Anticoagulation Status and Left Atrial Appendage Occlusion Indications in Hospitalized Cardiology Patients with Atrial Fibrillation: A Hellenic Cardiorenal Morbidity Snapshot (HECMOS) Sub-Study

• Published in: Medicina (Kaunas, Lithuania) Lithuania), 2023-10, Vol.59 (10), p.1881
• Main Authors: Tsiachris, Dimitris, Papakonstantinou, Panteleimon E, Doundoulakis, Ioannis, Tsioufis, Panagiotis, Botis, Michail, Dimitriadis, Kyriakos, Leontsinis, Ioannis, Kordalis, Athanasios, Antoniou, Christos-Konstantinos, Mantzouranis, Emmanouil, Iliakis, Panagiotis, Vlachakis, Panayotis K, Gatzoulis, Konstantinos A, Tsioufis, Konstantinos
• Format: Article
• Language: English
• Subjects: Ablation; Acute coronary syndromes; Administration, Oral; Anticoagulants; Anticoagulants - adverse effects; Atrial Appendage - surgery; Atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - drug therapy; Atrial Fibrillation - epidemiology; Cardiac arrhythmia; Cardiology; catheter ablation; Comorbidity; Datasets; Diabetes; Fainting; Female; Females; Health aspects; Heart; Heart failure; Hemorrhage - chemically induced; Hospitalization; Humans; Hypertension; Kidney diseases; Male; Morbidity; Patient compliance; Patients; Population; Prostheses; Pulmonary arteries; rhythm strategy; Risk factors; snapshot; Stroke; Stroke (Disease); Stroke - epidemiology; Stroke - etiology; Stroke - prevention & control; Treatment Outcome
• ISSN: 1648-9144; 1010-660X; 1648-9144
• DOI: 10.3390/medicina59101881

: The proper use of oral anticoagulants is crucial in the management of non-valvular atrial fibrillation (AF) patients. Left atrial appendage closure (LAAC) may be considered for stroke prevention in patients with AF and contraindications for long-term anticoagulant treatment. We aimed to assess anticoagulation status and LAAC indications in patients with AF from the HECMOS (Hellenic Cardiorenal Morbidity Snapshot) survey. : The HECMOS was a nationwide snapshot survey of cardiorenal morbidity in hospitalized cardiology patients. HECMOS used an electronic platform to collect demographic and clinically relevant information from all patients hospitalized on 3 March 2022 in 55 different cardiology departments. In this substudy, we included patients with known AF without mechanical prosthetic valves or moderate-to-severe mitral valve stenosis. Patients with prior stroke, previous major bleeding, poor adherence to anticoagulants, and end-stage renal disease were considered candidates for LAAC. : Two hundred fifty-six patients (mean age 76.6 ± 11.7, 148 males) were included in our analysis. Most of them ( = 159; 62%) suffered from persistent AF. The mean CHA2DS2-VASc score was 4.28 ± 1.7, while the mean HAS-BLED score was 1.47 ± 0.9. Three out of three patients with a a CHA2DS2-VASc score of 0 or 1 (female) were inappropriately anticoagulated. Sixteen out of eighteen patients with a CHA2DS2-VASc score 1 or 2 (if female) received anticoagulants. Thirty-one out of two hundred thirty-five patients with a CHA2DS2-VASc score > 1 or 2 (if female) were inappropriately not anticoagulated. Relative indications for LAAC were present in 68 patients with NVAF (63 had only one risk factor and 5 had two concurrent risk factors). In detail, 36 had a prior stroke, 17 patients had a history of major bleeding, 15 patients reported poor or no adherence to the anticoagulant therapy and 5 had an eGFR value < 15 mL/min/1.73 m for a total of 73 risk factors. Moreover, 33 had a HAS-BLED score ≥ 3. No LAAC treatment was recorded. : Anticoagulation status was nearly optimal in a high-thromboembolic-risk population of cardiology patients who were mainly treated using NOACs. One out of four AF patients should be screened for LAAC.