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siendo los anticoagulantes de acci&#243;n directa &#40;ACOD&#41; los f&#225;rmacos indicados de forma prioritaria frente a los antagonistas de la vitamina K &#40;AVK&#41; en las gu&#237;as de pr&#225;ctica cl&#237;nica<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">3&#44;5</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">En muchas ocasiones se retrasa el inicio de la terapia anticoagulante por el retraso diagn&#243;stico de la arritmia<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">6&#8211;8</span></a>&#46; Es frecuente que las manifestaciones cl&#237;nicas est&#233;n ausentes o pasen desapercibidas para los pacientes&#59; otras veces se pierde la oportunidad de llevar a cabo el diagn&#243;stico en contactos con el sistema sanitario&#46; Como resultado&#44; la FA se detecta en el momento del desarrollo de una complicaci&#243;n grave<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En este estudio nos propusimos analizar el retraso diagn&#243;stico en pacientes con un diagn&#243;stico reciente de FA&#46; 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Se incluyeron los primeros cinco pacientes elegibles atendidos por cada m&#233;dico entre el 8-11-2021 y el 8-02-2022&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">El objetivo primario fue identificar en pacientes con un diagn&#243;stico reciente de FA&#44; si hab&#237;a existido un retraso en el diagn&#243;stico&#46; Los objetivos secundarios fueron&#58; 1&#41; describir el perfil demogr&#225;fico y cl&#237;nico de los pacientes con un diagn&#243;stico reciente de FA y c&#243;mo se llev&#243; a cabo el proceso diagn&#243;stico&#59; 2&#41; estimar el tiempo de demora diagn&#243;stica en caso de existir&#59; 3&#41; determinar los factores cl&#237;nico-demogr&#225;ficos que podr&#237;an asociarse con un retraso en el diagn&#243;stico de FA&#59; 3&#41; determinar las causas por las que los pacientes con s&#237;ntomas compatibles de FA no acuden a consulta&#59; 4&#41; determinar si son frecuentes las oportunidades perdidas de diagn&#243;stico precoz de FA en el sistema sanitario&#59; y 5&#41; determinar el tratamiento preventivo de eventos tromboemb&#243;licos inicial&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Poblaci&#243;n en estudio y m&#233;dicos investigadores</span><p id="par0030" class="elsevierStylePara elsevierViewall">Los m&#233;dicos investigadores eran especialistas en cardiolog&#237;a&#44; medicina interna o AP&#44; o m&#233;dicos de los Servicios de Urgencias&#44; que pod&#237;an entrevistar y revisar la historia de cinco pacientes recientemente diagnosticados de FA en el periodo contemplado en el estudio&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Los criterios de inclusi&#243;n fueron los siguientes&#58; 1&#41; edad &#62;<span class="elsevierStyleHsp" style=""></span>18 a&#241;os&#59; 2&#41; residentes en Espa&#241;a&#59; 3&#41; FA permanente&#44; parox&#237;stica o persistente &#40;definida como FA de 7-30 d&#237;as de duraci&#243;n&#41; recientemente diagnosticada&#46; Se pod&#237;an reclutar los pacientes en el mismo momento de la consulta en la que se diagnostique el problema &#40;si el m&#233;dico responsable es investigador del estudio&#44; por ejemplo&#44; en AP&#44; Urgencias&#8230;&#41; o en la primera consulta de seguimiento especializada a la que se derive el paciente tras su detecci&#243;n &#40;por ejemplo&#44; consultas de medicina interna o cardiolog&#237;a&#41;&#46; Los criterios de exclusi&#243;n fueron&#58; 1&#41; inestabilidad cl&#237;nica a juicio del investigador&#59; 2&#41; imposibilidad de responder de manera adecuada a las preguntas de la entrevista&#59; 3&#41; haber realizado una encuesta sobre FA en los &#250;ltimos 30 d&#237;as &#40;para evitar casos duplicados atendidos por diferentes especialistas&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Variables</span><p id="par0040" class="elsevierStylePara elsevierViewall">La recogida de datos se realiz&#243; a trav&#233;s de un formulario espec&#237;ficamente dise&#241;ado para este estudio&#46; Se recogieron variables demogr&#225;ficas y datos sobre la experiencia profesional de los m&#233;dicos investigadores&#46; De los pacientes&#44; se recogieron variables sociodemogr&#225;ficas y cl&#237;nicas&#46; Adem&#225;s&#44; se recogieron detalles sobre c&#243;mo se hab&#237;a realizado el diagn&#243;stico de la FA&#44; contactos previos con el sistema sanitario y el manejo antitromb&#243;tico inicial&#46; Se pregunt&#243; sobre sintomatolog&#237;a previa compatible y los motivos para demorar la consulta por dicha sintomatolog&#237;a&#44; si era el caso&#46; Se recogi&#243; la impresi&#243;n cl&#237;nica de los m&#233;dicos responsables sobre el retraso diagn&#243;stico&#44; en particular si el m&#233;dico investigador cre&#237;a que la FA era o no de inicio reciente &#40;definida como una FA de menos de 30 d&#237;as de evoluci&#243;n&#41; y si&#44; por los s&#237;ntomas o por contactos previos con el sistema sanitario&#44; se hab&#237;a producido bajo su criterio un retraso evitable en el diagn&#243;stico&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Aspectos &#233;ticos</span><p id="par0045" class="elsevierStylePara elsevierViewall">El estudio se llev&#243; a cabo de acuerdo con los requerimientos &#233;ticos de las declaraciones de Helsinki&#44; revisi&#243;n de Fortaleza &#40;Brasil&#44; octubre 2013&#41; para la investigaci&#243;n con seres humanos<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a>&#44; y las <span class="elsevierStyleItalic">International</span><span class="elsevierStyleItalic">Guidelines for Ethical Review of Epidemiological Studies</span><a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a>&#46; Los participantes firmaron un consentimiento informado&#46; El proyecto fue aprobado por el Comit&#233; &#201;tico de Investigaci&#243;n Cl&#237;nica del Hospital Costa del Sol&#44; Marbella &#40;M&#225;laga&#41; &#40;c&#243;digo&#58; 003&#95;sep21&#95;PI - Detecci&#243;n FA&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Estudio estad&#237;stico</span><p id="par0050" class="elsevierStylePara elsevierViewall">Se estim&#243; la inclusi&#243;n de 1&#46;111 pacientes como muestra suficiente para estimar los resultados centrales del estudio con una precisi&#243;n del &#177;<span class="elsevierStyleHsp" style=""></span>3&#37; en