Oral anticoagulant treatment after bioprosthetic valvular intervention or valvuloplasty in patients with atrial fibrillation—A SWEDEHEART study

Aims To describe the prevalence of atrial fibrillation (AF), use of oral anticoagulants (OAC) and change in antithrombotic treatment patterns during follow-up after valve intervention with a biological prosthesis or valvuloplasty. Methods and results All patients with history of AF or new-onset AF discharged alive after valvular intervention (biological prosthesis or valvuloplasty) between 2010–2016 in Sweden were included (n = 7,362). Information about comorbidities was collected from national patient registers. Exposure to OAC was based on pharmacy dispensation data. In total 4,800 (65.2%) patients had a history of AF, and 2,562 (34.8%) patients developed new-onset AF, with 999 (39.0%) developing new-onset AF within 3 months after intervention. The proportion of patients with biological valve prosthesis was higher in patients with new-onset AF compared to history of AF (p<0.001). CHA2DS2-VASc score ≥2 was observed in 83.1% and 75.5% patients with history of AF and new-onset AF, respectively. Warfarin was more frequently dispensed than NOAC at discharge in patients with history of AF (43.9% vs 7.3%), and in patients with new-onset AF (36.6% vs 17.1%). Almost half of the AF population was not dispensed on any OAC at discharge (48.8% in patients with history of AF and 46.3% in patients with new-onset AF). Conclusion In this real world study of patients with AF and recent valvular intervention, risk of new-onset AF after valvular intervention is high emphasizing need for frequent rhythm monitoring after intervention. A considerable undertreatment with OAC was observed despite being indicated for the majority of the patients. Warfarin was the OAC most frequently dispensed.

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Oral Antithrombotic Use Among Myocardial Infarction Patients

Annals of Pharmacotherapy ◽

10.1345/aph.1c038 ◽

2003 ◽

Vol 37 (1) ◽

pp. 143-146 ◽

Cited By ~ 2

Author(s):

Menno E van der Elst ◽

Nelly Cisneros-Gonzalez ◽

Cornelis J de Blaey ◽

Henk Buurma ◽

Anthonius de Boer

Keyword(s):

Myocardial Infarction ◽

Record Linkage ◽

Antithrombotic Therapy ◽

Past History ◽

Oral Anticoagulants ◽

Antiplatelet Agents ◽

Antithrombotic Treatment ◽

History Of ◽

Using Data

OBJECTIVE To examine the use of oral antithrombotics (i.e., antiplatelet agents, oral anticoagulants) after myocardial infarction (MI) in the Netherlands from 1988 to 1998. METHODS Retrospective follow-up of 3800 patients with MI, using data from the PHARMO Record Linkage System. RESULTS From 1988 to 1998, oral antithrombotic treatment increased significantly from 54.0% to 88.9%. In 1998, only 75.8% of patients who experienced a MI in the late 1980s received oral antithrombotic treatment compared with 94.4% of those who experienced a recent MI. CONCLUSIONS Oral antithrombotics were considerably underused in patients with a past history of MI. Therefore, these patients should be reviewed for antithrombotic therapy to assess whether their failure to use oral antithrombotics was right or wrong, and whether treatment should be initiated if possible.

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P4745Concomitant oral anticoagulant and antidepressant therapy in patients with atrial fibrillation and risk of stroke and bleeding: a population based cohort study

European Heart Journal ◽

10.1093/eurheartj/ehz745.1121 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

J J Komen ◽

P Hjemdahl ◽

A K Mantel - Teeuwisse ◽

O H Klungel ◽

B Wettermark ◽

...

