The aim of the study was to analyze clinical characteristics of the consecutive sample of patients with atrial fibrillation (AFib) who were admitted to the UHC Zagreb Cardiology Clinic, part of the ESH Excellence centre of hypertension. This cohort is part of the ESH –FA project.
Design and method:
Consecutive sample of 201 patients with AFib (115 M, 86 F; averaged age 71.6) was enrolled in period 2014–2016. Data were collected from medical records. BP was measured following the ESH/ESC guidelines. Hypertension (HT) was defined as BP > = 140/90 mmHg and/or antihypertensive drugs treatment, chronic kidney disease (CKD) was defined as eGFR (CKD Epi < 60 ml/min).
Average BP values and heart rate were 133.5/80.2 mmHg, 82.2 bpm, and BMI was 31.1 kg/m2, there were 19.6% and 11.5% smokers and ex-smokers, respectively. CHD, cerebrovascular disease, heart failure, valvular disease, PAD, hypothyreosis, and CKD were established in 52.7%, 17.9%, 49.3%, 29.3%, 13.9%, 14.4% and 52.5%, respectively. Family history for CVD was positive in 43.2% patients. Prevalence of HT was 83.5%, and 63.7% were treated, while 20% were newly diagnosed. Only 30.2% HT had BP < 140/90 mmHg. Most frequently used antihypertensive drugs were beta blockers (67.6%), loopD (54.7%), ACEi (50.7%), potassium-sparingD (22.8%) and thiazide-likeD (17.9%). LoopD were prescribed more frequently in patients with CKD than in non-CKD as well as in HF than in non-HF patients. Hypokalemia was noticed in 18.9% patients and was mostly reported in non-HF patients (41.1%); it was associated with overuse of loopD and underuse of potassium-sparingD. First diagnosed, paroxysmal, permanent and persistent AFib were diagnosed in 5.4%, 33.3%, 51.2% and 10.4%, respectively. CHADVASC > 2 was determined in 78.9%; varfarin and NOAC were administered in 64.4% and 35.6% patients, respectively. In patients treated with varfarin INR > 2 was achieved in only 35.4%.
Better BP control and anticoagulation with more frequent use of NOACs is needed. Physicians must be aware of high prevalence of CKD in AFib patients and consequent drug dose adjustments.