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Background Despite progresses in the treatment of the thromboembolic risk related to atrial fibrillation (AF), the management of recurrences remains a challenge. Hypothesis To assess if congestive heart failure or left ventricular systolic dysfunction (CHA 2 DS 2 ‐VASc) score is predictive of early arrhythmia recurrence after AF cardioversion. Methods Systematic review and individual patient pooled meta‐analysis following Preferred Reporting Items for Systematic reviews and Meta‐Analyses guidelines. Inclusion criteria: observational trials in patients with AF undergoing cardioversion, available data on recurrence of AF and available data on CHA 2 DS 2 ‐VASc score. Clinical studies of interest were retrieved by PubMed, Cochrane Library, and Biomed Central. Seven authors were contacted for joining the patient level meta‐analysis, and three shared data regarding anthropometric measurements, risk factors, major comorbidities, and CHA 2 DS 2 ‐VASc score. The primary outcome was the recurrence of AF after cardioversion in patients free from antiarrhythmic prophylaxis. Univariate and multivariate logistic regression was performed. Results Overall, we collect data of 2889 patients: 61% were male, 50% with hypertension, 12% with diabetes, and 23% with history of ischemic heart disease. The median CHA2DS2‐VASc score was 2.. At the multivariate analysis, chronic kidney disease (odds ratio [OR] 1.94; 95% confidence interval [CI] 1.12‐3.27; P = 0.01), peripheral artery disease (OR 1.65; 95% CI 1.23‐2.19; P < 0,0001), previous use of beta blockers (OR 1.5; 95% CI 1.19‐1.88; P < 0.0001), and CHA2DS2‐VASc score > 2 (OR 1.37; 95% CI 1.1‐1.68; P = 0.002) were independent predictors of early recurrence of AF. Conclusions CHA2DS2‐VASc score predicts early recurrence of AF in the first 30 days after electrical or pharmacological cardioversion. Protocol registration PROSPERO (CRD42017075107).

Hypertension is one of the primary modifiable risk factor for cardiac and renal diseases with the prevalence around 30-45% of the general population, with a steep increase with ageing. The administration of blood pressure-lowering drugs is to reduce the risk of major clinical cardiovascular outcomes. Hypertension guidelines recommend combination therapy in patients with high cardiovascular risk and with subclinical organ damage as well as when monotherapy fails. Areas covered: As the etiology of essential hypertension is multifactorial, combination therapy using different classes of antihypertensive agents have greater effect than each on its own (synergistic effect), may have better tolerability (two components minimizing each other's side effects) and lead to improved patient compliance. Several studies assess the hypotensive efficacy on drug combination; there are also studies on triple drug combination. Expert commentary: At present, dual and triple combination therapy is available to hypertensive patients with good clinical outcomes, compliance and low profile of side effects. It is critical as patients' adherence to the pharmacological therapy significantly decreases the risk of long-term adverse events including mortality. It appears that combinations not only of hypotensive drugs but also with statins (as well as antidiabetics) will be widely used.

Admission anaemia significantly influences all-cause mortality in patients with STEMI treated invasively ina six-year follow-up and may be used for risk stratification in this population.

REVIEW ARTICLE Management of patients with AF and CKD 353link with AF because it leads not only to anatomic and metabolic changes in the cardiovascular system but also to alterations in the endocrine and nervous systems, hematopoiesis, and inflammatory response, which increases the risk of AF.2 The overload of the extracellular fluid might lead to left ventricular hypertrophy and ventricular diastolic dysfunction, which causes atrial remodeling, a well-known pathogenesis of AF. 6AF frequently occurs in renal failure population and ranges from 19% to 24%, rising to 27% in patients with end-stage renal disease (ESRD). 5,7In the Framingham Heart Study, 8 the prevalence of AF in patients with CKD was 15-fold higher than that in the general population, while in the Chronic Renal Insufficiency Cohort study, 9 AF was Introduction Atrial fibrillation (AF) is the most common cardiac arrhythmia, occurring in 1% to 2% of the general population. 1,2 The percentage of patients with AF increases with age from 0.14% in those younger than 50 years old, 4% in those between 60 and 70 years old, to 14% in those over 80 years old. 3 AF is a well-known risk factor for cardiovascular morbidity, especially thromboembolic complications (including ischemic stroke), and mortality that resulted in 112 000 deaths in 2013, compared with 29 000 deaths in 1990. 1,2,4During the past 10 years, chronic kidney disease (CKD) has been also identified as a major risk factor for cardiovascular morbidity and mortality, with rapidly increasing prevalence.5 Impairment of kidney function has a well-established ABSTRACTAtrial fibrillation (AF) frequently occurs in patients with chronic kidney disease (CKD), and the rate reaches even 30% in patients with end-stage renal disease (ESRD). Patients with AF and CKD have a significantly higher risk of thrombotic complications, particularly ischemic stroke, and at the same time, a higher bleeding risk (proportionally to the grade of renal failure). In addition, AF and CKD share a number of comorbidities and risk factors, which results in increased mortality rates. Moreover, disturbances in hemostasis are common complications of kidney disease. Their occurrence and severity correlate with worsening renal function, including ESRD. At present, the incidence of bleeding is declining, while thrombotic complications have become the predominant cause of mortality. Prophylactic antithrombotic treatment reduces the rate of stroke and other thrombotic complications. Vitamin K antagonists (VKAs) have long been used in anticoagulant therapy, and more recently, non-vitamin K oral anticoagulants (NOACs) have been introduced, which are direct thrombin inhibitors. NOACs are a valuable anticoagulant option in this group of patients as long as a summary of product characteristics is followed. They are at least as effective as warfarin, while being safer, especially when it comes to intracranial hemorrhage. Renal function should be evaluated before initiation of NOACs and reevaluated when clinically indicated. Importantly, disturb...

Antithrombotic management in AF is well implemented in Polish conditions, but we show the lack of pattern concerning who is being treated with OAC and ASA when it comes to the risk of stroke and bleeding.

Background: Information on epidemiology of atrial fibrillation (AF) in Middle European 001). Patients with valvular AF had more often permanent AF (p < 0.004). Valvular AF patients were more often prescribed antithrombotic therapy (p = 0.001). The in-hospital mortality did not differ between patients with valvular and non-valvular AF (p = 0.3). In multivariate logistic regression, odds of in-hospital death were higher for patients > 75 years old (OR = 6.26, p = 0.001,) and with ejection fraction < 35% (OR = 5.25, p < 0.001, (Cardiol J 2015; 22, 3: 296-305)