Keyword(s):

Atrial Fibrillation ◽

Propensity Score ◽

Oral Anticoagulant ◽

Cox Regression ◽

Oral Anticoagulants ◽

Anticoagulant Treatment ◽

Oral Anticoagulant Treatment ◽

Increased Risk ◽

Antidepressant Use

Abstract Background Anticoagulation treatment reduces the risk of stroke but increases the risk of bleeding in atrial fibrillation (AF) patients. Antidepressants use is associated with increased risk for stroke and bleeds. Objective To assess the association between antidepressant use in AF patients with oral anticoagulants and bleeding and stroke risk. Methods All AF patients newly prescribed with an oral anticoagulant in the Stockholm Healthcare database (n=2.3 million inhabitants) from July 2011 until 2016 were included and followed for one year or shorter if they stopped claiming oral anticoagulant treatment or had an outcome of interest. Outcomes were severe bleeds and strokes, requiring acute hospital care. During follow-up, patients were considered exposed to antidepressant after claiming a prescription for the duration of the prescription. With a time-varying Cox regression, we assessed the association between antidepressant use and strokes and bleeds, adjusting for confounders (i.e., age, sex, comorbidities, comedication, and year of inclusion). In addition, we performed a propensity score matched analysis to test the robustness of our findings. Results Of the 30,595 patients included after claiming a prescription for a NOAC (n=13,506) or warfarin (n=17,089), 4 303 claimed a prescription for an antidepressant during follow-up. A total of 712 severe bleeds and 551 strokes were recorded in the cohort. Concomitant oral anticoagulant and antidepressant use was associated with increased rates of severe bleeds (4.7 vs 2.7 per 100 person-years) compared to oral anticoagulant treatment without antidepressant use (aHR 1.42, 95% CI: 1.12–1.80), but not significantly associated with increased stroke rates (3.5 vs 2.1 per 100 person-years, aHR 1.23, 95% CI: 0.93–1.62). No significant differences were observed between different oral anticoagulant classes (i.e., warfarin or NOAC) or different antidepressant classes (i.e., SSRI, TCA, or other antidepressant). Additional propensity-score matched analyses yielded similar results but showed a significantly increased risk for stroke (HR: 1.47, 95% CI: 1.08–2.02). Incidence rates of strokes and bleeds Conclusion Concomitant use of an oral anticoagulant and an antidepressant, irrespective of type, is associated with an increased bleeding risk. Increased awareness and a critical consideration for the need of an antidepressant is recommended in this population. Acknowledgement/Funding Swedish Heart Lung Foundation

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3269Impact of type 2 diabetes on incidence and phenotype of heart failure in patients with atrial fibrillation

European Heart Journal ◽

10.1093/eurheartj/ehz745.0054 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Polovina ◽

I Milinkovic ◽

G Krljanac ◽

I Veljic ◽

I Petrovic-Djordjevic ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Type 2 Diabetes ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Diabetic Patients ◽

History Of ◽

New Onset

Abstract Background Type 2 diabetes (T2DM) portends adverse prognosis in patients with atrial fibrillation (AF). Whether T2DM independently increases the risk of incident heart failure (HF) in AF is uncertain. Also, HF phenotype developing in patients with vs. those without T2DM has not been characterised. Purpose In AF patients without a history of prior HF, we aimed to assess: 1) the impact of T2DM on the risk of new-onset HF; and 2) the association between T2DM and HF phenotype developing during the prospective follow-up. Methods We included diabetic and non-diabetic AF patients, without a history of HF. Baseline T2DM status was inferred from medical history, haemoglobin A1c levels and oral glucose tolerance test. Study outcome was the first hospital admission or emergency department treatment for new-onset HF during the prospective follow-up. The phenotype of new-onset HF was determined by echocardiographic exam performed following clinical stabilisation (at hospital discharge, or within a month after HF diagnosis). HF phenotype was defined as HFrEF (left ventricular ejection fraction [LVEF] <40%), HFmrEF (LVEF 40–49%) or HFpEF (LVEF≥50%). Cox regression analyses adjusted for age, sex, baseline LVEF, comorbidities, smoking status, alcohol intake, AF type (paroxysmal vs. non-paroxysmal) and T2DM treatment was used to analyse the association between T2DM and incident HF. Results Among 1,288 AF patients without prior HF (mean age: 62.1±12.7 years; 61% male), T2DM was present in 16.5%. Diabetic patients had higher mean baseline LVEF compared with nondiabetic patients (50.0±6.2% vs. 57.6±9.0%; P<0.001). During the median 5.5-year follow-up, new-onset HF occurred in 12.4% of patients (incidence rate, 2.9; 95% confidence interval [CI], 2.5–3.3 per 100 patient-years). Compared with non-diabetic patients, those with T2DM had a hazard ratio of 2.1 (95% CI, 1.6–2.8; P<0.001) for new-onset HF, independent of baseline LVEF or other factors. In addition, diabetic patients had a significantly greater decline in covariate-adjusted mean LVEF (−10.4%; 95% CI, −9.8% to −10.8%) at follow-up, compared with nondiabetic patients (−4.0%; 95% CI, −3.8% to −4.2%), P<0.001. The distribution of HF phenotypes at follow-up is presented in Figure. Among patients with T2DM, HFrEF (56.9%) was the most common phenotype of HF, whereas in patients without T2DM, HF mostly took the phenotype of HFpEF (75.0%). Conclusions T2DM is associated with an independent risk of new-onset HF in patients with AF and confers a greater decline in LVEF compared to individuals without T2DM. HFrEF was the most prevalent presenting phenotype of HF in AF patients with T2DM.

