How to improve long-term results of patients with atrial fibrillation of non-valvular ethiology after embolism to main arteries of the limbs

Abstract

BACKGROUND: In patients with atrial fibrillation, systemic thromboembolic complications dramatically worsen the long-term prognosis. There is currently no generally accepted treatment tactics for patients with atrial fibrillation of non-valvular ethiology after embolism to main arteries of the limbs. Objective: evaluate the efficacy of our approach for patients with atrial fibrillationof non-valvular ethiology who survived an embolism to main arteries of the limbs and acute limb ischemia.
 MATERIALS AND METHODS: For the period from 1991 to 2022, in the Department of Vascular Surgery of our institution, emergency care due to embolism and acute limb ischemia was provided to 1816 patients. In 1425 (78.5%) patients, the main disease that led to arterial embolism was non-valvular atrial fibrillation. In the long-term period after discharge from our clinic, it was possible to trace the fate of 216 patients and determine the cause of death for 106 patients. The main causes of death in the long-term period were the decompensation of chronic diseases of the cardiovascular system in 73,6% of patients and the recurrence of systemic thromboembolic complications in 21.7%. Since 2012, at our department an integrated approach has been developed and implemented. It included a set of measures aimed at compensating for chronic cardiovascular pathology and preventing the recurrence of systemic thromboembolic complications. The whole set of measures all patients underwent during their current hospitalization after the elimination of life-threatening complications associated with acute limb ischemia and the stabilization of their general condition. They formed the main group (n = 50). The control group (n = 166) consisted of patients after embolism and acute limb ischemia discharged before 2012. Their cardiac pathology was treated after discharge from our department on an outpatient basis in a polyclinic at their place of residence. The overall comparative survival rate was analyzed. The survival function was evaluated using the Kaplan – Meyer method.
 RESULTS: In the control group, long-term survival was low, and the median life expectancy was 24 months after discharge. In the main group, long-term survival improved significantly, and the median survival period was not reached during the observation time set. The differences in overall survival estimated using the likelihood ratio test were statistically significant (p = 0.001). When evaluating the groups, the risk of death in the main group was 2.2 times lower than in the control group for each month of follow-up (p = 0.003).
 CONCLUSION: the set of measures implemented in our clinic over the last decade for patients with atrial fibrillation of non-valvular ethiology hospitalized with arterial embolism and acute limb ischemia has proved its efficacy and significantly (p = 0.003) improved the survival rate of patients with long-term follow-up after discharge from our department.