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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Curvas de supervivencia de Kaplan-Meier en los pacientes con una o varias condiciones de estudio &#40;sarcopenia&#44; fragilidad y deterioro cognitivo&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La fibrilaci&#243;n auricular &#40;FA&#41; es la arritmia m&#225;s frecuente en todo el mundo y su prevalencia aumenta con la edad<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">1</span></a>&#46; Se asocia con un incremento de la mortalidad y del riesgo de sufrir un evento cerebrovascular<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">2</span></a>&#46; Los pacientes con FA suelen ser de edad avanzada&#44; tienen mucha comorbilidad y consumen muchos f&#225;rmacos&#46; Todo ello hace que sean pacientes muy fr&#225;giles<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">3</span></a>&#46; La fragilidad se define como un estado asociado al envejecimiento que se caracteriza por una disminuci&#243;n de la reserva fisiol&#243;gica&#44; un aumento del riesgo de incapacidad&#44; una p&#233;rdida de la resistencia y una mayor vulnerabilidad a eventos adversos manifestada por mayor morbimortalidad<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">4</span></a>&#46; En un estudio retrospectivo realizado en la Universidad de Mil&#225;n que incluy&#243; a 403 pacientes con FA el 57&#37; se clasificaron como fr&#225;giles&#44; el 29&#37; como pre-fr&#225;giles y &#250;nicamente el 14&#37; como no fr&#225;giles<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La sarcopenia es un s&#237;ndrome que se caracteriza por una p&#233;rdida gradual y generalizada de la masa muscular esquel&#233;tica y de la fuerza&#44; con riesgo de presentar resultados adversos como discapacidad f&#237;sica&#44; calidad de vida deficiente y mortalidad<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">5</span></a>&#46; Se considera primaria cuando no hay ninguna otra causa evidente salvo el envejecimiento&#44; y secundaria cuando hay una o varias otras causas<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">La incidencia de deterioro cognitivo en la FA est&#225; aumentada<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">7</span></a>&#46; En los estudios ONTARGET y TRANSCEND los pacientes con FA tuvieron un mayor riesgo de deterioro cognitivo y aparici&#243;n de demencia<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">8</span></a>&#46; Este riesgo es mayor cuanto mayor es la puntuaci&#243;n en las escalas CHADS<span class="elsevierStyleInf">2</span> y CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-Vasc<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">9</span></a>&#46; En un metaan&#225;lisis la FA se asoci&#243; con el deterioro cognitivo en los pacientes con y sin diagn&#243;stico de ictus<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El objetivo de este estudio fue determinar la prevalencia de la sarcopenia&#44; la fragilidad y el deterioro cognitivo en los pacientes ancianos con FA no valvular &#40;FANV&#41; y su influencia en la supervivencia&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Este an&#225;lisis es un subestudio de los pacientes incluidos en el registro NONAVASC&#46; El registro NONAVASC fue un estudio observacional&#44; prospectivo&#44; multic&#233;ntrico&#44; realizado en servicios de Medicina Interna de 64 hospitales en Espa&#241;a<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">11</span></a>&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Criterios de inclusi&#243;n</span><p id="par0030" class="elsevierStylePara elsevierViewall">Entre octubre de 2014 y mayo de 2015 cada investigador incluy&#243; de forma consecutiva al menos a 10 pacientes mayores de 75<span class="elsevierStyleHsp" style=""></span>a&#241;os hospitalizados por cualquier causa&#44; con presencia de FANV previa o diagnosticada durante el ingreso&#46; Se consider&#243; FANV la FA que aparec&#237;a en ausencia de estenosis mitral reum&#225;tica moderada-grave o pr&#243;tesis valvular<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">12</span></a>&#46; La clasificaci&#243;n de FANV en parox&#237;stica&#44; permanente o persistente se realiz&#243; seg&#250;n la definici&#243;n de las Gu&#237;as Europeas de la Sociedad Europea de Cardiolog&#237;a<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">13</span></a>&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Procedimientos</span><p id="par0035" class="elsevierStylePara elsevierViewall">La recogida de datos se realiz&#243; en una base anonimizada en l&#237;nea&#44; en la que se incluyeron par&#225;metros sociodemogr&#225;ficos&#44; cl&#237;nicos&#44; anal&#237;ticos&#44; de imagen&#44; terap&#233;uticos y evolutivos&#46; El riesgo tromb&#243;tico y hemorr&#225;gico al ingreso fue evaluado mediante las escalas CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-Vasc<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">14</span></a> y HAS-BLED<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">15</span></a>&#44; respectivamente&#46; La evaluaci&#243;n de la situaci&#243;n social&#44; funcional y cognitiva se realiz&#243; al ingreso mediante una entrevista personal con el paciente o con su cuidador principal&#46; La comorbilidad fue evaluada con el &#237;ndice de Charlson<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">16</span></a>&#44; la capacidad para realizar las actividades b&#225;sicas de la vida diaria con el &#237;ndice de Barthel<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">17</span></a> y el grado de deterioro cognitivo con el <span class="elsevierStyleItalic">Short Portable Mental State Questionnaire</span><a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">18</span></a>&#46; Se consider&#243; que exist&#237;a deterioro cognitivo cuando el n&#250;mero de errores en este cuestionario era &#8805;<span class="elsevierStyleHsp" style=""></span>4&#46; La sarcopenia se valor&#243; con la escala SARC-F<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">19</span></a> y se consider&#243; que la hab&#237;a cuando la puntuaci&#243;n era &#8805;<span class="elsevierStyleHsp" style=""></span>4&#46; La fragilidad se evalu&#243; con la escala FRAIL<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">20</span></a>&#44; y se consider&#243; fr&#225;giles a los pacientes con &#8805;<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>puntos&#46; Tambi&#233;n se recogieron los niveles de hemoglobina&#44; creatinina y plaquetas&#46; Se defini&#243; la insuficiencia renal como un filtrado glomerular inferior a 60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#46; Se recogi&#243; el n&#250;mero de f&#225;rmacos prescritos al alta y el uso de anticoagulantes orales&#46; Posteriormente se realiz&#243; un seguimiento durante un a&#241;o&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">El estudio fue aprobado por el Comit&#233; de &#201;tica de Investigaci&#243;n Cl&#237;nica del Hospital Universitario de La Princesa y todos los pacientes&#44; o sus familiares en caso de deterioro cognitivo&#44; dieron su consentimiento informado escrito&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">An&#225;lisis estad&#237;stico</span><p id="par0045" class="elsevierStylePara elsevierViewall">Las variables cualitativas se presentan como frecuencia absoluta y porcentaje y las cuantitativas&#44; como media y desviaci&#243;n est&#225;ndar&#46; Las comparaciones de las primeras se hicieron con el test de chi cuadrado&#44; aplicando la correcci&#243;n de Yates o el test de Fisher en caso necesario&#44; y las de las &#250;ltimas con el test t de Student&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Para estudiar las variables asociadas con la mortalidad se construy&#243; un modelo de regresi&#243;n de Cox&#46; Se excluyeron las variables con colinealidad y se incluyeron las variables edad&#44; sexo&#44; puntuaci&#243;n en el &#237;ndice de Charlson y las escalas CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-Vasc y HAS-BLED&#44; deterioro cognitivo&#44; fragilidad&#44; sarcopenia y prescripci&#243;n de anticoagulantes orales al alta&#46; En el an&#225;lisis multivariante se incluyeron aquellas con una significaci&#243;n estad&#237;stica p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;1 en el an&#225;lisis univariante&#46; Para el an&#225;lisis de supervivencia se construyeron las curvas de Kaplan-Meier para los pacientes con ninguna&#44; una&#44; dos o las tres condiciones del estudio&#44; es decir&#44; sarcopenia&#44; fragilidad y deterioro cognitivo&#46; Las curvas se compararon con test log-rank&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">En todos los casos el nivel de significaci&#243;n estad&#237;stica se estableci&#243; para un valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">El an&#225;lisis de los datos se realiz&#243; con el programa estad&#237;stico SPSS v&#46; 22&#46;0&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><p id="par0065" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> muestra el diagrama de flujo de inclusi&#243;n de pacientes&#46; De los 697 pacientes iniciales se perdieron 101 en el seguimiento &#40;14&#44;5&#37;&#41;&#46; Los pacientes perdidos ten&#237;an menos comorbilidad medida por el &#237;ndice de Charlson&#44; hab&#237;an ingresado menos en el a&#241;o previo&#44; consum&#237;an menos f&#225;rmacos y se les hab&#237;an prescrito menos anticoagulantes orales al alta&#46; No hab&#237;a diferencias en el resto de caracter&#237;sticas ni en la prevalencia de sarcopenia&#44; fragilidad y deterioro cognitivo&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Finalmente se incluyeron 596 pacientes&#44; con una edad media de 84&#44;9 &#40;5&#44;2&#41; a&#241;os&#46; Eran mujeres 315 &#40;52&#44;9&#37;&#41;&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se presentan las caracter&#237;sticas de los pacientes incluidos en el estudio&#46; La puntuaci&#243;n media en la escala CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-Vasc fue 5&#44;3 &#40;1&#44;4&#41; y en la escala HAS-BLED&#44; 2&#44;7 &#40;1&#44;2&#41;&#46; En la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a> se presenta la prevalencia de sarcopenia&#44; fragilidad y deterioro cognitivo&#46; Era frecuente la asociaci&#243;n entre las mismas&#58; 436 &#40;73&#44;1&#37;&#41; pacientes presentaban una de las condiciones y 136 &#40;22&#44;8&#37;&#41; las tres&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Sarcopenia</span><p id="par0075" class="elsevierStylePara elsevierViewall">La sarcopenia estaba presente en 295 &#40;49&#44;5&#37;&#41; pacientes&#46; Estos eran de mayor edad&#44; m&#225;s frecuentemente mujeres&#44; y con menos frecuencia ten&#237;an sobrepeso u obesidad&#46; En ellos la enfermedad cerebrovascular era m&#225;s frecuente&#44; ten&#237;an puntuaciones m&#225;s altas en la escala CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-Vasc pero no en la HAS-BLED y al alta se les prescribieron anticoagulantes orales con menos frecuencia &#40;49&#44;3&#37; vs 58&#44;7&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Adem&#225;s&#44; su capacidad para realizar las actividades b&#225;sicas de la vida diaria medida con el &#237;ndice de Barthel fue menor&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Fragilidad</span><p id="par0080" class="elsevierStylePara elsevierViewall">La fragilidad estaba presente en 305 &#40;51&#44;2&#37;&#41; pacientes&#46; Los pacientes fr&#225;giles eran con m&#225;s frecuencia mujeres&#44; ten&#237;an m&#225;s comorbilidad medida con el &#237;ndice de Charlson y ten&#237;an puntuaciones m&#225;s altas en las escalas CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-Vasc y HAS-BLED&#46; M&#225;s frecuentemente ten&#237;an historia de enfermedad cerebrovascular&#44; insuficiencia renal y hemorragia&#44; y su capacidad para realizar las actividades de la vida diaria era menor &#40;&#237;ndice de Barthel 56 vs 78&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; La prescripci&#243;n de anticoagulantes orales al alta fue menor en los pacientes fr&#225;giles &#40;44&#44;9&#37; vs 54&#44;0&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;027&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Deterioro cognitivo</span><p id="par0085" class="elsevierStylePara elsevierViewall">Doscientos cincuenta y un pacientes &#40;42&#44;1&#37;&#41; ten&#237;an deterioro cognitivo&#46; Estos pacientes eran de m&#225;s edad&#44; puntuaban m&#225;s bajo en el &#237;ndice de Barthel y con m&#225;s frecuencia eran mujeres y ten&#237;an enfermedad cerebrovascular y embolismo perif&#233;rico&#46; Con menos frecuencia ten&#237;an obesidad o sobrepeso&#44; insuficiencia cardiaca e historia de hemorragia&#46; Puntuaban m&#225;s alto en la escala CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-Vasc pero no en la HAS-BLED&#46; Al alta se les prescribieron anticoagulantes orales con menor frecuencia &#40;38&#44;2&#37; vs 57&#44;4&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Supervivencia</span><p id="par0090" class="elsevierStylePara elsevierViewall">Al cabo de un a&#241;o fallecieron 226 &#40;37&#44;9&#37;&#41; pacientes&#46; La <a class="elsevierStyleCrossRef" href="#fig0015">figura 3</a> muestra las curvas de supervivencia de Kaplan-Meier&#46; La supervivencia fue menor en los pacientes con sarcopenia &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>A&#41;&#44; fragilidad &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>B&#41; y deterioro cognitivo &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>C&#41;&#46; La mortalidad fue mayor cuantas m&#225;s de estas condiciones presentaba el paciente &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>D&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Los factores asociados con la mortalidad al cabo de un a&#241;o se presentan en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46; En el an&#225;lisis univariante esta estuvo asociada con la sarcopenia&#44; la fragilidad y el deterioro cognitivo&#46; Sin embargo&#44; en el an&#225;lisis multivariante solo la edad&#44; la comorbilidad medida con el &#237;ndice de Charlson&#44; el antecedente de embolismo perif&#233;rico previo y la sarcopenia &#40;HR&#58; 1&#44;775&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;270-2&#44;481&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; se asociaron de forma independiente con una mayor mortalidad&#44; y la prescripci&#243;n de anticoagulantes orales al alta &#40;HR&#59; 0&#44;415&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 0&#44;307-0&#44;560&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; con una disminuci&#243;n de la misma&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discusi&#243;n</span><p id="par0100" class="elsevierStylePara elsevierViewall">Los principales hallazgos de nuestro estudio fueron que la sarcopenia&#44; la fragilidad y el deterioro cognitivo son condiciones muy prevalentes&#44; y frecuentemente asociadas&#44; en los pacientes ancianos con FANV hospitalizados&#44; y que la sarcopenia se asocia de forma independiente con la mortalidad al cabo de un a&#241;o&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">La sarcopenia es una p&#233;rdida de masa o fuerza muscular asociada generalmente&#44; pero no exclusivamente&#44; al envejecimiento<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">21</span></a>&#46; Afecta al 5-13&#37; de los mayores de 60<span class="elsevierStyleHsp" style=""></span>a&#241;os y hasta al 50&#37; de los octogenarios<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">22</span></a>&#46; Puede aparecer de forma aguda durante la hospitalizaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">23</span></a>&#46; Uno de cada dos de nuestros pacientes ancianos hospitalizados con FANV ten&#237;a sarcopenia&#46; Hasta nuestro conocimiento no hay estudios sobre la asociaci&#243;n de sarcopenia y FANV&#46; Se ha observado una remodelaci&#243;n celular con desdiferenciaci&#243;n del cardiomiocito en la FANV<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">24</span></a> y una disregulaci&#243;n de la regeneraci&#243;n miog&#233;nica en la sarcopenia<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">25</span></a>&#46; Nosotros hipotetizamos que puede haber una relaci&#243;n entre ambas condiciones&#44; y creemos que son necesarios estudios para elucidar si la FANV es una manifestaci&#243;n de sarcopenia cardiaca o si la sarcopenia es una consecuencia sist&#233;mica de la FANV&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">La fragilidad es un estado de vulnerabilidad y p&#233;rdida de resistencia ante los factores estresantes externos que aumenta el riesgo de presentar resultados adversos como ca&#237;das&#44; discapacidad&#44; inmovilidad&#44; hospitalizaci&#243;n y muerte<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">26</span></a>&#46; Se caracteriza por p&#233;rdida de peso o altura&#44; debilidad&#44; agotamiento&#44; lentitud y baja actividad&#46; La prevalencia de fragilidad en los pacientes ancianos con FANV se ha estimado en el 39&#37;&#44; pero var&#237;a dependiendo del instrumento utilizado para medirla<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">27</span></a>&#46; La presencia de fragilidad fue del 25&#37; en estudios que utilizaron la <span class="elsevierStyleItalic">Clinical Frailty Scale</span> y del 53-60&#37; cuando se us&#243; la <span class="elsevierStyleItalic">Edmonton Frail Scale</span><a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">28-30</span></a>&#46; Nosotros&#44; utilizando la escala FRAIL&#44; hemos observado una prevalencia del 49&#44;8&#37;&#46; Por lo tanto&#44; puede concluirse que la fragilidad es frecuente en los ancianos con FANV&#46; Adem&#225;s en nuestro estudio la fragilidad se ha asociado con mayor riesgo de ictus medido con la escala CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-Vasc y con mayor riesgo de hemorragia medido con la escala HAS-BLED&#46; Esta asociaci&#243;n de la fragilidad con la puntuaci&#243;n en estas escalas ya hab&#237;a sido reportada previamente<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">31</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">La relaci&#243;n entre FANV y deterioro cognitivo est&#225; bien establecida<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">32</span></a>&#46; La FANV predispone a sufrir ictus&#44; y los ictus son causa de deterioro cognitivo&#46; Sin embargo&#44; se ha demostrado que la FANV se asocia con deterioro cognitivo aun en ausencia de ictus<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">10&#44;33</span></a>&#46; Adem&#225;s de los ictus manifiestos o silentes&#44; en la aparici&#243;n de deterioro cognitivo intervienen otros mecanismos&#44; como la hipoperfusi&#243;n cerebral&#44; el estado inflamatorio vascular con aumento de la producci&#243;n de prote&#237;na precursora amiloide&#44; las microhemorragias y factores gen&#233;ticos<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">34</span></a>&#46; Las puntuaciones m&#225;s altas en la escala CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-Vasc se asocian con mayor riesgo de aparici&#243;n de demencia<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">9</span></a>&#46; Nuestros pacientes con deterioro cognitivo puntuaron m&#225;s alto en dicha escala&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Nuestros pacientes puntuaban bajo en el &#237;ndice de Barthel indicando una alta discapacidad&#46; Tanto la sarcopenia como la fragilidad y el deterioro cognitivo provocan discapacidad&#46; Por esta raz&#243;n no hemos incluido la discapacidad en el an&#225;lisis de la mortalidad&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Se ha propuesto que la anticoagulaci&#243;n oral con warfarina puede disminuir hasta en un 20&#37; el riesgo de aparici&#243;n de demencia en los pacientes con FANV&#46; Adem&#225;s&#44; el riesgo disminuir&#237;a cuanto mayor fuera el tiempo en rango terap&#233;utico<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">35</span></a>&#46; El uso de los anticoagulantes orales de acci&#243;n directa tambi&#233;n se ha asociado con menor aparici&#243;n de demencia<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">36</span></a>&#46; Sin embargo&#44; al igual que en otros estudios previos&#44; los anticoagulantes orales fueron menos prescritos en nuestros pacientes con deterioro cognitivo<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">37</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Los anticoagulantes orales de acci&#243;n directa han demostrado disminuir los sangrados en los pacientes con fragilidad y con riesgo de ca&#237;das<a class="elsevierStyleCrossRefs" href="#bib0405"><span class="elsevierStyleSup">38&#44;39</span></a>&#46; Adem&#225;s&#44; rivaroxab&#225;n ha disminuido los ictus y los embolismos sist&#233;micos<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">38</span></a> y edoxab&#225;n ha reducido la mortalidad por todas las causas en estos pacientes<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">39</span></a>&#46; A pesar de ello&#44; y al igual que en otros estudios&#44; en nuestros pacientes con fragilidad la prescripci&#243;n de anticoagulantes orales fue menor<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">27</span></a>&#46; Sin embargo&#44; no puede olvidarse que en los enfermos con enfermedades en fase avanzada y FANV&#44; que con frecuencia tienen discapacidad y deterioro cognitivo&#44; el estado funcional y no la anticoagulaci&#243;n tienen una mayor asociaci&#243;n con la supervivencia<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">40</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">En nuestro estudio hemos observado con frecuencia la asociaci&#243;n de fragilidad y deterioro cognitivo&#44; denominada fragilidad cognitiva&#44; pero tambi&#233;n la asociaci&#243;n de sarcopenia y fragilidad&#44; y de sarcopenia y deterioro cognitivo&#46; Adem&#225;s&#44; todas estas condiciones se asociaron con la discapacidad y la mortalidad al cabo de un a&#241;o&#46; Sin embargo&#44; solo la sarcopenia lo hizo de forma independiente&#46; Es conocido que la sarcopenia en los ancianos est&#225; asociada con la mortalidad por todas las causas<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">41</span></a>&#46; La sarcopenia es un estado potencialmente reversible&#46; Las gu&#237;as recomiendan la actividad f&#237;sica y la intervenci&#243;n nutricional en los adultos con sarcopenia<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">42</span></a>&#46; Desafortunadamente&#44; los estudios que han evaluado el efecto de la rehabilitaci&#243;n cardiaca basada en el ejercicio en los pacientes con FA son peque&#241;os y de baja calidad<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">43</span></a>&#46; Por ello creemos que al diagnosticar una