Why Did All Patients with Atrial Fibrillation and High Risk of Stroke Not Receive Oral Anticoagulants? Results of the Polish Atrial Fibrillation (POL-AF) Registry
Abstract
:1. Introduction
2. Methods and Materials
2.1. Study Population
2.2. Covariates
2.3. Stroke Risk Assessment
2.4. Stroke Prevention Assessment
2.5. Statistical Analyses
3. Results
3.1. Baseline Characteristics
3.2. Antithrombotic Therapy Use
3.3. Predictors of the Individual Stroke Prevention Use
4. Discussion
5. Study Strengths and Limitations
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Clinical Characteristic | All n = 3614 | OAC n = 3306 | No OAC n = 308 | ||
---|---|---|---|---|---|
APT n = 135 | Heparin n = 96 | Without any Stroke Prophylaxis n = 77 | |||
Age mean (SD), years | 73.6 (10.3) | 73.5 (10.2) | 74.6 (10.3) | 72.6 (10.2) | 77.1 (12.1) |
<65 | 598 (16.5) | 555 (16.8) | 18 (13.3) | 15 (15.9) | 10 (13.3) |
65–74 | 1285 (35.6) | 1188 (35.9) | 46 (34.1) | 39 (40.6) | 24 (31.2) |
≥75 | 1731 (47.9) | 1563 (47.3) | 71 (52.6) | 42 (43.8) | 43 (55.8) |
Female | 1572 (43.5) | 1445 (43.7) | 60 (44.4) | 48 (50.0) | 32 (41.6) |
Type of atrial fibrillation | |||||
Paroxysmal | 1723 (47.7) | 1569 (47.5) | 80 (59.3) | 57 (59.4) | 35 (45.5) |
Persistent | 803 (22.2) | 760 (23.0) | 14 (10.4) | 15 (15.6) | 15 (19.5) |
Permanent | 1088 (30.1) | 977 (29.6) | 41 (30.4) | 24 (25.0) | 27 (35.1) |
Medical history | |||||
Hypertension | 3174 (87.4) | 2918 (88.3) | 112 (83.0) | 83 (86.5) | 63 (81.8) |
Heart failure | 2529 (70.0) | 2311 (69.9) | 92 (68.1) | 60 (62.5) | 50 (64.9) |
Vascular disease | 2207 (61.1) | 2005 (60.6) | 112 (83.0) | 64 (66.7) | 42 (54.5) |
Coronary artery disease | 1979 (54.8) | 1796 (54.3) | 107 (79.3) | 59 (61.5) | 36 (46.8) |
Previous myocardial infarction | 881 (24.4) | 782 (23.7) | 60 (44.4) | 25 (26.0) | 18 (23.4) |
Peripheral artery disease | 564 (15.6) | 500 (15.1) | 32 (23.7) | 21 (21.9) | 11 (14.3) |
Previous stroke/TIA/systemic embolism | 648 (17.9) | 599 (18.1) | 25 (18.5) | 28 (29.2) | 8 (10.4) |
Diabetes mellitus | 1341 (37.1) | 1218 (36.8) | 53 (39.3) | 35 (36.5) | 32 (41.6) |
Any previous bleeding | 118 (3.3) | 93 (2.8) | 14 (10.4) | 3 (3.1) | 4 (5.2) |
Intracranial bleeding | 29 (0.8) | 18 (0.5) | 4 (3.0) | 0 (0.0) | 2 (2.6) |
Gastrointestinal bleeding | 149 (4.1) | 138 (4.2) | 4 (3.0) | 2 (2.1) | 4 (5.2) |
Cancer | 186 (5.1) | 149 (4.5) | 13 (9.6) | 8 (8.3) | 5 (6.5) |
Hemoglobin < 12 g/dL | 872 (24.1) | 751 (22.7) | 45 (33.3) | 25 (26.0) | 30 (39.0) |
eGFR < 60 mL/min/1.73 m2 | 1731 (47.9) | 1555 (47.0) | 80 (59.3) | 40 (41.7) | 40 (51.9) |
eGFR < 30 mL/min/1.73 m2 | 255 (6.2) | 178 (5.4) | 24 (17.8) | 11 (11.5) | 12 (15.6) |
Thromboembolic risk | |||||
CHA2DS2VASc score mean (SD) | 4.7 (1.6) | 4.7 (1.6) | 4.9 (1.6) | 4.9 (1.6) | 4.5 (1.4) |
≥3 | 3331 (92.2) | 3047 (92.2) | 128 (94.8) | 90 (92.8) | 72 (93.5) |
≥5 | 1909 (52.8) | 1737 (52.5) | 80 (59.3) | 57 (59.4) | 39 (50.6) |
Bleeding risk | |||||
HAS-BLED score mean (SD) | 2.2 (0.8) | 2.2 (0.8) | 2.3 (0.9) | 2.21 (0.9) | 2.2 (0.8) |
≥3 | 1208 (33.4) | 1078 (32.6) | 58 (43.0) | 33 (34.4) | 27 (35.1) |
≥5 | 13 (0.4) | 11 (0.3) | 1 (0.7) | 0 (0.0) | 0 (0.0) |
