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Raif Kılıç1, Ahmet Ferhat Kaya2
1Department of Cardiology, Çermik State Hospital, Diyarbakır, Türkiye
2Department of Cardiology, Muş State Hospital, Muş, Türkiye
Keywords: Atrial fibrillation, major bleeding, malnutrition, mortality
Objectives: The aim of this study was to examine the clinical importance of malnutrition in patients with non-valvular atrial fibrillation (AF) aged 65 and over who were receiving anticoagulant treatment and to distinguish the differences between direct oral anticoagulants (DOACs) and warfarin therapy.
Patients and methods: Between January 2016 and December 2020, a total of 423 AF patients (183 males, 240 females; mean age: 73.4±5.8 years; range, 65 to 89 years) were retrospectively analyzed. The patients were divided into two groups according to the Controlling Nutritional Status (CONUT) score: ≥5 (n=92) and <5 (n=331). All patients were followed for at least two years from the first presentation.
Results: Major bleeding and mortality were found to be higher in the CONUT score ≥5 group (8.7% vs. 3.0%, p=0.017 and 18.5% vs. 10.0%, p=0.025, respectively). While there was higher major bleeding and mortality in CONUT ≥5 patients using warfarin, there was no significant difference in the DOAC group (warfarin p=0.009, DOAC p=0.337 and warfarin p=0.046, DOAC p=0.171, respectively). In the receiver operating characteristic analysis, a cut-off value of 3.5 of the CONUT score predicted both mortality and major bleeding (area under the curve [AUC]: 0.781, p<0.001 and AUC: 0.733, p=0.001, respectively).
Conclusion: According to the CONUT score, a higher rate of major bleeding and mortality was found in AF patients aged 65 and over
with moderate-severe malnutrition. Based on these findings, the use of DOAC may be more reliable in this patient group.
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