English Polski
Vol 16, No 6 (2021)
Original paper
Published online: 2021-12-15

open access

Page views 6307
Article views/downloads 596
Get Citation

Connect on Social Media

Connect on Social Media

Does the CHA2DS2-VASc score determine anticoagulant treatment in atrial fibrillation patients? Data from the POLish Atrial Fibrillation (POL-AF) Registry

Anna Szpotowicz1, Iwona Gorczyca-Głowacka23, Beata Uziębło-Życzkowska4, Małgorzata Maciorowska5, Maciej Wójcik6, Robert Błaszczyk6, Agnieszka Kapłon-Cieślicka7, Monika Gawałko789, Monika Budnik7, Tomasz Tokarek10, Renata Rajtar-Salwa10, Jacek Bil11, Michał Wojewódzki11, Janusz Bednarski1213, Elwira Bakuła-Ostalska12, Anna Tomaszuk-Kazberuk14, Anna Szyszkowska14, Marcin Wełnicki15, Artur Mamcarz15, Małgorzata Krzciuk16, Beata Wożakowska-Kapłon23
Folia Cardiologica 2021;16(6):359-368.

Abstract

Introduction. Oral anticoagulants (OAC) should be used in patients with atrial fibrillation (AF) depending on the thromboembolic risk assessed using the CHA2DS2-VASc score. The aim of the study is to verification if the CHA2DS2-VASc score influences using OACs in patients with AF and also to analyse predictors of OAC use in AF patients at non-high (intermediate and low) thromboembolic risk. Material and methods. The presented study has been based on the data from the POL-AF Registry which is a prospective, multicentre study including patients with diagnosed AF consecutively hospitalized in 10 cardiology centres from January to December 2019. Results. The study comprised 3,956 patients. A high risk of thromboembolic complications was observed in 91.4%, intermediate in 6.3% and low in 2.3% of them. OACs were administered to 81.1% of patients, including 91.5% at high, 90.3% at intermediate and 86.2% at low thromboembolic risk. CHA2DS2-VASc score was not a predictor of using OACs in all patients with AF [odds ratio (OR) 1.02, confidence interval (CI): 0.96–1.08, p = 0.747]. In the group of patients with non-high thromboembolic risk, the factor predisposing to OAC prescription was hospitalization due to electrical cardioversion [OR 6.55, CI: 1.52–28.21, p = 0,012], contrary to anaemia (OR 0.27, CI: 0.12–0.64, p = 0,003) and cancer (OR 0.14, CI: 0.03–0.57, p = 0.006), which decreased the chance of using OACs in this group. Conclusions. The CHA2DS2-VASc score was not a predictor of OAC use in the whole study cohort. In the significant proportion of non-high thromboembolic risk patients with AF, OACs were administered, mainly because of temporary indications.

Article available in PDF format

View PDF Download PDF file

References

  1. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991; 22(8): 983–988.
  2. Kishore A, Vail A, Majid A, et al. Detection of atrial fibrillation after ischemic stroke or transient ischemic attack: a systematic review and meta-analysis. Stroke. 2014; 45(2): 520–526.
  3. Park JW, Camm AJ, Lip GYH, et al. ESC Committee for Practice Guidelines (CPG). 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J. 2012; 33(21): 2719–2747.
  4. Kirchhof P, Benussi S, Kotecha D, et al. ESC Scientific Document Group. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016; 37(38): 2893–2962.
  5. Hindricks G, Potpara T, Dagres N, et al. ESC Scientific Document Group. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021; 42(5): 373–498.
  6. Verbrugge FH, Martin AC, Siegal D, et al. Impact of oral anticoagulation in patients with atrial fibrillation at very low thromboembolic risk. Heart. 2020; 106(11): 845–851.
  7. Steinberg BA, Blanco RG, Ollis D, et al. ORBIT-AF Steering Committee Investigators. Outcomes registry for better informed treatment of atrial fibrillation II: rationale and design of the ORBIT-AF II registry. Am Heart J. 2014; 168(2): 160–167.
  8. Potpara TS, Dan GA, Trendafilova E, et al. BALKAN-AF Investigators. Stroke prevention in atrial fibrillation and 'real world' adherence to guidelines in the Balkan Region: The BALKAN-AF Survey. Sci Rep. 2016; 6: 20432.
  9. Wełnicki M, Gorczyca I, Wójcik W, et al. Hyperuricemia as a marker of reduced left ventricular ejection fraction in patients with atrial fibrillation: results of the POL-AF Registry Study. J Clin Med. 2021; 10(9).
  10. Uziębło-Życzkowska B, Krzesiński P, Maciorowska M, et al. Antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention, including compliance with current guidelines-data from the POLish Atrial Fibrillation (POL-AF) Registry. Cardiovasc Diagn Ther. 2021; 11(1): 14–27.
  11. Gorczyca I, Jelonek O, Uziębło-Życzkowska B, et al. Trends in the prescription of non-vitamin K antagonist oral anticoagulants for atrial fibrillation: results of the Polish Atrial Fibrillation (POL-AF) Registry. J Clin Med. 2020; 9(11).
  12. Heidbuchel H, Verhamme P, Alings M, et al. ESC Scientific Document Group, European Heart Rhythm Association. EHRA practical guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation: executive summary. Eur Heart J. 2013; 34(27): 2094–2106.
  13. Steffel J, Verhamme P, Potpara TS, et al. ESC Scientific Document Group. The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: executive summary. Europace. 2018; 20(8): 1231–1242.
  14. Verbrugge FH, Martin AC, Siegal D, et al. Impact of oral anticoagulation in patients with atrial fibrillation at very low thromboembolic risk. Heart. 2020; 106(11): 845–851.
  15. Katz DF, Maddox TM, Turakhia M, et al. Contemporary trends in oral anticoagulant prescription in atrial fibrillation patients at low to moderate risk of stroke ater guideline-recommended change in use of the CHADS to the CHADS-VASc score for thromboembolic risk assessment: analysis from the National Cardiovascular Data Registry's Outpatient Practice Innovation and Clinical Excellence Atrial Fibrillation Registry. Circ Cardiovasc Qual Outcomes. 2017; 10(5).
  16. Wu J, Alsaeed ES, Barrett J, et al. Prescription of oral anticoagulants and antiplatelets for stroke prophylaxis in atrial fibrillation: nationwide time series ecological analysis. Europace. 2020; 22(9): 1311–1319.
  17. Kirchhof P, Ammentorp B, Darius H, et al. Management of atrial fibrillation in seven European countries after the publication of the 2010 ESC Guidelines on atrial fibrillation: primary results of the PREvention oF thromboemolic events--European Registry in Atrial Fibrillation (PREFER in AF). Europace. 2014; 16(1): 6–14.
  18. Gorczyca I, Chrapek M, Jelonek O, et al. Left atrial appendage thrombus formation despite continuous non-vitamin k antagonist oral anticoagulant therapy in atrial fibrillation patients undergoing electrical cardioversion or catheter ablation: a comparison of dabigatran and rivaroxaban. Cardiol Res Pract. 2020; 2020: 1206402.
  19. Gorczyca I, Michalska A, Chrapek M, et al. Thrombus in the left atrial appendage in patients with atrial fibrillation treated with non-vitamin K antagonist oral anticoagulants in clinical practice-A multicenter registry. J Cardiovasc Electrophysiol. 2020; 31(8): 2005–2012.
  20. Kapłon-Cieślicka A, Budnik M, Gawałko M, et al. Atrial fibrillation type and renal dysfunction as important predictors of left atrial thrombus. Heart. 2019; 105(17): 1310–1315.