Characteristics of patients with atrial fibrillation and chronic heart failure treated with direct oral anticoagulants: single-center registry

Aim

To evaluatie the clinical and demographic characteristics, comorbidities, risks of thromboembolic events and bleeding, physicians preferences and dosing errors for direct oral anticoagulants (DOAC) in patients with atrial fibrillation (AF) and chronic heart failure (CHF).

Material and methods

In a retrospective study, we enrolled consecutive patients with AF and CHF on DOAC who were hospitalized to our center. Clinical profile, physician preferences and dosing errors for DOAC were evaluated.

Results

A total of 388 patients (age 72.4±10.9 years, 59.3% males, non-paroxysmal AF in 58.8%, CHA2DS2-VASc score 4.7±1.5) were included. Most patients had NYHA class III-IV symptoms (67.9%). Prior myocardial infarction was identified in 37.6% of patients. Mean ejection fraction (EF) was 42.9±11.5%. The mean HAS-BLED score was 1.9±0.9. 26.3% of patients had HAS-BLED score ≥3. 10% of patients had nonmodifiable bleeding risk factors only, and 88.7% had modifiable bleeding risk factors (with or without nonmodifiable risk factors). Rivaroxaban was the most frequently prescribed DOAC (54.1%), whereas apixaban and dabigatran were used more rarely (24.2% and 21.7%, respectively). DOAC dosing errors were registered in 101 (29,6%) of 341 patients. Appropriate dosing was more frequent for dabigatran (in 95.2% of cases) and inappropriate dosing for apixaban (in 43.4% of cases).

Conclusion

The study population was characterized by high comorbidity rate and risk of thromboembolic complications. Bleeding risk can be minimized in most patients by modifying risk factors. Dosing errors (mainly inappropriately low doses) of DOAC were reported in almost every third patient with AF and HF.

Key words

Atrial fibrillation, heart failure, direct oral anticoagulants, CHA2DS2-VASc score, HAS-BLED score, dosing errors.