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The Therapy with Oral Anticoagulants in Patients with Atrial Fibrillation in Outpatient and Hospital Settings (Data from RECVASA Registries)

Rational Pharmacotherapy in Cardiology ◽

10.20996/1819-6446-2019-15-4-538-545 ◽

2019 ◽

Vol 15 (4) ◽

pp. 538-545 ◽

Cited By ~ 2

Author(s):

M. M. Loukianov ◽

S. Yu. Martsevich ◽

O. M. Drapkina ◽

S. S. Yakushin ◽

A. N. Vorobyev ◽

...

Keyword(s):

Atrial Fibrillation ◽

Oral Anticoagulants ◽

Hospital Treatment ◽

Pronounced Difference ◽

Period 2 ◽

Significant Difference ◽

History Of ◽

Low Incidence ◽

Outpatient Settings

Aim. To evaluate an incidence of oral anticoagulants (OAC) administration during longterm follow-up period in patients with atrial fibrillation (AF) enrolled in outpatient and hospital RECVASA registries.Material and methods. 3169 patients with AF were enrolled in outpatient registries RECVASA (Ryazan), RECVASA AF-Yaroslavl and hospital registries RECVASA AF (Moscow, Kursk, Tula), age 70.9±10.7 years, 43.1% men. The incidence of OAC administration was evaluated in hospital and outpatient settings, including longterm follow-up period (2-6 years).Results. OAC were administrated only in 42.2% of cases (1335 from 3169 patients; age 69.1±10.4 years, 43% men), including warfarin (817 patients; 26%) and non-vitamin K antagonist oral anticoagulants (NOAC) – 518 (16%). Patients with permanent and persistant types of AF had lower incidence of OAC administration (43% and 40%) than in cases of paroxysmal type (47.6%, p<0.05), despite of the higher СНА2DS2-VASc risk score (4.69±1.66 and 4.23±1.57 vs 3.81±1.69; р<0.05). Patients with and without history of stroke received OAC in 42.5% and 40% of cases that means no significant difference (p>0.05) contrary to the pronounced difference of thromboembolic risk in these groups (6.14±1.34 and 3.77±1.39; р<0.001). The incidence of OAC administration in hospitals (54.1%) was 2.3 times higher than before hospitalization (23.8%) and was 4.1 times higher than in outpatient registries (13.5%). During follow-up period after hospital treatment (2.3±0.9 years) this parameter decreased from 54.1% to 41.2%, but was still 1.8 times higher than before admission to the hospital. After 4 years follow-up in RECVASA (Ryazan) registry we revealed 4.4 times higher incidence of OAC administration compared with enrollment data (4.2% and 18.3%, р<0.0001). This data was confirmed by the information from outpatient medical cards of accidentally generated group (75 from 297 patients survived during follow-up period): 5.3% at baseline and 22.7% six years later.Conclusions. RECVASA registries in 5 regions of Russia revealed low incidence of OAC administration. The risk of thromboembolic events was higher in patients with AF and no OAC administration compared with patients who received OAC. Patients with paroxysmal type of AF received OAC more often than those with permanent type. There were no significant differences of incidence of OAC therapy in patients with and without history of stroke. Both questioning of patients with AF and analysis of medical cards in outpatient clinics revealed higher incidence of OAC administration after 4-6 years of follow-up compared with the stage of enrollment in registries.

