Atrial fibrillation is the most common sustained cardiac arrhythmia in the general population. According to data from the Spanish Heart Foundation (FEC), it affects more than 600,000 Spaniards and causes 35% of strokes. As Clara Bonanad, president of the Geriatric Cardiology Section of the Spanish Society of Cardiology (SEC) explains, “ the prevalence and incidence of atrial fibrillation is increasing in people over forty years of age in recent years . It is an arrhythmia that is linked to age and increases exponentially after sixty. There are studies that show that, in octogenarian patients, its prevalence can reach up to 20% ”.
David Vivas, coordinator of the SEC’s Cardiovascular Thrombosis Working Group, adds that this type of arrhythmia “favors the formation of intracardiac thrombi, which is why it is an important cause of cerebrovascular disease or stroke .”
Along the same lines, from the Research Agency of the Spanish Society of Cardiology, Juan Cosin explains that this condition “multiplies the risk of stroke by five, and not taking the appropriate anticoagulant exposes you to a higher risk.” Considering that strokes can have highly disabling consequences and that “those caused by atrial fibrillation have a worse prognosis than those of other etiologies”, the fact that each patient receives the appropriate medication is crucial. For this, it is urgent to end underdiagnosis problems, improving “screening programs”, and ensure that patients are correctly controlled once their medication has been prescribed.
In the words of Vivas, “the pandemic and the saturation of the health system has caused morbidity and mortality from other non-COVID-19 ailments – including cardiovascular disease – to have doubled.” According to Bonanad, the reason is that “a large part of the face-to-face visits have been transformed into telephone calls, therefore, it seems that this arrhythmia has been underdiagnosed and undertreated during 2020.”
On the one hand, on many occasions, ” it has not been possible to make an early diagnosis to start anticoagulant treatment ,” says Cosin. Another problem has to do with the fact that said medication “is based on vitamin K antagonist drugs, which requires periodic controls in the office. And, in these months, the suppression of presence has made the management of these patients difficult. In the peak periods of COVID-19, we have also had to stop doing ablations – scarring or destruction of the heart tissue that causes or sustains the abnormal heart rhythm – a fairly effective procedure, even curative, in many cases “, warns the specialist.
Change of treatments
One of the solutions that experts have found is to change treatments. According to Bonanad, “direct-acting oral anticoagulants (DOACs) have been shown to be as effective as vitamin K antagonists in preventing stroke and with lower rates of major bleeding –severe internal bleeding. They do not require close controls, as long as they are correctly adjusted in their dose to the clinical characteristics of the patient ”, he says.
However, not everything is so easy. Cosin points out that a bureaucratic procedure called a visa requires that the patient receive prior permission from the health system, which limits the prescription of DOACs. Fortunately, “during the pandemic, some autonomous communities made visas more flexible to allow these new anticoagulants to be prescribed, since they do not require follow-up, facilitate management and are the most recommended treatment by scientific societies at an international level,” says the specialist.
The autonomous communities that have chosen to abolish visas have to decide what to do now with this procedure. ” It is difficult to tell a patient, to whom you have prescribed a drug with fewer interactions with food or other medications, that he has to return to a treatment that also requires monthly controls ,” warns Cosin. For this reason, it expresses its wish that the visa be made more flexible, thus equating Spain to other countries in our European environment. “We trust that, regardless of the evolution of the pandemic, anticoagulant drugs can be prescribed following strictly clinical criteria and according to the recommendations of medical practice guidelines, without having the bureaucratic limitation of prescription visas,” says Vivas. For its part, Bonanad points out that “if this change in regulation is not made throughout the country, but only in some autonomous regions, it can generate inequalities.” For this reason, he urges that, “once the pandemic is controlled, the issue of visas can be reviewed and updated at the national level and make a global decision thinking about the benefit to patients, which will surely also be cost-effective. long-term benefit ”.
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