Atrial fibrillation in St Petersburg cohort: frequency, risk factors, antiarrhythmic therapy and thromboembolism prevention

Objective. The purpose of this study was to assess the prevalence and risk factors for atrial fibrillation (AF), to analyze the rates of administration of antiarrhythmic and anticoagulant therapy.

Design and methods. We performed a retrospective study by analyzing primary medical records of patients referred to cardiologists in a multidisciplinary outpatient clinic.

Results. Based on analysis of 24,215 outpatient records of patients referred to cardiologists of a multidisciplinary outpatient clinic, we found that 1822/24215 (7,5 %) patients had AF, the non-valve form of AF prevailed — 1783/1822 (97,7 %). AF was more common in patients over 60 years of age and in women (58,8 % vs 41,2 % in women and men, respectively, p = 0,001). Important risk factors for AF were advanced age, hypertension (HTN), coronary heart disease (CHD), and diabetes mellitus (DM). HTN, CHD, congestive heart failure (CHF) and DM were more common in patients older than 60 years. Among the methods of rhythm control and restoration, antiarrhythmic therapy 1179/1822 (64,7 %) prevailed, radiofrequency catheter ablation was performed in 93/1822 (5,1 %) patients. According to the CHA₂DS₂VAS_c scale, the risk of thromboembolic complications was the following: ≥ 2 scores (men) and ≥ 3 scores (women) were registered in 1494/1822 (83,8 %) patients, 1 score (men) and 2 scores (women) — in 205/1822 (11,3 %) patients, and HTN was the the only risk factor in 150/205 (73,2 %) subjects. Despite existing indications, anticoagulant therapy was not prescribed in 392/1525 (25,7 %) cases, and among patients with stroke or transient ischemic attack (TIA) — in 28/209 (13,4 %) cases. Non-vitamin K-antagonist oral anticoagulants (NOAC) prevailed and were administered in 1114/1275 (87,4 %) cases. Full-dose NOACs were prescribed in 643/1114 (57,7 %) cases, in a reduced dosage — in 471/1114 (42,3 %) cases. In the apixaban subgroup, the reduced dose was unreasonably prescribed in 164/380 (43,2 %) cases, in the rivaroxaban subgroup — in 196/586 (33,5 %) cases, in the dabigatran subgroup — in 21/148 (14,2 %) cases.

Conclusions. The prevalence of AF in outpatient cardiology practice is 7,5 %. Risk factors for AF are elderly age, HTN, CHD, CHF and DM. Only 5,1 % patients with AF underwent radiofrequency catheter ablation. Anticoagulant therapy was prescribed for the majority of AF patients, but was often not prescribed or recommended in low doses.

1. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37(38):2893-2962. doi:10.1093/eurheartj/ehw210

2. Staerk L, Sherer JA, Ko D, Benjamin E J, Helm RH. Atrial fibrillation epidemiology, pathophysiology, and clinical outcomes. Circ Res. 2017;120(9):1501-1517. doi:10.1161/CIRCRESAHA.117.309732

3. Jorgensen HS, Nakayama H, Reith J, Raaschou HO, Olsen TS. Acute stroke with atrial fibrillation. The Copenhagen Stroke Study. Stroke. 1996;27(10):1765-1769. doi:10.1161/01.str.27.10.1765

4. Lin HJ, Wolf PA, Kelly-Hayes M, Beiser AS, Kase CS, Benjamin EJ et al. Stroke severity in atrial fibrillation. The Framingham Study. Stroke. 1996;27(10):1760-1764. doi:10.1161/01.str.27.10.1760

5. Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ et al. Worldwide epidemiology of atrial fibrillation: A Global Burden of Disease 2010 Study. Circulation. 2014;129(8): 837-847. doi:10.1161/CIRCULATIONAHA.113.005119

6. Serdechnaya EV, Yuryeva SV, Tatarsky BA. Atrial fibrillation: epidemiology, specific features of the course of its different forms and survival of patients in the North-West of Russia. Kardiosomatika. 2012;3:45-51. In Russian.

7. Piccini IP, Hammill BG, Sinner MF, Jensen PN, Hernandez AF, Heckbert SR et al. Incidence and prevalence of atrial fibrillation and associated mortality among Medicare beneficiaries, 1993-2007. Circ Cardiovasc Qual Outcomes. 2012;5(1):85-93. doi:10.1161/CIRCOUTCOMES.111.962688

8. Schnabel RB, Yin X, Gona P, Larson MG, Beiser AS, McManus DD et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet. 2015;386(9989):154-162. doi:10.1016/S0140-6736(14)61774-8

9. Schnabel RB, Pecen L, Rzayeva N, Lucerna M, Purmah Y, Ojeda FM et al. Symptom burden of atrial fibrillation and its relation to interventions and outcome in Europe. J Am Heart Assoc. 2018;7(11): e007559. doi:10.1161/JAHA.117.007559

10. Huxley RR, Filion KB, Konety S, Alonso A. Meta-analysis of cohort and case-control studies of type 2 diabetes mellitus and risk of atrial fibrillation. Am J Cardiol. 2011;108(1):56-62. doi:10.1016/j.amjcard.2011.03.004

11. Michniewicz E, Mlodawska E, Lopatowska P, Tomaszuk-Kazberuk A, Malyszko J. Patients with atrial fibrillation and coronary artery disease — double trouble. Adv Med Sci. 2018; 63(1):30-35. doi:10.1016/j.advms.2017.06.005

12. Santhanakrishnan R, Wang N, Larson MG, Magnani JW, McManus DD, Lubitz SA et al. Atrial fibrillation begets heart failure and vice versa: temporal associations and differences in preserved versus reduced ejection fraction. Circulation. 2016;133(5):484-492. doi:10.1161/CIRCULATIONAHA.115.018614

13. Packer DL, Mark DB, Robb RA, Monahan KH, Bahn-son TD, Poole JE et al. Effect of catheter ablation vs antiarrhythmic drug therapy on mortality, stroke, bleeding, and cardiac arrest among patients with atrial fibrillation: the CABANA randomized clinical trial. J Am Med Assoc. 2019;321(13):1261-1274. doi:10.1001/jama.2019.0693

14. Mark DB, Anstrom KJ, Sheng S, Piccini JP, Baloch KN, Monahan KH et al. Effect of catheter ablation vs medical therapy on quality of life among patients with atrial fibrillation: the CABANA randomized clinical trial. J Am Med Assoc. 2019;321(13):1275-1285. doi:10.1001/jama.2019.0692

15. Marrouche NF, Brachmann J, Andresen D, Siebels J, Boersma L, Jordaens L et al. Catheter ablation for atrial fibrillation with heart failure. N Engl J Med. 2018;378(5):417-427. doi:10.1056/NEJMoa1707855

16. State registry of medications. [Electronic resource] URL: http://grls.rosminzdrav.ru. In Russian.