Clinical characteristics and frequency of anticoagulation in patients with atrial fibrillation and heart failure: results of a retrospective big data analysis
https://doi.org/10.15829/1728-8800-2023-3477
Abstract
Aim. To evaluate the clinical characteristics and frequency of prescribed anticoagulant therapy for patients with atrial fibrillation (AF) and heart failure (HF) in subjects of the Russian Federation based on a retrospective big data analysis using artificial intelligence technologies.
Material and methods. For retrospective analysis, information was obtained from the Webiomed predictive analytics platform, which includes depersonalized data from electronic health records of outand/ or inpatients in 6 subjects of the Russian Federation, extracted using artificial intelligence technologies. From the database of patients with AF (n=144431), a group of individuals (n=20970) with an established diagnosis of HF and information on left ventricular ejection fraction (LVEF) was selected.
Results. Patients with AF and HF (men, 43,7%; age 72,1±13,2 years; LVEF, 58,9±11,0%) had a history of smoking in 36,6% of cases, hypertension — in 86,7%, type 2 diabetes — in 26,6%, gout — in 2,7%, stage III and IV-V chronic kidney disease — in 50,9 and 15,6%, lower limb peripheral arterial disease — in 15,8%. The incidence of ischemic stroke, LV myocardial infarction and pulmonary embolism was 8,8, 14,7 and 2,4%, respectively. Anticoagulants, including direct oral ones, were administered to patients with AF and HF in 62,5% and 32,0% of cases, respectively. The frequency of their appointment did not significantly differ depending on LVEF.
Conclusion. Patients with AF and HF are characterized by significant comorbidity, a higher incidence of cardiovascular events compared with the group of individuals with AF without HF, and an unsatisfactory percentage of anticoagulant therapy.
Keywords
atrial fibrillation,
heart failure,
anticoagulant therapy,
retrospective analysis,
artificial intelligence
Supporting agencies: The study was carried out on an original scientific system “Multicomponent software and hardware system for automated collection, storage, markup of research and clinical biomedical data, their unification and analysis based on Data Center with Artificial Intelligence technologies” (№ 2075518) and financially supported by Ministry of Science and Higher Education of the Russian Federation within the Agreement № 075-15-2021-665.
About the Authors
M. A. Druzhilov
Petrozavodsk State University
Russian Federation
Russian Federation
Petrozavodsk
T. Yu. Kuznetsova
Petrozavodsk State University
Russian Federation
Russian Federation
Petrozavodsk
D. V. Gavrilov
OOO K-Sky
Russian Federation
Russian Federation
Petrozavodsk
A. E. Andreichenko
OOO K-Sky
Russian Federation
Russian Federation
Petrozavodsk
R. E. Novitsky
OOO K-Sky
Russian Federation
Russian Federation
Petrozavodsk
References
1. Arakelyan MG, Bockeria LA, Vasilieva EYu, et al. 2020 Clinical guidelines for Atrial fibrillation and atrial flutter. Russian Journal of Cardiology. 2021;26(7):4594. (In Russ.) doi:10.15829/1560-4071-2021-4594.
2. Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Russian Journal of Cardiology. 2021;26(9):4701. (In Russ.) doi:10.15829/1560-4071-2021-4701.
3. Boytsov SA, Luk’yanov MM, Yakushin SS, et al. Cardiovascular diseases registry (RECVAZA): diagnostics, concomitant cardiovascular pathology, comorbidities and treatment in the real outpatient-polyclinic practice. Cardiovascular Therapy and Prevention. 2014;13(6):44-50. (In Russ.) doi:10.15829/1728-8800-2014-6-3-8.
4. Stepina EV, Lukyanov MM, Bichurina MA, et al. Prescription of medications influencing prognosis in atrial fibrillation with arterial hypertension, coronary heart disease, chronic heart failure, by the registry REKVAZA-CLINIC. Cardiovascular Therapy and Prevention. 2017;16(2):33-8. (In Russ.) doi:10.15829/1728-8800-2017-2-33-38.
5. Polshakova IL, Povetkin SV. Drug Therapy Structure and Clinical Characteristics of Patients with Atrial Fibrillation According to Data of REKUR-AF Study. Rational Pharmacotherapy in Cardiology. 2018;14(5):733-40. (In Russ.) doi:10.20996/1819-6446-2018-14-5-733-740.
6. Mareev YuV, Polyakov DS, Vinogradova NG, et al. Epidemiology of atrial fibrillation in a representative sample of the European part of the Russian Federation. Analysis of EPOCH-CHF study. Kardiologiia. 2022;62(4):12-9. (In Russ.) doi:10.18087/cardio.2022.4.n1997.
7. Gagloeva DA, Mironov NYu, Lajovich LYu, et al. Atrial fibrillation and chronic heart failure: interrelationship and approaches to treatment. Russian Cardiology Bulletin. 2021;16(2):5-14. (In Russ.) doi:10.17116/Cardiobulletin2021160215.
8. Tereshchenko SN, Uskach TM. Treatment strategies for patients with atrial fibrillation and chronic heart failure. Terapevticheskii Arkhiv (Ter Arkh.). 2021;93(12):1545-50. (In Russ.) doi:10.26442/00403660.2021.12.201205.
9. Polyakov DS, Fomin IV, Belenkov YuN, et al. Chronic heart failure in the Russian Federation: what has changed over 20 years of follow-up? Results of the EPOCH-CHF study. Kardiologiia. 2021;61(4):4-14. (In Russ.) doi:10.18087/cardio.2021.4.n1628.
