Key result
AF patients with depressed renal function were less likely to receive oral anticoagulants and more likely to receive rate control or no OAC compared to those with preserved renal function (P<.05).
Why the study?
Atrial fibrillation often co-exists with renal function impairment, prompting an investigation into AF patient characteristics, management across creatinine clearance strata, and potential changes in NOAC use based on different renal function estimation equations.
Observational (n=2,712)
p-value: p=<.05
In patients with atrial fibrillation, worsening renal function is associated with higher stroke and bleeding risks but paradoxically lower rates of oral anticoagulant use.
AF patients with impaired renal function receive less OAC; observational data leave open whether targeted strategies improve outcomes.
Background Atrial fibrillation (AF) often co‐exists with renal function (RF) impairment. We investigated the characteristics and management of AF patients across creatinine clearance strata and potential changes in the use of nonvitamin K oral anticoagulants (NOAC) according to different equations for estimation of RF. Methods In this post hoc analysis of the BALKAN‐AF survey, patients were classified according to RF (Cockcroft‐Gault formula) as: preserved/mildly depressed RF (P‐RF) ≥50 mL/min, moderately depressed RF (MD‐RF) 30‐49 mL/min, and severely depressed RF (SD‐RF) <30 mL/min. Results Of 2712 enrolled patients, 2062 (76.0%) had data on RF. Patients with SD‐RF and MD‐RF were older, had higher mean value of European Heart Rhythm Association score, stroke and bleeding risk scores, and more comorbidities than patients with P‐RF (all P < .05). They received oral anticoagulants (OAC), AF catheter ablation, and electrical cardioversion less often than those with P‐RF (all P < .05). Rate control, no OAC, single‐antiplatelet therapy (SAPT) alone, and loop diuretics were more prevalent in patients with SD‐RF and MD‐RF than in subjects with P‐RF (all P < .005). An important change in NOAC therapy could appear in <1% of patients (Modification of Diet in Renal Disease formula) and in <1% of patients (Chronic Kidney Disease Epidemiology Collaboration group formula). Conclusions Patients with SD‐RF and MD‐RF were older, more symptomatic, had higher stroke and bleeding risk and more comorbidities than those with P‐RF. They were less likely to receive OAC and more likely to use rate control strategy, SAPT alone, and no OAC than subjects with P‐RF.
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Kozieł et al. (2020) conducted an observational in Atrial fibrillation (n=2,712). Depressed renal function (creatinine clearance <50 mL/min) vs. Preserved/mildly depressed renal function (≥50 mL/min) was evaluated on Use of oral anticoagulants and other management strategies (p=<.05). AF patients with depressed renal function were less likely to receive oral anticoagulants and more likely to receive rate control or no OAC compared to those with preserved renal function (P<.05).
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