Long-term outcomes and dynamics of pharmacotherapy in patients with atrial fibrillation according to the REKUR-AF study

The objective is to study the outcomes after 9 and 18 months in the framework of the REKUR-AF study and the dynamics of the drug treatment while implementing the components of the integrated approach in patients with atrial fibrillation (AF) under the regional center.

Materials and methods. The study was conducted in three stages: 1 – inclusion of 896 patients with AF being observed in medical organizations (MO) of Kursk and Kursk region from September 2015 to August 2016; 2 – receiving information on outcomes and pharmacotherapy from patients by telephone contact 9 months after; 3 – receiving information 18 months after the recruitment of patients with the research similar to the second stage. After 9 months of follow-up, the system to support pharmacotherapeutic decisions on antithrombotic therapy in patients with AF (DSS-AF) was introduced in MO of Kursk Region.

Results. The 2 and 3 stages provided the information obtained on 532 and 436 patients, among them 60 and 37 people died, respectively. The cause of death of most patients is cardiovascular pathology. Among the surviving patients, every third needed hospitalization mainly due to decompensation of chronic heart failure or paroxysm of AF. After 18 months of observation, the frequency of prescribing antiplatelet drugs (57.1%), angiotensin-converting enzyme inhibitors (55.6%), statins (53.9%) and diuretics (48.6%) was significantly lower than in the first stage of the study. The level of using oral anticoagulants (OAC) has significantly increased due to the period after the introduction of DSS-AF (from 18.3% of the stage 1 to 26.1% at the stage 3 of the work). In patients taking OAC, the frequency of fatal outcomes was significantly lower than in patients without anticoagulant therapy within 9 and 18 months of follow-up.

Conclusion. The paper shows the feasibility of using DSS-AF as a part of an integrated approach to the management of patients with AF to optimize the antithrombotic therapy of the indicated group of patients.