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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Atrial fibrillation &#40;AF&#41; is the most common arrhythmia in clinical practice&#44; with an estimated prevalence of 2&#46;5&#37; in the Portuguese population aged 40 and over according to the FAMA study&#46; The prevalence increases with age&#44; reaching 6&#46;6&#37; in the group aged 70 and over and 10&#46;5&#37; in those aged 80 and over&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In the FAMA study&#44; a third of patients with AF were not aware that they had the condition&#46; As AF can remain silent until complications occur&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> clinical screening is indicated for individuals aged 65 or over&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The main complications of AF are thromboembolic events&#44; particularly stroke&#46; For prevention of such events oral anticoagulation therapy &#40;OAC&#41; is recommended in patients with thromboembolic risk factors&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of this review was to estimate the prevalence of OAC therapy in patients with AF in Portugal by means of a systematic review and meta-analysis of epidemiologic studies&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Selection criteria</span><p id="par0020" class="elsevierStylePara elsevierViewall">Observational studies performed in mainland Portugal and&#47;or the islands of Madeira and the Azores that enrolled patients with AF or atrial flutter &#40;whether paroxysmal&#44; persistent or permanent&#41; and reported the proportion of anticoagulated patients were included&#46; Studies on specific populations or on specific interventions such as AF ablation were excluded since inclusion of patients who are not representative of the general AF population would introduce bias&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Databases and searches</span><p id="par0025" class="elsevierStylePara elsevierViewall">MEDLINE&#44; the Index of Portuguese Medical Journals and SIBUL &#40;the Bibliographic Catalog of the Integrated Library System of the University of Lisbon&#41; were searched&#46; The search included review of the references lists of the studies and literature reviews found&#44; but did not include abstracts of posters or oral communications at congresses&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Selection of studies and data extraction</span><p id="par0030" class="elsevierStylePara elsevierViewall">Potentially eligible studies were selected independently by two of the authors using the above inclusion and exclusion criteria and entered in a data extraction form showing the demographic characteristics of the study&#44; the thromboembolic risk factors of the population and the proportion of anticoagulated patients&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The selected studies were assessed qualitatively using criteria related to sampling&#44; measurement and analysis&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> No study was excluded on the basis of possible bias&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Any disagreement between the investigators was resolved by consensus&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Data synthesis</span><p id="par0045" class="elsevierStylePara elsevierViewall">The Stata<span class="elsevierStyleSup">&#174;</span> Statistical Software Package&#44; version 11&#46;0 &#40;StataCorp LP&#44; College Station&#44; TX&#41;&#44; was used to synthesise the results through meta-analysis and to determine the pooled estimated prevalence of anticoagulated AF patients&#46; In studies that stratified the population&#39;s thromboembolic risk&#44; the denominator of prevalence was the proportion of patients indicated for OAC&#46; The results of the individual and pooled studies were expressed in percentages &#40;prevalence&#41; and 95&#37; confidence intervals &#40;CI&#41;&#46; Inverse-variance weighting was used to aggregate the results of each study&#46; As considerable heterogeneity between studies was expected&#44; the random-effects model of DerSimonian and Laird<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> was used by default&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Statistical heterogeneity was assessed using the I<span class="elsevierStyleSup">2</span> test&#44; which calculates the percentage of total variation across studies that is due to heterogeneity rather than chance&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> An I<span class="elsevierStyleSup">2</span> of &#8805;50&#37; indicates significant heterogeneity&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In a separate analysis&#44; estimates of prevalence were calculated as a function of the environment of the study &#40;community or hospital&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">Seven studies were included for analysis&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;9&#8211;14</span></a> Supplementary Data Figure 1 shows the flowchart for study selection&#46; Three studies were cross-sectional<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;9&#44;13</span></a> and four were longitudinal &#40;three retrospective cohort studies<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#8211;12</span></a> and one prospective cohort study<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#41;&#46; Three were conducted in the general community<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;9&#44;13</span></a> and four in a hospital environment&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#8211;12&#44;14</span></a> These studies enrolled a total of 891 AF patients eligible for OAC&#46; Sample size ranged between 21 and 261 individuals&#44; most of them elderly &#40;mean age varying between 77 and 85&#46;5 years&#41; and thus generally at high thromboembolic risk&#46; Three studies included patients with significant valve disease or mechanical valves&#58; in Jorge et al&#46;&#44; 29&#37; of the population had at least moderate valve disease or mechanical valves&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> in Ascen&#231;&#227;o et al&#46;&#44; 20&#37; had mitral stenosis&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> and in Dores et al&#46;&#44; 6&#37; of the population had valvular AF&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Thromboembolic risk stratification was performed using the CHADS<span class="elsevierStyleInf">2</span> and CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc scores and the risk categories proposed in the 2006 American College of Cardiology&#47;American Heart Association&#47;European Society of Cardiology &#40;ACC&#47;AHA&#47;ESC&#41; guidelines<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Two studies did not report using any risk stratification tools&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;10</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">The main characteristics of the studies included are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The quality of the methodology in all seven studies was reasonable&#46; The main source of possible bias was the lack of representativeness of the sample &#8211; some studies were performed exclusively in a hospital environment or analyzed patient subgroups&#46; A qualitative analysis of the risk of bias is presented in Supplementary Data Figure 2&#46; The meta-analysis of the results reveals that the prevalence of OAC therapy in Portuguese patients with AF is 40&#37; &#40;95&#37; CI&#58; 32&#8211;48&#37;&#41;&#44; higher in community-based &#40;45&#37;&#59; 95&#37; CI&#58; 37&#8211;52&#37;&#41; than in hospital-based studies &#40;36&#37;&#59; 95&#37; CI&#58; 24&#8211;48&#37;&#41;&#44; although this difference was without statistical significance &#40;p&#61;0&#46;20&#41;&#46; These results are presented in <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">To assess the effect of including studies that used different risk stratification tools&#44; we analyzed the results for different subgroups&#46; The differences between the estimates obtained by different methods were not significant &#40;p&#61;0&#46;31&#41;&#59; the prevalence of anticoagulated patients was higher &#40;44&#37; &#91;37&#8211;51&#37;&#93; vs&#46; 30&#37; &#91;15&#8211;45&#37;&#93;&#41; in studies that reported using risk stratification tools than in those that did not&#44; but this was also not statistically significant &#40;p&#61;0&#46;10&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">AF is an important public health issue&#44; particularly in Portugal&#44; since it is a risk factor for stroke&#44; a significant cause of morbidity and mortality in this country&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> The risk of stroke is five times higher in patients with AF&#44; increasing with age&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Over 15&#37; of strokes are due to AF and they are generally more severe than those not associated with AF&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a> Stroke attributable to AF is associated with a 30-day mortality of 25&#37; and one-year mortality of 50&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> These patients have longer hospital stays and greater use of health resources&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">There is solid evidence that OAC reduces the risk of thromboembolic events&#46; Use of vitamin K antagonists is associated with a significant reduction of 64&#37; in relative risk for stroke&#44;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> and the new oral anticoagulants &#40;direct thrombin and Xa inhibitors&#41; have been shown to be at least as effective as vitamin K antagonists&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The low prevalence of anticoagulated patients found in this review underlines the need to promote change in prescribing habits&#46; The prevalence found in this study &#40;40&#37;&#41; is close to that in the Italian ISAF study &#40;46&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> However&#44; another study in Italy&#44; based on cardiology units&#44; showed a considerably higher prevalence of anticoagulation in AF patients with indication for OAC&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> and other recent studies paint a more optimistic picture&#46; The international prospective GARFIELD registry reported a prevalence of 62&#37; of OAC in patients with AF and CHADS<span class="elsevierStyleInf">2</span> score &#8805;2<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&#59; the German ATRIUM registry&#44; based on primary care data&#44; found a prevalence of 75&#37; in patients with AF and high thromboembolic risk<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>&#59; and the PREFER in AF registry&#44; using data from seven European countries&#44; showed a prevalence of 85&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Both in clinical trials and in the real world&#44; various reasons have been put forward for the failure of physicians to prescribe OAC for AF patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#44;27</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">In a hospital-based study&#44; Dores et al&#46; found that 19&#37; of patients with AF were considered to be contraindicated for OAC&#44; the most frequent reasons being previous bleeding dyscrasia&#44; alcoholism&#44; renal disease and inability to control INR&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Pereira-Da-Silva et al&#46; assessed predictors