las condiciones m&#225;s desfavorables &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>q<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;5&#41; de una distribuci&#243;n binomial&#46; Se analizaron las variables cualitativas mediante la distribuci&#243;n de frecuencias relativas &#40;&#37;&#41; con intervalos de confianza del 95&#37;&#46; Para las variables cuantitativas&#44; se utilizaron media y desviaci&#243;n est&#225;ndar junto con la mediana y el rango en casos de datos con dispersi&#243;n amplia o at&#237;pica&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Se realiz&#243; un estudio univariante analizando las variables que se relacionan con la presencia de un retraso diagn&#243;stico de la FA a juicio del investigador&#46; Se compararon variables cualitativas empleando la prueba estad&#237;stica de Chi al cuadrado o prueba exacta de Fisher&#44; seg&#250;n la circunstancia&#46; La comparaci&#243;n de variables cuantitativas se efectu&#243; mediante la prueba t de Student &#40;o U de Mann Whitney&#44; si las condiciones de las submuestras as&#237; lo exig&#237;a&#41; o el an&#225;lisis de la varianza &#40;o prueba de Kruskal-Wallis&#41; en los casos de comparaciones m&#250;ltiples&#44; complementado por un test <span class="elsevierStyleItalic">a posteriori</span> de comparaci&#243;n m&#250;ltiple &#40;Bonferroni&#44; Tukey&#41;&#46; Se consider&#243; que exist&#237;an diferencias significativas cuando p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis multivariante con un modelo de regresi&#243;n log&#237;stica&#44; teniendo como variable dependiente la existencia o no de un retraso diagn&#243;stico de la FA a juicio del investigador&#44; y como variables independientes las variables cl&#237;nicas o epidemiol&#243;gicas relacionadas con el retraso diagn&#243;stico en el estudio univariante con p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;20 y las variables cl&#237;nicas relevantes a juicio del equipo investigador&#46; Se emple&#243; el algoritmo de &#171;pasos atr&#225;s&#187; desde el modelo completo para obtener el modelo final ajustado&#46; Se emple&#243; el programa R Statistical Software &#40;v4&#46;2&#46;3&#59; R Core Team 2023&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Resultados</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Caracter&#237;stica de los investigadores</span><p id="par0065" class="elsevierStylePara elsevierViewall">Un total de 201 m&#233;dicos participaron en el estudio &#40;62&#44;2&#37; hombres&#44; mediana de edad 42 a&#241;os&#44; rango 29-70&#41;&#46; Proced&#237;an de todas las Comunidades Aut&#243;nomas de Espa&#241;a&#44; principalmente de Andaluc&#237;a &#40;47 m&#233;dicos&#41; y Catalu&#241;a &#40;40 m&#233;dicos&#41;&#46; El perfil se resume en la <a class="elsevierStyleCrossRef" href="#tbl0005">Tabla 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Caracter&#237;sticas de los pacientes</span><p id="par0070" class="elsevierStylePara elsevierViewall">Se incluyeron 948 pacientes en el estudio &#40;55&#37; hombres&#44; mediana de edad 74 a&#241;os&#44; rango 32-99&#41;&#46; Las caracter&#237;sticas y antecedentes se resumen en las <a class="elsevierStyleCrossRefs" href="#tbl0005">Tablas 1 y 2</a>&#46; En el 41&#44;8&#37; de los pacientes la FA se catalog&#243; como parox&#237;stica en el momento del diagn&#243;stico&#44; el 30&#44;9&#37; como persistente y el 27&#44;3&#37; como permanente &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Retraso diagn&#243;stico</span><p id="par0075" class="elsevierStylePara elsevierViewall">Los especialistas estimaron que en el 61&#44;7&#37; de los casos &#40;585 pacientes&#41; la FA era de inicio reciente &#40;&#8804;<span class="elsevierStyleHsp" style=""></span>30 d&#237;as de evoluci&#243;n&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">En 467 del total de 948 pacientes &#40;49&#44;3&#37;&#41; se consider&#243; que se hab&#237;a producido un retraso en el diagn&#243;stico&#46; Se estim&#243; que el diagn&#243;stico se pod&#237;a haber adelantado &#60;<span class="elsevierStyleHsp" style=""></span>7 d&#237;as en el 16&#44;5&#37; de los casos &#40;77 pacientes&#41;&#44; 7-30 d&#237;as en el 12&#44;6&#37; &#40;59 pacientes&#41;&#44; 1-6 meses en el 50&#44;7&#37; &#40;237 pacientes&#41;&#44; 6 meses-un a&#241;o en el 12&#44;4&#37; &#40;58 pacientes&#41; y &#62;<span class="elsevierStyleHsp" style=""></span>1 a&#241;o en el 7&#44;7&#37; de casos &#40;36 pacientes&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0015">Tabla 3</a> muestra la relaci&#243;n entre factores sociodemogr&#225;ficos y cl&#237;nicos y el retraso diagn&#243;stico&#46; En un an&#225;lisis multivariante&#44; las variables asociadas con el retraso diagn&#243;stico fueron la presencia de FA permanente o persistente respecto a FA parox&#237;stica&#44; la edad&#44; la presencia de enfermedad valvular&#44; HTA&#44; cardiopat&#237;a isqu&#233;mica o neoplasia activa &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Tabla 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Circunstancias del diagn&#243;stico</span><p id="par0090" class="elsevierStylePara elsevierViewall">Cuando se pregunt&#243; a los pacientes acerca de si hab&#237;an experimentado sintomatolog&#237;a previa compatible con FA&#44; m&#225;s de la mitad contestaron afirmativamente &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>516&#44; 54&#44;4&#37;&#41;&#46; Los s&#237;ntomas m&#225;s frecuentes fueron las palpitaciones &#40;67&#44;4&#37;&#41; y la disnea &#40;50&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figura 1</a>&#41;&#46; La mayor&#237;a hab&#237;a experimentado s&#237;ntomas en el mes previo al diagn&#243;stico&#58; el 33&#37; en los 7 d&#237;as anteriores y el 32&#37; entre 7-30 d&#237;as previos&#46; La proporci&#243;n de pacientes que hab&#237;a experimentado s&#237;ntomas entre 30 d&#237;as-6 meses&#44; entre 6 meses-un a&#241;o o &#62;<span class="elsevierStyleHsp" style=""></span>1 a&#241;o antes del diagn&#243;stico fue del 20&#44;2&#37;&#44; 7&#37; y 7&#44;8&#37;&#44; respectivamente&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Entre los 516 pacientes que tuvieron sintomatolog&#237;a previa&#44; 168 &#40;32&#44;6&#37;&#41; hab&#237;an consultado previamente por dicha sintomatolog&#237;a&#44; sin que se llegara al diagn&#243;stico&#46; Los restantes 348 pacientes &#40;67&#44;4&#37;&#41; no consultaron por sus s&#237;ntomas&#46; Entre los que no consultaron previo al diagn&#243;stico de FA&#44; el principal motivo fue que los s&#237;ntomas no les parecieron importantes &#40;26&#44;7&#37;&#41; o que los atribuyeron a otras causas &#40;estr&#233;s&#44; falta de sue&#241;o&#44; etc&#46;&#41; &#40;22&#44;7&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figura 1</a>&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">En el global de los pacientes&#44; el diagn&#243;stico de FA se realiz&#243; tras la realizaci&#243;n de pruebas complementarias por s&#237;ntomas compatibles en el 54&#44;1&#37; de los pacientes &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>513&#41;&#46; En el 37&#37; de los casos &#40;351 pacientes&#41;&#44; el diagn&#243;stico se produjo de manera casual&#44; bien durante la realizaci&#243;n de un electrocardiograma &#40;EKG&#41; &#40;20&#44;6&#37;&#59; 195 pacientes&#41; o durante una exploraci&#243;n no relacionada con la sospecha de FA &#40;16&#44;4&#37;&#41;&#46; En el 4&#44;4&#37; de los pacientes &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>42&#41;&#44; el diagn&#243;stico se llev&#243; a cabo tras un evento tromboemb&#243;lico y en el 1&#44;5&#37; de los casos &#40;14 pacientes&#41; a trav&#233;s de un cribado sistematizado&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Oportunidades perdidas de diagn&#243;stico</span><p id="par0105" class="elsevierStylePara elsevierViewall">Del total&#44; 709 pacientes &#40;74&#44;8&#37;&#41; expresaron que hab&#237;an tenido alg&#250;n contacto con el sistema sanitario en el a&#241;o previo al diagn&#243;stico&#58; 261 pacientes &#40;27&#44;5&#37;&#41; refirieron un contacto&#59; 318 &#40;33&#44;5&#37;&#41; entre 2-5 contactos y 130 &#40;13&#44;7&#37;&#41; &#62;<span class="elsevierStyleHsp" style=""></span>5 contactos previos&#46; No hubo diferencias significativas entre la proporci&#243;n de pacientes con contactos previos y el tipo de FA &#40;parox&#237;stica&#58; 74&#44;2&#37;&#44; permanente&#58; 75&#44;3&#37;&#44; persistente&#58; 77&#44;5&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;320&#41;&#46; La mitad de los pacientes con alg&#250;n contacto previo &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>354&#44; 49&#44;9&#37;&#41; se&#241;al&#243; que se les hab&#237;a realizado un cribado de FA por exploraci&#243;n f&#237;sica o por EKG en al menos uno de los contactos recibidos en el a&#241;o previo al diagn&#243;stico de FA&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Tratamiento antitromb&#243;tico</span><p id="par0110" class="elsevierStylePara elsevierViewall">Del total de pacientes&#44; a 888 &#40;93&#44;7&#37;&#41; se les hab&#237;a iniciado alg&#250;n tratamiento para la prevenci&#243;n de eventos tromboemb&#243;licos&#44; en su mayor&#237;a con alg&#250;n tratamiento anticoagulante &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>878&#44; 98&#44;9&#37;&#41;&#46; Al 3&#44;8&#37; de los pacientes que iniciaron tratamiento antitromb&#243;tico se les paut&#243; un antiagregante&#44; ya sea como &#250;nico tratamiento &#40;10 pacientes&#41; o bien en combinaci&#243;n con alg&#250;n anticoagulante oral &#40;24 pacientes&#41;&#44; siendo mayoritario el uso de &#225;cido acetilsalic&#237;lico &#40;83&#44;9&#37;&#44; entre los tratados con antiagregantes&#41;&#46; Respecto al tipo de tratamiento anticoagulante&#44; mayoritariamente se emple&#243; un anticoagulante oral de acci&#243;n directa &#40;601 pacientes&#44; 67&#44;7&#37; de los pacientes tratados&#41;&#46; La <a class="elsevierStyleCrossRef" href="#fig0010">Figura 2</a> refleja la distribuci&#243;n de los tratamientos anticoagulantes empleados&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Discusi&#243;n</span><p id="par0115" class="elsevierStylePara elsevierViewall">En este estudio transversal presentamos datos que sugieren la existencia de un retraso diagn&#243;stico de la FA en casi la mitad de los pacientes con diagn&#243;stico reciente de FA&#46; Muchos de estos pacientes no acuden a consulta a pesar de presentar s&#237;ntomas compatibles con FA&#44; o bien hab&#237;an tenido alg&#250;n contacto con el sistema sanitario en el a&#241;o previo al diagn&#243;stico&#59; sin embargo&#44; no se les realiz&#243; un cribado de FA&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">La FA es bastante prevalente en la poblaci&#243;n y tiene consecuencias potencialmente muy graves<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a>&#46; Se asocia de forma independiente con un riesgo casi cinco veces superior de ictus cardioemb&#243;lico y casi multiplica por dos el riesgo de muerte comparado con la poblaci&#243;n general<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">12&#44;13</span></a>&#46; Adem&#225;s&#44; cada vez hay m&#225;s evidencia de la asociaci&#243;n entre la FA y el desarrollo de accidentes cerebrovasculares silentes y la enfermedad cerebrovascular de peque&#241;o vaso<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a>&#46; El riesgo de complicaciones tromboemb&#243;licas disminuye significativamente si se instaura un tratamiento anticoagulante<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">3&#44;5</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">La prevalencia de FA no diagnosticada es dif&#237;cil de estimar&#44; pues depende de la poblaci&#243;n estudiada y del m&#233;todo de cribado empleado<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a>&#46; Se estima que podr&#237;a afectar al 1-2&#37; de la poblaci&#243;n general<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">6&#8211;8</span></a>&#44; a m&#225;s del 5&#37; de &#62;<span class="elsevierStyleHsp" style=""></span>75 a&#241;os con HTA<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a> y a cerca del 20&#37; los pacientes con un ictus previo<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a>&#46; Una dificultad para el diagn&#243;stico precoz es que cursa a menudo de forma asintom&#225;tica y&#44; en caso de s&#237;ntomas compatibles&#44; estos muestran una gran variabilidad en cuanto a su naturaleza&#44; frecuencia&#44; momento de aparici&#243;n y gravedad<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">15</span></a>&#46; Los pacientes con FA suelen presentar uno o m&#225;s de estos s&#237;ntomas compatibles&#44; incluyendo palpitaciones&#44; disnea&#44; fatiga&#44; s&#237;ncope