Clinical Profile of Patients with Atrial Fibrillation According to EHRA (Evaluated Heart Valves, Rheumatic or Artificial) Categorization in A Middle-Income Country

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  •   Rose Mary Ferreira Lisboa da Silva

  •   Pedro Antonio Oliveira Aquino Gusmão

  •   Marina de Abreu Arruda

  •   Marcos Antonio Santos Moura

  •   Ananda Queiroz Rocha Lima

  •   Nayara Jassanan Resende dos Santos

  •   Lailla Marilia Santos Mesquita

  •   Óliver Augusto Souza

Abstract

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in clinical practice. As of 2017, a functional EHRA (Evaluated Heart valves, Rheumatic or Artificial) categorization was proposed to replace the terms valvular and non-valvular AF. In our country, despite the incidence of rheumatic valve heart disease, studies on this new categorization are scarce Objective: to assess the clinical profile of patients (pts) with AF, using the EHRA categorization as a parameter. Methods: this is a prospective, observational and cross-sectional study with 475 pts with AF from a university institution. Clinical and laboratory evaluations were carried out, as well as the calculation of risk scores for embolism, bleeding and renal function. Statistical analysis was performed by non-parametric tests, in addition to the chi-square test. Results: the pts were divided into 3 groups, according to the EHRA categorization: EHRA 1, with 144 pts, with mitral stenosis or mechanical prosthesis; EHRA 2, with 46 pts with other valvular heart diseases; and EHRA 3, with 285 pts, without valvular heart disease. Mean ages were 51.5; 57.6 and 62.9 years, respectively (p<0.0001). The proportions of women were 75%; 52.1% and 40.7% (p<0.0001). The presentation of the AF was permanent in 68.1%; 60.9%; 52.3% of pts (p=0.008) and 86.0%; 47.8% and 53.3% of pts were using oral anticoagulants, respectively (p<0.0001). The means of left ventricular ejection fraction were 0.58; 0.57 and 0.46; of left atrium were 55.9; 52.5 and 48.1 mm; ATRIA score of 1.4; 1.3 and 2.1; and the glomerular filtration rate of 91.7; 91.1 and 75.0 mL/min/1.73m², respectively (p<0.0001). There was no difference among groups regarding blood pressure and heart rate at study entry and regarding the history of embolism. Conclusions: pts from the EHRA 1 categorization were younger, with a higher proportion of women, permanent AF and use of oral anticoagulants. Systolic dysfunction predominated in those without valve disease, who also had a higher bleeding score and greater impairment of renal function.


Keywords: Anticoagulation, atrial fibrillation, glomerular filtration rate, mechanical prosthetic heart valves, risk assessment, thromboembolism

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How to Cite
Lisboa da Silva, R. M. F., Gusmão, P. A. O. A., Arruda, M. de A., Moura, M. A. S., Lima, A. Q. R., dos Santos, N. J. R., Mesquita, L. M. S., & Souza, Óliver A. (2022). Clinical Profile of Patients with Atrial Fibrillation According to EHRA (Evaluated Heart Valves, Rheumatic or Artificial) Categorization in A Middle-Income Country. European Journal of Clinical Medicine, 3(1), 26–30. https://doi.org/10.24018/clinicmed.2022.3.1.161