Propuestas de mejora en el manejo de los pacientes anticoagulados con fibrilación auricular no valvular y riesgo de ictus

Abstract

Objectives. The purpose of this work is to provide a follow-up to the project carried out in 2017, in which the sensitization actions and training given to the group of medical specialists in family and community medicine contributed to the improvement of the anticoagulation process in patients with non-valvular atrial fibrillation (NVAF) and elevated risk of stroke. In this work, priority has been given to the recommendations suggested in the FMEA (Failure Mode and Effects Analysis) workshops conducted during 2017. Key factors of success and barriers for the recommendations with the greatest priority were identified. An operation plan for the implementation of said recommendations was made. In addition, all the actions necessary to be able to carry it out as well as proposals for distribution of responsibilities, if pertinent, were made. Material and methods. A total of 30 workshops with the contribution of 59 speakers (specialists in cardiology and family medicine) and the participation of 323 family physicians on a national level were carried out. The field work was conducted between 22 February and 26 June of 2018. Results. The recommendations given priority by the participants were: (a) to evaluate the change of treatment to DOAC; (b) to conduct an adequate follow-up to the patients; and (c) to carry out protocols or clinical practice guidelines on NVAF. The factors of success and barriers to carry them out were determined for each one of them. Finally, an operation plan was defined for each one of them. The participants concluded that a key success factor in the recommendations was to evaluate the change of treatment to DOAC and that the training to the family physicians would be a key factor to an adequate follow-up of the patients. This should be the responsibility of a multidisciplinary team with the support of the Pharmaceutical Industry and the Scientific Societies. Conclusions. The participants in the workshops considered that in order to improve the anticoagulation process in patients with NVAF, it is necessary to evaluate the change of treatment to DOAC, to conduct an adequate follow-up to the patients or to made protocols or clinical practice guidelines on NVAF. To do so, they made operation plans and stressed the need for training of the family physicians.