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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Curvas de supervivencia de Kaplan-Meier en los pacientes con una o varias condiciones de estudio &#40;sarcopenia&#44; fragilidad y deterioro cognitivo&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La fibrilaci&#243;n auricular &#40;FA&#41; es la arritmia m&#225;s frecuente en todo el mundo y su prevalencia aumenta con la edad<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">1</span></a>&#46; Se asocia con un incremento de la mortalidad y del riesgo de sufrir un evento cerebrovascular<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">2</span></a>&#46; Los pacientes con FA suelen ser de edad avanzada&#44; tienen mucha comorbilidad y consumen muchos f&#225;rmacos&#46; Todo ello hace que sean pacientes muy fr&#225;giles<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">3</span></a>&#46; La fragilidad se define como un estado asociado al envejecimiento que se caracteriza por una disminuci&#243;n de la reserva fisiol&#243;gica&#44; un aumento del riesgo de incapacidad&#44; una p&#233;rdida de la resistencia y una mayor vulnerabilidad a eventos adversos manifestada por mayor morbimortalidad<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">4</span></a>&#46; En un estudio retrospectivo realizado en la Universidad de Mil&#225;n que incluy&#243; a 403 pacientes con FA el 57&#37; se clasificaron como fr&#225;giles&#44; el 29&#37; como pre-fr&#225;giles y &#250;nicamente el 14&#37; como no fr&#225;giles<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La sarcopenia es un s&#237;ndrome que se caracteriza por una p&#233;rdida gradual y generalizada de la masa muscular esquel&#233;tica y de la fuerza&#44; con riesgo de presentar resultados adversos como discapacidad f&#237;sica&#44; calidad de vida deficiente y mortalidad<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">5</span></a>&#46; Se considera primaria cuando no hay ninguna otra causa evidente salvo el envejecimiento&#44; y secundaria cuando hay una o varias otras causas<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">La incidencia de deterioro cognitivo en la FA est&#225; aumentada<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">7</span></a>&#46; En los estudios ONTARGET y TRANSCEND los pacientes con FA tuvieron un mayor riesgo de deterioro cognitivo y aparici&#243;n de demencia<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">8</span></a>&#46; Este riesgo es mayor cuanto mayor es la puntuaci&#243;n en las escalas CHADS<span class="elsevierStyleInf">2</span> y CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-Vasc<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">9</span></a>&#46; En un metaan&#225;lisis la FA se asoci&#243; con el deterioro cognitivo en los pacientes con y sin diagn&#243;stico de ictus<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El objetivo de este estudio fue determinar la prevalencia de la sarcopenia&#44; la fragilidad y el deterioro cognitivo en los pacientes ancianos con FA no valvular &#40;FANV&#41; y su influencia en la supervivencia&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Este an&#225;lisis es un subestudio de los pacientes incluidos en el registro NONAVASC&#46; El registro NONAVASC fue un estudio observacional&#44; prospectivo&#44; multic&#233;ntrico&#44; realizado en servicios de Medicina Interna de 64 hospitales en Espa&#241;a<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">11</span></a>&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Criterios de inclusi&#243;n</span><p id="par0030" class="elsevierStylePara elsevierViewall">Entre octubre de 2014 y mayo de 2015 cada investigador incluy&#243; de forma consecutiva al menos a 10 pacientes mayores de 75<span class="elsevierStyleHsp" style=""></span>a&#241;os hospitalizados por cualquier causa&#44; con presencia de FANV previa o diagnosticada durante el ingreso&#46; Se consider&#243; FANV la FA que aparec&#237;a en ausencia de estenosis mitral reum&#225;tica moderada-grave o pr&#243;tesis valvular<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">12</span></a>&#46; La clasificaci&#243;n de FANV en parox&#237;stica&#44; permanente o persistente se realiz&#243; seg&#250;n la definici&#243;n de las Gu&#237;as Europeas de la Sociedad Europea de Cardiolog&#237;a<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">13</span></a>&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Procedimientos</span><p id="par0035" class="elsevierStylePara elsevierViewall">La recogida de datos se realiz&#243; en una base anonimizada en l&#237;nea&#44; en la que se incluyeron par&#225;metros sociodemogr&#225;ficos&#44; cl&#237;nicos&#44; anal&#237;ticos&#44; de imagen&#44; terap&#233;uticos y evolutivos&#46; El riesgo tromb&#243;tico y hemorr&#225;gico al ingreso fue evaluado mediante las escalas CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-Vasc<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">14</span></a> y HAS-BLED<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">15</span></a>&#44; respectivamente&#46; La evaluaci&#243;n de la situaci&#243;n social&#44; funcional y cognitiva se realiz&#243; al ingreso mediante una entrevista personal con el paciente o con su cuidador principal&#46; La comorbilidad fue evaluada con el &#237;ndice de Charlson<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">16</span></a>&#44; la capacidad para realizar las actividades b&#225;sicas de la vida diaria con el &#237;ndice de Barthel<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">17</span></a> y el grado de deterioro cognitivo con el <span class="elsevierStyleItalic">Short Portable Mental State Questionnaire</span><a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">18</span></a>&#46; Se consider&#243; que exist&#237;a deterioro cognitivo cuando el n&#250;mero de errores en este cuestionario era &#8805;<span class="elsevierStyleHsp" style=""></span>4&#46; La sarcopenia se valor&#243; con la escala SARC-F<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">19</span></a> y se consider&#243; que la hab&#237;a cuando la puntuaci&#243;n era &#8805;<span class="elsevierStyleHsp" style=""></span>4&#46; La fragilidad se evalu&#243; con la escala FRAIL<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">20</span></a>&#44; y se consider&#243; fr&#225;giles a los pacientes con &#8805;<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>puntos&#46; Tambi&#233;n se recogieron los niveles de hemoglobina&#44; creatinina y plaquetas&#46; Se defini&#243; la insuficiencia renal como