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

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.

Prehospital period in patients with COVID-19 and community acquired pneumonia: age characteristics, cardiovascular comorbidity and pharmacotherapy during epidemic wave (the data of hospital registry)

Aim To estimate age characteristics, proportion of concomitant cardiovascular diseases (CVD), cardiovascular pharmacotherapy during prehospital period in patients with COVID-19 and community acquired pneumonia (CAP) according the data of hospital registry. Methods The registry included all patients admitted to the special COVID-19 center from April 6 to June 2, 2020 with suspected or confirmed COVID-19 and CAP. This enrollment period was corresponding to the main part of the first epidemic wave of COVID-19 in megapolis (the number of new cases on April 6 and July 2, 2020 was 591 and 662, respectively, the maximal number, 6703 cases, was registered on May 7). COVID-19 was diagnosed in cases of positive polymerase chain reaction test (60.7%) or according to computed tomography data. Results The registry included 1.130 patients (age 57.5±12.8 years, 51.2% men). CAP was diagnosed in 94% of cases, CVD - in 52.9%. Mean age values (from the 1-st up to the 11-th weeks of enrollment period) were, respectively, week by week: 52.8; 54.3; 57.3; 59.6; 56.9; 60.0; 57.2; 62.7; 59.3; 57.4 and 62.2 years (p&lt;0.001; β-coefficient 0.78; 95% Confidential Interval, CI 0.50–1.07). The proportion of patients with CVD was for each of these weeks, respectively: 34.2%; 43.0%; 52.9%; 53.5%; 50.5%; 61.4%; 53.9%; 68.9; 63.1%; 54.8% and 66.7% (p&lt;0.001; Odds Ratio 1.04; 95% CI 1.02–1.06). So, during enrollment period the mean age of patients increased significantly (on average by 0.78 years per week) as well as the proportion of CVD cases increased from 34.2% up to 66.7% (average 51.5%). The mean duration of period from the first day of clinical symptoms until the date of hospitalization was 8.3±5.9 days (median 7; with Q1-Q3 from 5 to 10). There were no significant difference for the length of this period between groups of patients with and without CVD: 8.4±6.2 and 8.3±5.7 days (median 7; with Q1-Q3 from 5 to 10 for both groups), p=0.82; between age groups of ≥65 years and &lt;65 years: 8.8±7.2 and 8.1±5.3 days (median 7 with Q1-Q3 from 5 to 10, and 7 with Q1-Q3 from 4 to 10, respectively), p=0.07. Antihypertensive therapy during prehospital period was administered in 78.4% cases of hypertension, ACE inhibitors/sartans in patients with chronic heart failure (CHF) and history of myocardial infarction (MI) - in 64.6% and 52.3%, beta-blockers in CHF and history of MI – 54.4% and 42.2%, statins in coronary artery disease (CAD) – 28.9%, antiplatelets in CAD without atrial fibrillation (AF) – 50.4%, anticoagulants in AF – 57.5%. Conclusions Prehospital period in patients with COVID-19, community-acquired pneumonia enrolled into the hospital registry was characterized by rising of age and proportion of CVD cases during enrollment period. The correspondence of cardiovascular pharmacotherapy to clinical guidelines was insufficient that must be improved in clinical practice during time interval between first symptoms and hospitalization date. FUNDunding Acknowledgement Type of funding sources: None.

Characteristics of length of stay and cardiovascular pharmacotherapy advice among chronic obstructive pulmonary disease patients

