Cardiovascular disease is commonly accompanied by renal dysfunction. Multimorbidity in hospitalized patients impacts unfavorably on prognosis and hospital stay. We aimed to illustrate the contemporary burden of cardiorenal morbidity across inpatient cardiology care in Greece. The Hellenic Cardiorenal Morbidity Snapshot (HECMOS) used an electronic platform to collect demographic and clinically relevant information about all patients hospitalized on the 3^rd of March 2022 in Greece. The participating institutions covered all levels of inpatient cardiology care and most of the country's territories in order to collect a real-world, nation representative sample. 923 patients (males 68.4%, median age 73ys ± 14.8) were admitted in 55 different cardiology departments. 57.7% of the sample were older than 70 years of age. Hypertension was highly prevalent, present in 66% of cases. History of chronic HF, DM, AF and CKD was present in 38%, 31.8%, 30% and 26% respectively. 64.1% of the sample exhibited at least one of these four entities. Accordingly, a combination of at least 2 of them was recorded in 38.7%, of at least three in 18.2% whereas 4.3% of the sample combined all four morbid conditions in their past medical history. The most common combination was the coexistence of HF-AF accounting for 20.6% of the sample. 9 out of 10 non-electively admitted patients were hospitalized due to acute HF (39.9%), ACS (33.5%) or tachyarrhythmias (13.2%). HECMOS participants carried a remarkable burden of cardio-reno-metabolic disease. HF in conjunction with AF were found to be the most prevalent combination among the studied cardiorenal nexus of morbidities in the whole study population.

Non-vitamin K antagonist oral anticoagulants (NOACs) are considered the first-line therapy to prevent stroke in non-valvular atrial fibrillation (AF) ¹ and are recommended by the recent ESC guidelines in preference to vitamin K antagonists (VKAs). ¹ Non-vitamin K antagonist oral anticoagulants offer many advantages compared to VKAs, which include fixed dosing (up to two times a day), fewer dietary and drug interactions, predictable anticoagulation effect (rapid onset and offset) precluding the need for periprocedural bridging anticoagulation, and no need for regular monitoring of anticoagulant effect. Although NOACs are increasingly used in patients with AF in everyday clinical practice, the use of VKAs is still high, especially in elderly patients living in rural areas. ² Some physicians are still reluctant to prescribe NOACs in specific populations (i.e. elderly patients, patients with malignancies, patients with severe renal impairment, etc.) that are current under-represented in most studies and most importantly in the pivotal NOAC trials (RE-LY, ROCKET-AF, ARISTOTLE, ENGAGE AF-TIMI 48). In patients with creatinine clearance less than 25 mL/min estimated by the Cockcroft–Gault equation, randomized controlled trials-derived data on the effect of NOACs are lacking. These patients were excluded from the NOAC’s major clinical trials. Moreover, NOACs are still underused due to their higher costs, while patients on VKA therapy for several years may be averse to convert to new treatments.

RRH: Rural and Remote Health. Published article number: 4384 - Massive pericardial effusion without cardiac tamponade due to subclinical hypothyroidism (Hashimoto's disease)