Evolución clínica de los pacientes con FA y diabetes mellitus en la pandemia de COVID-19. Registro REFADI

INTRODUCTION AND OBJECTIVES: To analyze the evolution of patients with atrial fibrillation (AF) and diabetes in the mid-term follow-up during the COVID-19 pandemic and to describe its impact on this population. METHODS: Multicenter and prospective registry that included patients with AF and diabetes attended in cardiology clinics. A multivariate analysis was performed to determine the variables associated with the occurrence of clinical events and mortality. Recruitment was performed in February-December 2019. RESULTS: The evolution of 633 patients, 96,2% of those included in the REFADI registry with a median follow-up of 835 days was analyzed (mean age 73.8 ± 8.5 years, 54.3% male, CHA(2)DS(2)-VASc 4,34 ± 1,4, HAS-BLED 2,47 ± 0,96) were analyzed. The proportion of anticoagulated patients remained constant (95.6% vs 94.5%; P = .24). There was a decrease in the prescription of vitamin K antagonists (from 31.4% to 19.7%; P < .01), and an increase in the use of direct anticoagulants (from 62.0% to 70.3%; P < .01). During the follow-up there was an increase in the prescription of SGLT2 inhibitors (from 20.0% to 25.5%; P < .01) and GLP1 agonists (from 4.2% to 9.1%; P < .01). During this period, 17.2% of patients died, the majority from cardiovascular causes, 6.4% from COVID-19, 2.8% from stroke, and 1.8% from hemorrhage. Older age, lower ejection fraction, lower hemoglobin levels, and especially lower direct anticoagulants prescription were associated with mortality. CONCLUSIONS: Patients with AF and diabetes have a high thromboembolic risk and a high risk of developing complications, especially of cardiovascular origin.