Glomerular Filtration Rate: a prognostic marker in Atrial Fibrillation. A Sub-Analysis of the ATA-AF.

OBJECTIVE: An increased cardiovascular mortality and morbidity has been widely reported in patients with atrial fibrillation (AF). In this study, a sub-analysis of the AntiThrombotic Agents Atrial Fibrillation (ATA-AF) is performed with the aim to evaluate estimated Glomerular Filtration Rate (eGFR) as an independent prognostic marker of cardiovascular mortality and morbidity in patients with AF METHODS AND RESULTS: The ATA-AF study enrolled 7148 patients with AF, in 360 Italian centers. The eGFR was calculated from data reported in patient notes or hospital database. This post-hoc analysis included 1097 AF patients with eGFR data available and 1-year clinical follow-up. The endpoint was assessed as cardiovascular mortality and/or hospital admission for cardiovascular causes at follow-up. Patients were also divided in two groups according to the eGRF (<60 and ≥60 ml/min/1.73m2 ). The Kaplan-Meyer curve for the mentioned end-point showed a higher endpoint incidence in the group of patient with eGFR below 60 ml/min/1.73m2 (p <0.001). Using multivariate analysis (Cox regression), a trend toward a higher rate of occurrence of the primary endpoint was observed for eGFR below 60 ml/min/1.73m2 without reaching the conventional level of statistical significance (HR 1.40 CI 0.99-1.99, p=0.0572). When eGFR was included in the analysis as continuous variable a significant correlation was observed with the combined end-point at the Cox regression (HR 0.99, 95% CI 0.98-0.99, p=0.04).

CONCLUSION: The result of this post-hoc analysis indicates that an impaired eGRF is independently associated with worse prognosis among patients with AF.