Search

Background: There is ongoing debate around rate versus rhythm control strategies for managing atrial fibrillation (AF), however, much of the data comes from Western cohorts. Kerala‐AF represents the largest prospective AF cohort study from the Indian subcontinent. Objectives: To compare 12‐month outcomes between rate and rhythm control strategies. Methods: Patients aged ≥18 years with non‐transient AF were recruited from 53 hospitals across Kerala. Patients were stratified by rate or rhythm control. The primary outcome was a composite of all‐cause mortality, arterial thromboembolism, acute coronary syndrome or hospitalization due to heart failure or arrhythmia at 12 months. Secondary outcomes included bleeding events and individual components of the primary. Predictors of the composite outcome were analysed by logistic regression. Results: A total of 2901 patients (mean age 64.6 years, 51% female) were included (2464 rate control, 437 rhythm control). Rates of the primary composite outcome did not differ between groups (29.7% vs 30.0%; p =.955), nor did any component of the primary. Bleeding outcomes were also similar (1.6% vs 1.9%; p =.848). Independent predictors of the primary composite outcome were older age (aOR 1.01; p =.013), BMI <18 (aOR 1.51; p =.025), permanent AF (aOR 0.78; p =.010), HFpEF (aOR 1.40; p =.023), HFrEF (aOR 1.39; p =.004), chronic kidney disease (aOR 1.36; p <.001), and prior thromboembolism (aOR 1.31; p =.014). Conclusion: In the Kerala‐AF registry, 12‐month outcomes did not differ between rate and rhythm control cohorts. [ABSTRACT FROM AUTHOR]

Aims Data on the burden of acute heart failure (AHF) admissions, practice patterns, and outcomes are rare from India and other low- and middle-income countries. We aimed to describe the baseline characteristics, guideline-directed medical therapy (GDMT) prescribing patterns and 90-day mortality rates in patients admitted with AHF in Kerala, India. Methods and results The Cardiology Society of India-Kerala Acute Heart Failure Registry (CSI-KHFR) is an observational registry from 50 hospitals in Kerala, India, with prospective follow-up. Consecutive patients with AHF, who consented to participate, were enrolled. The 2016 European Society of Cardiology criteria were used for the diagnosis of AHF. Kaplan–Meier survival analysis and Cox-proportional hazard models were used for data analysis. The variables in the MAGGIC risk score were used in the multivariable model. A total of 7507 patients with AHF (37% female) participated in the CSI-KHFR. The mean age was 64.3 (12.9) years. More than two-third had reduced ejection fraction (EF) (67.5%). Nearly one-fourth (28%) of patients with heart failure (HF) with reduced EF received GDMT. Overall, in-hospital and 90-day mortality rates were 7% and 11.6%, respectively. Prescriptions of different components of GDMT were independently associated with 90-day mortality. Conclusion The CSI-KHFR recorded an in-hospital and 90-day mortality of 7% and 11.6%, respectively. Only one of four patients received GDMT. AHF mortality was independently associated with GDMT initiation. Quality improvement initiatives that focus on increasing GDMT prescription may improve the survival of HF patients in India. [ABSTRACT FROM AUTHOR]

Background and Aim: Reports on patients with nonvalvular atrial fibrillation (NVAF), particularly in the elderly, are few from India. This paper focuses on multimorbidity pattern, antithrombotic treatment and mortality of elderly NVAF patients from the state of Kerala, India. Methods: Clinical details of NVAF patients of age = 75 years from the cohort of KERALA-AF registry were analyzed for pattern of multimorbidity, antithrombotic treatment and one-year mortality. Results: The study comprised 753 patients with a median age of 80 years (IQR = 77-84), 53.5% being male. Multimorbidity was present in 94.5% of patients. Hypertension was the most common risk factor (74.4 %, n = 560) and chronic kidney disease was the major coexisting disease (78.9%, n = 594). Based on the number of comorbidities present, patients were grouped into three groups: < 3 comorbidities (18.1%), 3-5 comorbidities (63.9%), and > 5 comorbidities (17.6%). Oral anticoagulant therapy (OAC) was received by 62.5% (n = 472) of patients, mostly Vitamin K antagonist (VKA). Direct oral anticoagulants (DOAC) were used in 11.3% of patients. Antiplatelet therapy was used in 60.6% (n = 458) and the most commonly used antiplatelet was clopidogrel (44.6%). No antithrombotic treatment was used in 12.0% of patients (n = 91). One-year all-cause mortality was 19.6% (n = 148), higher in women but not statistically significant (p = 0.06). Kaplan-Meier survival curve indicated better one-year survival for patients who received OAC treatment (log rank test p < 0.0001, HR = 0.49 (95% CI = 0.35, 0.68), concordance = 0.58). Multivariate cox proportional hazards regression model showed OAC treatment (HR, 0.5; 95% CI, 0.36-0.7, P < 0.001) and age more than 80 years (HR, 1.53; 95% CI, 1.11 -2.1, P < 0.01) as predictors of one-year mortality. Mortality was not significantly different among the groups with different clustering of multimorbidity. Conclusion: Use of oral anticoagulation was associated with a reduced risk of mortality among elderly NVAF patients in the KERALA-AF Registry. However, more than one-third of elderly NVAF patients did not receive OAC, which calls for increased sensitization and training of treating doctors regarding optimal use of OAC in the elderly NVAF patients. Funding: The study received funding from the Cardiological Society of India-Kerala Chapter (CSI-K). [ABSTRACT FROM AUTHOR]