Predictive factors of adverse outcomes of atrial fibrillation in elderly patients: Results of the National Tunisian Registry of Atrial Fibrillation (NATURE-AF)

Abstract

INTRODUCTION: Atrial fibrillation (AF) is the most frequent sustained cardiac arrhythmia. Data related to its clinical characteristics, management, and predictive factors of poor outcomes in elderly in Tunisia remain scarce. We aimed to evaluate the predictive factors of adverse outcomes in the elderly at 12 months follow-up among AF patients in Tunisia including thromboembolic (TE) events, hemorrhagic events, and all-cause death. METHODS: We conducted a national, prospective, and analytic multicentric study based on NATURE-AF with a 12-month follow-up period between March 1, 2017, and May 31, 2017. We evaluated the predictive factors of adverse outcomes of AF in the elderly (≥ 75 years old). RESULTS: We included 915 patients with AF. We studied the elderly who represented 24% of the population. Females represented 52% of the elderly. Hypertension was present in 57% of the elderly, diabetes mellitus in 22.4%, dyslipidemia in 16%, obesity in 75.8%, chronic kidney disease in 22.8% and smoking in 13.2%. Prior TE accidents and hemorrhagic accidents happened in 12.8% and 3.7% respectively. The mean CHA2DS2-VASc score was 3.92±1.28. Vitamin-K-Antagonist was used in 59.8%. The mean TTR was 47.53±26.78. The rate control strategy was adopted in 68% of patients and beta-blockers were used in 37.9%. Hospitalization during the follow-up for adverse causes occurred in 13.4%. Adverse outcomes occurred in 19.6% including 3.2% TE events, 5% hemorrhagic events, and 11.4% deaths. After multivariate analyses, prior TE accidents (ORa=3.218; p=0.025; 95%CI [1.157-8.946]) and hospitalization during the follow-up (ORa=6.489; p=0.002; 95%CI [2.035-20.697]) were independent prognostic factors associated with adverse outcomes. CONCLUSION: Prior TE accidents and hospitalization during the follow-up are predictive factors of adverse outcomes in elderly with AF. Identifying them is crucial to enhancing public health strategies and lowering healthcare costs.