Atrial fibrillation in real clinical practice at the outpatient stage

The aim of the study was to analyze clinical and anamnestic data, the nature of anticoagulant therapy and the incidence of adverse events based on the data of the registry of atrial fibrillation (AF) patients at the outpatient stage (20192020).
Methods. The study involved 638 people (56.7% of them women) included in the registry of patients with AF, 68.2±4.5 of age. Inclusion criteria: patients over the age of 18 who applied for a consultation with a cardiologist at a cardiodispensary polyclinic and signed an informed consent.
Results. The analysis of clinical and anamnestic data of patients with tachyarrhythmia was carried out. Paroxysmal AF was registered in 311 (48.8%) patients, persistent in 138 (21.6%), long-term persistent in 44 (6.9%) and permanent in 142 (22.7%) patients. The average score on the CHA2DS2-VASc was 4.8±1.8 points, on the HAS-BLED score 2.8±1.6 points, on the 2MACE score 1.3±0.8 points. Compliance to treatment corresponded to 2.5±1.5 points. When analyzing the registry of AF patients, the characteristics of anticoagulant therapy are presented. In fact, 172 (27%) patients took rivaroxaban, 166 (25%) apixaban, 84 (13%) dabigatran and 210 (33%) patients took warfarin. Among those examined, the main cause of death in 30 (4.7%) patients was coronary artery disease, of which two had myocardial infarction.
Conclusion. Based on clinical and anamnestic data, a ‘portrait’ of a patient with AF at the outpatient stage is presented, which is characterized by a predominance of the risk of thrombotic complications over the risk of hemorrhagic and coronary events, with low adherence to treatment and implementation of doctor’s recommendations. When analyzing the register of patients with AF, the characteristics of anticoagulant therapy and the causes of adverse outcomes are presented.

1. Stewart S, Hart CL, Hole DJ, et al. Population prevalence, incidence, and predictors of atrial fibrillation in the Renfrew. Paisley study. Heart. 2001;86: 516-521. https:// doi.org/10.1136/heart.86.5.516.

2. Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001;285: 2370-2375. https://doi.org/10.1001/jama.285.18.2370.

3. Khidirova LD, Yakhontov DA, Zenin SA Atrial fibrillation in comorbid patients depending on the treatment regiment. Complex Issues of Cardiovascular Diseases. 2019;8(2): 21-29. (In Russ.). https://doi.org/10.17802/2306-1278-2019-8-2-21-29.

4. Naccarelli GV, Varker H, Lin J, et al. Increasing prevalence of atrial fibrillation and flutter in the United States. Am J Cardiol. 2009;104: 1534-1539. https://doi.org/10.1016/j.amjcard.2009.07.022.

5. Miyasaka Y, Barnes ME, Gersh BJ Secular trends in incidence of atrial fibrillation in Olmsted Country, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation. 2006;114: 119-125. https://doi.org/10.1161/CIRCULATIONAHA.105.595140.

6. Camm AJ, Breithardt G, Crijns H Real-life observations of clinical outcomes with rhythmand rate-control therapies for atrial fibrillation RECORDAF (Registry on Cardiac Rhythm Disorders Assessing the Control of Atrial Fibrillation). J Am Coll Cardiol. 2011;58(5): 493-501. https://doi.org/10.1016/j.jacc.2011.03.034.

7. Alam M, Bandeali SJ, Shahzad SA Real-life global survey evaluating patients with atrial fibrillation (REALISE-AF): results of an international observational registry. Expert Rev Cardiovasc Ther. 2012;10(3): 283-291. https://doi.org/10.1586/erc.12.8.

8. Nieuwlaat R, Capucci A, Camm AJ Atrial fibrillation management: a prospective survey in ESC member countries: the Euro Heart Survey on Atrial Fibrillation. Eur Heart J. 2005;26(22): 2422-2234. https://doi.org/10.1093/eurheartj/ehi505.

9. Reshetko OV, Sokolov AV, Furman NV Analysis of antithrombotic therapy of atrial fibrillation in international and Russian registries. Quality clinical practice. 2019;1: 83-96. (In Russ.). https://doi.org/10.24411/2588-0519-2019-10066.

10. Lukianov MM, Boycov SA, Yakushin SS, et al. Diagnosis, treatment, combined cardiovascular pathology and concomitant diseases of patients with a diagnosis of atrial fibrillation in conditions of real outpatient practice (according to the register of cardiovascular diseases REQUAZA). Rational Pharmacotherapy in cardiology. 2014;10(4): 366-377. (In Russ.). https://doi.org/10.20996/1819-6446-2014-10-4-366-377.