y&#44; con menor frecuencia&#44; dolor tor&#225;cico y mareos<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">15</span></a>&#46; No es infrecuente que los pacientes esperen semanas o meses desde de la aparici&#243;n de los primeros s&#237;ntomas para solicitar atenci&#243;n facultativa<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">9&#44;16</span></a>&#46; En nuestro estudio&#44; m&#225;s del 50&#37; de los pacientes hab&#237;a experimentado alg&#250;n s&#237;ntoma previo y&#44; de ellos&#44; el 67&#37; no consult&#243; por dicha sintomatolog&#237;a&#46; En estudios previos&#44; un 70&#37; de pacientes con FA de reciente diagn&#243;stico hab&#237;a retrasado la b&#250;squeda de atenci&#243;n m&#233;dica m&#225;s de una semana tras el inicio de los s&#237;ntomas<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">16</span></a>&#46; En nuestro caso&#44; las principales causas para no consultar incluyen la percepci&#243;n de escasa importancia que se les da a estos s&#237;ntomas o que estos se atribuyen a circunstancias distintas a la FA&#44; lo que tambi&#233;n ha sido descrito en estudios previos<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">16</span></a>&#46; Por ello&#44; ser&#237;a importante realizar tareas educativas y de sensibilizaci&#243;n dirigidas a la poblaci&#243;n general&#44; especialmente a &#62;<span class="elsevierStyleHsp" style=""></span>65 a&#241;os para que no demoren la consulta en caso de s&#237;ntomas compatibles&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Hay muchas iniciativas que han tratado de establecer el cribado sistem&#225;tico de la FA en la pr&#225;ctica cl&#237;nica<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a>&#46; Existen varias herramientas predictivas de su aparici&#243;n basadas en caracter&#237;sticas cl&#237;nicas&#44; pero ninguna ha sido ampliamente utilizada en la pr&#225;ctica<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a>&#46; Por otra parte&#44; existen estudios en marcha para determinar el beneficio de programas de cribado sistem&#225;tico&#44; pero por ahora el beneficio de la implementaci&#243;n generalizada del cribado en poblaciones no seleccionadas no est&#225; demostrado<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a>&#46; Probablemente por la falta de evidencia s&#243;lida&#44; las recomendaciones de cribado de FA var&#237;an seg&#250;n las distintas sociedades cient&#237;ficas&#46; La <span class="elsevierStyleItalic">United States Preventive Services Task Force</span> considera que la evidencia actual es insuficiente y no se puede determinar el balance beneficio&#47;riesgo del cribado de FA en adultos asintom&#225;ticos<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">18</span></a>&#46; Las gu&#237;as de la <span class="elsevierStyleItalic">European Society of Cardiology</span> &#40;ESC&#41; recomiendan el cribado oportunista de FA mediante la toma del pulso o la realizaci&#243;n de una tira de ritmo EKG en pacientes &#8805;<span class="elsevierStyleHsp" style=""></span>65 a&#241;os<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a>&#46; El cribado oportunista es un programa organizado que incluye la realizaci&#243;n del cribado de forma sistem&#225;tica como parte de la evaluaci&#243;n cl&#237;nica llevada a cabo de forma rutinaria en la consulta por cualquier otro motivo m&#233;dico<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a>&#46; Las gu&#237;as de la ESC tambi&#233;n recomiendan considerar el cribado sistem&#225;tico con EKG en individuos de &#8805;<span class="elsevierStyleHsp" style=""></span>75 a&#241;os o aquellos con alto riesgo de ictus<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a>&#46; Tanto el cribado sistem&#225;tico como el oportunista son m&#225;s rentables que la pr&#225;ctica habitual en pacientes &#62;<span class="elsevierStyleHsp" style=""></span>65 a&#241;os&#44; y el cribado oportunista tiene m&#225;s probabilidades de ser rentable que el cribado sistem&#225;tico en la poblaci&#243;n general<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">19</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Los resultados de nuestro estudio sugieren que el cribado de la FA en cualquier contacto de adultos mayores con el sistema sanitario podr&#237;a estar justificado&#44; ya que cerca de tres cuarta partes de los pacientes con un diagn&#243;stico reciente de FA hab&#237;a tenido contactos previos con el sistema sanitario&#46; Especialmente en los pacientes con FA permanente&#44; es posible que se hubiera adelantado el diagn&#243;stico de esta patolog&#237;a&#46; La palpaci&#243;n del pulso y&#47;o el EKG de corta duraci&#243;n en personas &#8805;<span class="elsevierStyleHsp" style=""></span>65 a&#241;os puede identificar al 1&#44;4&#37; de la poblaci&#243;n en este rango de edad con FA no diagnosticada previamente&#44; lo que sugiere un n&#250;mero necesario para el cribado de 70<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">3&#44;20</span></a>&#46; En nuestro estudio&#44; el riesgo de retraso diagn&#243;stico es m&#225;s frecuente en personas de mayor edad&#46; As&#237; que creemos justificado el cribado en personas de m&#225;s de 65 a&#241;os&#44; que&#44; como proponen las gu&#237;as de la ESC&#44; parece un umbral razonable&#46; Por otra parte&#44; el 4&#44;4&#37; de nuestros pacientes se diagnosticaron tras sufrir un evento tromboemb&#243;lico&#44; que muy probablemente podr&#237;a haberse evitado con el oportuno cribado previo&#46; A falta de un programa de cribado establecido&#44; ser&#237;a bueno promover iniciativas para sensibilizar al personal sanitario y aumentar la proactividad en el diagn&#243;stico precoz de FA&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Por otra parte&#44; el cribado se puede asociar con riesgos como un diagn&#243;stico err&#243;neo o llevar a pruebas invasivas innecesarias&#44; adem&#225;s de causar ansiedad al paciente<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a>&#46; Por ello se recomienda que se informe a las personas sometidas al cribado sobre las implicaciones terap&#233;uticas de la detecci&#243;n de FA&#44; que se organice una plataforma de derivaci&#243;n estructurada para los casos positivos y que el diagn&#243;stico definitivo de FA solo se establezca despu&#233;s de que el m&#233;dico revise el registro de EKG y confirme la