un filtrado glomerular inferior a 60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#46; Se recogi&#243; el n&#250;mero de f&#225;rmacos prescritos al alta y el uso de anticoagulantes orales&#46; Posteriormente se realiz&#243; un seguimiento durante un a&#241;o&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">El estudio fue aprobado por el Comit&#233; de &#201;tica de Investigaci&#243;n Cl&#237;nica del Hospital Universitario de La Princesa y todos los pacientes&#44; o sus familiares en caso de deterioro cognitivo&#44; dieron su consentimiento informado escrito&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">An&#225;lisis estad&#237;stico</span><p id="par0045" class="elsevierStylePara elsevierViewall">Las variables cualitativas se presentan como frecuencia absoluta y porcentaje y las cuantitativas&#44; como media y desviaci&#243;n est&#225;ndar&#46; Las comparaciones de las primeras se hicieron con el test de chi cuadrado&#44; aplicando la correcci&#243;n de Yates o el test de Fisher en caso necesario&#44; y las de las &#250;ltimas con el test t de Student&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Para estudiar las variables asociadas con la mortalidad se construy&#243; un modelo de regresi&#243;n de Cox&#46; Se excluyeron las variables con colinealidad y se incluyeron las variables edad&#44; sexo&#44; puntuaci&#243;n en el &#237;ndice de Charlson y las escalas CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-Vasc y HAS-BLED&#44; deterioro cognitivo&#44; fragilidad&#44; sarcopenia y prescripci&#243;n de anticoagulantes orales al alta&#46; En el an&#225;lisis multivariante se incluyeron aquellas con una significaci&#243;n estad&#237;stica p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;1 en el an&#225;lisis univariante&#46; Para el an&#225;lisis de supervivencia se construyeron las curvas de Kaplan-Meier para los pacientes con ninguna&#44; una&#44; dos o las tres condiciones del estudio&#44; es decir&#44; sarcopenia&#44; fragilidad y deterioro cognitivo&#46; Las curvas se compararon con test log-rank&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">En todos los casos el nivel de significaci&#243;n estad&#237;stica se estableci&#243; para un valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">El an&#225;lisis de los datos se realiz&#243; con el programa estad&#237;stico SPSS v&#46; 22&#46;0&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><p id="par0065" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> muestra el diagrama de flujo de inclusi&#243;n de pacientes&#46; De los 697 pacientes iniciales se perdieron 101 en el seguimiento &#40;14&#44;5&#37;&#41;&#46; Los pacientes perdidos ten&#237;an menos comorbilidad medida por el &#237;ndice de Charlson&#44; hab&#237;an ingresado menos en el a&#241;o previo&#44; consum&#237;an menos f&#225;rmacos y se les hab&#237;an prescrito menos anticoagulantes orales al alta&#46; No hab&#237;a diferencias en el resto de caracter&#237;sticas ni en la prevalencia de sarcopenia&#44; fragilidad y deterioro cognitivo&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Finalmente se incluyeron 596 pacientes&#44; con una edad media de 84&#44;9 &#40;5&#44;2&#41; a&#241;os&#46; Eran mujeres 315 &#40;52&#44;9&#37;&#41;&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se presentan las caracter&#237;sticas de los pacientes incluidos en el estudio&#46; La puntuaci&#243;n media en la escala CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-Vasc fue 5&#44;3 &#40;1&#44;4&#41; y en la escala HAS-BLED&#44; 2&#44;7 &#40;1&#44;2&#41;&#46; En la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a> se presenta la prevalencia de sarcopenia&#44; fragilidad y deterioro cognitivo&#46; Era frecuente la asociaci&#243;n entre las mismas&#58; 436 &#40;73&#44;1&#37;&#41; pacientes presentaban una de las condiciones y 136 &#40;22&#44;8&#37;&#41; las tres&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Sarcopenia</span><p id="par0075" class="elsevierStylePara elsevierViewall">La sarcopenia estaba presente en 295 &#40;49&#44;5&#37;&#41; pacientes&#46; Estos eran de mayor edad&#44; m&#225;s frecuentemente mujeres&#44; y con menos frecuencia ten&#237;an sobrepeso u obesidad&#46; En ellos la enfermedad cerebrovascular era m&#225;s frecuente&#44; ten&#237;an puntuaciones m&#225;s altas en la escala CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-Vasc pero no en la HAS-BLED y al alta se les prescribieron anticoagulantes orales con menos frecuencia &#40;49&#44;3&#37; vs 58&#44;7&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Adem&#225;s&#44; su capacidad para realizar las actividades b&#225;sicas de la vida diaria medida con el &#237;ndice de Barthel fue menor&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Fragilidad</span><p id="par0080" class="elsevierStylePara elsevierViewall">La fragilidad estaba presente en 305 &#40;51&#44;2&#37;&#41; pacientes&#46; Los pacientes fr&#225;giles eran con m&#225;s frecuencia mujeres&#44; ten&#237;an m&#225;s comorbilidad medida con el &#237;ndice de Charlson y ten&#237;an puntuaciones m&#225;s altas en las escalas CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-Vasc y HAS-BLED&#46; M&#225;s frecuentemente ten&#237;an historia de enfermedad cerebrovascular&#44; insuficiencia renal y hemorragia&#44; y su capacidad para realizar las actividades de la vida diaria era menor &#40;&#237;ndice de Barthel 56 vs 78&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; La prescripci&#243;n de anticoagulantes orales al alta fue menor en los pacientes fr&#225;giles &#40;44&#44;9&#37; vs 54&#44;0&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;027&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Deterioro cognitivo</span><p id="par0085" class="elsevierStylePara elsevierViewall">Doscientos cincuenta y un pacientes &#40;42&#44;1&#37;&#41; ten&#237;an deterioro cognitivo&#46; Estos pacientes eran de m&#225;s edad&#44; puntuaban m&#225;s bajo en el &#237;ndice de Barthel y con m&#225;s frecuencia eran mujeres y ten&#237;an enfermedad cerebrovascular y embolismo perif&#233;rico&#46; Con menos frecuencia ten&#237;an obesidad o sobrepeso&#44; insuficiencia cardiaca e historia de hemorragia&#46; Puntuaban m&#225;s alto en la escala CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-Vasc pero no en la HAS-BLED&#46; Al alta se les prescribieron anticoagulantes orales con menor frecuencia &#40;38&#44;2&#37; vs 57&#44;4&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Supervivencia</span><p id="par0090" class="elsevierStylePara elsevierViewall">Al cabo de un a&#241;o