DIAGNOSTICS, TREATMENT, ASSOCIATED CARDIOVASCULAR AND CONCOMITANT NON-CARDIAC DISEASES IN PATIENTS WITH DIAGNOSIS OF “ATRIAL FIBRILLATION” IN REAL OUTPATIENT PRACTICE (ACCORDING TO DATA OF REGISTRY OF CARDIOVASCULAR DISEASES, RECVASA)

Aim. To study the structure of risk factors and associated cardiovascular and concomitant non-cardiac diseases in patients with atrial fibrillation (AF) on the base of the data of registry, and to estimate diagnostics and treatment quality in real outpatient practice in the Ryazan region with high cardiovascular mortality rate.

Material and methods. A total of 3690 patients with AF, arterial hypertension (HT), ischemic heart disease (IHD) and chronic heart failure (CHF) consulted by general practitioners and cardiologists in three outpatient clinics of Ryazan, were enrolled into the outpatient REgistry of CardioVAScular diseAses (RECVASA). 530 of 3690 (14.4%) patients had the "atrial fibrillation" diagnosis in their outpatient charts: 175 (33.0%) men, 355 (67.0%) women, and mean age – 72.3±10.1 years.

Results. Permanent, paroxysmal or persistent forms of AF were indicated in outpatient charts of 43.2%, 26.4% and 24.7% of 530 AF patients, respectively, and 5.7% of outpatient charts did not specify AF form. All the AF patients had associated cardiovascular diseases (HT and/or IHD and/or CHF). The history of myocardial infarction, stroke and diabetes was revealed in 20.2%, 14.9% and 21.1% of patients, respectively. Revealed level of diagnostics did not satisfy adequate standard of examination with such cardiac pathology. Prescription of necessary drugs of some groups was insufficient, although indications existed. At the time of being included into the registry only 15.2% of AF patients received cardio-vascular drugs at a privileged price compared to 39.2% in the preceding years (p<0.05). AF diagnosis was confirmed in 84.2% of 76 randomly selected patients at its validation.

Conclusion. The RECVASA research revealed high incidence of cardiac comorbidity in patients with the AF, underestimation of cardiovascular risk factors, insufficient use of diagnostic tests and prescription of some drug groups recommended by national and international guidelines.

1. Go AS, Mozaffarian D, Roger VL, et al. Heart Disease and Stroke Statistics -2013 Update: A Report From the American Heart Association. Circulation 2013;127: e6-e245.

2. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL, eds. Global Burden of Disease and Risk Factors. Washington: Oxford University Press and World Bank; 2006.

3. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation 2014;129: published online March 28, 2014.

4. Camm AJ, Kirchof P, Gregory YH, et al. Guidelines for the management of atrial fibrillation. The task force of the management of patient with atrial fibrillation (2010 Version) of the European Society of Cardiology (ESC). Eur Heart J 2010; 31, 2369-429.

5. Diagnosis and treatment of atrial fibrillation. 2012 RSC/RSSA/RACVS guideline. Available at: http://scardio.ru/content/Guidelines/FP_rkj_13.pdf. Accessed by 06.08.2014. Russian (Диагностика и лечение фибрилляции предсердий. Рекомендации ВНОК, ВНОА, АССХ (2012). Доступно на: http://scardio.ru/content/Guidelines/FP_rkj_13.pdf. Проверено 06.08.2014).

6. Shalnova SA, Deev AD, Konstantinov VV. Prevalence of atrial fibrillation and its associations with traditional risk factors and coronary heart disease in Russian population. European Journal for Preventive Cardiology 2013; 20 suppl 1; P374.

7. Solnechnaya EV, Yurieva SV, Tatarskii BA, et al. Epidemiology of atrial fibrillation. Human Ecology 2006; 11: 48-52. Russian (Солнечная Е.В., Юрьева С.В., Татарский Б.А. и др. Эпидемиология фибрилляции предсердий. Экология человека 2006;11: 48-52).

8. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 1991; 22: 983-8.

9. Heeringa J, van der Kuip DA, Hofman A, et al. Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J 2006; 27: 949-53.

10. Gliklich RE. Registries for Evaluating Patient Outcomes: A User’s Guide. Rockville, MD: Agency for Healthcare Research and Quality; 2010.

11. Boytsov SA, Martsevich SYu, Kutishenko NP, et al. Registers in cardiology. Basic rules of conduct and a real opportunity. Cardiovascular Therapy and Prevention 2013; 12 (1); 4-9. Russian (Бойцов С.А., Марцевич С.Ю., Кутишенко Н.П. и др. Регистры в кардиологии. Основные правила проведения и реальные возможности. Кардиоваскулярная Терапия и Профилактика 2013; 12 (1); 4-9).

