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Diagnosis and Treatment for Patients with Atrial Fibrillation

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (31 May 2023) | Viewed by 5580

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Dr. Marcin Wełnicki

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Guest Editor

3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, 02-091 Warszawa, Poland
Interests: cardiology; clinical pharmacology; general and internal medicine; lung ultrasound; dyslipidemia and metabolic disorders

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Dear Colleagues,

There is no doubt that atrial fibrillation is the most common arrhythmia. The frequency of its occurrence has clearly increased over the last few decades, as already predicted by Professor Braunwald at the end of the last century. It was this outstanding cardiologist who anticipated that heart failure and atrial fibrillation would become cardiological epidemics of the 21st century. Although cardiologists mainly deal with atrial fibrillation, the prevalence of this arrhythmia means that it is not unknown to any field of medicine. Common risk factors for this arrhythmia, such as obesity, lack of physical activity, and smoking are an issue associated with increasingly appreciated lifestyle medicine. Arterial hypertension, chronic obstructive pulmonary disease, obstructive sleep apnea—these, in turn, are the scope of interest for classic specialties originating from internal medicine. The key aspect of treating patients, anticoagulation therapy, is the apple of cardiologists’ eye, but at the same time an important topic for neurologists and often difficult for gestroenterologists or surgeons. From risk factors, diagnostics, and treatment principles to complications and quality of life of affected patients, and the financial burden on health systems, atrial fibrillation is an extremely interesting topic for analysis, research, registries, and reviews and discussions. We hope that our Special Issue will reflect the complexity of this arrhythmia.

Dr. Marcin Wełnicki
Guest Editor

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Keywords

anticoagulant therapy
stroke
heart failure
obesity
antiarrhythmic drugs
telemedicine
catheter ablation
quality of life

Published Papers (3 papers)

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Research

13 pages, 1110 KiB

Open AccessArticle

Do Patients with Atrial Fibrillation and a History of Ischemic Stroke Overuse Reduced Doses of NOACs?—Results of the Polish Atrial Fibrillation (POL-AF) Registry

by Anna Szyszkowska, Łukasz Kuźma, Beata Wożakowska-Kapłon, Iwona Gorczyca-Głowacka, Olga Jelonek, Beata Uziębło-Życzkowska, Paweł Krzesiński, Maciej Wójcik, Robert Błaszczyk, Monika Gawałko, Agnieszka Kapłon-Cieślicka, Tomasz Tokarek, Renata Rajtar-Salwa, Jacek Bil, Michał Wojewódzki, Anna Szpotowicz, Małgorzata Krzciuk, Janusz Bednarski, Elwira Bakuła, Marcin Wełnicki, Artur Mamcarz and Anna Tomaszuk-Kazberuk Show full author list Hide full author list

Int. J. Environ. Res. Public Health 2022, 19(19), 11939; https://doi.org/10.3390/ijerph191911939 - 21 Sep 2022

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Abstract

Background: The aim of our study was to assess if patients with AF (atrial fibrillation) and a history of ischemic stroke (IS) excessively receive reduced doses of NOACs (non-vitamin K antagonist oral anticoagulants). Methods: The Polish AF (POL-AF) registry is a prospective, observational, multicenter study, including patients with AF from 10 cardiology hospital centers. In this study we focused on patients with IS in their past. Results: Among 3999 patients enrolled in the POL-AF registry, 479 (12%) had a previous history of IS. Compared to patients without IS history, post-stroke subjects had a higher CHA₂DS₂-VASc score (median score 7 vs. 4, p < 0.05). Of these subjects, 439 (92%) had anticoagulation therapy, 83 (18.9%) were treated with a vitamin K antagonist (VKA), 135 (30.8%) with rivaroxaban, 112 (25.5%) with dabigatran, and 109 (24.8%) with apixaban. There were a significant number of patients after IS with reduced doses of NOACs (48.9% for rivaroxaban, 45.5% for dabigatran, and 36.7% for apixaban). In many cases, patients were prescribed reduced doses of NOACs without any indication for reduction (28.8% of rivaroxaban use, 56.9% of dabigatran use, and 60.0% of apixaban use—out of reduced dosage groups, p = 0.06). Conclusions: A significant proportion of AF patients received reduced doses of NOAC after ischemic stroke in a sizeable number of cases, without indication for dose reduction. Full article

(This article belongs to the Special Issue Diagnosis and Treatment for Patients with Atrial Fibrillation)