Chronic obstructive pulmonary disease (COPD) increases the global disease burden due to its diverse adverse health effects on the respiratory and cardiovascular systems. This study aimed to elucidate the potential indicators of length of stay (LOS) and pharmacotherapy advice among COPD patients. Thereafter, hospitalized COPD patients with clinical records and respiratory and cardiovascular pharmacotherapy advice were retrospectively collected from a tertiary hospital between April 2017 and September 2020, and the determinants of LOS and cardiovascular pharmacotherapy advice were explored using regression analyses. Overall, 475 patients with COPD were recruited and stratified according to exacerbation and presence of Cor pulmonale (CP). The extended LOS, increased B-type natriuretic peptides (BNP), and a higher percentage of cardiovascular pharmacotherapy advice were observed in COPD with CP regardless of exacerbation, although the percentage of respiratory prescriptions was comparable. The presence of CP indicated a longer LOS ( B = 1.850, p < 0.001) for COPD regardless of exacerbation. Meanwhile, elevated BNP levels indicated cardiovascular pharmacotherapy advise for both COPD in exacerbation (OR = 1.003, p = 0.012) and absence of exacerbation (OR = 1.006, p = 0.015). Moreover, advice for trimetazidine use for COPD in exacerbation (OR = 1.005, p = 0.002) has been suggested. Therefore, CP appears to be an important comorbidity resulting in extended LOS for COPD, which is likely to be advised with cardiovascular pharmacotherapy, which might be guided through BNP monitoring.

Abstract P259: Cardiovascular Pharmacotherapy And Covid-19

COVID-19 illness is associated with cardiovascular vulnerabilities at all stages pre-infection, acute phase and subsequent chronic phase. The major cardiometabolic drivers identified to have epidemiological and mechanistic associations with COVID-19 are abnormal adiposity, dysglycaemia, dyslipidaemia, and hypertension. Recent findings demonstrate that cardiovascular risk reduction interventions may have short-term benefits on COVID-19 risk and outcomes. Our aim was to investigate the effect of cardiovascular pharmacotherapy on SARS-CoV-2 infection. Demographic data, cardiovascular disease and other comorbidities, prescription data, discharge outcomes, RT-PCR tests, and investigations were obtained through record linkage for all patients admitted between 01/04/2020 and 31/05/2020 to NHS Greater Glasgow & Clyde hospitals. The relationship between cardiovascular pharmacotherapy (antihypertensives and statins) and SARS-CoV-2 infection was analysed using multivariable logistic regression models. From 218,472 patient records available in Glasgow SafeHaven. 3,610 patients had confirmed COVID-19 based on clinical criteria or a positive RT-PCR test) and 18,050 propensity matched controls were selected. The average age was 62 years, 55% (1,985 of 3,610) females, 43% (1,552 of 3,610) resided in the most deprived areas (SIMD:1). There were 46% (1,660 of 3,610) on antihypertensive therapy and 35% (1,264 of 3,610) were on statin therapy. The risk of SARS-CoV-2 infection was greater in those with cancer, pulmonary or renal disease in the multivariable logistic regression model. Those on antihypertensive or statin therapy had an 11% (O.R.[95% CI]: 0.89 [0.82-0.97], p=0.007) and 9% (0.91 [0.83-0.99], p=0.03) lower risk of SARS-CoV-2 infection, respectively. The protective effect of statins and antihypertensive drugs were apparent only in those on both drug therapies (0.82 [0.74-0.92], p=0.001). Prior treatment with statins and antihypertensive drugs are associated with a lower risk of SARS-CoV-2 infection. The observed beneficial effect of statins and antihypertensives therapy warrants further investigation to address critical gaps in knowledge in prevention, treatment and long term follow up of patients with COVID-19.

Challenges in Cardiovascular Pharmacogenomics Implementation: A viewpoint from the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy

Pharmacogenomics promises to advance cardiovascular therapy, but there remain pragmatic barriers to implementation. These are particularly important to explore within Europe, as there are differences in the populations, availability of resources and expertise, as well as in ethico-legal frameworks. Differences in healthcare delivery across Europe present a challenge, but also opportunities to collaborate on PGx implementation. Clinical work force upskilling is already in progress but will require substantial input. Digital infrastructure and clinical support tools are likely to prove crucial. It is important that widespread implementation serves to narrow rather than widen any existing gaps in health equality between populations. This viewpoint supplements the working group position paper on cardiovascular pharmacogenomics to address these important themes.