FA<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">La principal limitaci&#243;n del estudio es su dise&#241;o transversal&#44; con obtenci&#243;n de datos retrospectivos&#44; y el car&#225;cter subjetivo de la definici&#243;n de &#171;retraso diagn&#243;stico&#187; por parte de los m&#233;dicos responsables&#46; Sin embargo&#44; por su propia naturaleza&#44; el retraso diagn&#243;stico no se puede establecer de manera objetiva en estudios prospectivos&#46; Consideramos que el dise&#241;o actual puede dar una aproximaci&#243;n al volumen del problema y permite sugerir recomendaciones para paliarlo&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conclusiones</span><p id="par0150" class="elsevierStylePara elsevierViewall">En una proporci&#243;n apreciable de casos de FA hay un retraso diagn&#243;stico que pone en riesgo al paciente&#46; Hay una proporci&#243;n importante de personas con s&#237;ntomas compatibles que no acuden a consulta&#46; Muchos pacientes tienen contactos con el sistema sanitario en los que se pierde la oportunidad de realizar un diagn&#243;stico temprano&#46; La sensibilizaci&#243;n&#44; tanto de pacientes como de sanitarios&#44; y la implementaci&#243;n de programas de cribado en poblaci&#243;n de mayor edad en cualquier contacto realizado con el sistema sanitario&#44; podr&#237;a disminuir la incidencia del retraso diagn&#243;stico y aumentar el n&#250;mero de pacientes que se podr&#237;a beneficiar del tratamiento anticoagulante&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Financiaci&#243;n</span><p id="par0155" class="elsevierStylePara elsevierViewall">Este estudio ha recibido una beca no condicionada del laboratorio Daiichi Sankyo S&#46;A&#46; para su desarrollo&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conflictos de intereses</span><p id="par0185" class="elsevierStylePara elsevierViewall">Fernando Richard Espiga&#44; Ra&#250;l Quir&#243;s L&#243;pez y Manuel Almendro Delia han recibido honorarios por parte de Daiichi Sankyo S&#46;A&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Fernando Caballero Mart&#237;nez&#44; Diana Monge Mart&#237;n y Fernando Neria Serrano no tienen ninguno conflicto de inter&#233;s&#46;</p></span></span>"
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    "resumen" => array:2 [
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Analizamos la frecuencia y los factores asociados al retraso en el diagn&#243;stico de la fibrilaci&#243;n auricular &#40;FA&#41; en pacientes recientemente diagnosticados&#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 descriptivo&#44; transversal&#44; multic&#233;ntrico&#46; Se recopilaron datos de pacientes reci&#233;n diagnosticados con FA mediante entrevistas y revisi&#243;n de historias cl&#237;nicas en consultas de cardiolog&#237;a cl&#237;nica&#44; medicina interna&#44; atenci&#243;n primaria y servicios de urgencias en Espa&#241;a&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Un total de 201 m&#233;dicos participaron en el estudio &#40;64&#44;2&#37; cardi&#243;logos&#44; 21&#44;4&#37; internistas&#41;&#46; Se incluyeron 948 pacientes &#40;58&#37; hombres&#59; edad media 72&#44;8 a&#241;os&#41;&#46; En el 41&#44;8&#37; de pacientes&#44; la FA se catalog&#243; como parox&#237;stica en el momento del diagn&#243;stico&#44; el 30&#44;9&#37; como persistente y el 27&#44;3&#37; como permanente&#46; El diagn&#243;stico fue casual en el 37&#37;&#46; En el 49&#44;3&#37; de los pacientes se consider&#243; que se hab&#237;a producido un retraso en el diagn&#243;stico&#46; El retraso se asoci&#243; a la presencia de FA permanente o persistente&#44; mayor edad o enfermedad valvular&#46; El 74&#44;8&#37; de los pacientes hab&#237;a tenido alg&#250;n contacto con el sistema sanitario en al a&#241;o previo&#46; Se pod&#237;a haber adelantado el diagn&#243;stico entre 1-6 meses en el 50&#44;7&#37; de los casos y m&#225;s de seis meses en el 20&#44;1&#37;&#46; El 54&#44;4&#37; de los pacientes hab&#237;a experimentado sintomatolog&#237;a previa compatible&#46; De ellos&#44; el 32&#44;6&#37; hab&#237;a consultado previamente&#44; sin que se llegara al diagn&#243;stico&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En una proporci&#243;n significativa de casos de FA hay un retraso diagn&#243;stico&#46; Muchas personas con s&#237;ntomas compatibles no acuden a consulta o tienen contactos con el sistema sanitario en los que se pierde la oportunidad de un diagn&#243;stico temprano&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">We analysed the frequency of atrial fibrillation &#40;AF&#41; delayed diagnosis and the factors associated with it in newly diagnosed patients&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">This was a descriptive&#44; cross-sectional&#44; multicentre study&#46; Data were collected from newly diagnosed patients with AF through medical records review and interviews during cardiology&#44; internal medicine&#44; primary care and emergency department consultations in Spain&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A total of 201 physicians participated in the study &#40;64&#46;2&#37; cardiologists&#44; 21&#46;4&#37; internists&#41;&#46; 948 patients &#40;58&#37; men&#59; mean age 72&#46;8 years&#41; were included&#46; In 41&#46;8&#37; of patients&#44; AF was classified as paroxysmal at diagnosis&#44; 30&#46;9&#37; as persistent and 27&#46;3&#37; as permanent&#46; The diagnosis was coincidental in 37&#37;&#46; It was considered that a delayed diagnosis occurred in 49&#46;3&#37; of patients&#46; This delay was associated with the presence of permanent or persistent AF&#44; older age or valvular disease&#46; 74&#46;8&#37; of patients had some contact with the healthcare system in the preceding year&#46; The diagnosis could have been established between 1-6 months earlier in 50&#46;7&#37; of cases and more than six months earlier in 20&#46;1&#37;&#46; 54&#46;4&#37; of the patients had experienced AF compatible symptomatology previously&#46; Of these&#44; 32&#46;6&#37; had a consultation without a diagnosis&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">In a significant proportion of AF cases&#44; there is a diagnostic delay&#46; Many people with compatible symptoms neither seek consultations nor contact the healthcare system facilities&#46; Consequently&#44; the opportunity for early diagnosis is lost&#46;</p></span>"
