Preview

Rational Pharmacotherapy in Cardiology

Advanced search

Patients with a Combination of Atrial Fibrillation and Chronic Heart Failure in Clinical Practice: Comorbidities, Drug Treatment and Outcomes

https://doi.org/10.20996/1819-6446-2021-12-05

Full Text:

Abstract

Aim. To assess in clinical practice the structure of multimorbidity, cardiovascular pharmacotherapy and outcomes in patients with a combination of atrial fibrillation (AF) and chronic heart failure (CHF) based on prospective registries of patients with cardiovascular diseases (CVD).

Materials and Methods. The data of 3795 patients with atrial fibrillation (AF) were analyzed within the registries RECVASA (Ryazan), RECVASA FP (Moscow, Kursk, Tula, Yaroslavl), REGION-PO and REGION-LD (Ryazan), REGION-Moscow, REGATA (Ryazan). The comparison groups consisted of 3016 (79.5%) patients with AF in combination with CHF and 779 (29.5%) patients with AF without CHF. The duration of prospective observation is from 2 to 6 years.

Results. Patients with a combination of AF and CHF (n=3016, age was 72.0±10.3 years; 41.8% of men) compared with patients with AF without CHF (n=779, age was 70.3±12.0 years; 43.5% of men) had a higher risk of thromboembolic complications (CHA2DS2-VASc – 4.68±1.59 and 3.10±1.50; p<0.001) and hemorrhagic complications (HAS-BLED – 1.59±0.77 and 1.33±0.76; p<0.05). Patients with a combination of AF and CHF significantly more often (p<0.001) than in the absence of CHF were diagnosed with arterial hypertension (93.9% and 83.8%), coronary heart disease (87.9% and 53,5%), myocardial infarction (28.4% and 14.0%), diabetes mellitus (22.4% and 7.7%), chronic kidney disease (24.8% and 16.2%), as well as respiratory diseases (20.1% and 15.3%; p=0.002). Patients with AF in the presence of CHF, compared with patients without CHF, were more often diagnosed with a permanent form of arrhythmia (49.3% and 32.9%; p<0.001) and less often paroxysmal (22.5% and 46.2%; p<0.001) form  of  arrhythmia.  Ejection  fraction  ≤40%  (9.3%  and  1.2%;  p<0.001),  heart  rate  ≥90/min  (23.7% and 19.3%; p=0.008) and blood pressure ≥140/90 mm Hg (59.9% and 52.2%; p<0.001) were recorded with AF in the presence of CHF more often than in the absence of CHF. The frequency of proper cardiovascular pharmacotherapy was higher, albeit insufficient, in the presence of CHF (64.9%) than in the absence of it (56.1%), but anticoagulants were prescribed less frequently when AF and CHF were combined (38.8% and  49, 0%; p<0.001). The frequency of unreasonable prescription of antiplatelet agents instead of anticoagulants was 52.5% and 33.3% (p<0.001) in the combination of AF, CHF and coronary heart disease, as well as in the combination of AF with coronary heart disease but without CHF. Patients with AF and CHF during the observation period compared with those without CHF had higher mortality from all causes (37.6% and 30.3%; p=0.001), the frequency of non-fatal cerebral stroke (8.2% and 5.4%; p=0.032) and myocardial infarction (4.7% and 2.5%; p=0.036), hospitalizations for CVD (22.8% and 15.5%; p<0.001).

Conclusion. Patients with a combination of AF and CHF, compared with the group of patients with AF without CHF, were older, had a higher risk of thromboembolic and hemorrhagic complications, they were more often diagnosed with other concomitant cardiovascular and chronic noncardiac diseases, decreased left ventricular ejection fraction, tachysystole, failure to achieve the target blood pressure level in the presence of arterial hypertension. The frequency of prescribing proper cardiovascular pharmacotherapy was higher, albeit insufficient, in the presence of CHF, while the frequency of prescribing anticoagulants was less. The  incidence of mortality from all causes, the development of non-fatal myocardial infarction   and cerebral stroke, as well as the incidence of hospitalizations for CVDs were higher in AF associated with CHF.

