Key result
In adults with newly diagnosed atrial fibrillation, severe chronic kidney disease (eGFR <15 ml/min/1.73m2) was associated with a significantly lower likelihood of receiving any AF therapy compared to those with normal kidney function (aHR 0.64).
Why the study?
AF is prevalent in CKD and linked to worse outcomes, but limited data exist on the use of AF pharmacotherapies and procedures by CKD status.
Does CKD severity reduce the receipt of targeted AF therapies in adults with newly diagnosed atrial fibrillation?
Cohort (n=115,564)
Yes
Does CKD severity reduce the receipt of targeted AF therapies in adults with newly diagnosed atrial fibrillation?
Hazard Ratio: 0.64 (95% CI 0.58–0.7)
In adults with newly diagnosed atrial fibrillation, increasing CKD severity is associated with a significantly lower likelihood of receiving rate control agents, anticoagulation, and AF-related procedures.
Background Atrial fibrillation (AF) is highly prevalent in CKD and is associated with worse cardiovascular and kidney outcomes. Limited data exist on use of AF pharmacotherapies and AF-related procedures by CKD status. We examined a large “real-world” contemporary population with incident AF to study the association of CKD with management of AF. Methods We identified patients with newly diagnosed AF between 2010 and 2017 from two large, integrated health care delivery systems. eGFR (≥60, 45–59, 30–44, 15–29, <15 ml/min per 1.73 m 2 ) was calculated from a minimum of two ambulatory serum creatinine measures separated by ≥90 days. AF medications and procedures were identified from electronic health records. We performed multivariable Fine–Gray subdistribution hazards regression to test the association of CKD severity with receipt of targeted AF therapies. Results Among 115,564 patients with incident AF, 34% had baseline CKD. In multivariable models, compared with those with eGFR >60 ml/min per 1.73 m 2 , patients with eGFR 30–44 (adjusted hazard ratio [aHR] 0.91; 95% CI, 0.99 to 0.93), 15–29 (aHR, 0.78; 95% CI, 0.75 to 0.82), and <15 ml/min per 1.73 m 2 (aHR, 0.64; 95% CI, 0.58–0.70) had lower use of any AF therapy. Patients with eGFR 15–29 ml/min per 1.73 m 2 had lower adjusted use of rate control agents (aHR, 0.61; 95% CI, 0.56 to 0.67), warfarin (aHR, 0.89; 95% CI, 0.84 to 0.94), and DOACs (aHR, 0.23; 95% CI, 0.19 to 0.27) compared with patients with eGFR >60 ml/min per 1.73 m 2 . These associations were even stronger for eGFR <15 ml/min per 1.73 m 2 . There was also a graded association between CKD severity and receipt of AF-related procedures (vs eGFR >60 ml/min per 1.73 m 2 ): eGFR 30–44 ml/min per 1.73 (aHR, 0.78; 95% CI, 0.70 to 0.87), eGFR 15–29 ml/min per 1.73 m 2 (aHR, 0.73; 95% CI, 0.61 to 0.88), and eGFR <15 ml/min per 1.73 m 2 (aHR, 0.48; 95% CI, 0.31 to 0.74). Conclusions In adults with newly diagnosed AF, CKD severity was associated with lower receipt of rate control agents, anticoagulation, and AF procedures. Additional data on efficacy and safety of AF therapies in CKD populations are needed to inform management strategies.
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Bansal et al. (2021) conducted a cohort in Incident Atrial Fibrillation (n=115,564). Severe chronic kidney disease (eGFR <15 ml/min/1.73m2) vs. No chronic kidney disease (eGFR >60 ml/min/1.73m2) was evaluated on Receipt of any AF therapy within 1 year (aHR 0.64, 95% CI 0.58-0.70). In adults with newly diagnosed atrial fibrillation, severe chronic kidney disease (eGFR <15 ml/min/1.73m2) was associated with a significantly lower likelihood of receiving any AF therapy compared to those with normal kidney function (aHR 0.64).
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