
dc.subject.keywords.eng.fl_str_mv Internal medicine
Medicine
Medical sciences
Health sciences
Atrial fibrillation
Anticoagulants
Therapeutic adherence
Fragility
Pulmonary embolism
Heart diseases
Geriatrics
dc.subject.lemb.spa.fl_str_mv Medicina interna
Medicina
Ciencias médicas
dc.subject.proposal.spa.fl_str_mv Ciencias de la salud
Fibrilación auricular
Anticoagulantes
Adherencia terapéutica
Fragilidad
description La fibrilación auricular no valvular (FANV) es la arrimia cardiaca más frecuente y su prevalencia aumenta proporcionalmente con la edad. Esta se relaciona con desenlances desfavorables como muerte, accidentes cerebrovasculares (ACV) y discapacidad. Aproximadamente el 80% de los ACV se pueden prevenir con el tratamiento anticoagulante oral (ACO), beneficio que es condicionado por una adecuada adherencia terapéutica. No existen estudios en Colombia que determinen cuales son los factores asociados con la adherencia al tratamiento anticoagulante en adultos mayores de 65 años ni la prevalencia de fragilidad en esta población, necesidad que justifica la realización del presente estudio. Objetivo: Determinar cuales factores se encuentran relacionados con la adherencia al tratamiento (ACO) de pacientes con FANV mayores de 65 años y determinar la prevalencia de fragilidad en la cohorte. Metodología: Estudio observacional analítico de corte transversal realizado en la clínica de anticoagulación de la clínica FOSCAL en pacientes con FANV mayores de 65 años. Se evaluó la adherencia terapéutica por la escala de Morisky 8 y la fragilidad por la escala FRAIL de manera telepresencial. Se realizó un análisis descriptivo de las variables sociodemográficas, clínicas y de fragilidad, luego se realizó un análisis bivariado para determinar cuáles variables independientes se relacionaron con una buena o mala adherencia. Se aceptó como significancia estadística un valor de p < 0.05. Resultados: Se recolectaron 102 pacientes (47% femenino y 53% masculino), con una promedio de edad de 76 años (mín 65 y máx 97 años). Las comorbilidades más frecuentes fueron HTA, insuficiencia cardiaca, dislipidemia, ERC y DM. Se encontró que la adherencia fue baja en el 42,1%, moderada en el 23,5% y alta en el 34,3% de los casos. La razón principal que refirieron los pacientes fue el olvido en la toma de su medicamento (50%). Las variables asociadas con una baja adherencia fueron la inconformidad con el despacho del medicamento OR 2,97 (IC 95% 1.1 – 8.2 - p 0,02) y el despacho inoportuno OR 5.85 (IC 95% 1.5 – 32.8 - p 0,005). La toma de antiagregantes plaquetarios (p 0,04) y la presencia de polifarmacia (p 0,04) se asociaron con una moderada-alta adherencia. La prevalencia de fragilidad fue del 50,9% y no tuvo impacto en la adherencia terapéutica (p 0,95). Conclusiones: La adherencia al tratamiento anticoagulante oral en pacientes con FANV mayores de 65 años fue en su mayoría moderada a baja. Las variables asociadas con menor adherencia fueron las relacionadas con el sumunistro de medicamentos. La fragilidad es una condición frecuente en adultos mayores con FANV, sin embargo esta no se asoció con mayor o menor adherencia y por tanto no debería condicionar la prescripción de la terapia anticoagulante si está clínicamente indicada. Es importante incluir la evaluación sistemática de la adherencia terapéutica en pacientes mayores para identificar factores que puedan modificar el beneficio esperado. Se sugiere establecer procesos administrativos diferenciales en pacientes que reciben ACODs con el objetivo de evitar inconvenientes administrativos con las autorizaciones y despachos del medicamento.