About the Authors

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

Michail M. Loukianov.

Moscow.



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

Sergey Yu. Martsevich.

Moscow.



Yu. V. Mareev
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Yuri V. Mareev.

Moscow.



S. S. Yakushin
Ryazan State Medical University named after Academician I.P. Pavlov
Russian Federation

Sergey S. Yakushin.

Ryazan.



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

Elena Yu. Andreenko.

Moscow.



A. N. Vorobiev
Ryazan State Medical University named after Academician I.P. Pavlov
Russian Federation

Alexander N. Vorobyev.

Ryazan



K. G. Pereverzeva
Ryazan State Medical University named after Academician I.P. Pavlov
Russian Federation

Kristina G. Pereverzeva.

Ryazan.



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

Alexander V. Zagrebelnyy.

Moscow.



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

Elena Yu. Okshina.

Moscow.



V. V. Yakusevich
Yaroslavl State Medical University
Russian Federation

Vladimir V. Yakusevich.

Yaroslavl.



Vl. Vl. Yakusevich
Yaroslavl State Medical University
Russian Federation

Vladimir Vl. Yakusevich.

Yaroslavl.



E. M. Pozdnyakova
Yaroslavl State Medical University
Russian Federation

Ekaterina M. Pozdnyakova.

Yaroslavl.



T. A. Gomova
Tula Regional Clinical Hospital
Russian Federation

Tatiana A. Gomova.

Tula.



E. E. Fedotova
Tula Regional Clinical Hospital
Russian Federation

Elena E. Fedotova.

Tula.



M. N. Valiakhmetov
Tula City hospital №3
Russian Federation

Marat N. Valiakhmetov.

Tula.



V. P. Mikhin
Kursk State Medical University
Russian Federation

Vadim P. Mikhin.

Kursk.



Yu. V. Maslennikova
Kursk State Medical University
Russian Federation

Yulia V. Maslennikova.

Kursk.



E. N. Belova
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Ekaterina N. Belova.

Moscow.



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

Vladislav G. Klyashtorny.

Moscow.



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

Egor V. Kudryashov.

Moscow.



A. N. Makoveeva
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Anna N. Makoveeva.

Moscow.



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

Julia E. Tatsii.

Moscow.



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

Sergey A. Boytsov.

Moscow.



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

Oksana M. Drapkina.

Moscow.



References

1. Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2021;42(5):373-498. DOI:10.1093/eurheartj/ehaa612.

2. Colilla S, Crow A, Petkun W, Singer DE, Simon T, Liu X. Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S. adult population. Am J Cardiol. 2013;112(8):1142-7. DOI:10.1016/j.amjcard.2013.05.063.

3. Heeringa J, Van Der Kuip DAM, Hofman A, et al. Prevalence, incidence and lifetime risk of atrial fibrillation: The Rotterdam study. Eur Heart J. 2006;27(8):949-53. DOI:10.1093/eurheartj/ehi825.

4. 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. J Am Med Assoc. 2001;285(18):2370-5. DOI:10.1001/jama.285.18.2370.

5. Allan V, Honarbakhsh S, Casas JP, et al. Are cardiovascular risk factors also associated with the incidence of atrial fibrillation?: A systematic review and field synopsis of 23 factors in 32 population-based cohorts of 20 million participants. Thromb Haemost. 2017;117(5):837-50. DOI:10.1160/TH16-11-0825.

6. Anter E, Jessup M, Callans DJ. Atrial fibrillation and heart failure: Treatment considerations for a dual epidemic. Circulation. 2009;119(18):2516-25. DOI:10.1161/CIRCULATIONAHA.108.821306.

7. Mareev Y, Cleland JGF. Should β-Blockers Be Used in Patients with Heart Failure and Atrial Fibrillation? Clin Ther. 2015;37(10):2215-24. DOI:10.1016/j.clinthera.2015.08.017.

8. Polyakov DS, Fomin I V, Belenkov YN, et al. Chronic heart failure in the Russian Federation: what has changed over 20 years of follow-up? Results of the EPOCH-CHF study. Kardiologiia. 2021;61(4):4-14. DOI:10.18087/cardio.2021.4.n1628.

