Disclosures David Wu and George Mansoor are employees of Merck & Co., Inc., and may own stock or hold stock options in the company. Christian Kempf, Marie-Sophie Schwalm and Jiyoung Chin are employees of Cegedim Strategic Data, which received payment from Merck & Co., Inc., for conducting the statistical analysis and for writing and reviewing the manuscript.
Renal function, attributes and coagulation treatment in atrial fibrillation (R-FACT Study): Retrospective, observational, longitudinal cohort study of renal function and antithrombotic treatment patterns in atrial fibrillation patients with documented eGFR in real-world clinical practices in Germany
Article first published online: 6 FEB 2014
© 2014 John Wiley & Sons Ltd
International Journal of Clinical Practice
Volume 68, Issue 6, pages 714–724, June 2014
How to Cite
Wu, D., Mansoor, G., Kempf, C., Schwalm, M.-S. and Chin, J. (2014), Renal function, attributes and coagulation treatment in atrial fibrillation (R-FACT Study): Retrospective, observational, longitudinal cohort study of renal function and antithrombotic treatment patterns in atrial fibrillation patients with documented eGFR in real-world clinical practices in Germany. International Journal of Clinical Practice, 68: 714–724. doi: 10.1111/ijcp.12379
- Issue published online: 18 MAY 2014
- Article first published online: 6 FEB 2014
- Manuscript Accepted: DEC 2013
- Manuscript Received: JUL 2013
- Merck & Co., Inc.
This retrospective, observational, longitudinal study aimed to document the distribution, changes in renal function [measured by estimated glomerular filtration (eGFR)] and antithrombotic treatment pattern in atrial fibrillation (AF) patients in real-world settings managed by general practitioners in Germany.
Methods and results
Data were extracted from the German Longitudinal Patient Database. A total of 15,900 patients with AF were identified. Among 1660 having eGFR available at baseline, 3.4% had severely impaired eGFR, 9.7% and 25.6% had moderate severe decrease and moderate decrease in eGFR, respectively, and 61.3% had mildly decreased/normal eGFR. Patients with moderately and severely decreased eGFR tended to be older. The proportion of patients with a CHADS2 score ≥ 2 was 92.9% in those with severely decreased eGFR, and 87.0% and 79.1% in those with moderately severe and moderately decreased eGFR. During follow up, 52.1% of patients with severely decreased eGFR, and 26.3% to 23.7% of patients with moderately decreased eGFR were not treated by antithrombotic. When comparing baseline with follow-up eGFR, 55.0% of patients showed decreased eGFR. Age, diabetes, dyslipidaemia and history of myocardial infarction were identified as significant predictors for renal function deterioration based on results from multivariate Cox regression model.
Moderate-to-severe renal dysfunction is prevalent (~38%) in German AF patients with documented eGFR managed in actual clinical practices. The risk of stroke, as measured by the CHADS2 score, was associated with decreased renal function. Treatment with anticoagulation therapies decreased with decreasing renal function, despite increasing risk of stroke. Anticoagulation treatments remain suboptimal during the 12-month follow up in patients with moderate or severe renal impairment.