Typical profile of a patient with atrial fibrillation in the Russian population based on medical registries. A systematic review

Aim. To compare clinical and anamnestic characteristics of patients with atrial fibrillation (AF) included in three large international stu­dies assessing the efficacy and safety of therapy with direct oral anti­coagu­lants, with the profile of a typical Russian patient with AF in clinical practi­ce, established by medical registries in the Russian Federation (RF).

Material and methods. A systematic review of scientific publications was con­ducted. The search was conducted in the E-library and Google Scholar databases. Publications from 8 registries of patients with AF, con­ducted in the Russian Federation from 2012 to 2023, were found, which present the clinical and anamnestic characteristics of patients. All studies included in the analysis meet the generally accepted require­ments for medical registries. The systematic review protocol was pre­viously recorded in the PROSPERO electronic database (CRD42024512425).

Results. A Russian patient with AF is a patient with a large number of cardiovascular pathologies and a high risk of thromboembolic events. According to the analysis, Russian patient with AF has an average age of ~70 years. Most patients have a diagnosis of hypertension, heart failure, while from one third to half of patients have a diagnosis of chronic kidney disease. From 20 to 30% of patients have a history of myocardial infarction and every fifth patient has type 2 diabetes.

Conclusion. In all countries around the world, including the Russian Fe­deration, for many years, medical registries have been one of the main sources of information on the characteristics of patients with AF and the disease course. They can supplement the available data from randomized clinical trials with real-world data. Comparison of clinical and anamnestic characteristics of patients in randomized clinical trials of direct oral anticoagulants with characteristics of patients in the Russian registries shows that patients included in the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K An­tagonism for Prevention of Stroke and Embolism Trial in Atrial Fib­rillation (ROCKET AF trial) were most similar to Russian patients with AF.

1. Joglar JA., Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2023;149(1):e1-e156. doi:10.1161/CIR.0000000000001193.

2. Connolly SJ, Ezekowitz MD, Yusuf S, et al. RE-LY Steering Com­mittee and Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361(12):1139-51. doi:10.1056/NEJMoa0905561.

3. Halperin JL, Hankey GJ, Wojdyla DM, et al. Efficacy and safety of rivaroxaban compared with warfarin among elderly patients with nonvalvular atrial fibrillation in the Rivaroxaban Once Daily, Oral, Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF). Circulation. 2014;130(2):138-46. doi:10.1161/CIRCULATIONAHA.113.005008.

4. Granger CB, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365(11):981-92. doi:10.1056/NEJMoa1107039.

5. Giugliano RP, Ruff CT, Braunwald E, et al. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2013; 369(22):2093-104. doi:10.1056/NEJMoa1310907.

6. Martsevich SYu, Navasardian AR, Zakharova NA, et al. New oral anticoagulants: is that plausible to implement the data from international trials to russian population? Cardiovascular Therapy and Prevention. 2015;14(5):48-52. (In Russ.) doi:10.15829/1728-8800-2015-5-48-52.

7. Schastlivtsev IV, Navasardyan AR, Lobastov KV. Registers, Their Place in Scientific Hierarchy and Clinical Significance on the Example of the RIETE Register. Flebologiya. 2022;16(3):227-37. (In Russ.) doi:10.17116/flebo202216031227.

8. Martsevich SYu, Lukina YuV, Kutishenko NP, et al. Guidelines "Medical registries. Role in evidence-based medicine. Recom­mendations for creation": a brief review. Cardiovascular Therapy and Prevention. 2023;22(6):3615. (In Russ.) doi:10.15829/1728-8800-2023-3615.

9. Martsevich SYu, Navasardyan AR, Lobastov KV, et al. Syste­matic review and meta-analysis: a critical examination of the methodology. Rational Pharmacotherapy in Cardiology. 2023;19(4):382-97. (In Russ.) doi:10.20996/1819-6446-2023-2923.

10. Boytsov SA, Loukianov 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.

11. Yakusevich VV, Pozdnyakova EM, Yakusevich VVl, et al. An outpatient with atrial fibrillation: key features. The first data of REKVAZA FP — Yaroslavl register. Rational Pharmacotherapy in Cardiology. 2015;11(2):149-52. (In Russ.) doi:10.20996/1819-6446-2015-11-2-149-152.