Reason for hospitalization | |||||
Electrical cardioversion | 796 (22.0) | 784 (23.7) | 5 (3.7) | 21 (21.9) | 4 (5.2) |
Planned coronarography/PCI | 372 (10.3) | 338 (10.2) | 21 (15.6) | 7 (7.3) | 5 (6.5) |
CIED implantation/reimplantation | 346 (9.6) | 329 (10.0) | 5 (3.7) | 11 (11.5) | 5 (6.5) |
Acute coronary syndrome | 240 (6.6) | 197 (6.0) | 38 (28.1) | 7 (7.3) | 4 (5.2) |
Heart failure | 788 (21.8) | 714 (21.6) | 24 (17.8) | 16 (16.7) | 23 (29.9) |
Ablation other than AF | 189 (5.2) | 172 (5.2) | 8 (5.9) | 7 (7.3) | 7 (9.1) |
AF without any procedures | 191 (5.3) | 180 (5.4) | 4 (3.0) | 5 (5.2) | 3 (3.9) |
Factors | OAC Versus No OAC | ||
---|---|---|---|
OR | 95%CI | p | |
Hospitalization due to electrical cardioversion | 6.02 | 3.32–10.89 | <0.001 |
Hypertension | 1.40 | 1.01–1.95 | 0.049 |
Age ≥ 75 | 1.06 | 0.82–1.36 | 0.701 |
Myocardial infarction | 0.89 | 0.68–1.17 | 0.400 |
Peripheral artery disease | 0.88 | 0.64–1.21 | 0.411 |
Intracranial bleeding | 0.15 | 0.07–0.35 | <0.001 |
Gastrointestinal bleeding | 0.25 | 0.17–0.37 | <0.001 |
Cancer | 0.37 | 0.25–0.55 | <0.001 |
Hospitalization due to acute coronary syndrome | 0.48 | 0.33–0.69 | <0.001 |
Hemoglobin < 12 g/dL | 0.62 | 0.48–0.81 | <0.001 |
eGFR < 60 mL/min/1.73 m2 | 0.86 | 0.67–1.11 | 0.238 |
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Szpotowicz, A.; Gorczyca, I.; Jelonek, O.; Uziębło-Życzkowska, B.; Maciorowska, M.; Wójcik, M.; Błaszczyk, R.; Kapłon-Cieślicka, A.; Gawałko, M.; Budnik, M.; et al. Why Did All Patients with Atrial Fibrillation and High Risk of Stroke Not Receive Oral Anticoagulants? Results of the Polish Atrial Fibrillation (POL-AF) Registry. J. Clin. Med. 2021, 10, 4611. https://doi.org/10.3390/jcm10194611
Szpotowicz A, Gorczyca I, Jelonek O, Uziębło-Życzkowska B, Maciorowska M, Wójcik M, Błaszczyk R, Kapłon-Cieślicka A, Gawałko M, Budnik M, et al. Why Did All Patients with Atrial Fibrillation and High Risk of Stroke Not Receive Oral Anticoagulants? Results of the Polish Atrial Fibrillation (POL-AF) Registry. Journal of Clinical Medicine. 2021; 10(19):4611. https://doi.org/10.3390/jcm10194611
Chicago/Turabian StyleSzpotowicz, Anna, Iwona Gorczyca, Olga Jelonek, Beata Uziębło-Życzkowska, Małgorzata Maciorowska, Maciej Wójcik, Robert Błaszczyk, Agnieszka Kapłon-Cieślicka, Monika Gawałko, Monika Budnik, and et al. 2021. "Why Did All Patients with Atrial Fibrillation and High Risk of Stroke Not Receive Oral Anticoagulants? Results of the Polish Atrial Fibrillation (POL-AF) Registry" Journal of Clinical Medicine 10, no. 19: 4611. https://doi.org/10.3390/jcm10194611
APA StyleSzpotowicz, A., Gorczyca, I., Jelonek, O., Uziębło-Życzkowska, B., Maciorowska, M., Wójcik, M., Błaszczyk, R., Kapłon-Cieślicka, A., Gawałko, M., Budnik, M., Tokarek, T., Rajtar-Salwa, R., Bil, J., Wojewódzki, M., Bednarski, J., Bakuła-Ostalska, E., Tomaszuk-Kazberuk, A., Szyszkowska, A., Wełnicki, M., ... Wożakowska-Kapłon, B. (2021). Why Did All Patients with Atrial Fibrillation and High Risk of Stroke Not Receive Oral Anticoagulants? Results of the Polish Atrial Fibrillation (POL-AF) Registry. Journal of Clinical Medicine, 10(19), 4611. https://doi.org/10.3390/jcm10194611