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15 pages, 3284 KiB

Open AccessArticle

Association of Hyperuricemia with Impaired Left Ventricular Systolic Function in Patients with Atrial Fibrillation and Preserved Kidney Function: Analysis of the POL-AF Registry Cohort

by Marcin Wełnicki, Iwona Gorczyca-Głowacka, Arkadiusz Lubas, Wiktor Wójcik, Olga Jelonek, Małgorzata Maciorowska, Beata Uziębło-Życzkowska, Maciej Wójcik, Robert Błaszczyk, Renata Rajtar-Salwa, Tomasz Tokarek, Jacek Bil, Michał Wojewódzki, Anna Szpotowicz, Małgorzata Krzciuk, Monika Gawałko, Agnieszka Kapłon-Cieślicka, Anna Tomaszuk-Kazberuk, Anna Szyszkowska, Janusz Bednarski, Elwira Bakuła-Ostalska, Beata Wożakowska-Kapłon and Artur Mamcarz Show full author list Hide full author list

Int. J. Environ. Res. Public Health 2022, 19(12), 7288; https://doi.org/10.3390/ijerph19127288 - 14 Jun 2022

Cited by 2 | Viewed by 1867

Abstract

Hyperuricemia is associated with the risk of developing atrial fibrillation (AF) and heart failure. However, coexisting chronic kidney disease and certain cardiovascular drugs make it difficult to determine whether hyperuricemia is a risk factor or merely a marker of pathology. We retrieved data from the Polish Atrial Fibrillation (POL-AF) registry, which included consecutive patients hospitalized with AF from January to December, 2019. We included 829 patients (mean age: 72.7 ± 11.1 years) with data on serum uric acid (UA, mean: 6.56 ± 1.78 mg/dL) and estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m². We found that UA and ejection fraction (EF) were significantly correlated (r = −0.15, p < 0.05), but not EF and eGFR or eGFR and UA. A multiple regression analysis adjusted for age, body mass index, eGFR, and UA, showed that UA was significantly associated with a reduced EF (R²: 0.021; p < 0.001). The UA cut-off indicative of an EF < 40% was 6.69 mg/dL (AUC, area under the curve: 0.607; 95% CI: 0.554–0.660; p = 0.001). Among drugs known to effect UA concentrations, we found that only diuretics were used more frequently in patients with high UA (above the median) than in patients with low UA (77.5% vs. 67%, p < 0.001). Among patients that used diuretics, UA remained significantly correlated with EF. Thus, we showed that reduced EF was associated with UA in patients with AF and normal renal function, independent of eGFR and diuretic use. Full article

(This article belongs to the Special Issue Diagnosis and Treatment for Patients with Atrial Fibrillation)

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11 pages, 8837 KiB

Open AccessArticle

Temporal Trends in Oral Anticoagulant Prescription in Atrial Fibrillation Patients between 2004 and 2019

by Iwona Gorczyca-Głowacka, Bernadetta Bielecka, Paweł Wałek, Magdalena Chrapek, Agnieszka Ciba-Stemplewska, Olga Jelonek, Anna Kot, Anna Czyżyk, Maciej Pióro, Agnieszka Major and Beata Wożakowska-Kapłon

Int. J. Environ. Res. Public Health 2022, 19(9), 5584; https://doi.org/10.3390/ijerph19095584 - 4 May 2022

Cited by 2 | Viewed by 1409

Abstract

Background: In the recent years, antithrombotic prophylaxis in patients with atrial fibrillation (AF) has changed significantly. The main aim of this study is to assess the temporal trends of antithrombotic therapy and identify factors predisposing oral anticoagulant (OAC) use in stroke prevention in AF patients. Methods: The present study is a retrospective, observational, single-center study, which includes consecutively hospitalized patients in the reference cardiology center from January 2004 to December 2019. Results: A total of 9656 patients (43.7% female, mean age 71.2 years) with AF between 2004–2019 are included. Among the total study population, in most of the patients (81.1%), OAC therapy was used, antiplatelet (APT) therapy was prescribed for 13.5% patients, heparins for 2.1% patients and 3.3% of patients did not receive any stroke prevention. OAC prescription significantly increased from 61.6% in 2004 to 97.4% in 2019. The independent predictors of OAC prescription were: the period of hospitalization, non-paroxysmal AF, age, hypertension, diabetes mellitus, previous thromboembolism, hospitalization due to electrical cardioversion, ablation or AF without any procedures. Conclusions: In hospitalized patients with AF, during sixteen years of the study period, a significant increase in OAC use and a decrease in APT use were noted. Factors other than these included in the CHA₂DS₂-VASc score were independent predictors of OAC use. Full article

(This article belongs to the Special Issue Diagnosis and Treatment for Patients with Atrial Fibrillation)

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