Abstract 18404: Current Status of Clinical Background of Hemodialysis Patients with Atrial Fibrillation in Japan: From the Fushimi Af Registry

Abstract

Background: Atrial fibrillation (AF) increases the risks of stroke and death, and the prevalence of AF is increasing significantly. Despite the remarkable effect of warfarin against embolic stroke, the use of warfarin in hemodialysis patients is controversial (or contraindicant), because of the high risk of bleeding in this patient population. The Fushimi AF Registry, a community-based prospective survey, was designed to enroll all of the AF patients living in Fushimi-ku, Kyoto, which is a typical urban district of Japan with a population of 283,000; rough estimate of 2,200 AF patients. The purpose of the study is to investigate the real-world current status of clinical backgrounds of Japanese AF patients, and to follow the clinical outcome in a long term. At present, we have enrolled 3,020 patients from March 2011 to March 2012.

Methods and Results: We compared the clinical backgrounds of AF patients between those with hemodialysis (HD; n=87) and without it (NHD; n=2,933). Although the mean age was comparable between the two groups (HD vs. non-HD: 72.7 vs. 74.2; NS), HD group showed significantly higher rates of various co-morbidities (heart failure 40.2% vs. 27.9%; hypertension 80.5% vs. 60.5%; diabetes mellitus 55.2% vs. 23.3%). The rates of atherosclerotic vascular diseases were much higher in HD group (coronary artery disease 42.5% vs. 15.2%; myocardial infarction 21.8% vs. 6.4%; peripheral artery disease 19.5% vs. 4.4%), whereas the rate of stroke was comparable (21.9% vs. 19.4%; NS). HD group had higher risk profiles (CHADS2 score 2.72 vs. 2.07; p<0.01), but received lower warfarin use (40.2% vs. 51.0 %; p=0.05). The rate of major bleeding was modestly higher in HD group (3.4% vs. 1.5%; p=0.15), but was much lower than previously reported (10-50%).

Conclusion: The Fushimi AF registry represents the clinical profile of real-world Japanese AF patients. Hemodialysis patients with AF have higher risk profiles, but receive lower warfarin treatment for stroke prevention. The bleeding risk may be lower than reported under careful management, and therefore the use of warfarin could be considered in patients with particularly high risk for stroke in a case-by-case basis.