The evaluation of demographic, biochemical and hematologic parameters of patient with atrial fibrillation

ABSTRACT Introduction Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. Ischemic stroke (IS) is the most disabling and even mortal complication of AF. A number of study reports that risk of IS is similar in all AF types. Anticoagulation is the accepted method of prevention of thromboembolic complications in all types of nonvalvular AF. In our study, all patients with AF admitted to cardiology outpatient clinic or hospitalized were categorized according to recommendations in 2010 Guideline for the management AF of European Society of Cardiology (ESC); and patients in each nonvalvular AF types were compared in terms of ejection fraction (EF), left atrial (LA) diameter, hematologic and biochemical parameters, medication, concomitant diseases, and future IS risk of AF patients was assessed with CHADS2 and CHADS2VA2Sc scores, and bleeding risk was assessed with HASBLED scores. Material and Methods A total of 200 consecutive patients with nonvalvular AF admitted to outpatient cardiology clinic or hospitalized at Dicle University Faculty of Medicine between Jan'12-Oct'13 were evaluated retrospectively. Valvular AF patients were not included in the present study. Patient infomations including name, age, gender, address, phone number, height, weight, AF type, concomitant diseases (diabetes mellitus [DM], hypertension [HT], heart failure [HF], ischemic cardiomyopathy [ICMP], dilated cardiomyopathy [DCMP], tyrotoxicosis, ischemic/hemorrhagic stroke, transient ischemic attack [TIA], systemic emboli), medication, were obtained from digital patient files. Also oral anticoagulant (OAC) and antiaggregant drug usage, reason why do not use OAC despite high (>2) CHA2DS2VASc score, INR value on admission, haematological and biochemical test results, and echocardiographic measures were recorded and analyzed for all patients with each AF type. Future IS risk of patients with nonvalvular AF were assessed with CHA2DS2VASc scores, while bleeding risk was assessed with HASBLED score. All of these variables were compared between paroxysmal AF (PAF) and persistent-permanent AF (PPAF) patient groups. Results The study population consist of 200 patients, 116 women (58%), was categorized as 144 patients with PPAF (72%) and 56 patients with PAF (28%). Both groups were similar in terms of gender. Mean age of the study population was 68.7 ± 11.7 years, while patients in PAF group were younger (63.9 ± 12.4) than PPAF group (70.6 ± 10.9 years) (p < 0.001). Mean CHADS2VA2Sc score of the study population was 3.52 ± 1.72; while that was higher in the PPAF group (3.85 ± 1.63) than that of PAF group (2.67±1.68) (p < 0.001). However when the patients were classified into low-medium-high risk profile for future stroke, the groups were similar with respect to low-or-medium class (p = 0.577), but there was a significant difference between groups when compared according to low-or-high risk class (p < 0.001), and medium-or-high class (p < 0.001). Patients with stroke/TIA, congestive HF, age > 75 years, and ICMP were significantly more frequent in the PPAF group (p < 0.05 for each). Mean HASBLED score of the study population was 1.95 ± 1.17, while PPAF group had significantly higher mean HASBLED score than PAF group (2.20±1.14 vs. 1.32±1.02 respectively; p < 0.001). OAC (warfarin) usage and achievement and maintenance of effective INR values were more frequent in the PPAF group than PAF group (p < 0.05 for each). The most frequent reason for not to use OAC (warfarin) in the whole study population was "not advised by the physician" with a ratio of 62 %. Meanwhile, the patients in the PPAF group were receiving medication with ACE inhibitor/ARB, diuretic, digoxin and clopidogrel more frequently than that of patients in the PAF group (p < 0.05 for each). On the echocardiographic examination, the PPAF group had lower EF and larger LA diameter than the PAF group (p < 0.05 for each). With respect to hematologic parameters, the patients in the PPAF group had higher neutrophil-to-lymphocyte ratio (NLR), platelet count, and red cell distribution width (RDW) than the PAF group (p < 0.05 for each). PPAF group had higher urea, ALT, uric acid, indirect bilirubin, triglyceride, total cholesterol, LDL, HDL, fasting glucose, GGT, and CRP level than the PAF group (p < 0.05 for each). By the multivariate logistic regression analysis, the HASBLED score, LA diameter, and GGT level were found to be the independent predictors of PPAF. Discussion Patient with AF are exposed to high risk of ischemic stroke. Our study suggest that patients with PAF are exposed to a similar IS risk as mentioned in the guideline (2010 ESC Guideline on the management of AF) while patient with PPAF have had a greater IS risk than predicted in the guideline according to their CHA2DS2VASc score. Also patients with PPAF have had more frequent concomitant debilitating disorders than PAF patients. Hematologic and biochemical parameters were poorer in the PPAF group. Despite numerous studies reporting high effectiveness of OAC treatment in the prevention IS in AF patients; only 27% of the high-risk patients in our study population were under OAC treatment and only 45% of them had been in the effective therapeutic INR ranges. OAC prescription habits of physicians to the high risk AF patients in the daily practice was assessed in the present study and inadequate advisement of OAC by physicians was found to be the most common reason of "not to use OAC", in spite of medical contraindications. Conclusion As a conclusion, although it is reported in the literature that all types of AF patients carry an increased risk for future ischemic stroke, our study suggest that patients with PPAF have co-morbid disorders more commonly and they are exposed to higher risk for ischemic stroke and bleeding compared to patients with PAF.