Management of patients with valvular and non-valvular atrial fibrillation in Poland: Results from Reference Cardiology University Center

Abstract

Background: Information on epidemiology of atrial fibrillation (AF) in Middle European Countries such as Poland is limited.

Methods: We studied 1,556 patients with AF. We focused on different types of AF in terms of clinical features and management.

Results: CHA₂DS₂-VASc score was 3.5 ± 1.7 and HAS-BLED score — 2.4 ± 1.1. In-hospital mortality was 2%. The CHA₂DS₂-VASc score was the highest in permanent AF (p < 0.001) and the HAS-BLED score was the highest in paroxysmal and permanent AF (p < 0.001). The CHA₂DS₂-VASc score ≥ 2 was found in the majority of non-valvular AF patients. Permanent AF was associated with the highest thromboembolic risk (p < 0.001). Valvular AF was more commonly observed in patients with permanent AF (p = 0.004). Seventy-one percent of pa­tients who had CHA₂DS₂-VASc > 2 received antithrombotic therapy. Acetylsalicylic acid alone was most common in paroxysmal AF (p < 0.001). Patients with valvular AF had more often permanent AF (p < 0.004). Valvular AF patients were more often prescribed antithrombotic therapy (p = 0.001). The in-hospital mortality did not differ between patients with valvular and non-valvular AF (p = 0.3). In multivariate logistic regression, odds of in-hospital death were higher for patients > 75 years old (OR = 6.26, p = 0.001, 95% CI 2.06–19.02) and with ejection fraction < 35% (OR = 5.25, p < 0.001, 95% CI 2.24–12.32).

Conclusions: Our population with AF have similar risk of stroke and bleeding as in Euro­pean registries. The need for anticoagulation in AF patients is well established in daily medical care in Poland similarly to Western Europe. Patients with valvular AF are more frequently prescribed antithrombotic therapy than patients with non-valvular AF. In-hospital mortality is relatively low in both valvular and non-valvular AF patients and is connected with old age and diminished ejection fraction.