Abstract 19130: Characteristics of Atrial Fibrillation in Hemodialysis Patients

Abstract

Objectives: Atrial fibrillation (AF) is the most common sustained arrhythmia in general population. Although several studies reported a high incidence and prevalence of AF in haemodialysis patients there is no substantial data on thromboembolic risk scales such as CHADS2 or CHADS-Vasc predicting stroke and mortality. The aim of this analysis was to evaluate the effectivenes of these scales for predicting stroke and mortality in haemodialysis patients with AF. Methods: A total of 402674 patients over the age 18 who had the diagnosis of non-valvular atrial fibrillation (AF). From this database haemodialysis patients were separated and reanalyzed. The main descriptive statistics of population contained in the database include major bleeding including intracranial and gastrointestinal bleeding, mortality, hospitalizations, and thoromboemboli risk scales. Results: There were 5505 haemodialysis patients with AF (52.4 % men).The four year follow-up data of the 2008 cohort of 992 haemodialysis patients with AF demonstrated 67.4 % mortality and 38.6 % ischemic stroke in four years. Mortality among hemodialysis patients have been shown to be significantly higher than the rest of the cohort (67.4% vs. 31.4% in the rest of the cohort, p < 0.000). The median CHA2DS2-VASc and CHADS score were 4 and 2 respectively among the 5505 heamodialysis patients in the registry. Acording to time dependent ROC curve analysis, CHADS2 was a more accurate scale than CHA2DS2-VASc for predicting stroke in heamodialysis patients upto 40 months-to-stroke after first AF diagnosis, beyond which CHADS2 and CHA2DS2-VASc perform similarly. Hemorrhagic stroke and major bleeding including GI bleeding were higher in warfarin users of haemodialysis patients than the rest of the cohort under warfarin ( 3.2% and 2 % respectively .p < 0.000). Conclusion: This analysis demonstrated that 1) The prevalence of AF in haemodialysis patients were significantly higher than those of general population, with higher mortality,2) CADS2 was a more accurate scale to CHA2DS2-VASc for predicting stroke up to 40 months. 3) Among the warfarin users ,in the Registry population major bleeding was much higher in the haemodialysis patients.