11. Stepina EV, Lukanova MM, Bichurina MA, et al. Therapy with oral anticoagulants in patients with atrial fibrillation in combination with arterial hypertension, ischemic heart disease, chronic heart failure at the hospital and ambulator stages of treatment according to the REQUAZA-CLINIC register. Rational Pharmacotherapy in Cardiology. 2017;13(2): 146-154. (In Russ.). https://doi.org/10.20996/1819-6446-2017-13-2-146-154.

12. Marcevich SU, Navasardan AR, Kutishenko NP, et al. Experience in studying atrial fibrillation based on the PROFILE register. Cardiovascular therapy and prevention. 2014;13(2): 35-39. (In Russ.). https://doi.org/10.15829/1728-8800-2014-2-35-39.

13. Linchak RM, Ovchinokova UV, Kuzovlev AN Prevalence and analysis of antithrombotic therapy in atrial fibrillation in Russia. Bulletin of SurSU. The medicine. 2019;4(42): 14-15. (In Russ.). https://doi.org/10.34822/2304-9448-2019-4-14-20.

14. Gorbunova EV, Duvanova SP, Filimonov KM, et al. Effektivnost’ modulya prinyatiya reshenij v personalizirovannom vybore antikoagulyanta. Kardiologiya. 2021;61(3): 18-22. (In Russ.). https://doi.org/10.18087/cardio.2021.3.n1511.

15. Yakusevich VV, Pozdnakova EM, Yakusevich VV, et al. Outpatient with atrial fibrillation: key characteristics. The first data of the REKVAZA FP register Yaroslavl. Rational Pharmacotherapy in Cardiology. 2015;11(2): 149-152. (In Russ.). https://doi.org/10.20996/1819-6446-2015-11-2-149-152.

16. Boycov SA, Lukanov MM, Yakushin SS, et al. Registry of Cardiovascular Diseases (RECVAZA): diagnostics, combined cardiovascular pathology, concomitant diseases and treatment in real outpatient practice. Cardiovascular therapy and prevention. 2014;13(6): 44-49. (In Russ.). https://doi.org/10.15829/1728-8800-2014-6-3-8.

17. Rychkov AYu, Khorkova NYu, Minulina AV How has the use of anticoagulants changed in patients with non-valvular atrial fibrillation. Journal of Arrhythmology. 2017;87: 5-6. (In Russ.).

18. Ionin VA, Barashkova EI, Filatova AG, et al. Atrial fibrillation in a cohort of outpatients in St. Petersburg: incidence, risk factors, antiarrhythmic therapy and prevention of thromboembolic complications. Arterial hypertension. 2020;26(2): 192-201. (In Russ.). https://doi.org/10.18705/1607-419X-2020-26-2-192-201.

19. Yavelov IS. Rivaroxaban in prevention of stroke in elderly patients with non-valvular atrial fibrillation. Kardiologiia. 2019;59(12S): 4-11. (In Russ.). https://doi.org/10.18087/cardio.n892.

20. Turov AN, Panfilov SV, Tschiglinzeva ОV The Efficacy, Safety and Adherence to Treatment when New Anticoagulants Taking in Over 75 Years Old Patients with Atrial Fibrillation. Rational Pharmacotherapy in Cardiology. 2020;16(1): 10-18. (In Russ.). https://doi.org/10.20996/1819-6446-2020-20-07.

21. Shubik YuV, Medvedev MM, Mikhaylov EN, et al. Management of atrial fibrillation in Russia: real clinical practice and current clinical guidelines. Journal of Arrhythmology. 2021;28(2): 55-63. (In Russ.). https://doi.org/10.35336/VA-2021-2-55-63.

22. Melechov AV, Gendlin GE, Dadashova EF, et al. Dynamics of the use of antithrombotic drugs in patients with atrial fibrillation: own data and a review of domestic registries. Russian medical journal. 2017;23(3): 116-126. (In Russ.). https://doi.org/10.18821/0869-2106-2017-23-3-116-126.

23. Polshakova IL, Povetkin SV The structure of drug therapy and clinical characteristics of patients with atrial fibrillation according to the RECUR-AF study. Rational Pharmacotherapy in Cardiology. 2018;14(5): 733-740. (In Russ.). https://doi.org/10.20996/1819-6446-2018-14-5-733-740.