of non-prescription of OAC in 103 eligible patients with AF and the reasons given by physicians&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> On multivariate analysis&#44; bedridden status or dementia and large number of bleeding risk factors predicted non-prescription&#46; In the 68 patients who were not prescribed OAC&#44; the most frequent reasons were high bleeding risk &#40;56&#37;&#41;&#44; perceived lack of benefit &#40;22&#37;&#41;&#44; inability to follow the therapeutic regimen &#40;10&#37;&#41; and difficulty in monitoring INR &#40;7&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> The reasons given for not prescribing new-generation anticoagulants were their high cost &#40;some not being subsidized by the State&#41;&#44; lack of expected benefit&#44; and bleeding risk&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Despite their cost&#44; the new anticoagulants&#44; as well as being cost-effective&#44;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28&#44;29</span></a> can overcome some of the barriers to prescription&#44; particularly because they do not require regular INR monitoring and have fewer drug-drug and drug-food interactions&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The current European Society of Cardiology guidelines recommend thromboembolic risk stratification using the CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc score&#44; a score of 0 indicating that the patient would not benefit from OAC&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;30</span></a> Some studies in this review used the previously recommended risk stratification tool&#44; CHADS<span class="elsevierStyleInf">2</span>&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> or the algorithm proposed in the 2006 ACC&#47;AHA&#47;ESC guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> Since the latter two exclude or underestimate risk in a proportion of patients who would benefit from OAC&#44; the prevalence of anticoagulation in patients indicated for the therapy could be even lower when based on the CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc score&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Furthermore&#44; two studies included a considerable number of patients with significant valve disease or prosthetic valves&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;12</span></a> These patients are more likely to be anticoagulated than those with non-valvular AF&#59; even so&#44; the prevalence of OAC was low in both studies&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The considerable heterogeneity found is not uncommon in prevalence studies&#44; due to multiple factors related to patients&#44; institutions and prescribers&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The heterogeneity observed between studies in the community compared to those in a hospital environment may be due to various factors&#44; the most obvious of which is the inclusion of Reis et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> in the meta-analysis&#46; This is the oldest of the hospital-based studies&#44; published in 2006 but analyzing OAC in patients admitted in 2004&#59; in this year there were 122 patients hospitalized for AF&#44; of whom 108 were indicated for long-term OAC&#44; but only 22&#46;2&#37; of these were anticoagulated at discharge&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">There are several possible reasons for the low rate of OAC in hospital-based studies&#44; particularly Reis et al&#46;&#44; including older age and the presence of comorbidities that would tend to heighten perception of greater bleeding risk&#46; Both these reasons have been put forward as a restraint on physicians prescribing OAC for fear of severe bleeding&#44; or the belief that the thromboembolic risk is lower than the bleeding risk&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> Moreover&#44; some of the studies included in our review predated the publication of the Birmingham Atrial Fibrillation Treatment of the Aged &#40;BAFTA&#41; study in 2007&#44; which showed that warfarin with a target INR of 2&#46;0&#8211;3&#46;0 was superior to aspirin in preventing cardiovascular events in patients aged &#8805;75 years&#44; with no significant differences in bleeding risk&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Limitations</span><p id="par0135" class="elsevierStylePara elsevierViewall">The conclusions of this review should be assessed bearing in mind the inherent limitations of the methodology used &#40;a meta-analysis of pooled study results rather than data on individual patients&#41;&#46; The inclusion of different population samples&#44; ages&#44; environments &#40;community vs&#46; hospital&#41; and thromboembolic risk stratification tools &#40;CHADS<span class="elsevierStyleInf">2</span>&#44; CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc and the 2006 ACC&#47;AHA&#47;ESC Guidelines&#41;&#44; all of which lead to clinical heterogeneity&#44; should be taken into consideration as well as the expected statistical heterogeneity&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusions</span><p id="par0140" class="elsevierStylePara elsevierViewall">The prevalence of OAC in Portuguese patients with AF is around 40&#37;&#46; Despite the evidence and the recommendations concerning the reduction of thromboembolic risk in AF patients with this therapy&#44; a significant proportion of the population at risk is not anticoagulated&#46; The level of OAC prescription in these patients is an indication of the quality of health care&#44; and there is an obvious need for change&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicts of interest</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction and Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Oral