title: Prevalence of Atrial Fibrillation and Antithrombotic Therapy in Hemodialysis Patients: Cross-Sectional Results of the Vienna InVestigation of AtriaL Fibrillation and Thromboembolism in Patients on HemoDIalysis (VIVALDI).
abstract: BACKGROUND
  Atrial fibrillation (AF) adds significant risk of stroke and thromboembolism in patients on hemodialysis (HD). The aim of this study was to investigate the prevalence of AF in a population-based cohort of HD patients and practice patterns of antithrombotic therapy for stroke prevention in AF.
  
  
  METHODS
  The Vienna InVestigation of AtriaL fibrillation and thromboembolism in patients on hemodialysis (VIVALDI), an ongoing prospective observational cohort study, investigates the prevalence of AF and the risk of thromboembolic events in HD patients in Vienna, Austria. We analyzed cross-sectional data of 626 patients (63.4% men, median age 66 years, approx. 73% of HD patients in Vienna), who provided informed consent. A structured interview with each patient was performed, recent and archived ECGs were viewed and medical histories were verified with electronic records.
  
  
  RESULTS
  The overall prevalence of AF was 26.5% (166 patients, 71.1% men, median age 72 years) of which 57.8% had paroxysmal AF, 3.0% persistent AF, 32.5% permanent AF, and 6.6% of patients had newly diagnosed AF. The median CHA2DS2-VASc Score was 4 [25th-75th percentile 3-5]. In multivariable analysis, AF was independently associated with age (odds ratio: 1.05 per year increase, 95% confidence interval: 1.03-1.07), male sex (1.7, 1.1-2.6), history of venous thromboembolism (2.0, 1.1-3.6), congestive heart failure (1.7, 1.1-2.5), history of or active cancer (1.5, 1.0-2.4) and time on HD (1.08 per year on HD, 1.03-1.13). Antithrombotic treatment was applied in 84.4% of AF patients (anticoagulant agents in 29.5%, antiplatelet agents in 33.7%, and both in 21.1%). In AF patients, vitamin-K-antagonists were used more often than low-molecular-weight heparins (30.1% and 19.9%).
  
  
  CONCLUSIONS
  The prevalence of AF is high amongst HD patients and is associated with age, sex, and distinct comorbidities. Practice patterns of antithrombotic treatment indicate a lack of consensus for stroke prevention in HD patients with AF.
authors.affiliation: Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
authors.forename: Oliver
authors.initials: O
authors.lastname: Königsbrügge
authors.affiliation: Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.|Department of Medicine, Clinical Division of Oncology, Medical University of Graz, Austria.
authors.forename: Florian
authors.initials: F
authors.lastname: Posch
authors.affiliation: Clinical Division of Nephrology, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
authors.forename: Marlies
authors.initials: M
authors.lastname: Antlanger
authors.affiliation: Department of Medicine VI, Wilhelminenspital, Vienna, Austria.
authors.forename: Josef
authors.initials: J
authors.lastname: Kovarik
authors.affiliation: Department of Medicine III, Donauspital, Vienna, Austria.
authors.forename: Renate
authors.initials: R
authors.lastname: Klauser-Braun
authors.affiliation: Department of Medicine III, Donauspital, Vienna, Austria.
authors.forename: Josef
authors.initials: J
authors.lastname: Kletzmayr
authors.affiliation: Department of Medicine I, Kaiser-Franz-Josef-Spital, Vienna, Austria.
authors.forename: Sabine
authors.initials: S
authors.lastname: Schmaldienst
authors.affiliation: Department of Medicine III, Hietzing Hospital, Vienna, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Auinger
authors.affiliation: Department of Medicine I, Rudolfstiftung Hospital, Vienna, Austria.
authors.forename: Günther
authors.initials: G
authors.lastname: Zuntner
authors.affiliation: Vienna Dialysis Center, Vienna, Austria.
authors.forename: Matthias
authors.initials: M
authors.lastname: Lorenz
authors.affiliation: Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
authors.forename: Ella
authors.initials: E
authors.lastname: Grilz
authors.affiliation: Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
authors.forename: Gerald
authors.initials: G
authors.lastname: Stampfel
authors.affiliation: Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
authors.forename: Stefan
authors.initials: S
authors.lastname: Steiner
authors.affiliation: Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Pabinger
authors.affiliation: Clinical Division of Nephrology, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
authors.forename: Marcus
authors.initials: M
authors.lastname: Säemann
authors.affiliation: Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.|Department of Medicine, Thrombosis and Hemostasis Program, McAllister Heart Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
authors.forename: Cihan
authors.initials: C
authors.lastname: Ay
mesh_terms: D000367:Age Factors; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology*; D001317:Austria / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D006435:Renal Dialysis; D013923:Thromboembolism / Q000188:drug therapy*; D013997:Time Factors
chemical_list: D000925:Anticoagulants