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Patients with Atrial Fibrillation in Clinical Practice: Comorbidity, Drug Treatment and Outcomes (Data from RECVASA Registries)

https://doi.org/10.20996/1819-6446-2020-12-01

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Abstract

Aim. To study comorbidity, drug therapy and outcomes in patients with atrial fibrillation (AF) included in the outpatient and hospital RECVASA registries.
Material and methods. Patients with AF (n=3169; age 70.9±10.7 years; 43.1% of men) in whom comorbidity, drug therapy, short-term and longterm outcomes (follow-up period from 2 to 6 years) were included in hospital registers RECVASA AF (Moscow, Kursk, Tula), as well as outpatient registers RECVASA (Ryazan) and RECVASA AF-Yaroslavl.
Results. Outpatient registries (n=934), as compared to hospital registries (n=2235), had a higher average age of patients (73.4±10.9 vs 69.9±10.5; p<0.05), the proportion of women ( 66.2% vs 53.0%; p<0.0001) and patients with combination of 3-4 cardiovascular diseases (CVD), including AF (98.0% vs 81.7%, p<0.0001), and also with chronic noncardiac diseases (81.5% vs 63.5%, p<0.0001), the risk of thromboembolic complications (CHA2DS2-VASc 4.65±1.58 vs 4.15±1.71; p<0.05) and hemorrhagic complications (HAS-BLED 1.69±0.75 vs 1.41±0.77; p<0.05), as well as a lower frequency of prescribing appropriate pharmacotherapy for CVD (55.6% vs 74.6%, p<0.0001). During the observation period, 633 (20.0%) patients died, and in 61.8% of cases - from cardiovascular causes. The mortality rate in one year in Moscow was 3.7%, in Yaroslavl - 9.7%, in Ryazan - 10.7%, in Kursk - 12.5% (on average for four registers - 10.3%). A higher risk of death (1.5-2.7 times) was significantly associated with age, male sex, persistent AF, history of myocardial infarction (MI) and acute cerebrovascular accident (ACVE), diabetes mellitus, chronic obstructive disease lungs (COPD), heart rate>80 bpm, systolic blood pressure <110 mm Hg, decreased hemoglobin level. A lower risk of death (1.2-2.4 times) was associated with the prescription of anticoagulants, angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs), betablockers, statins. The number of cases of stroke and MI was, respectively, 5.1 and 9.4 times less than the number of deaths from all causes. The higher risk of stroke in patients with AF during follow-up was significantly associated with female sex (risk ratio [RR]=1.61), permanent AF (RR=1.85), history of MI (RR=1.68) and ACVA (RR=2.69), HR>80 bpm (RR=1.50). Anticoagulant prescription in women was associated with a lower risk of ACVA (if adjusted for age: RR=0.54; p=0.04), in contrast to men (RR=1.11; p=0.79).
Conclusion. The majority of patients with AF registries in 5 regions of Russia had a combination of three or more cardiovascular diseases (73.9%), as well as chronic non-cardiac diseases (68.8%). The frequency of proper cardiovascular pharmacotherapy was insufficient (68.6%), especially at the outpatient stage (55.6%). Over the observation period (2-6 years), the average mortality per year was 10.3%, but at the same time it differed significantly in the regions (from 3.7% in Moscow to 9.7-12.5% in Yaroslavl, Ryazan and Kursk). Cardiovascular causes of deaths occurred in 62%. A higher risk of death (1.5-2.7 times) was associated with a history of stroke and MI, diabetes mellitus, COPD, heart rate>80 bpm, systolic blood pressure <110 mm Hg, decreased hemoglobin level. However, the risk of death decreased by 1.2-2.4 times in cases of prescription of anticoagulants, ACE inhibitors / ARBs, beta-blockers and statins. The risk of ACVA and MI was the highest in the presence of the history of this event (2.7 and 2.6 times, respectively). Anticoagulant prescription was significantly associated with a reduced risk of stroke in women.

About the Authors

M. M. Loukianov
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Michail M. Loukianov - MD, PhD, Head of Department of Clinical Cardiology, National Medical Research Center for Therapy and Preventive Medicine.
Petroverigsky per. 10, Moscow, 101990.



E. Yu. Andreenko
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Elena Yu. Andreenko - MD, PhD, Senior Researcher, Department of Clinical Cardiology, National Medical Research Center for Therapy and Preventive Medicine.
Petroverigsky per. 10, Moscow, 101990.



S. Yu. Martsevich
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Sergey Yu. Martsevich - MD, PhD, Professor, Head of Department of Preventive Pharmacotherapy, National Medical Research Center for Therapy and Preventive Medicine.
Petroverigsky per. 10, Moscow, 101990.



S. S. Yakushin
Ryazan State Medical University n.a. Academician I.P. Pavlov
Russian Federation

Sergey S. Yakushin - MD, PhD, Professor, Head of Chair of Hospital Therapy, Ryazan State Medical University n.a. Academician I.P. Pavlov.
Vysokovoltnaya ul. 9, Ryazan, 390026.



A. N. Vorobyev
Ryazan State Medical University n.a. Academician I.P. Pavlov
Russian Federation

Alexander N. Vorobyev - MD, PhD, Associate Professor, Chair of Polyclinic Therapy and Preventive Medicine, Ryazan State Medical University n.a. Academician I.P. Pavlov.
Vysokovoltnaya ul. 9, Ryazan, 390026.