fallecieron 226 &#40;37&#44;9&#37;&#41; pacientes&#46; La <a class="elsevierStyleCrossRef" href="#fig0015">figura 3</a> muestra las curvas de supervivencia de Kaplan-Meier&#46; La supervivencia fue menor en los pacientes con sarcopenia &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>A&#41;&#44; fragilidad &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>B&#41; y deterioro cognitivo &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>C&#41;&#46; La mortalidad fue mayor cuantas m&#225;s de estas condiciones presentaba el paciente &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>D&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Los factores asociados con la mortalidad al cabo de un a&#241;o se presentan en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46; En el an&#225;lisis univariante esta estuvo asociada con la sarcopenia&#44; la fragilidad y el deterioro cognitivo&#46; Sin embargo&#44; en el an&#225;lisis multivariante solo la edad&#44; la comorbilidad medida con el &#237;ndice de Charlson&#44; el antecedente de embolismo perif&#233;rico previo y la sarcopenia &#40;HR&#58; 1&#44;775&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;270-2&#44;481&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; se asociaron de forma independiente con una mayor mortalidad&#44; y la prescripci&#243;n de anticoagulantes orales al alta &#40;HR&#59; 0&#44;415&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 0&#44;307-0&#44;560&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; con una disminuci&#243;n de la misma&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discusi&#243;n</span><p id="par0100" class="elsevierStylePara elsevierViewall">Los principales hallazgos de nuestro estudio fueron que la sarcopenia&#44; la fragilidad y el deterioro cognitivo son condiciones muy prevalentes&#44; y frecuentemente asociadas&#44; en los pacientes ancianos con FANV hospitalizados&#44; y que la sarcopenia se asocia de forma independiente con la mortalidad al cabo de un a&#241;o&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">La sarcopenia es una p&#233;rdida de masa o fuerza muscular asociada generalmente&#44; pero no exclusivamente&#44; al envejecimiento<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">21</span></a>&#46; Afecta al 5-13&#37; de los mayores de 60<span class="elsevierStyleHsp" style=""></span>a&#241;os y hasta al 50&#37; de los octogenarios<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">22</span></a>&#46; Puede aparecer de forma aguda durante la hospitalizaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">23</span></a>&#46; Uno de cada dos de nuestros pacientes ancianos hospitalizados con FANV ten&#237;a sarcopenia&#46; Hasta nuestro conocimiento no hay estudios sobre la asociaci&#243;n de sarcopenia y FANV&#46; Se ha observado una remodelaci&#243;n celular con desdiferenciaci&#243;n del cardiomiocito en la FANV<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">24</span></a> y una disregulaci&#243;n de la regeneraci&#243;n miog&#233;nica en la sarcopenia<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">25</span></a>&#46; Nosotros hipotetizamos que puede haber una relaci&#243;n entre ambas condiciones&#44; y creemos que son necesarios estudios para elucidar si la FANV es una manifestaci&#243;n de sarcopenia cardiaca o si la sarcopenia es una consecuencia sist&#233;mica de la FANV&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">La fragilidad es un estado de vulnerabilidad y p&#233;rdida de resistencia ante los factores estresantes externos que aumenta el riesgo de presentar resultados adversos como ca&#237;das&#44; discapacidad&#44; inmovilidad&#44; hospitalizaci&#243;n y muerte<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">26</span></a>&#46; Se caracteriza por p&#233;rdida de peso o altura&#44; debilidad&#44; agotamiento&#44; lentitud y baja actividad&#46; La prevalencia de fragilidad en los pacientes ancianos con FANV se ha estimado en el 39&#37;&#44; pero var&#237;a dependiendo del instrumento utilizado para medirla<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">27</span></a>&#46; La presencia de fragilidad fue del 25&#37; en estudios que utilizaron la <span class="elsevierStyleItalic">Clinical Frailty Scale</span> y del 53-60&#37; cuando se us&#243; la <span class="elsevierStyleItalic">Edmonton Frail Scale</span><a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">28-30</span></a>&#46; Nosotros&#44; utilizando la escala FRAIL&#44; hemos observado una prevalencia del 49&#44;8&#37;&#46; Por lo tanto&#44; puede concluirse que la fragilidad es frecuente en los ancianos con FANV&#46; Adem&#225;s en nuestro estudio la fragilidad se ha asociado con mayor riesgo de ictus medido con la escala CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-Vasc y con mayor riesgo de hemorragia medido con la escala HAS-BLED&#46; Esta asociaci&#243;n de la fragilidad con la puntuaci&#243;n en estas escalas ya hab&#237;a sido reportada previamente<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">31</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">La relaci&#243;n entre FANV y deterioro cognitivo est&#225; bien establecida<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">32</span></a>&#46; La FANV predispone a sufrir ictus&#44; y los ictus son causa de deterioro cognitivo&#46; Sin embargo&#44; se ha demostrado que la FANV se asocia con deterioro cognitivo aun en ausencia de ictus<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">10&#44;33</span></a>&#46; Adem&#225;s de los ictus manifiestos o silentes&#44; en la aparici&#243;n de deterioro cognitivo intervienen otros mecanismos&#44; como la hipoperfusi&#243;n cerebral&#44; el estado inflamatorio vascular con aumento de la producci&#243;n de prote&#237;na precursora amiloide&#44; las microhemorragias y factores gen&#233;ticos<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">34</span></a>&#46; Las puntuaciones m&#225;s altas en la escala CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-Vasc se asocian con mayor riesgo de aparici&#243;n de demencia<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">9</span></a>&#46; Nuestros pacientes con deterioro cognitivo puntuaron m&#225;s alto en dicha escala&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Nuestros pacientes puntuaban bajo en el &#237;ndice de Barthel indicando una alta discapacidad&#46; Tanto la sarcopenia como la fragilidad y el deterioro cognitivo provocan discapacidad&#46; Por esta raz&#243;n no hemos incluido la discapacidad en el an&#225;lisis de la