anticoagulation &#40;OAC&#41; is an effective treatment in the prevention of thromboembolic events in patients with atrial fibrillation &#40;AF&#41;&#46; The aim of this review was to estimate the prevalence of OAC therapy in patients with AF in Portugal&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">MEDLINE&#44; the Index of Portuguese Medical Journals and SIBUL &#40;the Bibliographic Catalog of the Integrated Library System of the University of Lisbon&#41; were searched for Portuguese observational studies reporting the proportion of anticoagulated patients with AF&#46; The pooled estimated prevalence of anticoagulated patients and respective 95&#37; confidence interval &#40;CI&#41; were determined by means of a meta-analysis&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Seven studies were included for analysis&#44; of which four were conducted in a hospital environment and three in the general community&#46; These studies enrolled a total of 891 patients with AF&#46; The pooled estimated prevalence of anticoagulated patients was 40&#37; &#40;95&#37; CI&#58; 32&#8211;48&#37;&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The prevalence of OAC in Portuguese AF patients is low&#46; There is a need to promote change in OAC prescribing habits for AF patients in Portugal&#44; in accordance with international guidelines&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o e objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A anticoagula&#231;&#227;o oral &#233; uma terap&#234;utica eficaz na preven&#231;&#227;o de eventos tromboemb&#243;licos&#44; em doentes com fibrilha&#231;&#227;o auricular &#40;FA&#41;&#46; A presente revis&#227;o pretendeu estimar a preval&#234;ncia da terap&#234;utica anticoagulante oral em doentes com FA em Portugal&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Foi realizada uma pesquisa nas bases de dados MEDLINE&#44; &#205;ndex de Revistas M&#233;dicas Portuguesas e Cat&#225;logo Bibliogr&#225;fico do Sistema Integrado de Bibliotecas da antiga Universidade Cl&#225;ssica de Lisboa &#40;SIBUL&#41;&#46; Estudos observacionais nacionais que reportavam a propor&#231;&#227;o de doentes anticoagulados com fibrilha&#231;&#227;o auricular foram inclu&#237;dos&#46; A estimativa combinada de preval&#234;ncia de doentes com FA anticoagulados e o respetivo intervalo de confian&#231;a 95&#37; &#40;IC95&#37;&#41; foi determinada com recurso a meta-an&#225;lise&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Dos sete estudos inclu&#237;dos&#44; tr&#234;s estudos foram realizados em ambiente hospitalar e quatro foram realizados na comunidade em geral&#46; Do total de 891 doentes com FA&#44; a estimativa de preval&#234;ncia de doentes anticoagulados foi de 40&#37; &#40;IC95&#37; 32-48&#37;&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A preval&#234;ncia de doentes com FA anticoagulados na popula&#231;&#227;o estudada &#233; baixa&#46; &#201; necess&#225;rio promover a mudan&#231;a dos h&#225;bitos de prescri&#231;&#227;o de anticoagulantes em doentes com FA em Portugal&#44; em concord&#226;ncia com as recomenda&#231;&#245;es internacionais&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Caldeira D&#44; Barra M&#44; David C&#44; et al&#46; Preval&#234;ncia da anticoagula&#231;&#227;o oral em doentes com fibrilha&#231;&#227;o auricular em Portugal&#58; revis&#227;o sistem&#225;tica e meta-an&#225;lise de estudos observacionais&#46; Rev Port Cardiol&#46; 2014&#59;33&#58;555&#8211;560&#46;</p>"
      ]
    ]
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      0 => array:1 [
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          0 => array:4 [
            "apendice" => "<p id="par0160" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0070"
          ]
        ]
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Prevalence of oral anticoagulation in patients with atrial fibrillation&#46; CI&#58; confidence interval&#59; OAC&#58; oral anticoagulation&#46;</p>"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">ACC&#47;AHA&#47;ESC&#58; American College of Cardiology&#47;American Heart Association&#47;European Society of Cardiology&#59; AF&#58; atrial fibrillation&#59; CHLC&#58; Centro Hospitalar Lisboa Central&#59; HFF&#58; Hospital Prof&#46; Dr&#46; Fenando Fonseca&#59; HSFX&#58; Hospital S&#227;o Francisco Xavier&#59; HUC&#58; Hospitais da Universidade de Coimbra&#59; OAC&#58; oral anticoagulation&#59; USF&#58; Family Health Unit&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td 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" style="border-bottom: 2px solid black">Study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Study designEnvironment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Study period&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Patients eligible for OAC &#40;n&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Mean&#47;median age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Indication for OAC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><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">Ascen&#231;&#227;o et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</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">Cross-sectionalCommunity &#40;general practitioner sentinel network&#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">June 2003&#8211;November 2003&nbsp;\t\t\t\t\t\t\n
                  \t\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">243&nbsp;\t\t\t\t\t\t\n
                  \t\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&#37; &#62;65&nbsp;\t\t\t\t\t\t\n
