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Published on: February 26, 2013
Targeting stroke risk and improving outcomes in patients with atrial fibrillation in Latin America
Bruce Stambler1, Fernando Scazzuso2
1MD. Director, Cardiac Arrhythmia Research and Education, Piedmont Heart Institute, Atlanta, United States.
Insights
Stroke risk is high in low-income nations, with many atrial fibrillation patients not receiving adequate anticoagulation. Improving access to care and risk factor modification is crucial for stroke prevention in Latin America.
Area of Science:
- Cardiovascular Epidemiology
- Public Health
- Neurology
Background:
- Stroke represents a significant health burden, particularly in low and middle-income countries.
- Atrial fibrillation is a major modifiable risk factor for stroke.
- Latin America faces unique challenges in stroke management and prevention.
Purpose of the Study:
- To review stroke risk factors, focusing on atrial fibrillation.
- To examine the management and prevention strategies for stroke in Latin America.
- To analyze stroke outcomes across the Latin American region.
Main Methods:
- A narrative review of studies published between January 2009 and March 2015.
- Searches conducted in PubMed, Embase, Cochrane, SciELO, WHO, and PAHO databases.
- Focus on stroke epidemiology and atrial fibrillation management in Latin America.
Main Results:
- Low and middle-income nations, including most of Latin America, account for two-thirds of global strokes.
- Less than half of atrial fibrillation patients worldwide receive adequate anticoagulation.
- In Latin America, 46% of outpatients with atrial fibrillation did not receive guideline-compliant anticoagulation.
Conclusions:
- Atrial fibrillation-related strokes impose a substantial burden.
- Non-vitamin K antagonist oral anticoagulants offer a promising alternative for stroke risk reduction.
- Addressing healthcare inequalities and improving access to care are vital for effective stroke prevention in Latin America.
Context And Objective::
To examine stroke risk factors, including atrial fibrillation, management and prevention, and stroke outcomes across Latin America.
Design And Setting::
Narrative review conducted at Piedmont Heart Institute, United States.
Methods::
The PubMed, Embase and Cochrane databases were searched for stroke AND "Latin America" AND epidemiology (between January 2009 and March 2015). Further studies in the SciELO, World Health Organization and Pan-American Health Organization databases were used to address specific points.
Results::
Countries categorized as low or middle-income nations by the World Bank, which includes most of Latin America, account for two-thirds of all strokes. Globally, fewer than half of patients (median treatment level: 43.9%) with atrial fibrillation receive adequate anticoagulation to reduce stroke risk, which correlates with data from Latin America, where 46% of outpatients did not receive guideline-compliant anticoagulation, ranging from 41.8% in Brazil to 54.8% in Colombia.
Conclusions::
Atrial fibrillation-related stroke carries a heavy burden. Non-vitamin K antagonist oral anti-coagulants provide options for reducing the risk of atrial fibrillation-related stroke. However, cost-effectiveness comparisons with warfarin are warranted before observational health-economics study results can be applied clinically. Initiatives to remedy inequalities and improve access to care across Latin America should accompany risk factor modification and guideline-based prevention.
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