FANV&#44; y en su evoluci&#243;n posterior&#44; hay que prevenir y detectar precozmente la sarcopenia recomendando una correcta alimentaci&#243;n y pautas de ejercicio f&#237;sico adaptado&#46; Para conocer la eficacia de estas medidas ser&#225; necesario desarrollar ensayos cl&#237;nicos <span class="elsevierStyleItalic">ad hoc</span>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Nuestro estudio tiene varias limitaciones&#46; En primer lugar hubo un 14&#44;5&#37; de p&#233;rdidas en el seguimiento de los pacientes&#46; Aunque el umbral para considerar un estudio como v&#225;lido es del 20&#37;&#44; las p&#233;rdidas pueden afectar a la aplicabilidad y generalizaci&#243;n de los resultados&#46; En segundo lugar&#44; solo se han incluido ancianos con FANV hospitalizados en departamentos de medicina interna&#44; y por lo tanto los resultados observados pueden no ser aplicables a pacientes con FANV ingresados en salas de cardiolog&#237;a&#44; neurolog&#237;a o cuidados intensivos&#46; Adem&#225;s&#44; es conocido que la fragilidad y la sarcopenia son m&#225;s prevalentes en los pacientes hospitalizados&#44; y nuestros resultados no son aplicables a los ancianos con FANV visitados en los centros de atenci&#243;n primaria&#46; Finalmente&#44; la sarcopenia se ha diagnosticado con un cuestionario&#46; Es posible que los resultados fueran diferentes si se hubieran utilizado la medida de la prensi&#243;n de la mano y la bioimpedanciometr&#237;a&#46; Sin embargo&#44; el cuestionario SARC-F ha sido validado y&#44; por su sencillez y rapidez&#44; cada vez es m&#225;s utilizado en la cl&#237;nica&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Por otra parte&#44; nuestro estudio tambi&#233;n tiene fortalezas&#46; Es un estudio multic&#233;ntrico&#44; y es conocido que estos estudios tienen resultados m&#225;s robustos que los realizados en un &#250;nico centro&#46; Adem&#225;s&#44; el &#250;nico criterio de exclusi&#243;n fue no dar el consentimiento informado&#44; lo que garantiz&#243; una amplia representatividad de la muestra&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; la sarcopenia&#44; la fragilidad y el deterioro cognitivo son frecuentes en los ancianos con FANV y se asocian con una alta mortalidad&#46; Su detecci&#243;n debe formar parte de la evaluaci&#243;n exhaustiva de estos pacientes y es preciso adoptar estrategias para su prevenci&#243;n y tratamiento precoz&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Financiaci&#243;n</span><p id="par0155" class="elsevierStylePara elsevierViewall">El estudio NONAVASC fue financiado por una beca no condicionada de Bayer&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicto de intereses</span><p id="par0160" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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          "titulo" => "Abstract"
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              "titulo" => "Sarcopenia"
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              "titulo" => "Fragilidad"
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              "titulo" => "Deterioro cognitivo"
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    "fechaRecibido" => "2019-01-17"
    "fechaAceptado" => "2019-04-01"
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            2 => "Fragilidad"
            3 => "Deterioro cognitivo"
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            1 => "Sarcopenia"
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            3 => "Cognitive impairment"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Determinar la prevalencia de la sarcopenia&#44; la fragilidad y el deterioro cognitivo en pacientes ancianos con fibrilaci&#243;n auricular no valvular &#40;FANV&#41; y su influencia en la supervivencia&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio de cohortes&#44; prospectivo y multic&#233;ntrico realizado con pacientes &#62;<span class="elsevierStyleHsp" style=""></span>75<span class="elsevierStyleHsp" style=""></span>a&#241;os con FANV hospitalizados en servicios de Medicina Interna en Espa&#241;a&#46; Para cada paciente se recogieron los niveles de creatinina&#44; hemoglobina y plaquetas&#44; as&#237; como las escalas CHA2DS2-Vasc&#44; HAS-BLED&#44; el &#237;ndice de Charlson y el uso de anticoagulantes orales&#46; Se midi&#243; la sarcopenia con escala SARC-F&#44; la fragilidad con la escala FRAIL y el deterioro cognitivo con el <span class="elsevierStyleItalic">Short Portable Mental State Questionnaire</span>&#46; Se realiz&#243; seguimiento durante un a&#241;o&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 596 pacientes con FANV&#44; con edad media de 84&#44;9 &#40;DE&#58; 5&#44;2&#41; a&#241;os&#46; De ellos&#44; 295 &#40;49&#44;5&#37;&#41; presentaban sarcopenia&#44; 305 &#40;51&#44;2&#37;&#41; fragilidad y 251 &#40;42&#44;1&#37;&#41; deterioro cognitivo&#46; Al cabo de un a&#241;o fallecieron 226 &#40;37&#44;9&#37;&#41; pacientes&#46; La mortalidad fue superior en los pacientes con sarcopenia&#44; fragilidad y deterioro cognitivo&#46; En el an&#225;lisis multivariante la sarcopenia &#40;HR&#58; 1&#44;775&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;270-2&#44;481&#41;&#44; la edad&#44; la comorbilidad y el antecedente de embolismo perif&#233;rico se asociaron con mayor mortalidad&#44; y el uso de anticoagulantes orales al alta &#40;HR&#58; 0&#44;415&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 0&#44;307-0&#44;560&#41;&#44; con menor mortalidad&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En los pacientes ancianos con FANV la sarcopenia&#44; la fragilidad y el deterioro cognitivo son muy prevalentes y se asocian con frecuencia&#46; La sarcopenia se asocia a mayor mortalidad&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To determine the prevalence of sarcopenia&#44; frailty and cognitive impairment in elderly patients with nonvalvular atrial fibrillation &#40;NVAF&#41; and the factors&#8217; influence on survival&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Prospective&#44; multicentre cohort study of patients older than 75 years with NVAF hospitalised in internal medicine departments in Spain&#46; For each patient&#44; we recorded the creatinine&#44; haemoglobin and platelet levels&#44; the scores on the CHA2DS2-VASc and HAS-BLED scales and Charlson index&#44; as well as the use of oral anticoagulants&#46; We measured sarcopenia with the SARC-F scale&#44; frailty with the FRAIL scale and cognitive impairment with the Short Portable Mental State Questionnaire&#46; We also conducted a 1-year follow-up&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The study included 596 patients with NVAF&#44; with a mean age of 84&#46;9 &#40;SD&#58; 5&#46;2&#41; years&#46; Of these&#44; 295 &#40;49&#46;5&#37;&#41; presented sarcopenia&#44; 305 &#40;51&#46;2&#37;&#41; presented frailty&#44; and 251 &#40;42&#46;1&#37;&#41; presented cognitive impairment&#46; At the end of 1<span class="elsevierStyleHsp" style=""></span>year&#44; 226 &#40;37&#46;9&#37;&#41; patients had died&#46; Mortality was greater for the patients with sarcopenia&#44; frailty and cognitive impairment&#46; In the multivariate analysis&#44; sarcopenia &#40;HR&#58; 1&#46;775&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 1&#46;270-2&#46;481&#41;&#44; age&#44; comorbidity and a history of peripheral embolism were associated with increased mortality&#44; and the use of oral anticoagulants at discharge &#40;HR&#58; 0&#46;415&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 0&#46;307-0&#46;560&#41; was associated with lower mortality&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Sarcopenia&#44; frailty and cognitive impairment are very common in elderly patients with NVAF and are frequently associated&#46; Sarcopenia was associated with increased mortality&#46;</p></span>"
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            "etiqueta" => "Anexo"
            "titulo" => "Miembros del Grupo Riesgo Vascular de la Sociedad Espa&#241;ola de Medicina Interna"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Total &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>596&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sarcopenia</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Fragilidad</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Deterioro cognitivo</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">S&#237; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>295&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>301&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">S&#237; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>305&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>291&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">S&#237; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>251&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>345&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Edad<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#44;9 &#40;5&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#44;8 &#40;5&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#44;1 &#40;5&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#44;5 &#40;5&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#44;9 &#40;504&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;877&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#44;3 &#40;5&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83&#44;9 &#40;4&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sexo mujer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">315 &#40;52&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">191 &#40;64&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">124 &#40;41&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">185 &#40;60&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">130 &#40;44&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">164 &#40;65&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">151 &#40;43&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bajo peso &#40;IMC<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>20 kg&#47;m<span class="elsevierStyleSup">2</span>&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;3&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;5&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;2&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;159&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;4&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;3&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;246&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;4&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;3&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;379&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sobrepeso u obesidad &#40;IMC &#62;<span class="elsevierStyleHsp" style=""></span>25<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">367 &#40;65&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">166 &#40;60&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">201 &#40;70&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">188 &#40;65&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">179 &#40;66&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;847&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">127 &#40;55&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">240 &#40;72&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diabetes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">238 &#40;39&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">120 &#40;39&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;974&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">136 &#40;44&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">102 &#40;35&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">100 &#40;39&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">138 &#40;40&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;969&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hipertensi&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">524 &#40;87&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">257 &#40;87&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">267 &#40;88&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;553&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">275 &#40;90&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">249 &#40;85&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;085&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">218 &#40;86&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">306 &#40;88&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;495&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hiperlipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">268 &#40;45&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">124 &#40;42&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">144 &#40;48&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;143&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">145 &#40;47&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">123 &#40;42&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;209&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">114 &#40;45&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">154 &#40;44&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;865&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Insuficiencia cardiaca&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">407 &#40;68&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">198 &#40;67&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">209 &#40;69&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;543&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">217 &#40;71&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">190 &#40;65&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;125&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">158 &#40;62&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">249 &#40;72&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Antecedente de embolismo perif&#233;rico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">34 &#40;5&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">21 &#40;7&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;4&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;135&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;6&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;4&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;211&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">21 &#40;8&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13 &#40;3&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Antecedente previo de FA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">551 &#40;92&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">273 &#40;92&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">278 &#40;92&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;932&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">282 &#40;92&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">269 &#40;92&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;993&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">229 &#40;91&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">322 &#40;93&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;338&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Antecedente de hemorragia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85 &#40;14&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 13&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#218;lceras por presi&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;2&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ca&#237;das en el a&#241;o previo<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">169 &#40;28&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">69 &#40;24&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">84 &#40;24&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Tiene cuidador&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">414 &#40;69&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">210 &#40;84&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">204 &#40;59&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#205;ndice de Charlson<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">4&#44;1 &#40;2&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#44;2 &#40;2&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;6 &#40;2&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Escala CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-Vasc<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#44;1 &#40;1&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">5&#44;4 &#40;1&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#44;2 &#40;1&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;042&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Escala HAS-BLED<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;7 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;7 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;9 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;4 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;580&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#205;ndice de Barthel<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">67 &#40;31&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">44 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">89 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">56 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">78 &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">81 &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">SPMSQ<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Ingresos a&#241;o previo<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;061&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;6 &#40;1&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;752&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Hemoglobina &#40;g&#47;dl&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">226 &#40;99&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">218 &#40;96&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;331&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">233 &#40;104&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Creatinina &#40;mg&#47;dl&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;3 &#40;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#44;3 &#40;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#44;4 &#40;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#44;4 &#40;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;3 &#40;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;3 &#40;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alb&#250;mina &#40;g&#47;dl&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HAS-BLED&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;096 &#40;0&#44;984-1&#44;221&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;097&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;992 &#40;0&#44;878-1&#44;122&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;902&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Antecedente de embolismo perif&#233;rico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;995 &#40;1&#44;243-3&#44;201&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;004&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;091 &#40;1&#44;288-3&#44;395&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;003&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Sarcopenia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;508 &#40;1&#44;884-3&#44;340&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;775 &#40;1&#44;270-2&#44;481&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;866 &#40;1&#44;414-2&#44;463&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;108 &#40;1&#44;611-2&#44;757&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;266 &#40;0&#44;939-1&#44;707&#41;&nbsp;\t\t\t\t\t\t\n
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                          "etal" => true
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                          "autores" => array:6 [
                            0 => "A&#46;J&#46; Cruz-Jentoft"
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                            2 => "J&#46; Bauer"
                            3 => "Y&#46; Boirie"
                            4 => "T&#46; Cederholm"
                            5 => "F&#46; Landi"
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                            3 => "W&#46;T&#46; Longstreht Jr&#46;"
                            4 => "C&#46;M&#46; Sitlani"
                            5 => "S&#46; Dublin"
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                    0 => array:2 [
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                      "titulo" => "Increased risk of cognitive and functional decline in patients with atrial fibrillation&#58; Results of the ONTARGET and TRANSCEND studies"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46; Marzona"
                            1 => "M&#46; O&#8217;Donell"
                            2 => "K&#46; Teo"
                            3 => "P&#46; Gao"
                            4 => "C&#46; Anderson"
                            5 => "J&#46; Bosch"
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                    0 => array:2 [
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                      "titulo" => "Risk and prediction of dementia in patients with atrial fibrillation &#8212; A nationwide population-based cohort study"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;N&#46; Liao"
                            1 => "T&#46;F&#46; Chao"
                            2 => "C&#46;J&#46; Liu"
                            3 => "K&#46;L&#46; Wang"
                            4 => "S&#46;J&#46; Chen"
                            5 => "T&#46;C&#46; Tuan"
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                        ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijcard.2015.06.170"
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                        "tituloSerie" => "Int J Cardiol"
                        "fecha" => "2015"
                        "volumen" => "199"
                        "paginaInicial" => "25"
                        "paginaFinal" => "30"
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Original
Sarcopenia, fragilidad, deterioro cognitivo y mortalidad en pacientes ancianos con fibrilación auricular no valvular
Sarcopenia, frailty, cognitive impairment and mortality in elderly patients with non-valvular atrial fibrillation
M.A. Requena Callejaa, A. Arenas Miquéleza, J. Díez-Manglanoa,
Autor para correspondencia
jdiez@aragon.es

Autor para correspondencia.
