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Aim. Retrospective analysis of the clinical characteristics of elderly patients with atrial fibrillation (AF) and long-livers in individual subjects of the Russian Federation using artificial intelligence.Material and methods. The information was obtained from the Webiomed predictive analytics platform. The main database included 144431 patients with AF who received care in medical organizations in 6 constituent entities of the Russian Federation in the period 2016-2019. Of these, 56830 (39,3%) persons were aged ≥75 years: 47595 aged 75-89 years, 9235 aged ≥90 years.Results. Patients with AF aged ≥75 years compared with persons aged 18-74 years were characterized by a significantly higher incidence of hypertension, type 2 diabetes, estimated glomerular filtration rate <60 ml/min/1,73 m2, heart failure and peripheral atherosclerosis, thromboembolic (TEE), atherothrombotic and hemorrhagic events. The prescription rate of anticoagulant therapy (ACT) was 29,6% and was lower (p<0,001) compared with a subgroup of people with AF aged 1874 years with a high risk of TEE (41,2%). Among patients with AF aged ≥75 years, in 9,4% of cases, no additional (in relation to age and sex) CHA2DS2-VASc points were found, and in 1/3 of individuals there was only one additional points. With an increase CHA2DS2-VASc score in these patients, the ACT prescription rate increased from 13 to 55,5%. The prescription rate of acetylsalicylic acid was 12,8%. Only 33% of people with AF aged ≥75 years who had an ischemic stroke were prescribed ACT.Conclusion. The retrospective analysis indicates a high proportion of people aged ≥75 years in the structure of all patients with AF. This group is characterized by a significant comorbidity, a high TEE risk, hemorrhagic and atherothrombotic events. At the same time, the ACT prescription rate as of 2016-2019 in individual subjects of the Russian Federation did not meet the requirements of the clinical guidelines.
Aim. Retrospective analysis of the clinical characteristics of elderly patients with atrial fibrillation (AF) and long-livers in individual subjects of the Russian Federation using artificial intelligence.Material and methods. The information was obtained from the Webiomed predictive analytics platform. The main database included 144431 patients with AF who received care in medical organizations in 6 constituent entities of the Russian Federation in the period 2016-2019. Of these, 56830 (39,3%) persons were aged ≥75 years: 47595 aged 75-89 years, 9235 aged ≥90 years.Results. Patients with AF aged ≥75 years compared with persons aged 18-74 years were characterized by a significantly higher incidence of hypertension, type 2 diabetes, estimated glomerular filtration rate <60 ml/min/1,73 m2, heart failure and peripheral atherosclerosis, thromboembolic (TEE), atherothrombotic and hemorrhagic events. The prescription rate of anticoagulant therapy (ACT) was 29,6% and was lower (p<0,001) compared with a subgroup of people with AF aged 1874 years with a high risk of TEE (41,2%). Among patients with AF aged ≥75 years, in 9,4% of cases, no additional (in relation to age and sex) CHA2DS2-VASc points were found, and in 1/3 of individuals there was only one additional points. With an increase CHA2DS2-VASc score in these patients, the ACT prescription rate increased from 13 to 55,5%. The prescription rate of acetylsalicylic acid was 12,8%. Only 33% of people with AF aged ≥75 years who had an ischemic stroke were prescribed ACT.Conclusion. The retrospective analysis indicates a high proportion of people aged ≥75 years in the structure of all patients with AF. This group is characterized by a significant comorbidity, a high TEE risk, hemorrhagic and atherothrombotic events. At the same time, the ACT prescription rate as of 2016-2019 in individual subjects of the Russian Federation did not meet the requirements of the clinical guidelines.
This work is devoted to the dynamic study of heart rate variability indicators for one year in patients with paroxysmal atrial fibrillation treated with antiarrhythmic drugs metoprolol and cordarone. The study found that patients treated with metoprolol monotherapy had a weakening of parasympathetic effects on the heart, due to a decrease in Mean by 12.9%, Mo by 13%, Amo by 29.4%, SDNN by 28.3% compared to the group of healthy individuals, but they differed in stable indicators of heart rate variability and 33% retained sinus rhythm during the year. With cordarone monotherapy, there was a curative effect of sympathetic and parasympathetic effects on the heart, as indicated by an increase in: Mean by 15.9%, Mo by 15.9%, IVR by 95.5%, Amo by 41.1% and a decrease in SDNN by 37.5%, compared with the group of healthy individuals at the initial stage. A year later, a negative dynamics was revealed - the predominance of sympathetic influences on the heart compared to the groups of healthy individuals and the control due to an increase in: IVR by 363.3% and 238.5%; VPR by 116.7% and 106%; Amo by 111.2% and 72.9; IN by 304% and 246.8%; PAPR by 92% and 79.1%, respectively. During the year, 39% of patients left the study due to the replacement of antiarrhythmic therapy and 16.5% due to the development of a permanent form of atrial fibrillation. In the remaining patients in the study, in comparison with their initial data, there was a predominance of sympathetic effects on the heart due to an increase in IVR by 137%. In combination therapy with metoprolol and cordarone, there were no significant changes in heart rate variability compared to the initial ones. Initially, there was a decrease in overall heart rate variability due to a decrease in SDNN by 28.4% and a decrease in parasympathetic effects on the heart due to an increase in Amo by 45.2% and a decrease in Delta X by 32.9% compared to the group of healthy individuals. After a year, 40% left the study due to the replacement of antiarrhythmic therapy and 30% due to the development of a permanent form of atrial fibrillation. During dynamic observation of patients, it was found that the following indicators have the most important prognostic value in the development of atrial fibrillation: SDNN, Delta X and RMSSD. Therefore, it is very important to register an ECG with the measurement of these indicators at least once every 3 months for timely correction of treatment.
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