Revista Espanola de Cardiologia Suplementos最新文献

The main aim of management in patients with atrial fibrillation is to reduce the risk of stroke using appropriate antithrombotic treatment. However, despite adequate anticoagulation, there remains a substantial residual risk of ischemic events, particularly myocardial infarction and cardiovascular death. A more general approach is needed. Consequently, in patients with atrial fibrillation, anticoagulation treatment should seek to achieve the twin targets of reducing the risk of both stroke and ischemic events. Studies have demonstrated that vitamin K antagonists reduce the risk of stroke and ischemic events only when anticoagulation control is optimal, a situation that occurs in only a small number of patients. Direct oral anticoagulants are generally more effective and safer than vitamin K antagonists. However, not all direct oral anticoagulants appear to offer the same protection against ischemic events. It has been shown that rivaroxaban significantly reduces the risk of myocardial infarction (by 18%). In fact, studies demonstrate that rivaroxaban provides comprehensive vascular protection across a range of clinical scenarios, not only in patients with atrial fibrillation, but also in those with atherosclerotic vascular disease.

Cardiac rehabilitation is an essential part of continuing care for patients who have experienced an acute coronary syndrome. Moreover, a patient-centered approach requires the coordination of cardiology care and primary care in order to improve adherence to rehabilitation programs and to ensure appropriate continuing care. Community cardiac rehabilitation programs are essential for achieving the objectives of disease prevention. However, implementation may be difficult and program managers and specialists may need support. It is important to raise awareness of the need to support specialists who have taken the initiative in creating these programs. The aim of this paper was to summarize the basic elements of care and of the coordination between cardiology departments and primary care needed to create and develop community cardiac rehabilitation programs.

The COVID-19 pandemic has posed a challenge to the entire Spanish population and, in particular, to medical professionals who are dealing with a situación in which adaptability and rapid reactions are crucial for helping to slow the spread of the virus. At a time of uncertainty when there is an urgent need for Información to ensure that patients with cardiovascular disease receive the best care, the Spanish Society of Cardiology has produced a series of documents to aid decision-making.

The search for effective treatments against COVID-19 in the current pandemic has presented the scientific community with an enormous challenge. In fact, there is still no effective treatment for SARS-CoV-2 infection, apart from supportive measures. Research has focused on re-examining antiviral drugs that were previously used against other viral infections and on the use of anti-inflammatories, since COVID-19 patients can develop a hyperinflammatory state, which is associated with a poorer disease prognosis. However, these drugs, sometimes administered on a compassionate-use basis, can cause serious side effects or drug interactions that we should be aware of. The aim of this article is to provide an overview of what is currently known about the pharmacological therapies most frequently used against COVID-19 in our field, while paying particular attention to the adverse events and drug interactions that can affect the cardiovascular system.

Both diabetes mellitus and chronic kidney disease increase the risk of atrial fibrillation. In turn, the coexistence of diabetes and chronic kidney disease synergistically increases the thromboembolic risk associated with atrial fibrillation, which puts affected patients at a particularly high risk and makes it necessary to focus treatment not only on reducing the risk of embolism but also on providing more general prophylaxis. Although all oral anticoagulants are effective in reducing the risk of stroke in diabetic patients with atrial fibrillation, there are indications that rivaroxaban could also reduce cardiovascular mortality in this population, thereby providing additional benefits. Moreover, it has been reported that renal function deteriorates on vitamin K antagonist treatment (i.e. warfarin-related nephropathy). Consequently, the ideal anticoagulant treatment would decrease the risk of thromboembolic complications without also being associated with impaired renal function. In this context, it appears that some direct oral anticoagulants, such as dabigatran and rivaroxaban, may have a lower risk of adverse renal events than warfarin.

Although the risk of death is generally low in patients with SARS-CoV-2 infection, 15-20% of those infected experience lung disease with a varying degree of systemic involvement, which is referred to as coronavirus disease 2019 (COVID-19) and is associated with higher mortality. From the first patient series reported, myocardial damage has been observed in many individuals with COVID-19 and has been linked to an increased risk of death. This review summarizes current knowledge about cardiovascular disease and prognosis in patients with COVID-19, with a particular emphasis on different cardiovascular conditions and on the treatment of hospitalized patients.

The current situacion caused by the COVID-19 pandemic has forced us to reorganize outpatient care, along with other healthcare activities. Urgent measures imposed during the lockdown period have necessitated the reorganization of patient consultations, which has provided an opportunity to make changes that may become essential in the future. Now is the time to innovate by implementing new modalities of care, for example by trying out remote patient care, not only to guarantee patient safety, but also to optimize the use of health-care resources and expenditure and to avoid unnecessary consultations and the duplication of medical efforts. Previously, telemedicine has been used successfully both for communications between professionals and in the doctor-patient relationship. The development of Información and communication technologies has given us a plethora of opportunities for reorganization, which must be adapted to each real-life situación while bearing in mind that care quality is a priority.