<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2393-6797</journal-id>
<journal-title><![CDATA[Revista Uruguaya de Medicina Interna ]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. Urug. Med. Int.]]></abbrev-journal-title>
<issn>2393-6797</issn>
<publisher>
<publisher-name><![CDATA[Sociedad de Medicina Interna del Uruguay]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2393-67972023000300059</article-id>
<article-id pub-id-type="doi">10.26445/08.03.6</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Adherencia y calidad de vida en pacientes con fibrilación auricular e insuficiencia cardíaca anticoagulados con Apixaban]]></article-title>
<article-title xml:lang="en"><![CDATA[Adherence and quality of life in patients with atrial fibrillation and heart failure anticoagulated with Apixaban]]></article-title>
<article-title xml:lang="pt"><![CDATA[Adesão e qualidade de vida em pacientes com fibrilação atrial e insuficiência cardíaca anticoagulados com Apixabana]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Olaya Muñoz]]></surname>
<given-names><![CDATA[Qandi Xue]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Meneses Sánchez]]></surname>
<given-names><![CDATA[Johan Guillermo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ortiz]]></surname>
<given-names><![CDATA[Raúl Andres]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Tor Bales]]></surname>
<given-names><![CDATA[Carla Mikaela]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Silvera]]></surname>
<given-names><![CDATA[Gabriela]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ormaechea Gorricho]]></surname>
<given-names><![CDATA[Gabriela]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Silveira]]></surname>
<given-names><![CDATA[Anaulina]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad de la República Facultad de Medicina Unidad Multidisciplinaria de Insuficiencia Cardíaca. Hospital de Clínicas - &#8220;Dr Manuel Quintela&#8221;]]></institution>
<addr-line><![CDATA[Montevideo ]]></addr-line>
<country>Uruguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2023</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2023</year>
</pub-date>
<volume>8</volume>
<numero>3</numero>
<fpage>59</fpage>
<lpage>69</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_arttext&amp;pid=S2393-67972023000300059&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_abstract&amp;pid=S2393-67972023000300059&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_pdf&amp;pid=S2393-67972023000300059&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[resumen está disponible en el texto completo]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract:  Introduction:  Atrial fibrillation (AF) is the most common cardiac arrhythmia in patients with heart failure (HF), regardless of ejection fraction, leading to a greater risk of thromboembolic complications. Anticoagulation is one of the fundamental pillars in the treatment of AF, and prior to this, it is recommended to evaluate the embolic risk using the CHA2DS2-VASc score and the bleeding risk with the HAS-BLED score. There are two pharmacological groups of oral anticoagulants (OACs), vitamin K antagonists (VKAs), and direct oral anticoagulants (DOACs). Both groups have advantages and disadvantages in their use. VKAs require frequent monitoring to achieve INR levels within range, a greater number of drug and dietary interactions, leading to lower adherence, satisfaction, and quality of life. Likewise, scientific evidence supports the non-inferiority of DOACs versus VKAs, being recommended in recent clinical practice guidelines for the prevention of thrombotic events in all patients with AF except in cases where moderate to severe mitral stenosis or mechanical valve replacement coexist. To date, there are no published studies that assess adherence and impact on quality of life with the use of DOACs in HF with AF. Therefore, the objective of this research is to observe changes in adherence and quality of life of patients who were switched from VKA to DOAC, describing the occurrence of thrombotic or hemorrhagic events.  Methodology:  Quasi-experimental, prospective, longitudinal study. All patients over 18 years of age with AF without mechanical valve prosthesis or moderate/severe mitral stenosis, anticoagulated with warfarin with therapeutic range time (TTR) &#8804;65% and SAMe-T2R &#8805;2 were included. The Morisky questionnaire was administered to evaluate adherence, and the Anti-Clot Treatment Scale was used to evaluate satisfaction and quality of life. Thrombotic and hemorrhagic risk was evaluated by CHA2DS2-VASc and HAS-BLED. The questionnaires were applied using warfarin and the same questionnaires were repeated after replacing with DOAC for convenience, specifically apixaban. Statistical analysis was performed using the Kolmogorov-Smirnov test, Cochrane Q test, ANOVA, and STATAv.15.0.  Results:  43 patients, 31 of whom were male, 100% had CHA2DS2-VASC &gt;2, 37% had HAS-BLED &gt;3, and 62.8% had SAMe-TT2R2 &gt;2. There was a statistically significant difference (p&lt;0.001) in relation to the use of apixaban in quality of life, disease burden, and positive impact. No thrombotic or hemorrhagic events were observed with the use of apixaban.  Conclusions:  A statistically significant difference was observed in adherence, satisfaction, and quality of life with the use of apixaban, without thrombotic or hemorrhagic events.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo:  Introdução:  A fibrilação atrial (FA) é a arritmia cardíaca mais comum em pacientes com insuficiência cardíaca (IC), independentemente da fração de ejeção, o que leva a um maior risco de complicações tromboembólicas. A anticoagulação é um dos pilares fundamentais no tratamento da FA e, antes disso, é recomendado avaliar o risco embólico usando o escore CHA2DS2-VASc e o risco de sangramento com o escore HAS-BLED. Existem dois grupos farmacológicos de anticoagulantes orais (AOs): os antagonistas da vitamina K (AVKs) e os anticoagulantes orais diretos (DOACs). Ambos os grupos têm vantagens e desvantagens em seu uso. Os AVKs exigem monitoramento frequente para alcançar níveis de RNI dentro da faixa, um maior número de interações medicamentosas e alimentares, levando a menor adesão, satisfação e qualidade de vida. Da mesma forma, a evidência científica suporta a não inferioridade dos DOACs em relação aos AVKs, sendo recomendados nas diretrizes recentes de prática clínica para a prevenção de eventos trombóticos em todos os pacientes com FA, exceto nos casos em que coexistem estenose mitral moderada a grave ou substituição valvar mecânica. Até o momento, não há estudos publicados que avaliem a aderência e o impacto na qualidade de vida com o uso de DOACs em IC com FA. Portanto, o objetivo desta pesquisa é observar mudanças na adesão e qualidade de vida de pacientes que mudaram de AVK para DOAC, descrevendo a ocorrência de eventos trombóticos ou hemorrágicos.  Metodologia:  Estudo quase-experimental, prospectivo e longitudinal. Foram incluídos todos os pacientes com mais de 18 anos de idade com FA sem prótese valvar mecânica ou estenose mitral moderada/grave, anticoagulados com varfarina com tempo de alcance terapêutico (TTR) &#8804;65% e SAMe-T2R &#8805;2. O questionário Morisky foi administrado para avaliar a adesão, e a Escala de Tratamento Anticoagulante foi usada para avaliar a satisfação e qualidade de vida. O risco trombótico e hemorrágico foi avaliado pelo escore CHA2DS2-VASc e HAS-BLED. Os questionários foram aplicados usando varfarina e os mesmos questionários foram repetidos após a substituição por DOAC por conveniência, especificamente apixabana. A análise estatística foi realizada usando o teste de Kolmogorov-Smirnov, teste Q de Cochrane, ANOVA e STATAv.15.0.  Resultados:  Foram incluídos 43 pacientes, sendo 31 do sexo masculino. Todos os pacientes apresentavam CHA2DS2-VASC &gt;2, 37% tinham HAS-BLED &gt;3 e 62,8% tinham SAMe-TT2R2 &gt;2. Foi observada uma diferença estatisticamente significativa (p&lt;0,001) no que diz respeito ao uso de apixabana na qualidade de vida, carga da doença e impacto positivo. Não foram observados eventos tromboembólicos ou hemorrágicos com o uso de apixabana.  Conclusões: Foi observada uma diferença estatisticamente significativa na adesão, satisfação e qualidade de vida em relação ao uso de apixabana, sem eventos tromboembólicos ou hemorrágicos.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Fibrilación auricular]]></kwd>
<kwd lng="es"><![CDATA[anticoagulación]]></kwd>
<kwd lng="es"><![CDATA[calidad de vida]]></kwd>
<kwd lng="es"><![CDATA[adherencia]]></kwd>
<kwd lng="es"><![CDATA[apixaban]]></kwd>
<kwd lng="en"><![CDATA[Atrial fibrillation]]></kwd>
<kwd lng="en"><![CDATA[anticoagulation]]></kwd>
<kwd lng="en"><![CDATA[quality of life]]></kwd>
<kwd lng="en"><![CDATA[adherence]]></kwd>
<kwd lng="en"><![CDATA[apixaban]]></kwd>
<kwd lng="pt"><![CDATA[Fibrilação atrial]]></kwd>
<kwd lng="pt"><![CDATA[anticoagulação]]></kwd>
<kwd lng="pt"><![CDATA[qualidade de vida]]></kwd>
<kwd lng="pt"><![CDATA[adesão]]></kwd>
<kwd lng="pt"><![CDATA[apixabana]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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