10. Santhanakrishnan R, Wang N, Larson M, et al. Atrial fibrillation begets heart failure and vice versa: temporal associations and differences in preserved vs. reduced ejection fraction. Circulation. 2016;133(5):484-92. doi:10.1161/CIRCULATIONAHA.115.018614.
11. Druzhilov MA, Kuznetsova TYu. Obesity associated atrial fibrillation: epicardial fat tissue in etiopathogenesis. Russian Journal of Cardiology. 2017;(7):178-84. (In Russ.) doi:10.15829/1560-4071-2017-7-178-184.
12. Kotecha D, Chudasama R, Lane D, et al. Atrial fibrillation and heart failure due to reduced versus preserved ejection fraction: A systematic review and meta-analysis of death and adverse outcomes. Int J Cardiol. 2016;203:660-6. doi:10.1016/j.ijcard.2015.10.220.
13. Zafrir B, Lund L, Laroche C, et al. Prognostic implications of atrial fibrillation in heart failure with reduced, mid-range, and preserved ejection fraction: a report from 14964 patients in the European Society of Cardiology Heart Failure Long-Term Registry. Eur Heart J. 2018;39:4277-84. doi:10.1093/eurheartj/ehy626.
14. Pandey A, Kim S, Moore C, et al. Predictors and Prognostic Implications of Incident Heart Failure in Patients with Prevalent Atrial Fibrillation. JACC Heart Fail. 2017;5(1):44-52. doi:10.1016/j.jchf.2016.09.016.
15. Zhirov IV, Safronova NV, Osmolovskaya YuF, Тereshchenko SN. Prognostic value of atrial fibrillation in patients with heart failure and different left ventricular ejection fraction: results of the multicenter RIF-CHF register. Russian Journal of Cardiology. 2021;26(1):4200. (In Russ.) doi:10.15829/1560-4071-2021-4200.
16. Boytsov SA, Martsevich SYu, Kutishenko NP, et al. Registers in cardiology: their principles, rules, and real-word potential. Cardiovascular Therapy and Prevention. 2013;12(1):4-9. (In Russ.) doi:10.15829/1728-8800-2013-1-4-9.
17. Martsevich SYu, Kutishenko NP, Lukina YuV, et al. Observational studies and registers. Their quality and role in modern evidence-based medicine. Cardiovascular Therapy and Prevention. 2021;20(2):2786. (In Russ.) doi:10.15829/1728-8800-2021-2786.
18. Ryazanova SV, Mazaev VP, Komkov AA. New trends for artificial intelligence development in medicine. Cardiosomatics. 2021;12(4):227-33. (In Russ.) doi:10.17816/22217185.2021.4.201264.
19. Gusev AV, Zingerman BV, Tyufilin DS, Zinchenko VV. Electronic medical records as a source of real-world clinical data. Real-World Data & Evidence. 2022;2(2):8-20. (In Russ.) doi:10.37489/2782-3784-myrwd-13.
20. 2020 Clinical practice guidelines for Chronic heart failure. Russian Journal of Cardiology. 2020;25(11):4083. (In Russ.) doi:10.15829/1560-4071-2020-4083.
21. Siller-Matula J, Pecen L, Patti G, et al. Heart failure subtypes and thromboembolic risk in patients with atrial fibrillation: The PREFER in AF-HF substudy. Int J Cardiol. 2018;265:141-7. doi:10.1016/j.ijcard.2018.04.093.
22. Reshetko OV, Sokolov AV, Furman NV. Analysis of antithrombotic therapy of atrial fibrillation in international and Russian registries. Kachestvennaya klinicheskaya praktika. 2019;1:83-96. (In Russ.) doi:10.24411/2588-0519-2019-10066.
23. Tatarsky BA, Popov SV, Kazennova NV. Atrial fibrillation and heart failure: approaches to antithrombotic therapy. Russian Journal of Cardiology. 2017;(7):132-8. (In Russ.) doi:10.15829/1560-4071-2017-7-132-138.
24. Savarese G, Giugliano R, Rosano G, et al. Efficacy and safety of novel oral anticoagulants in patients with atrial fibrillation and heart failure: a meta-analysis. JACC Heart Fail. 2016;4(11):870-80. doi:10.1016/j.jchf.2016.07.012.
Supplementary files
What is already known about the subject?
- The prevalence of atrial fibrillation (AF) and heart failure (HF) continues to increase, including in Russia.
- When AF and HF are combined, there is a higher risk of thromboembolic complications, cardiovascular and all-cause death.
What might this study add?
- Patients with AF and HF are characterized by significant comorbidity, a higher incidence of cardiovascular events compared to the group of people with AF without HF, and an unsatisfactory percentage of anticoagulant therapy, which requires optimization of diagnostic and treatment algorithms and control over their implementation.
Review
For citations:
Druzhilov M.A., Kuznetsova T.Yu., Gavrilov D.V., Andreichenko A.E., Novitsky R.E. Clinical characteristics and frequency of anticoagulation in patients with atrial fibrillation and heart failure: results of a retrospective big data analysis. Cardiovascular Therapy and Prevention. 2023;22(2):3477. (In Russ.) https://doi.org/10.15829/1728-8800-2023-3477
Views:
675
Email this article 
