O.S. Sychov, A.O. Borodai, E.S. Borodai Rhythm control, adherence to anticoagulation therapy and risk of cardiovascular death in patients with non-valvular atrial fibrillation–flutter

The aim – to evaluate the risk of cardiovascular mortality in clinical practice with adherence to rhythm control strategy and anticoagulation therapy in patients with non-valvular atrial fibrillation and flutter (AF–AFl).

Material and methods. In a prospective observational study with a median follow-up of 36.8 (LQ 24.9–UQ 64.6) months we examined 293 patients with non-valvular AF–AFl, mean age 60.5±10.4 years, among them 81 (27.65 %) females. The mean CHA2DS2-VASc score was 2.25±1.46. All patients underwent clinical examination and transthoracic echocardiography. Transesophageal echocardiography was performed in 263 (89.76 %) patients.

Results. Cardiovascular death occurred in 20 (6.83 %) of cases during follow-up. 140 (52.83 %) patients were referred to the rhythm control group, and 125 (47.17 %) to the rate control group. Cardiac death occurred in only 1 (0.71 %) patient in the rhythm control group, versus 15 (12 %) patients of the rate control group (P<0,001). According to survey results, 138 (47.1 %) patients were adherent to the anticoagulation therapy (ACT), and 155 (52.9 %) were not adherent to. In the adherent to ACT group, cardiovascular death occurred in 4 (2.9 %) patients, versus 16 (10.32 %) in non-adherent group (P=0.004). In the multivariant regression model, history of stroke (relative risk (RR) 11.45, 95 % CІ 2.44–53.7, P=0.002) and myocardial infarction (RR 6.6, 95 % CІ 1.7–25.4, P=0,006), adherence to ACT (RR 0.07, 95 % CІ 0.014–0.34, P=0.001) and the rhythm control strategy (RR 0.06, 95 % CІ 0.01–0.48, P=0.008), independently reduced the risk of cardiovascular death. Conclusions. Rhythm control strategy independently of adherence to ACT recommendations reduces the risk of cardiovascular death in patients with non-valvular AF–AFl.

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