9. Oshchepkova EV, Lazareva NV, Satlykova DF, Tereshchenko SN. [The First Results of the Russian Register of Chronic Heart Failure. Kardiologiia. 2015;55(5):22-8.

10. Polyakov DS, Fomin IV, Valikulova FY, et al. The EPOCH-CHF epidemiological program: decompensated chronic heart failure in real-life clinical practice (EPOCH-D-CHF). Russ Hear Fail J. 2016;17(6):299-305. DOI:10.18087/RHFJ.2016.5.2239.

11. Lukina YV, Kutishenko NP, Tolpygina SN, et al. Main factors of adherence to new oral anticoagulants and its dynamics in outpatients with nonvalvular atrial fibrillation: Results of the antey study. Cardiovasc Ther Prev. 2020;19(5):2680. DOI:10.15829/1728-8800-2020-2680.

12. Boriani G, Proietti M, Laroche C, et al. Contemporary stroke prevention strategies in 11 096 European patients with atrial fibrillation: a report from the EURObservational Research Programme on Atrial Fibrillation (EORP-AF) Long-Term General Registry. Europace. 2018;20(5):747-57. DOI:10.1093/EUROPACE/EUX301.

13. Belenkov Y, Arutunov G, Barbarash O, et al. Value of comparative studies of “real clinical practice” in modern cardiology. Position paper based on the expert council discussion dated 12/18/2020. Kardiologiia. 2021;61(5):79-81. DOI:10.18087/CARDIO.2021.5.N1646.

14. Cohen AT, Goto S, Schreiber K, Torp-Pedersen C. Why do we need observational studies of everyday patients in the real-life setting? Eur Hear J Suppl. 2015;17(suppl_D):D2-D8. DOI:10.1093/EUR-HEARTJ/SUV035.

15. Martsevich SY, Kutishenko NP, Lukina Y V, et al. Observational studies and registers. Their quality and role in modern evidence-based medicine. Cardiovasc Ther Prev. 2021;20(2):61-6. DOI:10.15829/1728-8800-2021-2786.

16. Loukianov MM, Boytsov SA, Yakushin SS, et al. Diagnostics, treatment, associated cardiovascular and concomitant non-cardiac diseases in patients with diagnosis of" atrial fibrillation" in real outpatient practice (according to data of registry of cardiovascular diseases, RECVASA). Rational Pharmacotherapy in Cardiology. 2014;10(4):366-77. DOI:10.20996/1819-6446-2014-10-4-366-377.

17. Loukianov MM, Martsevich SY, Drapkina OM, et al. The therapy with oral anticoagulants in patients with atrial fibrillation in outpatient and hospital settings (data from RECVASA registries). Ration Pharmacother Cardiol. 2019;15(4):538-45. DOI:10.20996/1819-6446-2019-15-4-538-545.

18. Martsevich SY, Kutishenko NP, Lukyanov MM, et al. Hospital register of patients with acute cerebrovascular accident (REGION): Characteristics of patient and outcomes of hospital treatment. Cardiovasc Ther Prev. 2018;17(6):32-8. DOI:10.15829/1728-8800-2018-6-32-38.

19. Pereverzeva KG, Yakushin SS, Gracheva AI, et al. Post-myocardial infarction patients: A comparison of management by a physician and a cardiologist according to the REGATA register. Cardiovasc Ther Prev. 2020;19(3):2525. DOI:10.15829/1728-8800-2020-2525.

20. Loukianov MM, Yakushin SS, Martsevich SY, et al. Cardiovascular diseases and drug treatment in patients with the history of cerebral stroke: Data of the outpatient registry region. Rational Pharmacotherapy in Cardiology. 2018;14(6):879-86. DOI:10.20996/1819-6446-2018-14-6-870-878.

21. Valiakhmetov MN, Gomova TA, Loukianov MM, et al. Patients with atrial fibrillation in multidisciplinary hospital: Structure of hospitalization, concomitant cardiovascular diseases and drug treatment (data of RECVASA AF-Tula registry). Rational Pharmacotherapy in Cardiology. 2017;13(4):495-505. DOI:10.20996/1819-6446-2017-13-4-495-505.

