Browsing by Author "Dan, Gheorghe Andrei (6701679438)"

INTRODUCTION The Atrial fibrillation Better Care (ABC) pathway provides a useful way of simplifying decision-making considerations in a holistic approach to atrial fibrillation management. OBJECTIVES To evaluate adherence to the ABC pathway and to determine major gaps in adherence in patients in the BALKAN-AF survey. PATIENTS AND METHODS In this ancillary analysis, patients from the BALKAN-AF survey were divided into the following groups: A (avoid stroke) + B (better symptom control) + C (cardiovascular and co- morbidity risk management)-adherent and -nonadherent management. RESULTS Among 2712 enrolled patients, 1013 (43.8%) patients with mean (SD) age of 68.8 (10.2) years and mean CHA2DS2-VASc score of 3.4 (1.8) had A+B+C-adherent management and 1299 (56.2%) had A+B+C-nonadherent management. Independent predictors of increased A+B+C-adherent manage- ment were: capital city (odds ratio [OR], 1.23; 95% CI, 1.03-1.46; P = 0.02), treatment by cardiologist (OR, 1.34; 95% CI, 1.08-1.66; P = 0.01), hypertension (OR, 2.2; 95% CI, 1.74-2.77; P <0.001), dia- betes mellitus (OR, 1.28; 95% CI, 1.05-1.57; P = 0.01), and multimorbidity (the presence of 2 or more long-term conditions) (OR, 1.85; 95% CI, 1.43-2.38; P <0.001). Independent predictors of decreased A+B+C-adherent management were: age 80 years or older (OR, 0.61; 95% CI, 0.48-0.76; P <0.001) and history of bleeding (OR, 0.5; 95% CI, 0.33-0.75; P = 0.001). CONCLUSIONS Physicians' adherence to integrated AF management based on the ABC pathway was suboptimal. Addressing the identified clinical and system-related factors associated with A+B+C-nonadherent manage- ment using targeted approaches is needed to optimize treatment of patients with AF in the Balkan region. © by Medycyna Praktyczna, Kraków 2020

Background: Chronic kidney disease (CKD) and atrial fibrillation (AF) often coexist, making accurate renal function estimation crucial, typically through equations calculating estimated glomerular filtration rate (eGFR) or creatinine clearance (CrCl). Objective: To compare the concordance and predictive performance of different renal function estimation equations in a European cohort of AF patients. Methods: We analyzed data from AF patients enrolled in a prospective observational European registry. Renal function was estimated using eight formulas: BIS-1, CG, CG-BSA, CKD-EPI, EKFC, FAS, LMR and MDRD. Concordance between formulas was assessed using weighted Cohen's Kappa, while Cox regression and receiver operating characteristic (ROC) curves evaluated their association with outcomes (composite of all-cause death, any coronary revascularization and any thromboembolism). Results: We included 8,506 patients. CKD-EPI demonstrated good to excellent concordance with other formulas, with the lowest concordance with CG (K = 0.607; 95% CI, 0.595-0.618) and the highest with MDRD (K = 0.880; 95% CI, 0.873-0.887). The risk of adverse outcomes increased sharply when renal function dropped below 60 ml/min across all formulas. CG-BSA and CG formulas showed the best discriminative ability for predicting composite outcomes (AUC 0.660, 95% CI 0.644-0.677, and 0.661, 95% CI 0.644-0.678, respectively). Based on integrated discrimination improvement (IDI) analysis, compared to the CKD-EPI equation, the CG and CG-BSA formulas showed significant improvements in sensitivity of 0.9% and 1.1%, respectively Conclusion: Equations for estimating renal function vary in concordance, with potential implications for drug prescription and predicting adverse events. CG and CG-BSA formulas showed superior performance in identifying patients at risk for adverse outcomes. © 2025 The Authors