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Abstract 1738: Lone Atrial Fibrillation: Long-Term Clinical and Echocardiographic Follow-up from the Canadian Registry of Atrial Fibrillation

Circulation ◽

10.1161/circ.116.suppl_16.ii_366-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Peter Leong-Sit ◽

Karin H Humphries ◽

May Lee ◽

George J Klein ◽

Robert Sheldon ◽

...

Keyword(s):

Atrial Fibrillation ◽

Heart Disease ◽

Structural Heart Disease ◽

Lone Atrial Fibrillation ◽

Lv Mass ◽

Significant Difference ◽

History Of ◽

New Onset

Background: The natural history of lone atrial fibrillation (AF) is unclear with conflicting data in the literature. We aimed to better describe the clinical outcomes and echocardiographic changes associated with lone AF. Methods: The Canadian Registry of Atrial Fibrillation (CARAF) enrolled 803 non-surgical and non-flutter patients with new onset AF between 1990 and 1996. At enrollment, patients were classified as lone AF (LAF) or not lone AF (Not LAF) based on structural heart disease or hyperthyroidism. Clinical data was prospectively collected with follow-up at 3 months, 1 year, then annually; echocardiograms were performed at enrollment and years 2, 4, and 7. Results: The LAF group (n=212) had a median age of 57 (1 st quartile 44, 3 rd quartile 67) while the Not LAF group (n=591) had a median age of 67 (59, 73), p<0.0001. During the median follow-up of 8 years in the LAF group and 7 years in the Not LAF group, there was a significant difference in survival free from stroke or embolism favoring the LAF group (Figure ). At 8 years, the probability of remaining free of chronic AF was 78.8% vs 69.3% (p=0.02) and free of symptomatic or documented recurrence of AF was 40.1% vs 26.9% (p<0.01) in the LAF vs Not LAF group. The LAF group had smaller LV diastolic and systolic dimensions by 5.5% and 10.2%, respectively, vs the Not LAF group (p<0.0001). The LV mass was smaller at baseline by 21.1% (p<0.0001) vs the Not LAF group, but increased at a greater rate (4.0% vs 0.9%/2 years, p<0.0001). Conclusions: Lone AF, compared to non-lone AF, is associated with a lower rate of death, stroke or embolism, recurrence and progression to chronic AF. Interestingly, LV mass increased significantly only in the Lone AF group.

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Abstract 057: Understanding of Treatment Strategies Among Patients Newly Diagnosed With Atrial Fibrillation: Findings From SATELITTE

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.057 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Brystana G Kaufman ◽

Sunghee Kim ◽

Karen Pieper ◽

Michael D Ezekowitz ◽

Gregg C Fonarow ◽

...

Keyword(s):