12. Martsevich SY, Lukina YV, Kutishenko NP, et al. Adherence to Treatment with New Oral Anticoagulants in Atrial Fibrillation Patients in Real Clinical Practice (Results of the ANTEY Study). Rational Pharmacotherapy in Cardiology. 2019;15(6):864-72. (In Russ.) doi:10.20996/1819-6446-2019-15-6-864-872.

13. Polshakova IL, Povetkin SV Clinical characteristics and analysis of pharmacotherapy of patients with atrial fibrillation and coronary artery disease in outpatient practice according to the data of the study of recurrent AF. Therapy. 2021;7(2):50-5. (In Russ.) doi:10.18565/therapy.2021.2.50-55.

14. Loukianov MM, Martsevich SYu, Drapkina OM, et al. The The­rapy with Oral Anticoagulants in Patients with Atrial Fibrillation in Outpatient and Hospital Settings (Data from RECVASA Re­gistries). Rational Pharmacotherapy in Cardiology. 2019;15(4): 538-45. (In Russ.) doi:10.20996/1819-6446-2019-15-4-538-545.

15. Valiakhmetov MN, Gomova TA, Loukianov MM, et al. Patients with atrial fibrillation in multidisciplinary hospital: structure of hospitalization, concomitant cardiovascular diseases and drug treatment (data of RECVASA AF-Tula registry). Rational Pharmacotherapy in Cardiology. 2017;13(4):495-505. (In Russ.) doi:10.20996/1819-6446-2017-13-4-495-505.

16. Mikhin VP, Maslennikova YuV, Loukianov MM, et al. Structure of mortality and evaluation of death risk in patients with combination of atrial fibrillation and coronary heart disease (RECVASA AF-Kursk registry data). Kursk Scientific and Practical Bulletin "Man and His Health". 2017;(4):35-41. (In Russ.) doi:10.21626/vestnik/2017-4/07.

17. Tuchkov AA, Gogolashvili NG, Yaskevich RA. Assessment of Antithrombotic Therapy in Patients with Atrial Fibrillation for 2015-2017 According to the Registry of the Clinic of the Scientific Research Institute of Medical Problems of the North of Krasnoyarsk City. Rational Pharmacotherapy in Car­dio­logy. 2019;15(1):­43-8. (In Russ.) doi:10.20996/1819-6446-2019-15-1-43-48.

18. Shlyakhto EV, Ezhov AV, Zenin SA, et al. Clinical portrait of the atrial fibrillation patient in Russian Federation. data from the global registry GLORIA AF. Russian Journal of Cardiology. 2017;(9):21-7. (In Russ.)

19. Martsevich SYu, Navasardian AR, Kutishenko NP, et al. Stu­dying atrial fibrillationon the basis of the "PROFILE" registry. Car­diovascular Therapy and Prevention. 2014;13(2):35-9. (In Russ.) doi:10.15829/1728-8800-2014-2-35-39.

20. Sulimov VA, Golicyn SP, Panchenko EP, et al. Diagnosis and treatment of atrial fibrillation. Recommendations RSC, RSSA and ACS. Russian Journal of Cardiology. 2013;18(4 S3):1-100. (In Russ.) EDN: SXRTGB

21. Lobastov KV, Navasardyan AR, Schastlivtsev IV. Treatment and Secondary Prevention of Venous Thromboembolism in Real Clinical Practice Based on Health Care Professional Survey. Rational Pharmacotherapy in Cardiology. 2021;17(3):376-85. (In Russ.) doi: 10.20996/1819-6446-2021-06-01.

22. DiMarco JP, Flaker G, Waldo AL, et al. Factors affecting bleeding risk during anticoagulant therapy in patients with atrial fibrillation: Observations from the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Study. Am Heart J. 2005; 149(4):650-6. doi:10.1016/j.ahj.2004.11.015.

23. Schrutka L, Seirer B, Duca F, et al. Patients with Heart Failure and Preserved Ejection Fraction Are at Risk of Gastrointestinal Bleeding. J Clin Med. 2019;8(8):1240. doi:10.3390/jcm8081240.

24. Matsiras D, Bezati S, Ventoulis I, et al. Gut Failure: A Review of the Pathophysiology and Therapeutic Potentials in the Gut–Heart Axis. J Clin Med. 2023;12(7):2567. doi:10.3390/jcm12072567.