title: [Anticoagulation in polypathological patients with atrial fibrillation].
abstract: OBJECTIVE
  To determine the use of oral anticoagulants in polypathological patients with atrial fibrillation and its influence on mortality and loss of functionality.
  
  
  METHODS
  Patients with polypathological patient criteria and atrial fibrillation were included in an observational, prospective and multicenter study. Data on demographic, clinical, functional and sociofamilial characteristics, CHADS2 score, levels of hemoglobin, albumin and creatinine, use of oral anticoagulants and survival and functional status at one year were collected.
  
  
  RESULTS
  Five hundred and thirty-two (32.6%) of 1,632 polypathological patients had atrial fibrillation. The stroke risk was high in 505 (94.9%), moderate in 24 (4.5%) and low in 3 (0.6%) patients. Oral anticoagulants were used in 61% of patients with CHADS2 score≥2 and in 37.5% with CHADS2 score=1. Oral anticoagulants were less used in older patients, with more functional and cognitive impairment. Heart failure was associated with more use of oral anticoagulants. There was no difference by the presence of hypertension, diabetes, anemia, renal insufficiency or stroke. In multivariate analysis the use of oral anticoagulants was independently associated with lower age, lower cognitive impairment, absence of hepatic disease and with higher stroke risk. The prescription of oral anticoagulants was independently associated with more survival at one year with no influence on functional status.
  
  
  CONCLUSIONS
  Oral anticoagulants are underused in polypathological patients with atrial fibrillation despite being associated with more survival.
authors.affiliation: Grupo de Paciente Pluripatológico y de Enfermedad Avanzada, Sociedad Española de Medicina Interna, España. jdiez@aragon.es
authors.forename: Jesús
authors.initials: J
authors.lastname: Díez-Manglano
authors.forename: Máximo
authors.initials: M
authors.lastname: Bernabeu-Wittel
authors.forename: Bosco
authors.initials: B
authors.lastname: Barón-Franco
authors.forename: José
authors.initials: J
authors.lastname: Murcia-Zaragoza
authors.forename: Aurelio
authors.initials: A
authors.lastname: Fuertes Martín
authors.forename: Antonio
authors.initials: A
authors.lastname: Alemán
authors.forename: Manuel
authors.initials: M
authors.lastname: Ollero-Baturone
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000453:epidemiology; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications*; D002318:Cardiovascular Diseases / Q000453:epidemiology; D003072:Cognition Disorders / Q000453:epidemiology; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000453:epidemiology; D008107:Liver Diseases / Q000453:epidemiology; D008297:Male; D009369:Neoplasms / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D012306:Risk; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*; D015996:Survival Rate; D019851:Thrombophilia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants