Atrial fibrillation in St Petersburg cohort: frequency, risk factors, antiarrhythmic therapy and thromboembolism prevention
В. А. Ионин, E. I. Barashkova, А. G. Filatova, Е. И. Баранова, Е. V. Shlyakhto
Abstract
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 CHA 2 DS 2 VAS 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.