publishDate 2020
dc.date.accessioned.none.fl_str_mv 2020-08-22T01:41:55Z
dc.date.available.none.fl_str_mv 2020-08-22T01:41:55Z
dc.date.issued.none.fl_str_mv 2020-06-08
dc.type.driver.none.fl_str_mv info:eu-repo/semantics/masterThesis
dc.type.local.spa.fl_str_mv Tesis
dc.type.redcol.none.fl_str_mv http://purl.org/redcol/resource_type/TM
dc.identifier.uri.none.fl_str_mv http://hdl.handle.net/20.500.12749/7196
dc.identifier.instname.spa.fl_str_mv instname:Universidad Autónoma de Bucaramanga - UNAB
dc.identifier.reponame.spa.fl_str_mv reponame:Repositorio Institucional UNAB
dc.identifier.repourl.spa.fl_str_mv repourl:https://repository.unab.edu.co
url http://hdl.handle.net/20.500.12749/7196
identifier_str_mv instname:Universidad Autónoma de Bucaramanga - UNAB
reponame:Repositorio Institucional UNAB
repourl:https://repository.unab.edu.co
dc.language.iso.spa.fl_str_mv spa
language spa
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spelling Cadena Sanabria, Miguel Oswaldo6b29f22f-ae10-4483-865e-0d3732363bcaOchoa Vera, Miguel Enriquebf83ca83-93c9-401e-91d3-b424889e868fRodríguez Rocha, Wiston Alberto83c4107b-ddc9-4a6c-9eb3-0ca6064517cehttps://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0001339250https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000898465https://scholar.google.es/citations?hl=es&user=8fdkkOoAAAAJhttps://scholar.google.es/citations?hl=es&user=jQUx5WcAAAAJhttps://orcid.org/0000-0001-9807-3029https://orcid.org/0000-0002-4552-3388https://www.scopus.com/authid/detail.uri?authorId=56437735000https://www.scopus.com/authid/detail.uri?authorId=36987156500https://www.researchgate.net/profile/Miguel_Cadena-Sanabriahttps://www.researchgate.net/profile/Miguel_Ochoa7Floridablanca (Santander, Colombia)2020-08-22T01:41:55Z2020-08-22T01:41:55Z2020-06-08http://hdl.handle.net/20.500.12749/7196instname:Universidad Autónoma de Bucaramanga - UNABreponame:Repositorio Institucional UNABrepourl:https://repository.unab.edu.coLa fibrilación auricular no valvular (FANV) es la arrimia cardiaca más frecuente y su prevalencia aumenta proporcionalmente con la edad. Esta se relaciona con desenlances desfavorables como muerte, accidentes cerebrovasculares (ACV) y discapacidad. Aproximadamente el 80% de los ACV se pueden prevenir con el tratamiento anticoagulante oral (ACO), beneficio que es condicionado por una adecuada adherencia terapéutica. No existen estudios en Colombia que determinen cuales son los factores asociados con la adherencia al tratamiento anticoagulante en adultos mayores de 65 años ni la prevalencia de fragilidad en esta población, necesidad que justifica la realización del presente estudio. Objetivo: Determinar cuales factores se encuentran relacionados con la adherencia al tratamiento (ACO) de pacientes con FANV mayores de 65 años y determinar la prevalencia de fragilidad en la cohorte. Metodología: Estudio observacional analítico de corte transversal realizado en la clínica de anticoagulación de la clínica FOSCAL en pacientes con FANV mayores de 65 años. Se evaluó la adherencia terapéutica por la escala de Morisky 8 y la fragilidad por la escala FRAIL de manera telepresencial. Se realizó un análisis descriptivo de las variables sociodemográficas, clínicas y de fragilidad, luego se realizó un análisis bivariado para determinar cuáles variables independientes se relacionaron con una buena o mala adherencia. Se aceptó como significancia estadística un valor de p < 0.05. Resultados: Se recolectaron 102 pacientes (47% femenino y 53% masculino), con una promedio de edad de 76 años (mín 65 y máx 97 años). Las comorbilidades más frecuentes fueron HTA, insuficiencia cardiaca, dislipidemia, ERC y DM. Se encontró que la adherencia fue baja en el 42,1%, moderada en el 23,5% y alta en el 34,3% de los casos. La razón principal que refirieron los pacientes fue el olvido en la toma de su medicamento (50%). Las variables asociadas con una baja adherencia fueron la inconformidad con el despacho del medicamento OR 2,97 (IC 95% 1.1 – 8.2 - p 0,02) y el despacho inoportuno OR 5.85 (IC 95% 1.5 – 32.8 - p 0,005). La toma de antiagregantes plaquetarios (p 0,04) y la presencia de polifarmacia (p 0,04) se asociaron con una moderada-alta adherencia. La prevalencia de fragilidad fue del 50,9% y no tuvo impacto en la adherencia terapéutica (p 0,95). Conclusiones: La adherencia al tratamiento anticoagulante oral en pacientes con FANV mayores de 65 años fue en su mayoría moderada a baja. Las variables asociadas con menor adherencia fueron las relacionadas con el sumunistro de medicamentos. La fragilidad es una condición frecuente en adultos mayores con FANV, sin embargo esta no se asoció con mayor o menor adherencia y por tanto no debería condicionar la prescripción de la terapia anticoagulante si está clínicamente indicada. Es importante incluir la evaluación sistemática de la adherencia terapéutica en pacientes mayores para identificar factores que puedan modificar el beneficio esperado. Se sugiere establecer procesos administrativos diferenciales en pacientes que reciben ACODs con el objetivo de evitar inconvenientes