Clinical InvestigationChanges in glomerular filtration rate and outcomes in patients with atrial fibrillation
Section snippets
Methods
Between January 2000 and December 2010, 8962 patients seen in the Cardiology department in our institution with a diagnosis of AF were identified.1., 2. The regional university hospital of Tours serves approximately 400,000 inhabitants and is the only public institution in an area of about 4,000 km2. The information for each patient was extracted from computerized data of hospitalization and consultation of our institution. During follow-up, information on outcomes was recorded and we defined
Results
Of 8962 individuals with AF seen in the cardiology department, 2653 had several available serum creatinine data allowing the eGFR (expressed in mL/min per 1.73 m2) and eGFR evolution (slope of eGFR, expressed in mL/min per 1.73 m2/year) to be calculated (Figure 1). The number of samples with creatinine level assessment was 12±14 per patient (median 7, interquartile range 4-14).
Baseline characteristics are shown in Table 1. The eGFR at baseline in this population was 65.5 mL/min per 1.73 m2.
Discussion
In this large series of AF patients, our principal findings are as follows: (i) incidence rates of IS/TE, mortality and bleeding increased with worsening eGFR; (ii) worsening eGFR was an independent predictor of IS/TE and of bleeding, and a better predictor of IS/TE than renal function at baseline; (iii) worsening eGFR did not improve the predictive ability of the CHA2DS2VASc and HAS-BLED scores for identifying a higher risk of IS/TE or bleeding events; and (iv) when the benefit of IS reduction
Conclusions
Worsening renal function (rather than renal impairment) is associated with poor outcomes in individuals with AF across the whole range of renal function, as measured by eGFR. Incidence rates of IS/TE, mortality and bleeding substantially increased with worsening eGFR. Worsening eGFR was an independent predictor of IS/TE and of bleeding, and a better predictor of IS/TE than baseline renal impairment. These observations may have implications for future risk prediction tools of outcomes in AF as
Disclosures
This study has received no financial or material support.
LF has served as a speaker or consultant for Bayer, BMS/Pfizer, Boehringer Ingelheim, Medtronic and Novartis. NC has received consulting honoraria from Boston Scientific, Medtronic, St. Jude Medical, and Sorin-LivaNova. DA has received funding for conference travel and educational symposia from Astra Zeneca, Eli-Lilly, Novartis, Bayer, MSD, Amgen, Pfizer. DB has received clinical study support from Biotronik, Boston Scientific, Medtronic,
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All of the authors have contributed to and approved the final version of the manuscript for submission.