, A. Gullónb, A. Posec, F. Formigad, J.M. Mostazae, J.M. Cepedaf, C. Suárezb, en nombre de los investigadores del estudio NONAVASC , Grupo de Riesgo Vascular de la Sociedad Española de Medicina Interna 1
a Departamento de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, España
b Departamento de Medicina Interna, Hospital Universitario de La Princesa, Madrid, España
c Departamento de Medicina Interna, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España
d Departamento de Medicina Interna, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, España
e Departamento de Medicina Interna, Hospital Carlos III, Madrid, España
f Departamento de Medicina Interna, Hospital Vega Baja, Orihuela, Alicante, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La fibrilaci&#243;n auricular &#40;FA&#41; es la arritmia m&#225;s frecuente en todo el mundo y su prevalencia aumenta con la edad<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">1</span></a>&#46; Se asocia con un incremento de la mortalidad y del riesgo de sufrir un evento cerebrovascular<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">2</span></a>&#46; Los pacientes con FA suelen ser de edad avanzada&#44; tienen mucha comorbilidad y consumen muchos f&#225;rmacos&#46; Todo ello hace que sean pacientes muy fr&#225;giles<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">3</span></a>&#46; La fragilidad se define como un estado asociado al envejecimiento que se caracteriza por una disminuci&#243;n de la reserva fisiol&#243;gica&#44; un aumento del riesgo de incapacidad&#44; una p&#233;rdida de la resistencia y una mayor vulnerabilidad a eventos adversos manifestada por mayor morbimortalidad<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">4</span></a>&#46; En un estudio retrospectivo realizado en la Universidad de Mil&#225;n que incluy&#243; a 403 pacientes con FA el 57&#37; se clasificaron como fr&#225;giles&#44; el 29&#37; como pre-fr&#225;giles y &#250;nicamente el 14&#37; como no fr&#225;giles<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La sarcopenia es un s&#237;ndrome que se caracteriza por una p&#233;rdida gradual y generalizada de la masa muscular esquel&#233;tica y de la fuerza&#44; con riesgo de presentar resultados adversos como discapacidad f&#237;sica&#44; calidad de vida deficiente y mortalidad<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">5</span></a>&#46; Se considera primaria cuando no hay ninguna otra causa evidente salvo el envejecimiento&#44; y secundaria cuando hay una o varias otras causas<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">La incidencia de deterioro cognitivo en la FA est&#225; aumentada<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">7</span></a>&#46; En los estudios ONTARGET y TRANSCEND los pacientes con FA tuvieron un mayor riesgo de deterioro cognitivo y aparici&#243;n de demencia<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">8</span></a>&#46; Este riesgo es mayor cuanto mayor es la puntuaci&#243;n en las escalas CHADS<span class="elsevierStyleInf">2</span> y CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-Vasc<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">9</span></a>&#46; En un metaan&#225;lisis la FA se asoci&#243; con el deterioro cognitivo en los pacientes con y sin diagn&#243;stico de ictus<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El objetivo de este estudio fue determinar la prevalencia de la sarcopenia&#44; la fragilidad y el deterioro cognitivo en los pacientes ancianos con FA no valvular &#40;FANV&#41; y su influencia en la supervivencia&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Este an&#225;lisis es un subestudio de los pacientes incluidos en el registro NONAVASC&#46; El registro NONAVASC fue un estudio observacional&#44; prospectivo&#44; multic&#233;ntrico&#44; realizado en servicios de Medicina Interna de 64 hospitales en Espa&#241;a<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">11</span></a>&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Criterios de inclusi&#243;n</span><p id="par0030" class="elsevierStylePara elsevierViewall">Entre octubre de 2014 y mayo de 2015 cada investigador incluy&#243; de forma consecutiva al menos a 10 pacientes mayores de 75<span class="elsevierStyleHsp" style=""></span>a&#241;os hospitalizados por cualquier causa&#44; con presencia de FANV previa o diagnosticada durante el ingreso&#46; Se consider&#243; FANV la FA que aparec&#237;a en ausencia de estenosis mitral reum&#225;tica moderada-grave o pr&#243;tesis valvular<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">12</span></a>&#46; La clasificaci&#243;n de FANV en parox&#237;stica&#44; permanente o persistente se realiz&#243; seg&#250;n la definici&#243;n de las Gu&#237;as Europeas de la Sociedad Europea de Cardiolog&#237;a<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">13</span></a>&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Procedimientos</span><p id="par0035" class="elsevierStylePara elsevierViewall">La recogida de datos se realiz&#243; en una base anonimizada en l&#237;nea&#44; en la que se incluyeron par&#225;metros sociodemogr&#225;ficos&#44; cl&#237;nicos&#44; anal&#237;ticos&#44; de imagen&#44; terap&#233;uticos y evolutivos&#46; El riesgo tromb&#243;tico y hemorr&#225;gico al ingreso fue evaluado mediante las escalas CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-Vasc<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">14</span></a> y HAS-BLED<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">15</span></a>&#44; respectivamente&#46; La evaluaci&#243;n de la situaci&#243;n social&#44; funcional y cognitiva se realiz&#243; al ingreso mediante una entrevista personal con el paciente o con su cuidador principal&#46; La comorbilidad fue evaluada con el &#237;ndice de Charlson<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">16</span></a>&#44; la capacidad para realizar las actividades b&#225;sicas de la vida diaria con el &#237;ndice de Barthel<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">17</span></a> y el grado de deterioro cognitivo con el <span class="elsevierStyleItalic">Short Portable Mental State Questionnaire</span><a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">18</span></a>&#46; Se consider&#243; que exist&#237;a deterioro cognitivo cuando el n&#250;mero de errores en este cuestionario era &#8805;<span class="elsevierStyleHsp" style=""></span>4&#46; La sarcopenia se valor&#243; con la escala SARC-F<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">19</span></a> y se consider&#243; que la hab&#237;a cuando la puntuaci&#243;n era &#8805;<span class="elsevierStyleHsp" style=""></span>4&#46; La fragilidad se evalu&#243; con la escala FRAIL<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">20</span></a>&#44; y se consider&#243; fr&#225;giles a los pacientes con &#8805;<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>puntos&#46; Tambi&#233;n se recogieron los niveles de hemoglobina&#44; creatinina y plaquetas&#46; Se defini&#243; la insuficiencia renal como un filtrado glomerular inferior a 60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#46; Se recogi&#243; el n&#250;mero de f&#225;rmacos prescritos al alta y el uso de anticoagulantes orales&#46; Posteriormente se realiz&#243; un seguimiento durante un a&#241;o&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">El estudio fue aprobado por el Comit&#233; de &#201;tica de Investigaci&#243;n Cl&#237;nica del Hospital Universitario de La Princesa y todos los pacientes&#44; o sus familiares en caso de deterioro cognitivo&#44; dieron su consentimiento informado escrito&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">An&#225;lisis estad&#237;stico</span><p id="par0045" class="elsevierStylePara elsevierViewall">Las variables cualitativas se presentan como frecuencia absoluta y porcentaje y las cuantitativas&#44; como media y desviaci&#243;n est&#225;ndar&#46; Las comparaciones de las primeras se hicieron con el test de chi cuadrado&#44; aplicando la correcci&#243;n de Yates o el test de Fisher en caso necesario&#44; y las de las &#250;ltimas con el test t de Student&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Para estudiar las variables asociadas con la mortalidad se construy&#243; un modelo de regresi&#243;n de Cox&#46; Se excluyeron las variables con colinealidad y se incluyeron las variables edad&#44; sexo&#44; puntuaci&#243;n en el &#237;ndice de Charlson y las escalas CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-Vasc y HAS-BLED&#44; deterioro cognitivo&#44; fragilidad&#44; sarcopenia y prescripci&#243;n de anticoagulantes orales al alta&#46; En el an&#225;lisis multivariante se incluyeron aquellas con una significaci&#243;n estad&#237;stica p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;1 en el an&#225;lisis univariante&#46; Para el an&#225;lisis de supervivencia se construyeron las curvas de Kaplan-Meier para los pacientes con ninguna&#44; una&#44; dos o las tres condiciones del estudio&#44; es decir&#44; sarcopenia&#44; fragilidad y deterioro cognitivo&#46; Las curvas se compararon con test log-rank&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">En todos los casos el nivel de significaci&#243;n estad&#237;stica se estableci&#243; para un valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">El an&#225;lisis de los datos se realiz&#243; con el programa estad&#237;stico SPSS v&#46; 22&#46;0&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><p id="par0065" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> muestra el diagrama de flujo de inclusi&#243;n de pacientes&#46; De los 697 pacientes iniciales se perdieron 101 en el seguimiento &#40;14&#44;5&#37;&#41;&#46; Los pacientes perdidos ten&#237;an menos comorbilidad medida por el &#237;ndice de Charlson&#44; hab&#237;an ingresado menos en el a&#241;o previo&#44; consum&#237;an menos f&#225;rmacos y se les hab&#237;an prescrito menos anticoagulantes orales al alta&#46; No hab&#237;a diferencias en el resto de caracter&#237;sticas ni en la prevalencia de sarcopenia&#44; fragilidad y deterioro cognitivo&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Finalmente se incluyeron 596 pacientes&#44; con una edad media de 84&#44;9 &#40;5&#44;2&#41; a&#241;os&#46; Eran mujeres 315 &#40;52&#44;9&#37;&#41;&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se presentan las caracter&#237;sticas de los pacientes incluidos en el estudio&#46; La puntuaci&#243;n media en la escala CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-Vasc fue 5&#44;3 &#40;1&#44;4&#41; y en la escala HAS-BLED&#44; 2&#44;7 &#40;1&#44;2&#41;&#46; En la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a> se presenta la prevalencia de sarcopenia&#44; fragilidad y deterioro cognitivo&#46; Era frecuente la asociaci&#243;n entre las mismas&#58; 436 &#40;73&#44;1&#37;&#41; pacientes presentaban una de las condiciones y 136 &#40;22&#44;8&#37;&#41; las tres&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Sarcopenia</span><p id="par0075" class="elsevierStylePara elsevierViewall">La sarcopenia estaba presente en 295 &#40;49&#44;5&#37;&#41; pacientes&#46; Estos eran de mayor edad&#44; m&#225;s frecuentemente mujeres&#44; y con menos frecuencia ten&#237;an sobrepeso u obesidad&#46; En ellos la enfermedad cerebrovascular era m&#225;s frecuente&#44; ten&#237;an puntuaciones m&#225;s altas en la escala CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-Vasc pero no en la HAS-BLED y al alta se les prescribieron anticoagulantes orales con menos