mortalidad&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Se ha propuesto que la anticoagulaci&#243;n oral con warfarina puede disminuir hasta en un 20&#37; el riesgo de aparici&#243;n de demencia en los pacientes con FANV&#46; Adem&#225;s&#44; el riesgo disminuir&#237;a cuanto mayor fuera el tiempo en rango terap&#233;utico<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">35</span></a>&#46; El uso de los anticoagulantes orales de acci&#243;n directa tambi&#233;n se ha asociado con menor aparici&#243;n de demencia<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">36</span></a>&#46; Sin embargo&#44; al igual que en otros estudios previos&#44; los anticoagulantes orales fueron menos prescritos en nuestros pacientes con deterioro cognitivo<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">37</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Los anticoagulantes orales de acci&#243;n directa han demostrado disminuir los sangrados en los pacientes con fragilidad y con riesgo de ca&#237;das<a class="elsevierStyleCrossRefs" href="#bib0405"><span class="elsevierStyleSup">38&#44;39</span></a>&#46; Adem&#225;s&#44; rivaroxab&#225;n ha disminuido los ictus y los embolismos sist&#233;micos<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">38</span></a> y edoxab&#225;n ha reducido la mortalidad por todas las causas en estos pacientes<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">39</span></a>&#46; A pesar de ello&#44; y al igual que en otros estudios&#44; en nuestros pacientes con fragilidad la prescripci&#243;n de anticoagulantes orales fue menor<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">27</span></a>&#46; Sin embargo&#44; no puede olvidarse que en los enfermos con enfermedades en fase avanzada y FANV&#44; que con frecuencia tienen discapacidad y deterioro cognitivo&#44; el estado funcional y no la anticoagulaci&#243;n tienen una mayor asociaci&#243;n con la supervivencia<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">40</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">En nuestro estudio hemos observado con frecuencia la asociaci&#243;n de fragilidad y deterioro cognitivo&#44; denominada fragilidad cognitiva&#44; pero tambi&#233;n la asociaci&#243;n de sarcopenia y fragilidad&#44; y de sarcopenia y deterioro cognitivo&#46; Adem&#225;s&#44; todas estas condiciones se asociaron con la discapacidad y la mortalidad al cabo de un a&#241;o&#46; Sin embargo&#44; solo la sarcopenia lo hizo de forma independiente&#46; Es conocido que la sarcopenia en los ancianos est&#225; asociada con la mortalidad por todas las causas<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">41</span></a>&#46; La sarcopenia es un estado potencialmente reversible&#46; Las gu&#237;as recomiendan la actividad f&#237;sica y la intervenci&#243;n nutricional en los adultos con sarcopenia<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">42</span></a>&#46; Desafortunadamente&#44; los estudios que han evaluado el efecto de la rehabilitaci&#243;n cardiaca basada en el ejercicio en los pacientes con FA son peque&#241;os y de baja calidad<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">43</span></a>&#46; Por ello creemos que al diagnosticar una FANV&#44; y en su evoluci&#243;n posterior&#44; hay que prevenir y detectar precozmente la sarcopenia recomendando una correcta alimentaci&#243;n y pautas de ejercicio f&#237;sico adaptado&#46; Para conocer la eficacia de estas medidas ser&#225; necesario desarrollar ensayos cl&#237;nicos <span class="elsevierStyleItalic">ad hoc</span>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Nuestro estudio tiene varias limitaciones&#46; En primer lugar hubo un 14&#44;5&#37; de p&#233;rdidas en el seguimiento de los pacientes&#46; Aunque el umbral para considerar un estudio como v&#225;lido es del 20&#37;&#44; las p&#233;rdidas pueden afectar a la aplicabilidad y generalizaci&#243;n de los resultados&#46; En segundo lugar&#44; solo se han incluido ancianos con FANV hospitalizados en departamentos de medicina interna&#44; y por lo tanto los resultados observados pueden no ser aplicables a pacientes con FANV ingresados en salas de cardiolog&#237;a&#44; neurolog&#237;a o cuidados intensivos&#46; Adem&#225;s&#44; es conocido que la fragilidad y la sarcopenia son m&#225;s prevalentes en los pacientes hospitalizados&#44; y nuestros resultados no son aplicables a los ancianos con FANV visitados en los centros de atenci&#243;n primaria&#46; Finalmente&#44; la sarcopenia se ha diagnosticado con un cuestionario&#46; Es posible que los resultados fueran diferentes si se hubieran utilizado la medida de la prensi&#243;n de la mano y la bioimpedanciometr&#237;a&#46; Sin embargo&#44; el cuestionario SARC-F ha sido validado y&#44; por su sencillez y rapidez&#44; cada vez es m&#225;s utilizado en la cl&#237;nica&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Por otra parte&#44; nuestro estudio tambi&#233;n tiene fortalezas&#46; Es un estudio multic&#233;ntrico&#44; y es conocido que estos estudios tienen resultados m&#225;s robustos que los realizados en un &#250;nico centro&#46; Adem&#225;s&#44; el &#250;nico criterio de exclusi&#243;n fue no dar el consentimiento informado&#44; lo que garantiz&#243; una amplia representatividad de la muestra&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; la sarcopenia&#44; la fragilidad y el deterioro cognitivo son frecuentes en los ancianos con FANV y se asocian con una alta mortalidad&#46; Su detecci&#243;n debe formar parte de la evaluaci&#243;n exhaustiva de estos pacientes y es preciso adoptar estrategias para su prevenci&#243;n y tratamiento precoz&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Financiaci&#243;n</span><p id="par0155" class="elsevierStylePara elsevierViewall">El estudio NONAVASC fue financiado por una beca no condicionada de Bayer&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicto de intereses</span><p id="par0160" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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          "titulo" => "Abstract"
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              "titulo" => "Sarcopenia"
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              "titulo" => "Fragilidad"
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              "titulo" => "Deterioro cognitivo"
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    "fechaRecibido" => "2019-01-17"
    "fechaAceptado" => "2019-04-01"
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            2 => "Fragilidad"
            3 => "Deterioro cognitivo"