K. G. Pereverzeva
Ryazan State Medical University n.a. Academician I.P. Pavlov
Russian Federation

Kristina G. Pereverzeva - MD, PhD, Assistant, Chair of Hospital Therapy, Ryazan State Medical University n.a. Academician I.P. Pavlov.
Vysokovoltnaya ul. 9, Ryazan, 390026.



A. V. Zagrebelnyy
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Alexander V. Zagrebelnyy - MD, PhD, Senior Researcher, Department of Preventive Pharmacotherapy, National Medical Research Center for Therapy and Preventive Medicine.
Petroverigsky per. 10, Moscow, 101990.



E. Yu. Okshina
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Elena Yu. Okshina - MD, PhD, Senior Researcher, Department of Clinical Cardiology, National Medical Research Center for Therapy and Preventive Medicine.
Petroverigsky per. 10, Moscow, 101990.



V. V. Yakusevich
Yaroslavl State Medical University
Russian Federation

Vladimir Val. Yakusevich - MD, PhD, Professor, Chair of Clinical Pharmacology, Yaroslavl State Medical University.
Revolutsionnaya ul. 5, Yaroslavl, 150000.



V. Vl. Yakusevich
Yaroslavl State Medical University
Russian Federation

Vladimir Vl. Yakusevich - MD, Researcher, Chair of Clinical Pharmacology, Yaroslavl State Medical University.
Revolutsionnaya ul. 5, Yaroslavl, 150000.



E. M. Pozdnyakova
Yaroslavl State Medical University
Russian Federation

Ekaterina M. Pozdnyakova - MD, Researcher, Department of Clinical Pharmacology, Yaroslavl State Medical University.
Revolutsionnaya ul. 5, Yaroslavl, 150000.



T. A. Gomova
Tula Regional Clinical Hospital
Russian Federation

Tatiana A. Gomova - MD, PhD, Deputy Chief Physician for General Issues, Tula Regional Clinical Hospital.
Yablochkova ul. 1а, Tula, 300053.



E. E. Fedotova
Tula Regional Clinical Hospital
Russian Federation

Elena E. Fedotova - MD, Cardiologist, Clinical and Diagnostic Center, Tula Regional Clinical Hospital.
Yablochkova ul. 1а, Tula, 300053.



M. N. Valiakhmetov
City Hospital №3
Russian Federation

Marat N. Valiakhmetov - MD, Deputy Chief Physician for Therapeutic Care, City Hospital №3.
Pushkina ul. 17, Tula, pos. Mendeleev, pos. 2-Zapadny, 300910.



V. P. Mikhin
Kursk State Medical University
Russian Federation

Vadim P. Mikhin - MD, PhD, Professor, Head of Chair of Internal Medicine №2, Kursk State Medical University.
Karla Marksa ul. 3, Kursk, 305041.



Yu. V. Maslennikova
Kursk State Medical University
Russian Federation

Yulia V. Maslennikova - MD, PhD, Assistant, Chair of Internal Medicine №2, Kursk State Medical University
Karla Marksa ul. 3, Kursk, 305041.



V. G. Klyashtorny
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Vladislav G. Klyashtorny - PhD (in Biology), Researcher, Laboratory of Biostatistics, National Medical Research Center for Therapy and Preventive Medicine.
Petroverigsky per. 10, Moscow, 101990.



E. V. Kudryashov
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Egor V. Kudryashov - Programmer, Laboratory of Biostatistics, National Medical Research Center for Therapy and Preventive Medicine.
Petroverigsky per. 10, Moscow, 101990.



Ju. E. Tatsii
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Julia E. Tatsii - Resident, National Medical Research Center for Therapy and Preventive Medicine.
Petroverigsky per. 10, Moscow, 101990.



S. A. Boytsov
National Medical Research Center of Cardiology
Russian Federation

Sergey A. Boytsov - MD, PhD, Professor, Academician of the Russian Academy of Sciences, General Director of National Medical Research Center of Cardiology.
Tretya Cherepkovskaya ul. 15a, Moscow, 121552.



O. M. Drapkina
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Oxana M. Drapkina - MD, PhD, Professor, Corresponding Member of the Russian Academy of Sciences, Director of National Medical Research Center for Therapy and Preventive Medicine.
Petroverigsky per. 10, Moscow, 101990.



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For citation:


Loukianov M.M., Andreenko E.Yu., Martsevich S.Yu., Yakushin S.S., Vorobyev A.N., Pereverzeva K.G., Zagrebelnyy A.V., Okshina E.Yu., Yakusevich V.V., Yakusevich V.V., Pozdnyakova E.M., Gomova T.A., Fedotova E.E., Valiakhmetov M.N., Mikhin V.P., Maslennikova Yu.V., Klyashtorny V.G., Kudryashov E.V., Tatsii J.E., Boytsov S.A., Drapkina O.M. Patients with Atrial Fibrillation in Clinical Practice: Comorbidity, Drug Treatment and Outcomes (Data from RECVASA Registries). Rational Pharmacotherapy in Cardiology. 2020;16(6):888-898. (In Russ.) https://doi.org/10.20996/1819-6446-2020-12-01

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ISSN 1819-6446 (Print)
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