frecuencia &#40;49&#44;3&#37; vs 58&#44;7&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Adem&#225;s&#44; su capacidad para realizar las actividades b&#225;sicas de la vida diaria medida con el &#237;ndice de Barthel fue menor&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Fragilidad</span><p id="par0080" class="elsevierStylePara elsevierViewall">La fragilidad estaba presente en 305 &#40;51&#44;2&#37;&#41; pacientes&#46; Los pacientes fr&#225;giles eran con m&#225;s frecuencia mujeres&#44; ten&#237;an m&#225;s comorbilidad medida con el &#237;ndice de Charlson y ten&#237;an puntuaciones m&#225;s altas en las escalas CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-Vasc y HAS-BLED&#46; M&#225;s frecuentemente ten&#237;an historia de enfermedad cerebrovascular&#44; insuficiencia renal y hemorragia&#44; y su capacidad para realizar las actividades de la vida diaria era menor &#40;&#237;ndice de Barthel 56 vs 78&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; La prescripci&#243;n de anticoagulantes orales al alta fue menor en los pacientes fr&#225;giles &#40;44&#44;9&#37; vs 54&#44;0&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;027&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Deterioro cognitivo</span><p id="par0085" class="elsevierStylePara elsevierViewall">Doscientos cincuenta y un pacientes &#40;42&#44;1&#37;&#41; ten&#237;an deterioro cognitivo&#46; Estos pacientes eran de m&#225;s edad&#44; puntuaban m&#225;s bajo en el &#237;ndice de Barthel y con m&#225;s frecuencia eran mujeres y ten&#237;an enfermedad cerebrovascular y embolismo perif&#233;rico&#46; Con menos frecuencia ten&#237;an obesidad o sobrepeso&#44; insuficiencia cardiaca e historia de hemorragia&#46; Puntuaban m&#225;s alto en la escala CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-Vasc pero no en la HAS-BLED&#46; Al alta se les prescribieron anticoagulantes orales con menor frecuencia &#40;38&#44;2&#37; vs 57&#44;4&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Supervivencia</span><p id="par0090" class="elsevierStylePara elsevierViewall">Al cabo de un a&#241;o fallecieron 226 &#40;37&#44;9&#37;&#41; pacientes&#46; La <a class="elsevierStyleCrossRef" href="#fig0015">figura 3</a> muestra las curvas de supervivencia de Kaplan-Meier&#46; La supervivencia fue menor en los pacientes con sarcopenia &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>A&#41;&#44; fragilidad &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>B&#41; y deterioro cognitivo &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>C&#41;&#46; La mortalidad fue mayor cuantas m&#225;s de estas condiciones presentaba el paciente &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>D&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Los factores asociados con la mortalidad al cabo de un a&#241;o se presentan en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46; En el an&#225;lisis univariante esta estuvo asociada con la sarcopenia&#44; la fragilidad y el deterioro cognitivo&#46; Sin embargo&#44; en el an&#225;lisis multivariante solo la edad&#44; la comorbilidad medida con el &#237;ndice de Charlson&#44; el antecedente de embolismo perif&#233;rico previo y la sarcopenia &#40;HR&#58; 1&#44;775&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;270-2&#44;481&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; se asociaron de forma independiente con una mayor mortalidad&#44; y la prescripci&#243;n de anticoagulantes orales al alta &#40;HR&#59; 0&#44;415&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 0&#44;307-0&#44;560&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; con una disminuci&#243;n de la misma&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discusi&#243;n</span><p id="par0100" class="elsevierStylePara elsevierViewall">Los principales hallazgos de nuestro estudio fueron que la sarcopenia&#44; la fragilidad y el deterioro cognitivo son condiciones muy prevalentes&#44; y frecuentemente asociadas&#44; en los pacientes ancianos con FANV hospitalizados&#44; y que la sarcopenia se asocia de forma independiente con la mortalidad al cabo de un a&#241;o&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">La sarcopenia es una p&#233;rdida de masa o fuerza muscular asociada generalmente&#44; pero no exclusivamente&#44; al envejecimiento<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">21</span></a>&#46; Afecta al 5-13&#37; de los mayores de 60<span class="elsevierStyleHsp" style=""></span>a&#241;os y hasta al 50&#37; de los octogenarios<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">22</span></a>&#46; Puede aparecer de forma aguda durante la hospitalizaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">23</span></a>&#46; Uno de cada dos de nuestros pacientes ancianos hospitalizados con FANV ten&#237;a sarcopenia&#46; Hasta nuestro conocimiento no hay estudios sobre la asociaci&#243;n de sarcopenia y FANV&#46; Se ha observado una remodelaci&#243;n celular con desdiferenciaci&#243;n del cardiomiocito en la FANV<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">24</span></a> y una disregulaci&#243;n de la regeneraci&#243;n miog&#233;nica en la sarcopenia<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">25</span></a>&#46; Nosotros hipotetizamos que puede haber una relaci&#243;n entre ambas condiciones&#44; y creemos que son necesarios estudios para elucidar si la FANV es una manifestaci&#243;n de sarcopenia cardiaca o si la sarcopenia es una consecuencia sist&#233;mica de la FANV&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">La fragilidad es un estado de vulnerabilidad y p&#233;rdida de resistencia ante los factores estresantes externos que aumenta el riesgo de presentar resultados adversos como ca&#237;das&#44; discapacidad&#44; inmovilidad&#44; hospitalizaci&#243;n y muerte<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">26</span></a>&#46; Se caracteriza por p&#233;rdida de peso o altura&#44; debilidad&#44; agotamiento&#44; lentitud y baja actividad&#46; La prevalencia de fragilidad en los pacientes ancianos con FANV se ha estimado en el 39&#37;&#44; pero var&#237;a dependiendo del instrumento utilizado para medirla<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">27</span></a>&#46; La presencia de fragilidad fue del 25&#37; en estudios que utilizaron la <span class="elsevierStyleItalic">Clinical Frailty Scale</span> y del 53-60&#37; cuando se us&#243; la <span class="elsevierStyleItalic">Edmonton Frail Scale</span><a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">28-30</span></a>&#46; Nosotros&#44; utilizando la escala FRAIL&#44; hemos observado una prevalencia del 49&#44;8&#37;&#46; Por lo tanto&#44; puede concluirse que la fragilidad es frecuente en los ancianos con FANV&#46; Adem&#225;s en nuestro estudio la fragilidad se ha asociado con mayor riesgo de ictus medido con la escala CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-Vasc y con mayor riesgo de hemorragia medido con la escala HAS-BLED&#46; Esta asociaci&#243;n de la fragilidad con la puntuaci&#243;n en estas escalas ya hab&#237;a sido reportada previamente<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">31</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">La relaci&#243;n entre FANV y deterioro cognitivo est&#225; bien establecida<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">32</span></a>&#46; La FANV predispone a sufrir ictus&#44; y los ictus son causa de deterioro cognitivo&#46; Sin embargo&#44; se ha demostrado que la FANV se asocia con deterioro cognitivo aun en ausencia de ictus<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">10&#44;33</span></a>&#46; Adem&#225;s de los ictus manifiestos o silentes&#44; en la aparici&#243;n de deterioro cognitivo intervienen otros mecanismos&#44; como la hipoperfusi&#243;n cerebral&#44; el estado inflamatorio vascular con aumento de la producci&#243;n de prote&#237;na precursora amiloide&#44; las microhemorragias y factores gen&#233;ticos<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">34</span></a>&#46; Las puntuaciones m&#225;s altas en la escala CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-Vasc se asocian con mayor riesgo de aparici&#243;n de demencia<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">9</span></a>&#46; Nuestros pacientes con deterioro cognitivo puntuaron m&#225;s alto en dicha escala&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Nuestros pacientes puntuaban bajo en el &#237;ndice de Barthel indicando una alta discapacidad&#46; Tanto la sarcopenia como la fragilidad y el deterioro cognitivo provocan discapacidad&#46; Por esta raz&#243;n no hemos incluido la discapacidad en el an&#225;lisis de la mortalidad&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Se ha propuesto que la anticoagulaci&#243;n oral con warfarina puede disminuir hasta en un 20&#37; el riesgo de aparici&#243;n de demencia en los pacientes con FANV&#46; Adem&#225;s&#44; el riesgo disminuir&#237;a cuanto mayor fuera el tiempo en rango terap&#233;utico<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">35</span></a>&#46; El uso de los anticoagulantes orales de acci&#243;n directa tambi&#233;n se ha asociado con menor aparici&#243;n de demencia<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">36</span></a>&#46; Sin embargo&#44; al igual que en otros estudios previos&#44; los anticoagulantes orales fueron menos prescritos en nuestros pacientes con deterioro cognitivo<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">37</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Los anticoagulantes orales de acci&#243;n directa han demostrado disminuir los sangrados en los pacientes con fragilidad y con riesgo de ca&#237;das<a class="elsevierStyleCrossRefs" href="#bib0405"><span class="elsevierStyleSup">38&#44;39</span></a>&#46; Adem&#225;s&#44; rivaroxab&#225;n ha disminuido los ictus y los embolismos sist&#233;micos<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">38</span></a> y edoxab&#225;n ha reducido la mortalidad por todas las causas en estos pacientes<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">39</span></a>&#46; A pesar de ello&#44; y al igual que en otros estudios&#44; en nuestros pacientes con fragilidad la prescripci&#243;n de anticoagulantes orales fue menor<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">27</span></a>&#46; Sin embargo&#44; no puede olvidarse que en los enfermos con enfermedades en fase avanzada y FANV&#44; que con frecuencia tienen discapacidad y deterioro cognitivo&#44; el estado funcional y no la anticoagulaci&#243;n tienen una mayor asociaci&#243;n con la supervivencia<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">40</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">En nuestro estudio hemos observado con frecuencia la asociaci&#243;n de fragilidad y deterioro cognitivo&#44; denominada fragilidad cognitiva&#44; pero tambi&#233;n la asociaci&#243;n de sarcopenia y fragilidad&#44; y de sarcopenia y deterioro cognitivo&#46; Adem&#225;s&#44; todas estas condiciones se asociaron con la discapacidad y la mortalidad al cabo de un a&#241;o&#46; Sin embargo&#44; solo la sarcopenia lo hizo de forma independiente&#46; Es conocido que la sarcopenia en los ancianos est&#225; asociada con la mortalidad por todas las causas<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">41</span></a>&#46; La sarcopenia es un estado potencialmente reversible&#46; Las gu&#237;as recomiendan la actividad f&#237;sica y la intervenci&#243;n nutricional en los adultos con