Atrial Fibrillation ◽

Survey Data ◽

Oral Anticoagulants ◽

Rhythm Control ◽

Medical Decision ◽

Community Practice ◽

Newly Diagnosed ◽

Patient Understanding ◽

New Onset

Introduction: Patient understanding of available therapies for atrial fibrillation (AF) is foundational to shared medical decision making and long term medication adherence. Yet, there is a paucity of data regarding the extent to which patients newly diagnosed with AF in routine community practice understand their options. Hypotheses: 1) Understanding of warfarin, novel oral anticoagulants (NOAC), rhythm control therapy, cardioversion and radio frequency ablation changes little from baseline to 6 months and 2) treatment rates at 6 months are associated with patient understanding of therapies at baseline. Methods: We analyzed survey data from SATELLITE, a substudy of new-onset AF patients enrolled at 56 US sites participating in the ORBIT-AF registry. Patients were surveyed at the baseline and 6 month follow up clinic visit using Likert scales. Agreement between time points was assessed with the McNemar test, and the relationship between understanding and treatment was assessed only for the subset not on treatment at baseline. Results: Of 1000 patients enrolled in SATELLITE, 506 had 6-month survey data (data collection is continuing). Among these, the median age was 69.0 years (IQR 63.0 - 76.0) and 93.7% (474 of 506) were white. There was evidence of improvement in the self-reported understanding of warfarin and NOACs from baseline to 6 months, but not for rhythm control, ablation or cardioversion. The proportion reporting high understanding improved significantly for warfarin (p<.0001) and NOACs (p<.0001) from 47% (223 of 474) and 51% (245 of 481) at baseline to 60% (284 of 474) and 69% (332 of 481) at 6 months respectively (Figure 1). Patients with high understanding of the benefits of ablation (p=0.0005) and options for ablation (p=0.0093) at baseline were more likely to have this therapy at the 6 month follow up (N=590), but improved understanding was not associated with increased use of warfarin/NOACs (N=83) or rhythm control (N=444). Conclusions: Patients with new-onset AF had improved self-reported understanding of some treatment options over the first 6-months from diagnosis; however, factors other than patient understanding may influence AF treatments received at 6 months. Patient understanding of AF treatments remains suboptimal at 6 months, and our results suggest a need for ongoing patient education.

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Reasons for and consequences of oral anticoagulant underuse in atrial fibrillation with heart failure

Heart ◽

10.1136/heartjnl-2017-312720 ◽

2018 ◽

Vol 104 (13) ◽

pp. 1093-1100 ◽

Cited By ~ 15

Author(s):

Gianluigi Savarese ◽

Ulrik Sartipy ◽

Leif Friberg ◽

Ulf Dahlström ◽

Lars H Lund

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Major Bleeding ◽

Oral Anticoagulants ◽

Bleeding Risk ◽

Patients With Heart Failure ◽

Unit Increase ◽

History Of ◽

Logistic Regressions

ObjectiveAtrial fibrillation (AF) is common in patients with heart failure (HF), and oral anticoagulants (OAC) are indicated. The aim was to assess prevalence of, predictors of and consequences of OAC non-use.MethodsWe included patients with AF, HF and no previous valve replacement from the Swedish Heart Failure Registry. High and low CHA2DS2-VASc and HAS-BLED scores were defined as above/below median. Multivariable logistic regressions were used to assess the associations between baseline characteristics and OAC use and between CHA2DS2-VASc and HAS-BLED scores and OAC use. Multivariable Cox regressions were used to assess associations between CHA2DS2-VASc and HAS-BLED scores, OAC use and two composite outcomes: all-cause death/stroke and all-cause death/major bleeding.ResultsOf 21 865 patients, only 12 659 (58%) received OAC. Selected predictors of OAC non-use were treatment with platelet inhibitors, less use of HF treatments, paroxysmal AF, history of bleeding, no previous stroke, planned follow-up in primary care, older age, living alone, lower income and variables associated with more severe HF. For each 1-unit increase in CHA2DS2-VASc and HAS-BLED, the ORs (95% CI) of OAC use were 1.24 (1.21–1.27) and 0.32 (0.30–0.33), and the HRs for death/stroke were 1.08 (1.06–1.10) and for death/major bleeding 1.18 (1.15–1.21), respectively. For high versus low CHA2DS2-VASc and HAS-BLED, the ORs of OAC use were 1.23 (1.15–1.32) and 0.20 (0.19–0.21), and the HRs for death/stroke were 1.25 (1.19–1.30) and for death/major bleeding 1.28 (1.21–1.34), respectively.ConclusionsPatients with AF and concomitant HF do not receive OAC on rational grounds. Bleeding risk inappropriately affects decision-making more than stroke risk.