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            1 => "Sarcopenia"
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            3 => "Cognitive impairment"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Determinar la prevalencia de la sarcopenia&#44; la fragilidad y el deterioro cognitivo en pacientes ancianos con fibrilaci&#243;n auricular no valvular &#40;FANV&#41; y su influencia en la supervivencia&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio de cohortes&#44; prospectivo y multic&#233;ntrico realizado con pacientes &#62;<span class="elsevierStyleHsp" style=""></span>75<span class="elsevierStyleHsp" style=""></span>a&#241;os con FANV hospitalizados en servicios de Medicina Interna en Espa&#241;a&#46; Para cada paciente se recogieron los niveles de creatinina&#44; hemoglobina y plaquetas&#44; as&#237; como las escalas CHA2DS2-Vasc&#44; HAS-BLED&#44; el &#237;ndice de Charlson y el uso de anticoagulantes orales&#46; Se midi&#243; la sarcopenia con escala SARC-F&#44; la fragilidad con la escala FRAIL y el deterioro cognitivo con el <span class="elsevierStyleItalic">Short Portable Mental State Questionnaire</span>&#46; Se realiz&#243; seguimiento durante un a&#241;o&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 596 pacientes con FANV&#44; con edad media de 84&#44;9 &#40;DE&#58; 5&#44;2&#41; a&#241;os&#46; De ellos&#44; 295 &#40;49&#44;5&#37;&#41; presentaban sarcopenia&#44; 305 &#40;51&#44;2&#37;&#41; fragilidad y 251 &#40;42&#44;1&#37;&#41; deterioro cognitivo&#46; Al cabo de un a&#241;o fallecieron 226 &#40;37&#44;9&#37;&#41; pacientes&#46; La mortalidad fue superior en los pacientes con sarcopenia&#44; fragilidad y deterioro cognitivo&#46; En el an&#225;lisis multivariante la sarcopenia &#40;HR&#58; 1&#44;775&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;270-2&#44;481&#41;&#44; la edad&#44; la comorbilidad y el antecedente de embolismo perif&#233;rico se asociaron con mayor mortalidad&#44; y el uso de anticoagulantes orales al alta &#40;HR&#58; 0&#44;415&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 0&#44;307-0&#44;560&#41;&#44; con menor mortalidad&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En los pacientes ancianos con FANV la sarcopenia&#44; la fragilidad y el deterioro cognitivo son muy prevalentes y se asocian con frecuencia&#46; La sarcopenia se asocia a mayor mortalidad&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To determine the prevalence of sarcopenia&#44; frailty and cognitive impairment in elderly patients with nonvalvular atrial fibrillation &#40;NVAF&#41; and the factors&#8217; influence on survival&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Prospective&#44; multicentre cohort study of patients older than 75 years with NVAF hospitalised in internal medicine departments in Spain&#46; For each patient&#44; we recorded the creatinine&#44; haemoglobin and platelet levels&#44; the scores on the CHA2DS2-VASc and HAS-BLED scales and Charlson index&#44; as well as the use of oral anticoagulants&#46; We measured sarcopenia with the SARC-F scale&#44; frailty with the FRAIL scale and cognitive impairment with the Short Portable Mental State Questionnaire&#46; We also conducted a 1-year follow-up&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The study included 596 patients with NVAF&#44; with a mean age of 84&#46;9 &#40;SD&#58; 5&#46;2&#41; years&#46; Of these&#44; 295 &#40;49&#46;5&#37;&#41; presented sarcopenia&#44; 305 &#40;51&#46;2&#37;&#41; presented frailty&#44; and 251 &#40;42&#46;1&#37;&#41; presented cognitive impairment&#46; At the end of 1<span class="elsevierStyleHsp" style=""></span>year&#44; 226 &#40;37&#46;9&#37;&#41; patients had died&#46; Mortality was greater for the patients with sarcopenia&#44; frailty and cognitive impairment&#46; In the multivariate analysis&#44; sarcopenia &#40;HR&#58; 1&#46;775&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 1&#46;270-2&#46;481&#41;&#44; age&#44; comorbidity and a history of peripheral embolism were associated with increased mortality&#44; and the use of oral anticoagulants at discharge &#40;HR&#58; 0&#46;415&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 0&#46;307-0&#46;560&#41; was associated with lower mortality&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Sarcopenia&#44; frailty and cognitive impairment are very common in elderly patients with NVAF and are frequently associated&#46; Sarcopenia was associated with increased mortality&#46;</p></span>"
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            "etiqueta" => "Anexo"
            "titulo" => "Miembros del Grupo Riesgo Vascular de la Sociedad Espa&#241;ola de Medicina Interna"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Total &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>596&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sarcopenia</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Fragilidad</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Deterioro cognitivo</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">S&#237; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>295&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>301&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">S&#237; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>305&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>291&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">S&#237; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>251&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>345&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Edad<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#44;9 &#40;5&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#44;8 &#40;5&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#44;1 &#40;5&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#44;5 &#40;5&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#44;9 &#40;504&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;877&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#44;3 &#40;5&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83&#44;9 &#40;4&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sexo mujer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">315 &#40;52&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">191 &#40;64&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">124 &#40;41&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">185 &#40;60&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">130 &#40;44&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">164 &#40;65&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">151 &#40;43&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bajo peso &#40;IMC<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>20 kg&#47;m<span class="elsevierStyleSup">2</span>&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;3&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;5&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;2&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;159&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;4&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;3&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;246&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;4&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;3&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;379&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sobrepeso u obesidad &#40;IMC &#62;<span class="elsevierStyleHsp" style=""></span>25<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">367 &#40;65&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">166 &#40;60&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">201 &#40;70&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">188 &#40;65&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">179 &#40;66&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;847&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">127 &#40;55&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">240 &#40;72&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diabetes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">238 &#40;39&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">120 &#40;39&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;974&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">136 &#40;44&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">102 &#40;35&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">100 &#40;39&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">138 &#40;40&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;969&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hipertensi&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">524 &#40;87&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">257 &#40;87&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">267 &#40;88&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;553&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">275 &#40;90&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">249 &#40;85&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;085&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">218 &#40;86&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">306 &#40;88&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;495&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hiperlipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">268 &#40;45&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">124 &#40;42&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">144 &#40;48&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;143&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">145 &#40;47&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">123 &#40;42&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;209&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">114 &#40;45&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">154 &#40;44&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;865&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Insuficiencia cardiaca&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">407 &#40;68&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">198 &#40;67&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">209 &#40;69&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;543&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">217 &#40;71&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">190 &#40;65&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;125&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">158 &#40;62&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">249 &#40;72&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Antecedente de embolismo perif&#233;rico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">34 &#40;5&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">21 &#40;7&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;4&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;135&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;6&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;4&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;211&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">21 &#40;8&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13 &#40;3&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Antecedente previo de FA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">551 &#40;92&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">273 &#40;92&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">278 &#40;92&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;932&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">282 &#40;92&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">269 &#40;92&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;993&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">229 &#40;91&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">322 &#40;93&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;338&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Antecedente de hemorragia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85 &#40;14&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 13&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#218;lceras por presi&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;2&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ca&#237;das en el a&#241;o previo<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">169 &#40;28&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">69 &#40;24&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">84 &#40;24&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Tiene cuidador&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">414 &#40;69&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">210 &#40;84&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">204 &#40;59&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#205;ndice de Charlson<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">4&#44;1 &#40;2&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#44;2 &#40;2&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;6 &#40;2&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Escala CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-Vasc<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#44;1 &#40;1&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">5&#44;4 &#40;1&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#44;2 &#40;1&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;042&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Escala HAS-BLED<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;7 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;7 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;9 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;4 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;580&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#205;ndice de Barthel<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">67 &#40;31&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">44 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">89 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">56 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">78 &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">81 &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">SPMSQ<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Ingresos a&#241;o previo<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;061&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;6 &#40;1&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;752&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Hemoglobina &#40;g&#47;dl&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">226 &#40;99&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">218 &#40;96&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;331&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">233 &#40;104&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Creatinina &#40;mg&#47;dl&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;3 &#40;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#44;3 &#40;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#44;4 &#40;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#44;4 &#40;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;3 &#40;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;3 &#40;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alb&#250;mina &#40;g&#47;dl&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HAS-BLED&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;096 &#40;0&#44;984-1&#44;221&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;097&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;992 &#40;0&#44;878-1&#44;122&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;902&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Antecedente de embolismo perif&#233;rico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;995 &#40;1&#44;243-3&#44;201&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;004&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;091 &#40;1&#44;288-3&#44;395&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;003&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Sarcopenia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;508 &#40;1&#44;884-3&#44;340&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;775 &#40;1&#44;270-2&#44;481&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;866 &#40;1&#44;414-2&#44;463&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;108 &#40;1&#44;611-2&#44;757&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;266 &#40;0&#44;939-1&#44;707&#41;&nbsp;\t\t\t\t\t\t\n
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                          "etal" => true
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                          "autores" => array:6 [
                            0 => "A&#46;J&#46; Cruz-Jentoft"
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                            2 => "J&#46; Bauer"
                            3 => "Y&#46; Boirie"
                            4 => "T&#46; Cederholm"
                            5 => "F&#46; Landi"
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                            3 => "W&#46;T&#46; Longstreht Jr&#46;"
                            4 => "C&#46;M&#46; Sitlani"
                            5 => "S&#46; Dublin"
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                    0 => array:2 [
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                      "titulo" => "Increased risk of cognitive and functional decline in patients with atrial fibrillation&#58; Results of the ONTARGET and TRANSCEND studies"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46; Marzona"
                            1 => "M&#46; O&#8217;Donell"
                            2 => "K&#46; Teo"
                            3 => "P&#46; Gao"
                            4 => "C&#46; Anderson"
                            5 => "J&#46; Bosch"
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                    0 => array:2 [
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                      "titulo" => "Risk and prediction of dementia in patients with atrial fibrillation &#8212; A nationwide population-based cohort study"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;N&#46; Liao"
                            1 => "T&#46;F&#46; Chao"
                            2 => "C&#46;J&#46; Liu"
                            3 => "K&#46;L&#46; Wang"
                            4 => "S&#46;J&#46; Chen"
                            5 => "T&#46;C&#46; Tuan"
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                        ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijcard.2015.06.170"
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                        "tituloSerie" => "Int J Cardiol"
                        "fecha" => "2015"
                        "volumen" => "199"
                        "paginaInicial" => "25"
                        "paginaFinal" => "30"
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Vol. 219. Núm. 8.
Páginas 424-432 (noviembre 2019)
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Vol. 219. Núm. 8.
Páginas 424-432 (noviembre 2019)
Original
Sarcopenia, fragilidad, deterioro cognitivo y mortalidad en pacientes ancianos con fibrilación auricular no valvular
Sarcopenia, frailty, cognitive impairment and mortality in elderly patients with non-valvular atrial fibrillation
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275
M.A. Requena Callejaa, A. Arenas Miquéleza, J. Díez-Manglanoa,
Autor para correspondencia
jdiez@aragon.es

