Antithrombotic prescription and clinical outcomes among patients with atrial fibrillation

Abstract

Patients with atrial fibrillation (AF) are at risk of developing heart failure and stroke, which contribute to its high morbidity and mortality. Optimal anticoagulation therapy significantly reduces stroke risk, though it predisposes patients to bleeding. There is little information on the outcomes of patients with AF receiving antithrombotic therapy in our setting. This study aimed at determining the heart failure, ischemic stroke, major bleeding, hospitalisation and mortality rates, to compare the outcomes according to antithrombotic treatment, and to determine the predictors of adverse outcomes in patients with AF. It was a hospital-based prospective cohort study, using a retrospective atrial fibrillation registry. Baseline characteristics were obtained from the registry and follow-up was done 12 months after inclusion in the registry. We enrolled 113 participants, and follow-up was completed for 107 of them (94.7%). The mean age was 70 ± 12 years with a marked female predominance (F:M= 2.1:1). Antiplatelets, Vitamin K Antagonists and Non Vitamin K oral anticoagulants were the prescribed antithrombotic treatment in 24.8%, 52.2% and 23% of the population respectively. Hospitalisation was the most frequent event (35.1%), followed by heart failure (18.6%) and death (16.8%). Ischemic stroke occurred in 5 (5.2%) participants and major bleeding in 3 (3.1%). Overall, 47.7% of the participants experienced an outcome. There was no difference in the outcomes of patients according to their antithrombotic treatment. Previous heart failure and sedentary lifestyle were independently associated with mortality ( P = 0.019 and 0.025 respectively). Age > 60 years was associated with hospitalisation ( P = 0.031) and male gender with ischemic stroke ( P = 0.043). AF related morbidity and mortality remains high due to sub-optimal anticoagulation. More strategies are needed to improve the outcomes of those patients.