THE IMPACTOF ANTICOAGULANTS IN ATRIAL FIBRILATION IN VIEW OF CHA2DS2VASC SCORE

Abstract

Atrial fibrillation (AF) is the most common and clinically relevant form of cardiac arrhythmia, which is deemed an epidemic of cardiovascular diseases in the 21st century. This arrhythmia is related to high levels of morbidity and mortality, causing a significant strain on the healthcare system. 

Thus, stratification of the patients into different categories of risk according to CHA2DS2Vasc scale is an essential step for developing treatment strategies. Nevertheless, insufficient data exists about the frequency of application of the risk scale and anticoagulation therapy in clinical practice.

The purpose of this research is the assessment of the compliance with the guidelines related to the calculation of CHA2DS2Vasc index and anticoagulant therapy of AF patients.

This was a multi-center cross-sectional study which included the patients with AF admitted to the hospitals from January 2021 to January 2022. Patient characteristics such as age, presence of comorbidity, and time of having AF were taken into account. Patients' initial hematological and biochemical parameters were included. Calculation of CHA2DS2Vasc index by the treating team and their therapy were recorded.

The study consisted of 70 subjects, 51.42% of which were female, with the mean age being 65.37 ± 13.79 years. 71% of the patients had hypertension, whereas 44.28% of the patients had heart failure. 21.42% of the patients were hospitalized in the past due to atrial fibrillation, and 20% of the patients were diagnosed with stroke in their past medical history. CHA2DS2Vasc score was calculated in 2.85% of the patients, and oral anticoagulants were used in only 18.57% of the patients. Oral anticoagulants were used only in 21.42% of the patients with past history of stroke. Underuse of oral anticoagulants in patients with atrial fibrillation was significantly influenced by female gender, hypertension, diabetes mellitus, stroke, smoking, and heart failure (all p < 0.05).

CHA2DS2Vasc score underuse is significant in the current practices in Iraq. More studies need to be conducted to validate the findings of the study and to discover the reasons behind non-compliance with treatment guidelines.