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Riesgo bajo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">112 &#40;11&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">85 &#40;15&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">27 &#40;6&#44;8&#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</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Riesgo moderado&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">639 &#40;67&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">359 &#40;65&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">280 &#40;70&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Riesgo alto&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">197 &#40;20&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">106 &#40;19&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">91 &#40;22&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Riesgo tromboemb&#243;lico &#40;CHA2DS2-VASc&#41;&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Riesgo bajo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">55 &#40;5&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">52 &#40;9&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;0&#44;8&#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</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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Riesgo moderado&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">103 &#40;10&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">87 &#40;15&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16 &#40;4&#44;0&#41;&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"><span class="elsevierStyleHsp" style=""></span>Riesgo alto&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">790 &#40;83&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">411 &#40;74&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">379 &#40;95&#44;2&#41;&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"><span class="elsevierStyleItalic">Comorbilidades&#44; n &#40;&#37;&#41;</span>&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 ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hipertensi&#243;n arterial&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">760 &#40;80&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">423 &#40;76&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">337 &#40;84&#44;7&#41;&nbsp;\t\t\t\t\t\t\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 ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">322 &#40;34&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">181 &#40;32&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">141 &#40;35&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;419&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hiperlipemia&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">433 &#40;45&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">255 &#40;46&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">178 &#40;44&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;617&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Abuso de alcohol&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">72 &#40;7&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">62 &#40;11&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;2&#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
                  \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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tabaquismo&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">204 &#40;21&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">162 &#40;29&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">42 &#40;10&#44;6&#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"><span class="elsevierStyleHsp" style=""></span>Obesidad&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">314 &#40;33&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">178 &#40;32&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">136 &#40;34&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;56&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"><span class="elsevierStyleHsp" style=""></span>EPOC&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">120 &#40;12&#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">90 &#40;16&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Sexo femenino</span>&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;38&#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">213 &#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;026&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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Jubilado&#47;a</span>&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">350 &#40;72&#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">387 &#40;82&#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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Vive solo&#47;a</span>&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">71 &#40;14&#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">84 &#40;18&#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;179&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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Seguro privado</span>&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">82 &#40;17&#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">59 &#40;12&#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;056&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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Lugar de residencia</span>&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Rural&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;28&#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
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                  \t\t\t\t">133 &#40;28&#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  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">0&#44;943</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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Urbano&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">343 &#40;71&#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">334 &#40;71&#44;5&#41;&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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Nivel de estudios</span>&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
