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Epidemiology of atrial fibrillation in Galicia: Insights from ‘big data’
Epidemiologia da fibrilhação auricular na Galiza: perspetivas de uma vasta quantidade de dados
Diogo Magalhães Cavaco
Serviço de Cardiologia, Hospital de Santa Cruz, CHLO, Carnaxide, Portugal
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"lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204919300108?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117306881?idApp=UINPBA00004E" "url" => "/08702551/0000003800000001/v5_201911281009/S0870255117306881/v5_201911281009/en/main.assets" ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>" "titulo" => "Epidemiology of atrial fibrillation in Galicia: Insights from ‘big data’" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "31" "paginaFinal" => "32" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Diogo Magalhães Cavaco" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Diogo Magalhães" "apellidos" => "Cavaco" "email" => array:1 [ 0 => "cavacodm@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Serviço de Cardiologia, Hospital de Santa Cruz, CHLO, Carnaxide, Portugal" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Epidemiologia da fibrilhação auricular na Galiza: perspetivas de uma vasta quantidade de dados" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Epidemiological data on most medical conditions have traditionally been derived from registries and clinical trials. Although such data are obtained under highly controlled conditions, it is not certain whether the results correlate with key epidemiological indicators such as incidence, prevalence, mortality, morbidity and treatment status in a given population. The larger the number of subjects included, the greater the probability of obtaining an accurate result.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Over the last decade, there has been a rapid digital transformation in healthcare, with the increased use of electronic medical records, healthcare information systems, and handheld, wearable and smart devices. A massive quantity and variety of health-related data today is in digital form, including not only clinical information, but also data on genomics and proteomics, sociodemographics and insurance claims.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">This kind of information is what is known as ‘big data’, many of the current applications of which are not related to medicine. It is by analyzing big data that companies such as Google, Amazon and Netflix are able to predict the behavior of their customers (what products they can be persuaded to buy, what kind of advertisements or movies they want to see, and so on).</p><p id="par0020" class="elsevierStylePara elsevierViewall">New data analysis methods have also been developed to handle big data. Machine learning automates analytical model building. Data mining uses machine learning processes for knowledge discovery and predictive modeling in large datasets, searching for hidden insights. Unlike traditional statistical methods, these tools do not start with a predefined model; the model is built at the same time as underlying patterns are discovered. Nevertheless, traditional statistical methods can also be applied to big data.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Electronic medical records for entire regions and populations constitute a vast quantity of data and many epidemiological and clinical insights can be obtained from this information.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In the current issue of the <span class="elsevierStyleItalic">Journal</span>, Rodríguez-Mañero et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> present a study using electronic health records from the Spanish region of Galicia. The population is composed of around 380<span class="elsevierStyleHsp" style=""></span>000 individuals according to the population information technology system of the Galician regional health service. Information on diagnosis, treatment status and complications in atrial fibrillation patients was obtained from various sources, including primary health care, hospital discharge and pharmacy records. Traditional statistical methods were used to handle this large amount of data.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The authors were able to estimate the overall prevalence of atrial fibrillation in Galicia. The figure they obtained (2.08%) is similar to that obtained from Spanish registries. This is not the first such study to be published. In an Israel-based population study, the prevalence of atrial fibrillation was 3.0% in individuals older than 21 years.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> As in other studies, the prevalence increases with age and is the same overall in men and women, although women tend to develop atrial fibrillation later in life.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The treatment status of patients diagnosed with atrial fibrillation was also assessed. Overall, two-thirds of the patients were anticoagulated, a slightly higher figure according to the authors than that reported in previous Spanish studies. Most of these patients (71.6%) were treated with vitamin K antagonists. As expected, the rate of oral anticoagulation prescription increased with higher CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>VASc scores.