22. Mikhin VP, Maslennikova YV, Lukyanov MM, et al. Drug therapy in patients with coronary heart disease in combination with atrial fibrillation in real medical practice (results of RECVASA AF-Kursk registry). Kursk Scientific and Practical Bulletin "Man and His Health". 2017;(2):49-54. DOI:10.21626/vestnik/2017-2/09.

23. Yakusevich VV, Pozdnyakova EM, Yakusevich VV, et al. An outpatient with atrial fibrillation: key features. The first data of REKVAZA FP-YAROSLAVL register. Rational Pharmacotherapy in Cardiology. 2015;11(2):149-52. DOI:10.20996/1819-6446-2015-11-2-149-152.

24. Lip GYH, Laroche C, Popescu MI, et al. Heart failure in patients with atrial fibrillation in Europe: A report from the EURObservational Research Programme Pilot survey on Atrial Fibrillation. Eur J Heart Fail. 2015;17(6):570-82. DOI:10.1002/ejhf.254.

25. Santhanakrishnan R, Wang N, Larson MG, et al. Atrial fibrillation begets heart failure and vice versa: Temporal associations and differences in preserved versus reduced ejection fraction. Circulation. 2016;133(5):484-92. DOI:10.1161/CIRCULATIONAHA.115.018614.

26. Mareev Y V, Garganeeva AA, Tukish OV, et al. Difficulties in diagnosis of heart failure with preserved ejection fraction in clinical practice: dissonance between echocardiography, NTproBNP and H2HFPEF score. Kardiologiia. 2019;59(12S):37-45. DOI:10.18087/cardio.n695.

27. Polyakov DS, Fomin IV, Belenkov YuN, et al. Chronic heart failure in the Russian Federation: what has changed over 20 years of follow-up? Results of the EPOCH-CHF study. Kardiologiia. 2021;61(4):4-14. DOI:10.18087/cardio.2021.4.n1628.

28. Chiang CE, Naditch-Brûlé L, Murin J, et al. Distribution and risk profile of paroxysmal, persistent, and permanent atrial fibrillation in routine clinical practice: insight from the real-life global survey evaluating patients with atrial fibrillation international registry. Circ Arrhythm Electrophysiol. 2012;5(4):632-9. DOI:10.1161/CIRCEP.112.970749.

29. Tereshchenko SN, Galyavich AS, Uskach TM, et al. 2020 Clinical practice guidelines for Chronic heart failure. Russ J Cardiol. 2020;25(11):4083. DOI:DOI:10.15829/1560-4071-2020-4083.

30. McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599-3726. DOI:10.1093/eurheartj/ehab368.

31. Tereshchenko SN, Zhirov IV, Romanova NV, et al The first Russian register of patients with chronic heart failure and atrial fibrillation (RIF-CHF): Study design. Rational Pharmacotherapy in Cardiology. 2015;11(6):577-81. DOI:10.20996/1819-6446-2015-11-6-577-581)

32. Cottin Y, Maalem Ben Messaoud B, Monin A, et al. Temporal relationship between atrial fibrillation and heart failure development analysis from a nationwide database. J Clin Med. 2021;10(21):5101. DOI:10.3390/jcm10215101.


Review

For citation:


Loukianov M.M., Martsevich S.Yu., Mareev Yu.V., Yakushin S.S., Andreenko E.Yu., Vorobiev A.N., Pereverzeva K.G., Zagrebelny 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., Belova E.N., Klyashtorny V.G., Kudryashov E.V., Makoveeva A.N., Tatsiy Yu.E., Boytsov S.A., Drapkina O.M. Patients with a Combination of Atrial Fibrillation and Chronic Heart Failure in Clinical Practice: Comorbidities, Drug Treatment and Outcomes. Rational Pharmacotherapy in Cardiology. 2021;17(6):816-824. https://doi.org/10.20996/1819-6446-2021-12-05

Views: 97


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)