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                  \t\t\t\t">&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="" valign="\n
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                  \t\t\t\t">&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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Sin estudios&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">72 &#40;15&#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">93 &#40;19&#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  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;004</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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Educaci&#243;n primaria&#47;secundaria&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">186 &#40;38&#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">210 &#40;45&#44;0&#41;&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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Bachillerato o equivalente&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">141 &#40;29&#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">97 &#40;20&#44;8&#41;&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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Estudios universitarios o equivalente&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">82 &#40;17&#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">67 &#40;14&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Factores cl&#237;nicos&#44; n &#40;&#37;&#41;</span></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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Tipo de fibrilaci&#243;n auricular</span>&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Permanente&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">99 &#40;20&#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">160 &#40;34&#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  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;</span><span class="elsevierStyleHsp" style=""></span>0&#44;001</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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Persistente&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;25&#44;6&#37;&#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">170 &#40;36&#46;4&#41;&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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Parox&#237;stica&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">259 &#40;53&#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">137 &#40;29&#44;3&#41;&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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Eventos tromboemb&#243;licos</span>&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">62 &#40;12&#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">59 &#40;12&#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;906&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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hipertensi&#243;n arterial</span>&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">365 &#40;75&#44;9&#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">395 &#40;84&#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"><span class="elsevierStyleBold">&#60;</span><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 ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Diabetes</span>&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">159 &#40;33&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">163 &#40;34&#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">0&#44;548&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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hiperlipemia</span>&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">214 &#40;44&#44;5&#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">219 &#40;46&#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">0&#44;457&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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Abuso de alcohol</span>&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">37 &#40;7&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">35 &#40;7&#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">0&#44;909&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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Tabaquismo</span>&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">112 &#40;23&#44;3&#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">92 &#40;19&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;179&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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Obesidad</span>&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">151 &#40;31&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">163 &#40;34&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;251&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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">EPOC</span>&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">52 &#40;10&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">68 &#40;14&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;083&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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Apnea obstructiva del sue&#241;o</span>&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">42 &#40;8&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">40 &#40;8&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;927&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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Enfermedad renal cr&#243;nica</span>&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">64 &#40;13&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">65 &#40;13&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;783&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hipertiroidismo</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;1&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;1&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;573&nbsp;\t\t\t\t\t\t\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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Enfermedades inflamatorias</span>&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">15 &#40;3&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;2&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;611&nbsp;\t\t\t\t\t\t\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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Insuficiencia cardiaca</span>&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">88 &#40;18&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">100 &#40;21&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;229&nbsp;\t\t\t\t\t\t\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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Cardiopat&#237;a isqu&#233;mica</span>&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">76 &#40;15&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">58 &#40;12&#44;4&#41;&nbsp;\t\t\t\t\t\t\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 ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Enfermedad valvular</span>&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">46 &#40;9&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">40 &#40;8&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;593&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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Cirug&#237;a concomitante al diagn&#243;stico</span>&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">10 &#40;2&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;1&#44;9&#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;868&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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Neoplasia activa &#40;en tratamiento con QT y&#47;o RT&#41;</span>&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">15 &#40;3&#44;1&#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">7 &#40;1&#44;5&#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;098&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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Anemia</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><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
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">60 &#40;12&#44;5&#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">56 &#40;12&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">122 &#40;26&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estudio multivariante ajustado</th></tr><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IC 95&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&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="" valign="\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"><span class="elsevierStyleHsp" style=""></span>Parox&#237;stica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8212;&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="" valign="\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
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Permanente&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;61&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\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Persistente&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\ttable-entry\n
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                  \t\t\t\t\ttable-entry\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;02&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">1&#44;01 a 1&#44;04&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">&#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"><span class="elsevierStyleItalic">Enfermedad valvular</span>&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">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\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
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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\ttable-entry\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;049&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
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\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
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                  \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">&#8212;&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">&#8212;&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="" valign="\n
                  \t\t\t\t\ttop\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"><span class="elsevierStyleHsp" style=""></span>S&#237;&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
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                  \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
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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
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Cardiopat&#237;a isqu&#233;mica</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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"><span class="elsevierStyleHsp" style=""></span>No&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">&#8212;&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">&#8212;&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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
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DOI: 10.1016/j.rce.2024.06.011
Disponible online el 10 de septiembre de 2024
Retraso diagnóstico y oportunidades perdidas en la detección precoz de la fibrilación auricular: estudio transversal
Delayed diagnosis and missed opportunities in the early detection of atrial fibrillation: a cross-sectional study
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F. Richard Espigaa,
Autor para correspondencia
frichardespiga@gmail.com

Autor de correspondencia.
, M. Almendro Deliab, F. Caballero Martínezc, D. Monge Martínd, F. Neria Serranoe, R. Quirós Lópezf
a Servicio de Urgencias Hospital Universitario de Burgos, Burgos, España
b Unidad de Investigación Cardiovascular y Ensayos Clínicos, Hospital Universitario Virgen Macarena, Sevilla, España
c Decano Facultad de Medicina, Universidad Francisco de Vitoria, Madrid, España
d Vicedecana de Investigación, Facultad de Medicina, Universidad Francisco de Vitoria, Madrid, España
e Unidad de apoyo a la investigación, Facultad de Medicina, Universidad Francisco de Vitoria, Madrid, España
f Servicio de Medicina Interna, Hospital Costa del Sol de Marbella, Málaga, España

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