Autor para correspondencia.
, A. Gullónb, A. Posec, F. Formigad, J.M. Mostazae, J.M. Cepedaf, C. Suárezb, en nombre de los investigadores del estudio NONAVASC , Grupo de Riesgo Vascular de la Sociedad Española de Medicina Interna 1
a Departamento de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, España
b Departamento de Medicina Interna, Hospital Universitario de La Princesa, Madrid, España
c Departamento de Medicina Interna, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España
d Departamento de Medicina Interna, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, España
e Departamento de Medicina Interna, Hospital Carlos III, Madrid, España
f Departamento de Medicina Interna, Hospital Vega Baja, Orihuela, Alicante, España
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Tabla 1. Características basales de los pacientes incluidos en el estudio
Tabla 2. Condiciones asociadas con la mortalidad al año
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Resumen
Objetivos

Determinar la prevalencia de la sarcopenia, la fragilidad y el deterioro cognitivo en pacientes ancianos con fibrilación auricular no valvular (FANV) y su influencia en la supervivencia.

Métodos

Estudio de cohortes, prospectivo y multicéntrico realizado con pacientes >75años con FANV hospitalizados en servicios de Medicina Interna en España. Para cada paciente se recogieron los niveles de creatinina, hemoglobina y plaquetas, así como las escalas CHA2DS2-Vasc, HAS-BLED, el índice de Charlson y el uso de anticoagulantes orales. Se midió la sarcopenia con escala SARC-F, la fragilidad con la escala FRAIL y el deterioro cognitivo con el Short Portable Mental State Questionnaire. Se realizó seguimiento durante un año.

Resultados

Se incluyeron 596 pacientes con FANV, con edad media de 84,9 (DE: 5,2) años. De ellos, 295 (49,5%) presentaban sarcopenia, 305 (51,2%) fragilidad y 251 (42,1%) deterioro cognitivo. Al cabo de un año fallecieron 226 (37,9%) pacientes. La mortalidad fue superior en los pacientes con sarcopenia, fragilidad y deterioro cognitivo. En el análisis multivariante la sarcopenia (HR: 1,775; IC95%: 1,270-2,481), la edad, la comorbilidad y el antecedente de embolismo periférico se asociaron con mayor mortalidad, y el uso de anticoagulantes orales al alta (HR: 0,415; IC95%: 0,307-0,560), con menor mortalidad.

Conclusiones

En los pacientes ancianos con FANV la sarcopenia, la fragilidad y el deterioro cognitivo son muy prevalentes y se asocian con frecuencia. La sarcopenia se asocia a mayor mortalidad.

Palabras clave:
Fibrilación auricular
Sarcopenia
Fragilidad
Deterioro cognitivo
Mortalidad
Ancianos
Estudio de cohortes
Abstract
Objectives

To determine the prevalence of sarcopenia, frailty and cognitive impairment in elderly patients with nonvalvular atrial fibrillation (NVAF) and the factors’ influence on survival.

Methods

Prospective, multicentre cohort study of patients older than 75 years with NVAF hospitalised in internal medicine departments in Spain. For each patient, we recorded the creatinine, haemoglobin and platelet levels, the scores on the CHA2DS2-VASc and HAS-BLED scales and Charlson index, as well as the use of oral anticoagulants. We measured sarcopenia with the SARC-F scale, frailty with the FRAIL scale and cognitive impairment with the Short Portable Mental State Questionnaire. We also conducted a 1-year follow-up.

Results

The study included 596 patients with NVAF, with a mean age of 84.9 (SD: 5.2) years. Of these, 295 (49.5%) presented sarcopenia, 305 (51.2%) presented frailty, and 251 (42.1%) presented cognitive impairment. At the end of 1year, 226 (37.9%) patients had died. Mortality was greater for the patients with sarcopenia, frailty and cognitive impairment. In the multivariate analysis, sarcopenia (HR: 1.775; 95%CI: 1.270-2.481), age, comorbidity and a history of peripheral embolism were associated with increased mortality, and the use of oral anticoagulants at discharge (HR: 0.415; 95%CI: 0.307-0.560) was associated with lower mortality.

Conclusions

Sarcopenia, frailty and cognitive impairment are very common in elderly patients with NVAF and are frequently associated. Sarcopenia was associated with increased mortality.

Keywords:
Atrial fibrillation
Sarcopenia
Frailty
Cognitive impairment
Mortality
Elderly
Cohort study

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