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P3345Stroke and death in atrial fibrillation patients newly treated by oral anticoagulants in France: a national cohort study 2012–2016

European Heart Journal ◽

10.1093/eurheartj/ehz745.0221 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A Gabet ◽

E Chatignoux ◽

Y Bejot ◽

V Olie

Keyword(s):

Atrial Fibrillation ◽

Oral Anticoagulants ◽

National Level ◽

Subdistribution Hazard ◽

Stroke Incidence ◽

Coronary Syndrome ◽

Number Of Patients ◽

Incidence And Mortality ◽

History Of

Abstract Background Introduction of new oral anticoagulants (OAC) lead to an increase in atrial fibrillation (AF) patients treated with those drugs. Few epidemiological data on outcomes are available in France or abroad in this population. There is an important need to follow up patients newly diagnosed for AF and treated by OAC, and estimate stroke and mortality outcomes at national level in unselected patients' population. The French “Système national des données de santé” (SNDS) gathered enough medical information on the overall French population, with complete follow-up until patient's death. Purpose The objective of this study was to analyze stroke and death outcomes and their determinants in a cohort of AF patients newly treated by OAC in France between 2012 and 2016. Methods All AF patients aged over 20 years old, residing in France, and newly treated by OAC between 2012 and 2016 were included in a cohort. The date of OAC delivery was considered as the inclusion date. Patients were followed till 31 of December 2017. Main outcomes studied were the first hospitalisation for stroke or death. We used a Fine and Gray regression model to estimate subdistribution hazard ratio (SHR) for stroke. Cox regression models were used to compute cause-specific hazard ratios (CSHR) for stroke and death respectively. Analyses were adjusted for main confounders. Results The total number of patients enrolled in the study for the period 2012–2016 was 662,298. Mean age at inclusion was 74.9 years old. Women accounted for 47.8% of the study population. Globally, 3.8% of patients experienced stroke after initiation of OAC and 13.9% of patients died over the study period with 1.1% of death occurring after a stroke. The median follow-up for stroke or death events was 1094 days, 1208 days for stroke and 1123 days for death. Incidence rates of stroke or death reached 53.3 [53.0–53.6] per 1,000 person-year and, 11.3 [11.2–11.5] and 44.0 [43.7–44.3] for stroke and death respectively. Advanced age, history of stroke, acute coronary syndrome (ACS), chronic kidney disease (CKD), treated hypertension, diabetes and to be included during the first year of the study period were associated with an increase in the subdistribution hazard of stroke. Significant differences were found by age group such as an increase in SHR for stroke in women aged over 85 years compared to men of the same age. Cause-specific analyzes gave similar results for stroke. History of heart failure, ACS, CKD, hemorrhages, treated hypertension and diabetes were associated with increased hazard of death. On the contrary, female sex was associated with a significant decrease in the hazard of death only. Conclusion Stroke incidence and mortality rate in AF patients newly treated by OAC were high. Several factors were associated with increased hazard of stroke and death but differed according to patient's age.

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Long term antithrombotic treatment in atrial fibrillation patients undergoing coronary surgery

European Heart Journal ◽

10.1093/ehjci/ehaa946.2953 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Skibniewski ◽

D Venetsanos ◽

M Janzon ◽

L Karlsson ◽

S Lawesson Sederholm ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cox Regression ◽

