Clinical Profile of Patients with Atrial Fibrillation According to EHRA (Evaluated Heart Valves, Rheumatic or Artificial) Categorization in A Middle-Income Country

Abstract

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in clinical practice. As of 2017, a functional EHRA (Evaluated Heart valves, Rheumatic or Artificial) categorization was proposed to replace the terms valvular and non-valvular AF. In our country, despite the incidence of rheumatic valve heart disease, studies on this new categorization are scarce Objective: to assess the clinical profile of patients (pts) with AF, using the EHRA categorization as a parameter. Methods: this is a prospective, observational and cross-sectional study with 475 pts with AF from a university institution. Clinical and laboratory evaluations were carried out, as well as the calculation of risk scores for embolism, bleeding and renal function. Statistical analysis was performed by non-parametric tests, in addition to the chi-square test. Results: the pts were divided into 3 groups, according to the EHRA categorization: EHRA 1, with 144 pts, with mitral stenosis or mechanical prosthesis; EHRA 2, with 46 pts with other valvular heart diseases; and EHRA 3, with 285 pts, without valvular heart disease. Mean ages were 51.5; 57.6 and 62.9 years, respectively (p<0.0001). The proportions of women were 75%; 52.1% and 40.7% (p<0.0001). The presentation of the AF was permanent in 68.1%; 60.9%; 52.3% of pts (p=0.008) and 86.0%; 47.8% and 53.3% of pts were using oral anticoagulants, respectively (p<0.0001). The means of left ventricular ejection fraction were 0.58; 0.57 and 0.46; of left atrium were 55.9; 52.5 and 48.1 mm; ATRIA score of 1.4; 1.3 and 2.1; and the glomerular filtration rate of 91.7; 91.1 and 75.0 mL/min/1.73m², respectively (p<0.0001). There was no difference among groups regarding blood pressure and heart rate at study entry and regarding the history of embolism. Conclusions: pts from the EHRA 1 categorization were younger, with a higher proportion of women, permanent AF and use of oral anticoagulants. Systolic dysfunction predominated in those without valve disease, who also had a higher bleeding score and greater impairment of renal function.