Glomerular filtration rate: A prognostic marker in atrial fibrillation-A subanalysis of the AntiThrombotic Agents Atrial Fibrillation

Clin Cardiol. 2018 Dec;41(12):1570-1577. doi: 10.1002/clc.23065. Epub 2018 Dec 4.

Abstract

Objective: An increased cardiovascular mortality and morbidity has been widely reported in patients with atrial fibrillation (AF). In this study, a subanalysis of the AntiThrombotic Agents Atrial Fibrillation (ATA-AF) is performed with the aim to evaluate estimated glomerular filtration rate (eGFR) as an independent prognostic marker of cardiovascular mortality and morbidity in patients with AF.

Methods and results: The ATA-AF study enrolled 7148 patients with AF, in 360 Italian centers. The eGFR was calculated from data reported in patient notes or hospital database. This post-hoc analysis included 1097 AF patients with eGFR data available and 1-year clinical follow-up. The endpoint was assessed as cardiovascular mortality and/or hospital admission for cardiovascular causes at follow-up. Patients were also divided in two groups according to the eGFR (<60 and ≥60 mL/min/1.73 m2 ). The Kaplan-Meyer curve for the mentioned endpoint showed a higher endpoint incidence in the group of patient with eGFR below 60 mL/min/1.73 m2 (P < 0.001). Using multivariate analysis (Cox regression), a trend toward a higher rate of occurrence of the primary endpoint was observed for eGFR below 60 mL/min/1.73 m2 without reaching the conventional level of statistical significance (hazard ratio [HR] 1.40; 95% confidence interval [CI] 0.99-1.99; P = 0.0572). When eGFR was included in the analysis as continuous variable a significant correlation was observed with the combined endpoint at the Cox regression (HR 0.99, 95% CI 0.98-0.99, P = 0.04).

Conclusion: The result of this post-hoc analysis indicates that an impaired eGFR is independently associated with worse prognosis among patients with AF.

Keywords: atrial fibrillation; glomerular filtration rate; mortality.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Atrial Fibrillation / diagnosis*
  • Atrial Fibrillation / drug therapy
  • Atrial Fibrillation / epidemiology
  • Female
  • Fibrinolytic Agents / therapeutic use*
  • Follow-Up Studies
  • Glomerular Filtration Rate / physiology*
  • Humans
  • Incidence
  • Italy / epidemiology
  • Male
  • Morbidity / trends
  • Prognosis
  • Renal Insufficiency / epidemiology
  • Renal Insufficiency / etiology
  • Renal Insufficiency / physiopathology*
  • Retrospective Studies
  • Risk Assessment / methods*
  • Risk Factors
  • Survival Rate / trends
  • Time Factors

Substances

  • Fibrinolytic Agents