</p><p id="par0045" class="elsevierStylePara elsevierViewall">There are some advantages of this kind of study derived from the longitudinal nature of the data (although they are not explored in the paper). It will be interesting to see the changes in patterns of anticoagulation. Will a higher percentage of patients be anticoagulated in the future? How will direct oral anticoagulants (DOACs) affect this? It is likely that in 2019, the number of patients anticoagulated with vitamin K antagonists will be lower compared to DOACs than in 2014.</p><p id="par0050" class="elsevierStylePara elsevierViewall">With regard to mortality, the study also confirms data obtained from registries. Mortality of atrial fibrillation patients was high, and was related to the disease – patients with higher CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>VASc scores had higher mortality (confirming the power of this score), as did females and patients with dementia.</p><p id="par0055" class="elsevierStylePara elsevierViewall">A limitation of this kind of study (as in any large-scale epidemiological database-based study) is variability in coding by multiple physicians at different steps of the process, which means the system is prone to error.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Although the information in this paper is not new, it confirms that epidemiological indicators obtained from clinical registries and small epidemiological studies are of good quality and reliable.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The main strength of the study is, of course, the size of the database and the reliable coverage of the entire population of a particular region.</p><p id="par0070" class="elsevierStylePara elsevierViewall">It will be interesting to see if genuine ‘big data’ applications will be developed for this subset of the Spanish population – more could be learned about the prognosis, unknown risk factors and outcomes of these patients using these new tools.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Big data analytics to improve cardiovascular care: promise and challenges" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.S. Rumsfeld" 1 => "K.E. Joynt" 2 => "T.M. Maddox" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/nrcardio.2016.42" "Revista" => array:7 [ "tituloSerie" => "Nat Rev Cardiol" "fecha" => "2016" "volumen" => "13" "paginaInicial" => "350" "paginaFinal" => "359" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27009423" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1056872715000458" "estado" => "S300" "issn" => "10568727" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Machine learning for prediction of 30-day mortality after ST elevation myocardial infraction: an Acute Coronary Syndrome Israeli Survey data mining study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R. Shouval" 1 => "A. Hadanny" 2 => "N. Shlomo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijcard.2017.05.067" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2017" "volumen" => "246" "paginaInicial" => "7" "paginaFinal" => "13" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28867023" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence and outcomes of atrial fibrillation in a European healthcare area gained through the processing of a health information technology system" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Rodríguez-Mañero" 1 => "E. López-Pardo" 2 => "A. 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| 2024 Maio | 38 | 19 | 57 |
| 2024 Abril | 29 | 36 | 65 |
| 2024 Maro | 35 | 24 | 59 |
| 2024 Fevereiro | 35 | 25 | 60 |
| 2024 Janeiro | 25 | 28 | 53 |
| 2023 Dezembro | 21 | 25 | 46 |
| 2023 Novembro | 38 | 29 | 67 |
| 2023 Outubro | 22 | 16 | 38 |
| 2023 Setembro | 25 | 17 | 42 |
| 2023 Agosto | 34 | 27 | 61 |
| 2023 Julho | 27 | 15 | 42 |
| 2023 Junho | 24 | 10 | 34 |
| 2023 Maio | 36 | 26 | 62 |
| 2023 Abril | 19 | 9 | 28 |
| 2023 Maro | 33 | 19 | 52 |
| 2023 Fevereiro | 33 | 19 | 52 |
| 2023 Janeiro | 17 | 16 | 33 |
| 2022 Dezembro | 46 | 29 | 75 |
| 2022 Novembro | 33 | 26 | 59 |
| 2022 Outubro | 42 | 24 | 66 |
| 2022 Setembro | 21 | 42 | 63 |
| 2022 Agosto | 31 | 39 | 70 |
| 2022 Julho | 22 | 42 | 64 |
| 2022 Junho | 22 | 31 | 53 |
| 2022 Maio | 19 | 29 | 48 |
| 2022 Abril | 35 | 29 | 64 |
| 2022 Maro | 26 | 52 | 78 |
| 2022 Fevereiro | 22 | 40 | 62 |
| 2022 Janeiro | 21 | 28 | 49 |
| 2021 Dezembro | 22 | 32 | 54 |
| 2021 Novembro | 25 | 45 | 70 |
| 2021 Outubro | 29 | 52 | 81 |
| 2021 Setembro | 19 | 26 | 45 |
| 2021 Agosto | 21 | 31 | 52 |
| 2021 Julho | 12 | 26 | 38 |
| 2021 Junho | 13 | 21 | 34 |
| 2021 Maio | 25 | 30 | 55 |
| 2021 Abril | 31 | 34 | 65 |
| 2021 Maro | 56 | 20 | 76 |
| 2021 Fevereiro | 30 | 14 | 44 |
| 2021 Janeiro | 34 | 8 | 42 |
| 2020 Dezembro | 26 | 11 | 37 |
| 2020 Novembro | 18 | 22 | 40 |
| 2020 Outubro | 19 | 17 | 36 |
| 2020 Setembro | 28 | 10 | 38 |
| 2020 Agosto | 35 | 10 | 45 |
| 2020 Julho | 13 | 10 | 23 |
| 2020 Junho | 27 | 12 | 39 |
| 2020 Maio | 35 | 9 | 44 |
| 2020 Abril | 38 | 15 | 53 |
| 2020 Maro | 49 | 19 | 68 |
| 2020 Fevereiro | 95 | 21 | 116 |
| 2020 Janeiro | 58 | 9 | 67 |
| 2019 Dezembro | 27 | 10 | 37 |
| 2019 Novembro | 12 | 5 | 17 |
| 2019 Outubro | 28 | 7 | 35 |
| 2019 Setembro | 45 | 11 | 56 |
| 2019 Agosto | 31 | 10 | 41 |
| 2019 Julho | 16 | 14 | 30 |
| 2019 Junho | 22 | 24 | 46 |
| 2019 Maio | 28 | 15 | 43 |
| 2019 Abril | 37 | 37 | 74 |
| 2019 Maro | 46 | 31 | 77 |
| 2019 Fevereiro | 45 | 35 | 80 |
| 2019 Janeiro | 8 | 8 | 16 |
Mostrar tudo