                  \t\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">CHADS<span class="elsevierStyleInf">2</span> &#8805;2&#44; mitral stenosis or intracavitary thrombus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Reis et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</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">RetrospectiveHospital &#40;HFF&#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">January 1996&#8211;December 2004 &#40;data from 2004&#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">108&nbsp;\t\t\t\t\t\t\n
                  \t\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">78&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\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">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bonhorst et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</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">Cross-sectionalCommunity&nbsp;\t\t\t\t\t\t\n
                  \t\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">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\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">119 &#40;previous diagnosis of AF&#41;&#47;69&#37; total AF&nbsp;\t\t\t\t\t\t\n
                  \t\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">77&nbsp;\t\t\t\t\t\t\n
                  \t\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">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dores et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</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">RetrospectiveHospital &#40;HSFX&#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">October 2006&#8211;October 2007&nbsp;\t\t\t\t\t\t\n
                  \t\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">126&nbsp;\t\t\t\t\t\t\n
                  \t\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">77&nbsp;\t\t\t\t\t\t\n
                  \t\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">Moderate to high risk according to 2006 ACC&#47;AHA&#47;ESC guidelines&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Jorge et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</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">RetrospectiveHospital &#40;HUC&#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">December 2005&#8211;June 2007&nbsp;\t\t\t\t\t\t\n
                  \t\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">161&nbsp;\t\t\t\t\t\t\n
                  \t\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">80&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\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">CHADS<span class="elsevierStyleInf">2</span> &#8805;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#225; et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</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">Cross-sectionalCommunity &#40;USFSa&#250;de em Fam&#237;lia&#44; Maia&#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">2011&nbsp;\t\t\t\t\t\t\n
                  \t\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">31&nbsp;\t\t\t\t\t\t\n
                  \t\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&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\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">CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc &#8805;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pereira-Da-Silva et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</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">RetrospectiveHospital &#40;CHLC&#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">April 2011&#8211;October 2011&nbsp;\t\t\t\t\t\t\n
                  \t\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">103&nbsp;\t\t\t\t\t\t\n
                  \t\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">79&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\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">CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc &#8805;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                    0 => array:2 [
                      "titulo" => "Prevalence of atrial fibrillation in the Portuguese population aged 40 and over&#58; the FAMA study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
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                            2 => "P&#46; Adrag&#227;o"
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                        "tituloSerie" => "Rev Port Cardiol"
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                        "paginaInicial" => "331"
                        "paginaFinal" => "350"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20635561"
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                    0 => array:2 [
                      "titulo" => "A survey of atrial fibrillation in general practice&#58; the West Birmingham Atrial Fibrillation Project"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "G&#46;Y&#46; Lip"
                            1 => "D&#46;J&#46; Golding"
                            2 => "M&#46; Nazir"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Gen Pract"
                        "fecha" => "1997"
                        "volumen" => "47"
                        "paginaInicial" => "285"
                        "paginaFinal" => "289"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9219403"
                            "web" => "Medline"
                          ]
                        ]
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                ]
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            2 => array:3 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Increasing prevalence of atrial fibrillation and flutter in the United States"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "G&#46;V&#46; Naccarelli"
                            1 => "H&#46; Varker"
                            2 => "J&#46; Lin"
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