Anticoagulant therapy and prognosis in patients with CHF and AF in the setting of real-life clinical practice

Background. Prevalence of atrial fibrillation (AF) grows with the increase in CHF FC and reaches 45% in III-IV FC CHF. With an adequate anticoagulant (AC) therapy, the risk of thromboembolic complications does not significantly differ between patients with I-II FC and III-IV FC CHF. Of particular interest is studying administration of the anticoagulant treatment and correspondence between the SAMe-TT₂R₂ scale and actual TTR values in patients with CHF and AF in real-life clinical practice. Aim. Toanalyze the efficacy of anticoagulant therapy and prognosis in patients with CHF and AF in the setting of real-life clinical practice. Materials and methods. The study included 272 patients with CHF and AF who were discharged from the hospital where they had been treated for decompensated CHF and who were followed up as outpatients for a year. Efficacy of the AC therapy was evaluated; parameters of CHA₂DS₂-VASc, HAS-BLED, and SAMe-TT₂R2 scales were calculated at baseline. TTR was computed to determine the mainte nance time. Results. Patients with CHF had permanent (56.3%), persistent (38.6%), or paroxysmal (5.1%) AF. The mean CHA₂DS₂-VASc score was 3.83±1.16 and the mean HAS-BLED score was 1.3±0.83. SAMe-TT₂R₂ scores were 0 for 1.6% of patients; 1 for 36.9%, and 2< for 61.5%. At baseline, one third of patients with CHF and AF received antiplatelet therapy (APT) and every forth patient received no therapy. At one year, 69.0% of patients took AC on a constant basis (р<0.001), including warfarin (30.4%, р=0.9), NOACs (38.6%, р<0.001), specifically, rivaroxaban (22.8%, р<0.001), dabigatran (9.8%), and apixaban (6.0%). All-cause mortality was 6.4% for patients with CHF and AF who received anticoagulants whereas it was 2.2 times higher with any antiplatelet therapy or no therapy (р=0.03, OR=2.4; 1.0-5.7). One-year cardiovascular mortality was 3.7% for the AC treatment group and 3.2 times higher for the APT and no therapy group (р=0.01, OR=3.5; 1.3-9.5). The TTR index >70% was observed for 12.6% patients receiving warfarin. One female patient from the NOAC group had fatal GI bleeding. Non-fatal bleeding was observed 1.3 times more frequently during the warfarin treatment (OR=1.3; 0.2-9.2; р=0.8). Conclusion. Most patients with CHF and AF had high CHA₂DS₂-VASc values and low HAS-BLED values. In real-life outpatient practice, there is a gap between clinical recommendations and reality. Maintaining sufficient TTR values in patients with CHF and AF receiving warfarin is not always possible, which supports the priority of NOAC treatment.

хроническая сердечная недостаточность, фибрилляция предсердий, лечение, НОАК, сердечно-сосудистые осложнения, общая и сердечно-сосудистая смертность, chronic heart failure, atrial fibrillation, treatment, NOAC, cardiovascular complications, total and cardiovascular mortality

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