Poor Outcomes Associated with Antithrombotic Potential Undertreatment in Patients with Atrial Fibrillation: A Retrospective Cohort Study

Abstract

Objectives: To design and validate a simple, reliable and easy to use questionnaire to identify patients under vitamin K antagonists (VKA) treatment with sub-optimal time in therapeutic range (TTR; without needing the TTR values), in order to allow a closer follow-up of the actual anticoagulant treatment or guiding a possible treatment changes. MethOds: Non-interventional, cross-sectional, multicenter design. A cardiologist expert panel identified those clinical variables capable of forecasting a good TTR control. The 5 proposed indicators (ICUSI) were included in an electronic clinical record form along with thromboembolic (CHADS2 & CHA2DS2-VASc) and hemorrhagic (HAS-BLED) risk indexes. A patient diary collecting last 6 month INR measures was also included. Discriminant capabilities were assessed using binary logistic regression respect to TTR control (Rosendaal & direct methods), and discriminant validity using the area under the curve (AUC) of the ROC curve. A total of 870 patients with documented AF diagnosis, receiving VKA, and meeting the selection criteria were included. Patients were recruited at 54 Cardiology departments covering all the Spanish territory. Results: The final sample contained 777 (88.9%) of assessable cases: 45% women, 13% lived alone, and 67% did not have caregiver. Mean age was 75.3±9.2 years, mean TTR= 66.0±19.8% and 46.7% attained INR control between 2-3 (Rosendaal TTR≥ 65%). Individually, ICUSI indicators were statistically significant (p< 0.05) respect to Rosendaal or Direct non-optimal control, but one item was discarded in the overall estimation. The ICUSI index was statistically discriminant with respect to 6 months TTR< 65% with AUC= 0.705 (SE= 0.018). Using the cut-off value ICUSI≥ 1 the risk of TTR< 65%: sensitivity= 80.9%, specificity= 44.9%, positive predictive value= 62.6%, and negative predictive value= 67.4%. cOnclusiOns: Initial evidences on the ICUSI validity support a good predictive behavior on screening patients with bad anticoagulant control.

Atrial cardiomyopathy — a new concept with a long history

“…Однако если учесть, что все перечисленные классы ПКМ имеют один общий признак -электромеханическую дисфункцию предсердий, обусловленную структурным, механическим и электрическим ремоделированием, а эти изменения чаще всего приводят к развитию предсердной аритмии -ФП [5][6][7], которая ассоциирована с повышенным риском развития ТЭО, декомпенсации СН и смертности вследствие инсульта [11,[13][14][15][16][17][18][19][20], вполне ожидаемо, что анализ этиологии ПКМ, оценка показателей предсердной гемодинамики (спекл-трекинг, тканевой допплер), макроскопическое определение степени фиброза предсердий при использовании магнитно-резонансной томографии (МРТ) с контрастным усилением и выявление прокоагуляционного статуса пациентов будут иметь важное прогностическое и терапевтическое значение.…”