sarcopenia<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">42</span></a>&#46; Desafortunadamente&#44; los estudios que han evaluado el efecto de la rehabilitaci&#243;n cardiaca basada en el ejercicio en los pacientes con FA son peque&#241;os y de baja calidad<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">43</span></a>&#46; Por ello creemos que al diagnosticar una FANV&#44; y en su evoluci&#243;n posterior&#44; hay que prevenir y detectar precozmente la sarcopenia recomendando una correcta alimentaci&#243;n y pautas de ejercicio f&#237;sico adaptado&#46; Para conocer la eficacia de estas medidas ser&#225; necesario desarrollar ensayos cl&#237;nicos <span class="elsevierStyleItalic">ad hoc</span>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Nuestro estudio tiene varias limitaciones&#46; En primer lugar hubo un 14&#44;5&#37; de p&#233;rdidas en el seguimiento de los pacientes&#46; Aunque el umbral para considerar un estudio como v&#225;lido es del 20&#37;&#44; las p&#233;rdidas pueden afectar a la aplicabilidad y generalizaci&#243;n de los resultados&#46; En segundo lugar&#44; solo se han incluido ancianos con FANV hospitalizados en departamentos de medicina interna&#44; y por lo tanto los resultados observados pueden no ser aplicables a pacientes con FANV ingresados en salas de cardiolog&#237;a&#44; neurolog&#237;a o cuidados intensivos&#46; Adem&#225;s&#44; es conocido que la fragilidad y la sarcopenia son m&#225;s prevalentes en los pacientes hospitalizados&#44; y nuestros resultados no son aplicables a los ancianos con FANV visitados en los centros de atenci&#243;n primaria&#46; Finalmente&#44; la sarcopenia se ha diagnosticado con un cuestionario&#46; Es posible que los resultados fueran diferentes si se hubieran utilizado la medida de la prensi&#243;n de la mano y la bioimpedanciometr&#237;a&#46; Sin embargo&#44; el cuestionario SARC-F ha sido validado y&#44; por su sencillez y rapidez&#44; cada vez es m&#225;s utilizado en la cl&#237;nica&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Por otra parte&#44; nuestro estudio tambi&#233;n tiene fortalezas&#46; Es un estudio multic&#233;ntrico&#44; y es conocido que estos estudios tienen resultados m&#225;s robustos que los realizados en un &#250;nico centro&#46; Adem&#225;s&#44; el &#250;nico criterio de exclusi&#243;n fue no dar el consentimiento informado&#44; lo que garantiz&#243; una amplia representatividad de la muestra&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; la sarcopenia&#44; la fragilidad y el deterioro cognitivo son frecuentes en los ancianos con FANV y se asocian con una alta mortalidad&#46; Su detecci&#243;n debe formar parte de la evaluaci&#243;n exhaustiva de estos pacientes y es preciso adoptar estrategias para su prevenci&#243;n y tratamiento precoz&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Financiaci&#243;n</span><p id="par0155" class="elsevierStylePara elsevierViewall">El estudio NONAVASC fue financiado por una beca no condicionada de Bayer&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicto de intereses</span><p id="par0160" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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          "titulo" => "Abstract"
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              "titulo" => "Sarcopenia"
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              "titulo" => "Fragilidad"
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              "titulo" => "Deterioro cognitivo"
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    "fechaRecibido" => "2019-01-17"
    "fechaAceptado" => "2019-04-01"
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            2 => "Fragilidad"
            3 => "Deterioro cognitivo"
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            1 => "Sarcopenia"
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            3 => "Cognitive impairment"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Determinar la prevalencia de la sarcopenia&#44; la fragilidad y el deterioro cognitivo en pacientes ancianos con fibrilaci&#243;n auricular no valvular &#40;FANV&#41; y su influencia en la supervivencia&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio de cohortes&#44; prospectivo y multic&#233;ntrico realizado con pacientes &#62;<span class="elsevierStyleHsp" style=""></span>75<span class="elsevierStyleHsp" style=""></span>a&#241;os con FANV hospitalizados en servicios de Medicina Interna en Espa&#241;a&#46; Para cada paciente se recogieron los niveles de creatinina&#44; hemoglobina y plaquetas&#44; as&#237; como las escalas CHA2DS2-Vasc&#44; HAS-BLED&#44; el &#237;ndice de Charlson y el uso de anticoagulantes orales&#46; Se midi&#243; la sarcopenia con escala SARC-F&#44; la fragilidad con la escala FRAIL y el deterioro cognitivo con el <span class="elsevierStyleItalic">Short Portable Mental State Questionnaire</span>&#46; Se realiz&#243; seguimiento durante un a&#241;o&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 596 pacientes con FANV&#44; con edad media de 84&#44;9 &#40;DE&#58; 5&#44;2&#41; a&#241;os&#46; De ellos&#44; 295 &#40;49&#44;5&#37;&#41; presentaban sarcopenia&#44; 305 &#40;51&#44;2&#37;&#41; fragilidad y 251 &#40;42&#44;1&#37;&#41; deterioro cognitivo&#46; Al cabo de un a&#241;o fallecieron 226 &#40;37&#44;9&#37;&#41; pacientes&#46; La mortalidad fue superior en los pacientes con sarcopenia&#44; fragilidad y deterioro cognitivo&#46; En el an&#225;lisis multivariante la sarcopenia &#40;HR&#58; 1&#44;775&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;270-2&#44;481&#41;&#44; la edad&#44; la comorbilidad y el antecedente de embolismo perif&#233;rico se asociaron con mayor mortalidad&#44; y el uso de anticoagulantes orales al alta &#40;HR&#58; 0&#44;415&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 0&#44;307-0&#44;560&#41;&#44; con menor mortalidad&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En los pacientes ancianos con FANV la sarcopenia&#44; la fragilidad y el deterioro cognitivo son muy prevalentes y se asocian con frecuencia&#46; La sarcopenia se asocia a mayor mortalidad&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To determine the prevalence of sarcopenia&#44; frailty and cognitive impairment in elderly patients with nonvalvular atrial fibrillation &#40;NVAF&#41; and the factors&#8217; influence on survival&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Prospective&#44; multicentre cohort study of patients older than 75 years with NVAF hospitalised in internal medicine departments in Spain&#46; For each patient&#44; we recorded the creatinine&#44; haemoglobin and platelet levels&#44; the scores on the CHA2DS2-VASc and HAS-BLED scales and Charlson index&#44; as well as the use of oral anticoagulants&#46; We measured sarcopenia with the SARC-F scale&#44; frailty with the FRAIL scale and cognitive impairment with the Short Portable Mental State Questionnaire&#46; We also conducted a 1-year follow-up&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The study included 596 patients with NVAF&#44; with a mean age of 84&#46;9 &#40;SD&#58; 5&#46;2&#41; years&#46; Of these&#44; 295 &#40;49&#46;5&#37;&#41; presented sarcopenia&#44; 305 &#40;51&#46;2&#37;&#41; presented frailty&#44; and 251 &#40;42&#46;1&#37;&#41; presented cognitive impairment&#46; At the end of 1<span class="elsevierStyleHsp" style=""></span>year&#44; 226 &#40;37&#46;9&#37;&#41; patients had died&#46; Mortality was greater for the patients with sarcopenia&#44; frailty and cognitive impairment&#46; In the multivariate analysis&#44; sarcopenia &#40;HR&#58; 1&#46;775&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 1&#46;270-2&#46;481&#41;&#44; age&#44; comorbidity and a history of peripheral embolism were associated with increased mortality&#44; and the use of oral anticoagulants at discharge &#40;HR&#58; 0&#46;415&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 0&#46;307-0&#46;560&#41; was associated with lower mortality&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Sarcopenia&#44; frailty and cognitive impairment are very common in elderly patients with NVAF and are frequently associated&#46; Sarcopenia was associated with increased mortality&#46;</p></span>"
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            "etiqueta" => "Anexo"
            "titulo" => "Miembros del Grupo Riesgo Vascular de la Sociedad Espa&#241;ola de Medicina Interna"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Total &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>596&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sarcopenia</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Fragilidad</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Deterioro cognitivo</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">S&#237; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>295&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>301&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">S&#237; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>305&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>291&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">S&#237; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>251&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>345&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Edad<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#44;9 &#40;5&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#44;8 &#40;5&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#44;1 &#40;5&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#44;5 &#40;5&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#44;9 &#40;504&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;877&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#44;3 &#40;5&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83&#44;9 &#40;4&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sexo mujer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">315 &#40;52&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">191 &#40;64&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">124 &#40;41&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">185 &#40;60&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">130 &#40;44&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">164 &#40;65&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">151 &#40;43&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bajo peso &#40;IMC<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>20 kg&#47;m<span class="elsevierStyleSup">2</span>&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;3&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;5&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;2&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;159&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;4&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;3&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;246&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;4&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;3&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;379&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sobrepeso u obesidad &#40;IMC &#62;<span class="elsevierStyleHsp" style=""></span>25<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">367 &#40;65&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">166 &#40;60&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">201 &#40;70&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">188 &#40;65&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">179 &#40;66&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;847&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">127 &#40;55&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">240 &#40;72&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diabetes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">238 &#40;39&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">120 &#40;39&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;974&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">136 &#40;44&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">102 &#40;35&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">100 &#40;39&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">138 &#40;40&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;969&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hipertensi&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">524 &#40;87&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">257 &#40;87&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">267 &#40;88&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;553&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">275 &#40;90&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">249 &#40;85&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;085&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">218 &#40;86&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">306 &#40;88&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;495&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hiperlipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">268 &#40;45&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">124 &#40;42&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">144 &#40;48&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;143&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">145 &#40;47&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">123 &#40;42&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;209&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">114 &#40;45&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">154 &#40;44&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;865&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Insuficiencia cardiaca&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">407 &#40;68&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">198 &#40;67&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">209 &#40;69&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;543&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">217 &#40;71&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">190 &#40;65&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;125&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">158 &#40;62&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">249 &#40;72&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Antecedente de embolismo perif&#233;rico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">34 &#40;5&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">21 &#40;7&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;4&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;135&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;6&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;4&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;211&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">21 &#40;8&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13 &#40;3&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Antecedente previo de FA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">551 &#40;92&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">273 &#40;92&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">278 &#40;92&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;932&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">282 &#40;92&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">269 &#40;92&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;993&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">229 &#40;91&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">322 &#40;93&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;338&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Antecedente de hemorragia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85 &#40;14&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 13&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#218;lceras por presi&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;2&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ca&#237;das en el a&#241;o previo<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">169 &#40;28&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">69 &#40;24&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">84 &#40;24&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Tiene cuidador&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">414 &#40;69&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">210 &#40;84&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">204 &#40;59&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#205;ndice de Charlson<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">4&#44;1 &#40;2&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#44;2 &#40;2&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;6 &#40;2&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Escala CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-Vasc<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#44;1 &#40;1&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">5&#44;4 &#40;1&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#44;2 &#40;1&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;042&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Escala HAS-BLED<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;7 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;7 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;9 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;4 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;580&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#205;ndice de Barthel<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">67 &#40;31&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">44 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">89 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">56 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">78 &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">81 &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">SPMSQ<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Ingresos a&#241;o previo<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;061&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;6 &#40;1&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;752&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Hemoglobina &#40;g&#47;dl&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">226 &#40;99&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">218 &#40;96&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;331&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">233 &#40;104&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Creatinina &#40;mg&#47;dl&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;3 &#40;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#44;3 &#40;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#44;4 &#40;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#44;4 &#40;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;3 &#40;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;3 &#40;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alb&#250;mina &#40;g&#47;dl&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HAS-BLED&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;096 &#40;0&#44;984-1&#44;221&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;097&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;992 &#40;0&#44;878-1&#44;122&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;902&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Antecedente de embolismo perif&#233;rico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;995 &#40;1&#44;243-3&#44;201&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;004&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;091 &#40;1&#44;288-3&#44;395&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;003&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Sarcopenia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;508 &#40;1&#44;884-3&#44;340&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;775 &#40;1&#44;270-2&#44;481&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;866 &#40;1&#44;414-2&#44;463&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;108 &#40;1&#44;611-2&#44;757&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;266 &#40;0&#44;939-1&#44;707&#41;&nbsp;\t\t\t\t\t\t\n
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                          "etal" => true
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                          "autores" => array:6 [
                            0 => "A&#46;J&#46; Cruz-Jentoft"
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                            2 => "J&#46; Bauer"
                            3 => "Y&#46; Boirie"
                            4 => "T&#46; Cederholm"
                            5 => "F&#46; Landi"
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                            3 => "W&#46;T&#46; Longstreht Jr&#46;"
                            4 => "C&#46;M&#46; Sitlani"
                            5 => "S&#46; Dublin"
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                    0 => array:2 [
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                      "titulo" => "Increased risk of cognitive and functional decline in patients with atrial fibrillation&#58; Results of the ONTARGET and TRANSCEND studies"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46; Marzona"
                            1 => "M&#46; O&#8217;Donell"
                            2 => "K&#46; Teo"
                            3 => "P&#46; Gao"
                            4 => "C&#46; Anderson"
                            5 => "J&#46; Bosch"
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                    0 => array:2 [
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                      "titulo" => "Risk and prediction of dementia in patients with atrial fibrillation &#8212; A nationwide population-based cohort study"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;N&#46; Liao"
                            1 => "T&#46;F&#46; Chao"
                            2 => "C&#46;J&#46; Liu"
                            3 => "K&#46;L&#46; Wang"
                            4 => "S&#46;J&#46; Chen"
                            5 => "T&#46;C&#46; Tuan"
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                        ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijcard.2015.06.170"
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                        "tituloSerie" => "Int J Cardiol"
                        "fecha" => "2015"
                        "volumen" => "199"
                        "paginaInicial" => "25"
                        "paginaFinal" => "30"
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ISSN: 00142565
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