administrativos con las autorizaciones y despachos del medicamento.PLANTEAMIENTO DEL PROBLEMA Y JUSTIFICACIÓN 12 OBJETIVOS 14 GENERAL 14 ESPECÍFICOS 14 MARCO TEÓRICO 14 DEFINICIÓN E HISTORIA DE LA FIBRILACIÓN AURICULAR 14 EPIDEMIOLOGÍA 15 ETIOLOGÍA, PATOGENIA Y FACTORES DE RIESGO 15 DIAGNÓSTICO Y CLASIFICACIÓN 17 TRATAMIENTO ANTICOAGULANTE 19 ADHERENCIA AL TRATAMIENTO ANTICOAGULANTE 26 ESTADO DEL ARTE 31 HIPÓTESIS 33 METODOLOGÍA 33 DISEÑO DEL ESTUDIO 33 LUGARES 33 POBLACIÓN 33 CRITERIOS DE INCLUSIÓN 34 CRITERIOS DE EXCLUSIÓN 34 CÁLCULO DE TAMAÑO DE MUESTRA 34 MUESTREO 35 PLAN DE RECOLECCIÓN DE LA INFORMACIÓN 35 VARIABLES 36 CONTROL DE CALIDAD DE LOS DATOS 45 MONITOREO DE LOS DATOS 45 MANEJO DE LOS DATOS 45 PLAN DE ANÁLISIS DE DATOS 45 RESULTADOS E IMPACTOS ESPERADOS 46 DISPOSICIONES VIGENTES 48 IMPACTO AMBIENTAL DEL PROYECTO 48 CONSIDERACIONES ÉTICAS 48 CRONOGRAMA DE ACTIVIDADES 50 PRESUPUESTO 50 RESULTADOS 51 ANÁLISIS DESCRIPTIVO 52 ANÁLISIS BIVARIADO 61 DISCUSIÓN 70 CONCLUSIONES 77 REFERENCIAS BIBLIOGRÁFICAS 78 ANEXOS 87EspecializaciónNonvalvular atrial fibrillation (NVAF) is the most frequent cardiac arrhythmia and its prevalence increases proportionally with age. This is related to unfavorable outcomes such as death, strokes (strokes) and disability. Approximately 80% of strokes can be prevented with oral anticoagulant treatment (ACO), a benefit that is conditioned by adequate therapeutic adherence. There are no studies in Colombia that determine which factors are associated with adherence to anticoagulant treatment in adults over 65 years of age, nor the prevalence of frailty in this population, a need that justifies the performance of this study. Objective: To determine which factors are related to the adherence to treatment (OAC) of patients with NVAF older than 65 years and to determine the prevalence of frailty in the cohort. Methods: Observational analytical cross-sectional study carried out in the anticoagulation clinic of the FOSCAL clinic in patients with NVAF older than 65 years. Therapeutic adherence was evaluated by the Morisky 8 scale and fragility by the FRAIL scale in a telepresence way. A descriptive analysis of the sociodemographic, clinical and frailty variables was performed, then a bivariate analysis was performed to determine which independent variables were related to good or bad adherence. A value of p <0.05 was accepted as statistical significance. Results: 102 patients were collected (47% female and 53% male), with an average age of 76 years (min 65 and max 97 years). The most frequent comorbidities were hypertension, heart failure, dyslipidemia, CKD, and DM. Adherence was found to be low in 42.1%, moderate in 23.5% and high in 34.3% of cases. The main reason reported by patients was forgetfulness in taking their medication (50%). The variables associated with low adherence were nonconformity with the dispensing of the drug OR 2.97 (95% CI 1.1 - 8.2 - p 0.02) and the inappropriate timing OR 5.85 (95% CI 1.5 - 32.8 - p 0.005). Taking antiplatelet agents (p 0.04) and the presence of polypharmacy (p 0.04) were associated with moderate-high adherence. The prevalence of frailty was 50.9% and had no impact on therapeutic adherence (p 0.95). Conclusions: Adherence to oral anticoagulant treatment in patients with NVAF older than 65 years was mostly moderate to low. The variables associated with less adherence were those related to the supply of medications. Frailty is a frequent condition in older adults with NVAF, however this was not associated with more or less adherence and therefore should not condition the prescription of anticoagulant therapy if it is clinically indicated. It is important to include the systematic evaluation of therapeutic adherence in older patients to identify factors that can modify the expected benefit. It is suggested to establish differential administrative processes in patients receiving DOACs in order to avoid administrative inconveniences with the authorizations and dispatches of the medication.application/pdfspahttp://creativecommons.org/licenses/by-nc-nd/2.5/co/Abierto (Texto Completo)info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Atribución-NoComercial-SinDerivadas 2.5 ColombiaEmbolia pulmonarCardiopatíasGeriatríaInternal medicineMedicineMedical sciencesHealth sciencesAtrial fibrillationAnticoagulantsTherapeutic adherenceFragilityPulmonary embolismHeart diseasesGeriatricsMedicina internaMedicinaCiencias médicasCiencias de la saludFibrilación auricularAnticoagulantesAdherencia terapéuticaFragilidadFactores asociados con la adherencia al tratamiento anticoagulante oral de pacientes con fibrilación auricular no valvular mayores de 65 añosFactors associated with adherence to oral anticoagulant treatment in patients with nonvalvular atrial fibrillation over 65 years of ageEspecialista en Medicina InternaUniversidad Autónoma de Bucaramanga UNABFacultad Ciencias de la SaludEspecialización en Medicina Internainfo:eu-repo/semantics/masterThesisTesishttp://purl.org/redcol/resource_type/TM1. 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