TY - JOUR
T1 - Treatment implications of renal disease in patients with atrial fibrillation
T2 - The BALKAN-AF survey
AU - Kozieł, Monika
AU - Simovic, Stefan
AU - Pavlovic, Nikola
AU - Nedeljkovic, Milan
AU - Kocijancic, Aleksandar
AU - Paparisto, Vilma
AU - Music, Ljilja
AU - Trendafilova, Elina
AU - Dan, Anca Rodica
AU - Manola, Sime
AU - Kusljugic, Zumreta
AU - Dan, Gheorghe Andrei
AU - Lip, Gregory Y.H.
AU - Potpara, Tatjana S.
AU - BALKAN‑AF Investigators
PY - 2020/10
Y1 - 2020/10
N2 - Background: Atrial fibrillation (AF) often co-exists with renal function (RF) impairment. We investigated the characteristics and management of AF patients across creatinine clearance strata and potential changes in the use of nonvitamin K oral anticoagulants (NOAC) according to different equations for estimation of RF. Methods: In this post hoc analysis of the BALKAN-AF survey, patients were classified according to RF (Cockcroft-Gault formula) as: preserved/mildly depressed RF (P-RF) ≥50 mL/min, moderately depressed RF (MD-RF) 30-49 mL/min, and severely depressed RF (SD-RF) <30 mL/min. Results: Of 2712 enrolled patients, 2062 (76.0%) had data on RF. Patients with SD-RF and MD-RF were older, had higher mean value of European Heart Rhythm Association score, stroke and bleeding risk scores, and more comorbidities than patients with P-RF (all P <.05). They received oral anticoagulants (OAC), AF catheter ablation, and electrical cardioversion less often than those with P-RF (all P <.05). Rate control, no OAC, single-antiplatelet therapy (SAPT) alone, and loop diuretics were more prevalent in patients with SD-RF and MD-RF than in subjects with P-RF (all P <.005). An important change in NOAC therapy could appear in <1% of patients (Modification of Diet in Renal Disease formula) and in <1% of patients (Chronic Kidney Disease Epidemiology Collaboration group formula). Conclusions: Patients with SD-RF and MD-RF were older, more symptomatic, had higher stroke and bleeding risk and more comorbidities than those with P-RF. They were less likely to receive OAC and more likely to use rate control strategy, SAPT alone, and no OAC than subjects with P-RF.
AB - Background: Atrial fibrillation (AF) often co-exists with renal function (RF) impairment. We investigated the characteristics and management of AF patients across creatinine clearance strata and potential changes in the use of nonvitamin K oral anticoagulants (NOAC) according to different equations for estimation of RF. Methods: In this post hoc analysis of the BALKAN-AF survey, patients were classified according to RF (Cockcroft-Gault formula) as: preserved/mildly depressed RF (P-RF) ≥50 mL/min, moderately depressed RF (MD-RF) 30-49 mL/min, and severely depressed RF (SD-RF) <30 mL/min. Results: Of 2712 enrolled patients, 2062 (76.0%) had data on RF. Patients with SD-RF and MD-RF were older, had higher mean value of European Heart Rhythm Association score, stroke and bleeding risk scores, and more comorbidities than patients with P-RF (all P <.05). They received oral anticoagulants (OAC), AF catheter ablation, and electrical cardioversion less often than those with P-RF (all P <.05). Rate control, no OAC, single-antiplatelet therapy (SAPT) alone, and loop diuretics were more prevalent in patients with SD-RF and MD-RF than in subjects with P-RF (all P <.005). An important change in NOAC therapy could appear in <1% of patients (Modification of Diet in Renal Disease formula) and in <1% of patients (Chronic Kidney Disease Epidemiology Collaboration group formula). Conclusions: Patients with SD-RF and MD-RF were older, more symptomatic, had higher stroke and bleeding risk and more comorbidities than those with P-RF. They were less likely to receive OAC and more likely to use rate control strategy, SAPT alone, and no OAC than subjects with P-RF.
KW - atrial fibrillation
KW - BALKAN-AF survey
KW - creatinine clearance
KW - oral anticoagulant therapy
KW - renal function
UR - http://www.scopus.com/inward/record.url?scp=85088105971&partnerID=8YFLogxK
U2 - 10.1002/joa3.12404
DO - 10.1002/joa3.12404
M3 - Journal article
C2 - 33024464
AN - SCOPUS:85088105971
SN - 1880-4276
VL - 36
SP - 863
EP - 873
JO - Journal of Arrhythmia
JF - Journal of Arrhythmia
IS - 5
ER -