Cosín-Sales Juan, Polo-García Jose, Gavín Sebastián Olga, Rubio Cabezas Marta, Lloret Avellá María
Department of Cardiology, Hospital Arnau de Vilanova, Valencia, Spain.
Primary Care, Centro de Salud de Casar de Cáceres, Cáceres, Spain.
Front Cardiovasc Med. 2025 Mar 5;12:1426072. doi: 10.3389/fcvm.2025.1426072. eCollection 2025.
The use of vitamin K antagonists (VKA) in patients with atrial fibrillation (AF) in Spain remains high, even though the available data on anticoagulation control (TRT, time in therapeutic range) shows suboptimal results. The objective of the AMFA project, an atlas of the management of anticoagulation in patients with AF, was to describe oral anticoagulation management in Spanish´ patients.
The AMFA Project is a descriptive, multicenter study. It included information from 60 healthcare areas from each of the 17 Spanish regions. Consensus methodologies were used to analyze qualitative information obtained from the physicians' experience and perception and quantitative data collected through a specialized study questionnaire. In this questionnaire, experts were asked to include data of the last 10 consecutive patients attended with AF on anticoagulation treatment.
Records from 1,580 patients were obtained from 176 experts. Of them, 34.7% were cardiologists, 32.9% general practitioners (GPs), and 32.4% hematologists. The utilization rates of Direct Oral Anticoagulants (DOACs) and VKAs in clinical practice was 55.8% and 43.3%, respectively, which was not correlated with experts' perception. Clinical practice data revealed that 30.3% of the patients included did not have international normalized ratio (INR) or TTR data available, while only 3.8% of the experts reported that INR/TTR information was not available according to their perception. Considering only patients who had INR and TTR available, clinical practice showed that 59.0% of the patients had their coagulation in range, while the remaining 41.0% were uncontrolled. This result matches with the general perception reported by the experts, 62.6% of patients in range. Additionally, up to 22.2% of patients received DOAC treatment at suboptimal doses.
These data highlight the suboptimal control of the INR of patients, as well as the difficulties in DOACs access in Spain. The study uncovers the need to implement actions to improve INR control, facilitate access to DOACs treatment, and standardize AF patients' management. Establishing protocols that facilitate intervention may optimize the management of the patients with AF.
在西班牙，心房颤动（AF）患者中维生素K拮抗剂（VKA）的使用比例仍然很高，尽管关于抗凝控制（治疗时间范围，TRT）的现有数据显示结果并不理想。AMFA项目（一项AF患者抗凝管理图谱）的目的是描述西班牙患者的口服抗凝管理情况。
AMFA项目是一项描述性多中心研究。它纳入了来自西班牙17个地区中每个地区60个医疗区域的信息。采用共识方法分析从医生经验和认知中获得的定性信息以及通过专门研究问卷收集的定量数据。在该问卷中，要求专家纳入最近连续10例接受抗凝治疗的AF患者的数据。
从176位专家处获得了1580例患者的记录。其中，34.7%是心脏病专家，32.9%是全科医生（GP），32.4%是血液科医生。直接口服抗凝剂（DOAC）和VKA在临床实践中的使用率分别为55.8%和43.3%，这与专家的认知不相关。临床实践数据显示，纳入的患者中有30.3%没有国际标准化比值（INR）或治疗时间范围（TTR）数据，而只有3.8%的专家报告根据他们的认知没有INR/TTR信息。仅考虑有INR和TTR数据的患者，临床实践表明59.0%的患者凝血指标在正常范围内，而其余41.0%未得到控制。这一结果与专家报告的总体认知相符，即62.6%的患者指标在正常范围内。此外，高达22.2%的患者接受的DOAC治疗剂量未达最佳。
这些数据凸显了患者INR控制不佳以及西班牙在获取DOAC方面存在的困难。该研究揭示了采取行动改善INR控制、促进DOAC治疗的获取以及规范AF患者管理的必要性。建立便于干预的方案可能会优化AF患者的管理。