Oral Anticoagulants ◽

Public Institution ◽

Bleeding Complications ◽

Funding Source ◽

Antithrombotic Treatment ◽

Real World Data ◽

History Of ◽

One Year

Abstract Introduction Current revascularisation guidelines from ESC recommend treatment with oral anticoagulants (OAC) alone in atrial fibrillation (AF) patients treated with coronary artery by-pass grafting (CABG), after one year of treatment with OAC and platelet inhibition (PI). Little is known about current treatment practice and there is a paucity of evidence to guide decision making. Purpose To assess treatment patterns and clinical outcome of OAC as sole antithrombotic treatment one year after CABG in patients with a history of AF, in comparison to PI only and OAC+PI. Method We included 2 112 patients (out of 32908 who underwent isolated CABG) from 2006 to 2014 with a history of atrial fibrillation, alive one year after surgery and a CHA2DS2-VASC-score ≥2. Based on data on individual dispensed prescriptions 1 to 1.5 years after surgery, patients were assigned to one of three treatment arms: PI alone (n=931), OAC alone (n=814) or combination of OAC+PI (n=367). Differences in MACE (death, myocardial infarction [MI] and stroke) between the three groups were assessed using a Cox regression model. Data are presented as hazard ratios (HR) with 95% confidence intervals [CI], adjusted for CHA2DS2-VASC-score (which include age, sex, hypertension [HT], congestive heart failure [CHF], stroke, vascular disease and diabetes) for MACE and the individual components of MACE; and CHA2DS2-VASC+history of bleeding regarding readmission for bleeding. Median follow-up was 3 years, range (0.5–3). Results Patients treated with PI only were younger (71, 72 and 73 years) and less often had HT (62%, 72 and 70%), and CHF (30, 40 and 40%) in the PI, PI+OAC and OAC groups respectively. Patients treated with PI only, more often had a history of MI (54%) compared to OAC (42%) but not to PI+OAC (53%). The cumulative incidence of MACE at three years was 18.9, 14.0 and 14.9% in the PI, PI+OAC and OAC groups, respectively. The corresponding numbers were for death 9.9, 9.0 and 11.2%, MI 4.6, 3.5 and 1.9%, stroke 6.0, 2.7 and 2.7% and readmission for bleeding 5.9, 11.3 and 7.0%, respectively. After adjustment, PI only was associated with significantly higher risk for MACE (HR 1.36, 95% CI: 1.06–1.75), MI (HR 2.82, 95% CI: 1.47–5.40), and stroke (HR 2.34, 95% CI: 1.36–4.02); while PI+OAC was associated with higher risk for MI (HR 2.43, 95% CI: 1.09–5.34) and bleeding complications (HR 1.58, 95% CI: 1.01–2.46), compared to OAC only. Conclusions In CABG patients with a history of AF and an indication for OAC, one year after surgery, treatment with OAC alone was associated with lower MACE rate than PI alone, driven by lower rates of MI and stroke. In addition, OAC only was associated with less bleeding complications than PI+OAC. These real-world data provide support to current ESC guidelines recommending OAC alone one year after CABG surgery. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): County council of Östergötland, Sweden

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Novel Predictors For New Onset Atrial Fibrillation After Typical Atrial Flutter Ablation: An Invasive Prospective Study

10.21203/rs.3.rs-605959/v1 ◽

2021 ◽

Author(s):

Ermengol Vallès ◽

Julio Martí-Almor ◽

Nuria Grau ◽

Benjamin Casteigt ◽

Begoña Benito ◽

...

Keyword(s):

Atrial Fibrillation ◽

Loop Recorder ◽

Thromboembolic Risk ◽

Typical Atrial Flutter ◽

High Incidence ◽

History Of ◽

Onset Atrial Fibrillation ◽

New Onset

Abstract Purpose: Patients undergoing cavotricuspid isthmus (CTI) ablation for typical flutter (AFL) have a high incidence of new onset atrial fibrillation (AF). We aimed to analyze the incidence and predictors for new onset AF in this subset of patients to stratify thromboembolic risk. Methods: Between 2016 and 2019, 70 patients without history of AF but with high-risk for developing AF, based on a recent AFL ablation or a high PACE score for AF risk, were prospectively included. All patients were monitored continuously by implantable loop recorder and followed by remote monitoring.Results: Overall 48 patients were included after CTI ablation and 22 patients were included based on a high PACE score. New onset AF rate at 12 months was significantly higher in the AFL group compared to PACE group (56.3% vs 22.7%, p=0.011). History of AFL was the only independent predictor for new onset AF (HR:3.82; 95% CI:1.46-10.03; p=0.006) at a median follow-up of 12 months (Q1-Q3:4-19 months). In the AFL group, two very strong independent predictors for new onset AF were a PACE score ³30 (HR:6.9; 95% CI:1.71-27.91; p=0.007) and HV interval ³55 (HR:11.86; 95% CI:2.57-54.8; p=0.002).Conclusions: AFL is the most important predictor for new onset AF. In patients undergoing AFL ablation, a high PACE score and/or long HV interval predict even higher risk, and may be useful in decision for empiric long-term anticoagulation.

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