12. Boytsov SA, Jakushin SS, Martsevich SYu, et al. Outpatient polyclinic case of cardiovascular diseases in the Ryazan region (RECVAZA): key challenges, the experience of creating and first results. Ration Pharmacother Cardiol 2013; 9 (1): 4-14. Russian (Бойцов С.А., Якушин С.С., Марцевич С.Ю. и др. Амбулаторно-поликлинический регистр кардиоваскулярных заболеваний в Рязанской области (РЕКВАЗА): основные задачи, опыт создания и первые результаты. Рациональная Фармакотерапия в Кардиологии 2013; 9(1): 4-14).

13. Kakkar AK, Mueller I, Bassand JP et al. International longitudinal registry of patients with atrial fibrillation at risk of stroke: Global Anticoagulant Registry in the FIELD (GARFIELD). Am Heart J 2012; 163(1): 13-19.e1.

14. Camm AJ, Breithardt G, Crijns H., et al. Real-life observations of clinical outcomes with rhythm- and rate-control therapies for atrial fibrillation RECORDAF (Registry on Cardiac Rhythm Disorders Assessing the Control of Atrial Fibrillation). J Am Coll Cardiol 2011; 58(5):493-501.

15. Alam M1, Bandeali SJ, Shahzad SA, Lakkis N. Real-life global survey evaluating patients with atrial fibrillation (REALISE-AF): results of an international observational registry. Expert Rev Cardiovasc Ther 2012;10(3):283-91.

16. Kirchhof P, Ammentorp B, Darius H. et al. Management of atrial fibrillation in seven European countries after the publication of the 2010 ESC Guidelines on atrial fibrillation: primary results of the PREvention oF thromboembolic events—European Registry in Atrial Fibrillation (PREFER in AF). Europace 2014 Jan;16(1):6-14.

17. Oldgren J, Healey JS, Ezekowitz M, et al. Variations in etiology and management of atrial fibrillation in a prospective registry of 15,400 emergency department patients in 46 countries: The RE-LY AF Registry. Circulation 2014; doi:10.1161/circulationaha.113.005451.

18. Christiansen CB, Olesen JB, Gislason G, et al. Cardiovascular and non-cardiovascular hospital admissions associated with atrial fibrillation: a Danish nationwide, retrospective cohort study BMJ Open 2013;3:e001800. doi:10.1136/bmjopen-2012-001800.

19. Meinertz T., Kirch W., Rosin L., ey al. Management of atrial fibrillation by primary care physicians in Germany: baseline results of the ATRIUM registry. Clin Res Cardiol 2011; 100: 897-905.

20. Reynolds M.R., Essebag V., Zimetbaum P., Cohen D.J. Healthcare Resource Utilization and Costs Associated with Recurrent Episodes of Atrial fibrillation: The FRACTAL Registry. J Cardiovasc Electrophysiol 2007; 18(6): 628-33.

21. Nabauer M., Gerth A., Limbourg T. et al. The Registry of the German Competence NETwork on Atrial Fibrillation: patient characteristics and initial management. Europace 2009; 11: 423-34.

22. Potpara T, Polovina M.M., Mujovic N.M. Patient preferences at ten years following initial diagnosis of atrial fibrillation: the Belgrade Atrial Fibrillation Study. Patient Preference and Adherence 2013:7 835-42.

23. Lee S.H., Park S-J, Byeon K, et al. Risk Factors between Patients with Lone and Non-Lone Atrial Fibrillation. J Korean Med Sci 2013; 28(8): 1174-80.

24. Fostbol E.L., D.N.Holmes, J.P.Piccini et al. Provider speciality and atrial fibrillation treatment strategies in United States community practice: findings from the ORBIT-AF registry. J Am Heart Assoc. 2013;2:e000110.

25. Martsevich SYu, Navasardyan AR, Kutishenko NP, et al. learning experience atrial fibrillation on the basis of the PROFILE register. Cardiovascular Therapy and Prevention 2014; (2): 35-9. Марцевич С.Ю., Навасардян А.Р., Кутишенко Н.П. и др. Опыт изучения фибрилляции предсердий на базе регистра ПРОФИЛЬ. Кардиоваскулярная Терапия и Профилактика 2014; (2): 35-9.

26. Kannel WB, Abbott RD, Savage DD, McNamara PM. Coronary heart disease and atrial fibrillation: The Framingham Study. Am Heart J 1983; 106: 389-96.

27. Lok NS, Lau CP. Presentation and management of patients admitted with atrial fibrillation: A review of 291 cases in a regional hospital. Int J Cardiol 1995; 48: 271-8.

28. Health and demographic indicators of the Russian Federation (2012). Statistical materials. Moscow: Russian Ministry of Health; 2013. Russian (Медико-демографические показатели Российской Федерации (2012). Статистические материалы.. М.: Минздрав России; 2013).