Aumento da carga de comorbidades e risco de morte cardiovascular em doentes com fibrilação arterial na Europa em dez anos

Estes autores de vários países encontram mudanças significativas na epidemiologia da FA ao longo de uma década em Europa, com doentes mais velhos, mais sobrecarregados com comorbidades. Foi encontrado um maior uso de OAC. Apesar de uma redução verificada no risco de eventos tromboembólicos, um alto risco de morte relacionada com a CV ainda era evidente. Foram estas as conclusões de um estudo recente publicado no Eur J Intern Med. 2018 Sep;55:28-34.

Increased burden of comorbidities and risk of cardiovascular death in atrial fibrillation patients in Europe over ten years: A comparison between EORP-AF pilot and EHS-AF registries.

Proietti M(1), Laroche C(2), Nieuwlaat R(3), Crijns HJGM(4), Maggioni AP(5), Lane DA(1), Boriani G(6), Lip GYH(7); EORP-AF General Pilot Registry; Euro Heart Survey on AF Investigators.

BACKGROUND: In 2002, the European Society of Cardiology conducted the Euro Heart  Survey (EHS), while in 2014concluded 1-year follow-up of the EURObservational Research Programme AF (EORP-AF) Pilot Registry.

METHODS: We analysed differences in clinical profiles, therapeutic approaches and outcomes between these two cohorts after propensity score matching (PSM).

RESULTS: After PSM, 5206 patients were analysed. In EORP-AF there were more elderly patients than EHS (p < .001). EORP-AF patients were more burdened with cardiovascular (CV) and non-CV comorbidities, with a higher proportion of patients with high thromboembolic risk. EORP-AF patients used more oral-anticoagulant (OAC) (p < .001). At 1-year follow-up EORP-AF patients had lower risk for thromboembolic and CV events, readmission for AF and other CV reasons (all p < .001), showing conversely a higher risk for CV death (p = .015). Kaplan-Meier curves showed that EORP-AF patients had higher risk for CV death (p < .0001) and all-cause death (p = .0019). Cox regression confirmed that EORP-AF patients were at higher risk for CV death (p = .021).

CONCLUSIONS: We found significant changes in AF epidemiology over a decade in Europe, with older patients, more burdened with comorbidities. A greater use of OAC was found. Despite a reduction in risk for thromboembolic events, a high risk of CV-related death was still evident.

Eur J Intern Med. 2018 Sep;55:28-34.