Thromboembolism and Major Bleeding in Patients with Atrial Fibrillation and EHRA Type 2 Valvular Heart Disease: The Jordan Atrial Fibrillation (JoFib) Study

Figures & data

Table 1 Characteristics of AF Patients According to EHRA Classification

Variable	EHRA Type 1 n=170 (8.40%)	EHRA Type 2 n=339 (16.80%)	Non-VHD n=1511 (74.80%)	p
Age in years (mean±SD)	61.86±11.80	72.26±13.29	67.62±13.387	<0.0001
Gender (female)	115 (67.60%)	197 (58.10%)	779 (51.60%)	<0.0001
HTN	92 (54.10%)	258 (76.10%)	1155 (76.40%)	<0.0001
DM	55 (32.40%)	145 (42.80%)	680 (45.00%)	0.007
HF	34 (20.00%)	134 (39.50%)	313 (20.70%)	<0.0001
CAD	11 (6.50%)	30 (8.80%)	178 (11.80%)	0.047
Dyslipidemia	46 (27.10%)	137 (40.40%)	725 (48.00%)	<0.0001
Current smoker	26 (15.30%)	33 (9.70%)	222 (14.70%)	0.05
BMI (mean±SD)	27.86 ±5.43	29.19 ±5.80	29.63±5.74	0.001
Previous thromboembolic event	24 (14.10%)	48 (14.20%)	246 (16.30%)	0.520
COPD	5 (2.90%)	16 (4.70%)	51 (3.40%)	0.435
Thyroid disease	20 (11.80%)	37 (10.90%)	149 (9.90%)	0.659
CKD	8 (4.70%)	36 (10.60%)	135 (8.90%)	0.084
Cancer	13 (7.60%)	27 (8.00%)	77 (5.10%)	0.069
Sleep apnea	3 (1.80%)	18 (5.30%)	62 (4.10%)	0.164
Permanent AF	78 (45.90%)	132 (38.90%)	394 (26.10%)	<0.0001
CHA2DS2VASc score (mean±SD)	2.93±1.58	4.06±1.508	3.57±1.872	<0.0001
HAS-BLED score (mean±SD)	1.29 ±1.064	1.8±1.052	1.66±1.117	<0.0001
CHA2DS2VASc comorbidity	132 (77.60%)	310 (91.40%)	1308 (86.60%)	<0.0001
History of ablation	1 (0.60%)	6 (1.80%)	21 (1.40%)	0.561
History of electric cardioversion	14 (8.20%)	10 (2.90%)	86 (5.70%)	0.033
Permanent pacemaker	2 (1.20%)	9 (2.70%)	28 (1.90%)	0.473
First AF episode	22 (12.90%)	75 (22.10%)	464 (30.70%)	<0.0001
Left Ventricular Ejection Fraction (mean±SD) (n=1905)	53.0909±11.1513	48.8018±13.5298	54.3281±11.98152	<0.0001
Left Ventricular Ejection Fraction ≤45% (n=1905)	35 (21.20%)	121 (35.80%)	288 (20.50%)	<0.0001
Left Ventricular Hypertrophy (n=1827)	52 (34.70%)	122 (37.80%)	534 (39.40%)	0.483
Left Atrial Size in cm (mean±SD) (n=1727)	4.9489±0.90306	4.6606±0.71891	4.1649±0.71942	<0.0001
Pulmonary Hypertension (n=2009)	76 (45.00%)	180 (53.30%)	255 (17.00%)	<0.0001
Medications
Anticoagulant	164 (96.50%)	295 (87.00%)	1195 (79.10%)	<0.0001
Antiplatelet	47 (27.60%)	122 (36.00%)	623 (41.20%)	0.001
Two antiplatelet agents	2 (1.20%)	24 (7.10%)	97 (6.40%)	0.018
Beta blocker	144 (84.70%)	274 (80.80%)	1203 (79.60%)	0.275
Amiodarone	28 (16.50%)	46 (13.60%)	314 (20.80%)	0.006
Nondihydropyridine Calcium channel blocker	9 (5.30%)	34 (10.00%)	175 (11.60%)	0.038
Digoxin	57 (33.50%)	50 (14.70%)	209 (13.80%)	<0.0001
Angiotensin-converting enzyme inhibitor or Angiotensin-II receptor blocker	41 (24.10%)	148 (43.70%)	599 (39.60%)	<0.0001
Class 1c antiarrhythmic	2 (1.20%)	2 (0.60%)	35 (2.30%)	0.086
Statin	36 (21.20%)	129 (38.10%)	592 (39.20%)	<0.0001
Diuretic	78 (45.90%)	182 (53.70%)	531 (35.10%)	<0.0001

Figure 1 Thromboembolism survival curve, adjusted, in AF patients according to EHRA VHD classification; 1946 patients, and 77 events.

Figure 2 Major bleeding survival curve, adjusted, in AF patients according to EHRA VHD classification; 1946 patients and 46 events.

Table 2 OAC in AF Patients According to EHRA Classification

	EHRA Type 1 VHD	EHRA Type 2 VHD	Non-VHD	p
Anticoagulated	164 (96.50%)	295 (87.00%)	1195 (79.10%)	<0.0001
Warfarin	148 (87.10%)	126 (37.20%)	375 (24.80%)	<0.0001
NOAC	16 (9.40%)	164 (48.40%)	779 (51.60%)	<0.0001
Rivaroxaban	10 (5.90%)	88 (26.00%)	380 (25.10%)	<0.0001
Apixaban	4 (2.40%)	59 (17.40%)	304 (20.10%)	<0.0001
Dabigatran	2 (1.20%)	17 (5.00%)	94 (6.20%)	0.022
Edoxaban	0 (0.00%)	0 (0.00%)	1 (0.10%)	0.845
Enoxaparin	0 (0.00%)	5 (1.50%)	41 (2.70%)	0.044

Figure 3 Thromboembolism survival curve, adjusted, in AF patients with EHRA type 2 VHD according to OAC; 325 patients, and 22 events.

Figure 4 Major bleeding survival curve in AF patients with EHRA type 2 VHD according to OAC; 325 patients, and 14 events comparison among patients on NOACs, warfarin, and non-anticoagulated patients.

Figure 5 Thromboembolism survival curve in AF patients with EHRA type 2 VHD according to OAC; 308 patients; 22 events; comparison among patients on rivaroxaban, apixaban, warfarin, and non-anticoagulated patients.