129 The presence of chronic kidney disease is a key predictor of mortality and thromboembolic complications in individuals diagnosed with atrial fibrillation

Introduction Atrial fibrillation (AF), the most prevalent cardiac arrhythmia globally, affects approximately 1.5 million individuals in the United Kingdom.¹ Anticoagulant therapy is commonly initiated for AF patients based on established risk scores like CHA2DS2-VASc and ORBIT, which predict potential stroke and bleeding complications, respectively.² However, chronic kidney disease (CKD) is an independent and under-recognized risk factor for stroke in AF patients.³ Studies have shown that the co-existence of CKD and AF significantly increases the risk of ischemic stroke, bleeding, and subsequent mortality.⁴ ⁵ Therefore, incorporating CKD evaluation into stroke risk assessment for AF patients is crucial for optimal clinical decision-making and improved patient outcomes. Purpose This study investigated the association between CKD and AF and aimed to determine if concurrent CKD was associated with: Increased one-year mortality rates. Increased incidence of thromboembolic complications. Increased rates of readmission within one year for AF-related complications. Methods We conducted a retrospective analysis of 320 consecutive emergency department (ED) presentations for AF between January 2021 and November 2021, utilizing electronic patient records. The analysis included demographic data, past medical history, medications, investigations, and one-year outcomes: mortality, thromboembolic complications, significant bleeding, and AF-related readmissions. Basic statistical methods were employed for analysis. Results A total of 320 consecutive ED presentations with AF (169 females, 151 males) were included, with a mean age of 71.93 years (figure 1). Twenty-three (7%) patients died within one year, with 14 (61%) having pre-existing CKD (p < 0.05) (figure 2). Notably, 51% (143) of the total patient population had CKD, with 14 (60%) of them succumbing to death within one year. Similarly, among the 33 patients (12%) readmitted within one year, 20 (60%) had CKD. The prevalence of thromboembolic complications was 5% (15 patients), with 67% (10 patients) having co-existing CKD (figure 2). Conclusion While established risk scores like CHA2DS2-VASc and ORBIT offer guidance in stroke risk stratification and bleeding assessment, no validated tool currently exists for predicting mortality and readmission rates in AF patients. Our findings highlight the need for incorporating CKD into future risk assessment tools. Further extensive research is warranted to confirm the validity and potential benefits of using CKD in risk stratification for this patient population. References Chung SC, Sofat R, Acosta-Mena D, Taylor JA, Lambiase PD, Casas JP, Providencia R. Atrial fibrillation epidemiology, disparity and healthcare contacts: a population-wide study of 5.6 million individuals. Lancet Reg Health Eur. 2021 Aug;7:100157. doi: 10.1016/j.lanepe.2021.100157. PMID: 34405204; PMCID: PMC8351189. Longenecker JC, Coresh J, Powe NR, Levey AS, Fink NE, Martin A, et al. Traditional cardiovascular disease risk factors in dialysis patients compared with the general population: the CHOICE Study. J Am Soc Nephrol. 2002;13:1918–27. Lee M, Saver JL, Chang KH, Liao HW, Chang SC, Ovbiagele B. Low glomerular filtration rate and risk of stroke: meta-analysis. BMJ 2010;341:c4249. Epub 2010/10/05. Molnar AO, Bota SE, Garg AX, Harel Z, Lam N, McArthur E, et al. The risk of major hemorrhage with CKD. JAmSocNephrol. 2016;27(9):2825–32. Conflict of Interest Nil