Manuel Odin de Los Rios Ibarra

BACKGROUND: Atrial Fibrillation (AF) is associated with an increased risk of stroke and systemic embolism. Several studies have suggested that female AF patients could have a greater risk for stroke. There is scarce information about clinical characteristics and use of antithrombotic therapies in Latin American patients with nonvalvular AF. OBJECTIVE: To describe the gender differences in clinical characteristics, thromboembolic risk, and antithrombotic therapy of patients with nonvalvular AF recruited in Mexico, an upper middle-income country, into the prospective national CARMEN-AF Registry. METHODS: A total of 1423 consecutive patients, with at least one thromboembolic risk factor were enrolled in CARMEN-AF Registry during a three-year period (2014-2017). They were categorized according to Gender. RESULTS: Overall, 48.6% were women, mean age 70 ± 12 years. Diabetes, smoking, alcoholism, non-ischemic cardiomyopathy, coronary artery disease, and obstructive sleep apnea were higher in men. Most women were found with paroxysmal AF (40.6%), and most men with permanent AF (44.0%). No gender differences were found in the use of vitamin K antagonists (VKA) (30.5% in women vs. 28.0% in men). No gender differences were found in the use of direct oral anticoagulants (DOAC) (33.8% women vs 35.4% men). CONCLUSIONS: CARMEN-AF Registry demonstrates that in Mexico, regardless of gender, a large proportion of patients remain undertreated. No gender differences were found in the use of VKA or DOAC.

<strong>Background:</strong> Documenting the patterns of oral anticoagulation therapy (OAT) is essential to prevent thromboembolic complications of nonvalvular atrial fibrillation (NVAF). <strong>Objective:</strong> To report the patterns of OAT according to age and thromboembolic risk in patients included in CARMEN-AF, a nationwide registry of NVAF in Mexico, an upper middle-income country. <strong>Material and methods:</strong> There were 1,423 consecutive patients =18 years old and with at least one thromboembolic risk factor enrolled in the CARMEN-AF Registry at their regular clinical visit during a three-year period. They were analyzed according to 1) age, 2) AF type, and 3) CHA₂DS₂-VASc score. <strong>Results:</strong> Overall, 16.4% of patients did not receive antithrombotic treatment, 19.4% received antiplatelet drugs (APD), 29.2% vitamin K antagonists (VKA), and 34.6% direct oral anticoagulants (DOAC). With increasing age, the proportion of subjects treated with VKA decreased significantly from 36.2% in subjects 2DS₂-VASc =2) compared with the moderate risk group (41% in CHA₂DS₂-VASc = 1). <strong>Conclusions:</strong> VKA use for NVAF in Mexico decreased in relation to increasing age. The proportion of DOAC therapy was the same in all age groups. Nevertheless, elderly patients with high thromboembolic risk received a suboptimal thromboprophylaxis. These data could help to improve gaps in the implementation of global guidelines. <strong>Clinical trial registration:</strong> <a href="http://www.clinicaltrials.gov" target="_blank">http://www.clinicaltrials.gov</a>. Unique identifier: NCT02334852. <strong>Highlights:</strong> <ul><li>CARMEN-AF is a nationwide multi-centric registry seeking to bridge the data gap on anticoagulation therapy for NVAF in Mexico.</li><li>Elderly patients are more prone to receive suboptimal OAT for NVAF.</li><li>DOAC were less frequently used in high thromboembolic risk patients (CHA₂DS₂-VASc =2).</li></ul>

Introduction. Transcatheter closure of patent ductus arteriosus (PDA) has been performed since 1971; the use of detachable coils was introduced in 1992, results obtained with this procedure are similar to those obtained by surgical occlusion. Transcatheter closure of PDA avoids thoracotomy, decreased length of hospitalization and complications, and reduce expenses. Material and methods. From December 1999 to October 2000, 7 patients with PDA studied at Hospital General of Culiacan (a second level hospital) were managed using occluding spring coils. Results. Age varied from 6 months to 16 years, 6 patients were females; normal pulmonary artery tension was found in all cases. Aortic diameter ranged from 2 to 5.2 mm and an arterial catheter was used in all cases to implant the device. The closure was successfully achieved in all cases; patients are doing well after 2 to 10 months of follow-up. Conclusion. The transcatheter closure of PDA is a safe procedure that can be carried-out in a second level hospital; pediatric interventional cardiology offers several benefits to the patient and their families.

Abstract Introduction In 2019 the ESC/EAS published the update on their guidelines for the management of dyslipidemias. For patients with prior myocardial infarction or stroke, they recommend achieving an LDL level &amp;lt;55mg/dL as a primary objective, and a non-HDL level &amp;lt;85mg/dL as a secondary target. Objective To analyze the impact and application that the 2019 ESC/EAS dyslipidemia guideline has on the management of dyslipidemia for secondary prevention. Methods Using data from a nationwide register in Mexico, a retrospective study was performed, including adult patients from 2018–2020 treated for hyperlipidemia and with prior history of stroke, myocardial infarction, or peripheral artery disease, with at least one follow-up visit. Patients were divided into 2 groups according to their LDL target attainment, furthermore, those with an appropriate LDL target were subdivided into 2 groups according to the attainment of the secondary target. Results 590 patients were included, the mean age at the last visit was 67 years, 68% were men. The most frequent cardiovascular event was myocardial infarction (75%). The most frequent comorbidity found was obesity (79%). 60% of the sample was on high-intensity statin treatment and 5% received only life-style modifications. When the LDL target attainment was analyzed, only 124 patients (21%) had an adequate control (group 1). Patients in this group had a lower mean age (66±12 vs 67±10), BMI was higher in this group (29 vs 28), meanwhile, blood pressure measurements were slightly lower (systolic 123 vs 126 mmHg, diastolic 73 vs 75 mmHg). They had, however, a higher frequency of comorbidities, such as T2D (46% vs 39%), hypertension (77% vs 73%) and heart failure (26% vs 23%). There were also differences in the pharmacological treatments: in group 1, 58% of the patients were treated with a high-intensity statin (vs 60% in group 2), 24% were treated with a moderate-intensity statin (vs 35% in group 2) and only 16% received a dual treatment strategy with ezetimibe (vs 13% in group 2). Only 8 patients received a PCSK9 inhibitor, and only one of them had an adequate LDL target. When the secondary target attainment was analyzed for patients in group 1, 85% of them had also an adequate control (subgroup 1). Conclusions The treatment targets from the update on the guidelines, are associated with undertreatment of high-risk patients on secondary prevention. At the current time, less than half of the patients included in this study achieved the optimal target, and only 60% of patients are receiving the appropriate intensity of treatment. There might be different patient-physician related barriers to achieving a good control, one to be considered is the important economic implication of the new pharmacologic options. More studies are required to study the before mentioned barriers and to suggest a proper population-based approach to improve adherence to cardiovascular guidelines for secondary prevention. Funding Acknowledgement Type of funding sources: None.