Distribution and Risk Profile of Paroxysmal, Persistent, and Permanent Atrial Fibrillation in Routine Clinical Practice: Insight From the RealiseAF International Registry

Study Questions:

What are the characteristics of atrial fibrillation (AF) encountered in clinical practice?

Methods:

This was an international, cross-sectional, observational survey of 9,816 patients with AF seen by cardiologists or internists at 831 sites in 26 countries between October 2009 and May 2010.

Results:

The AF was paroxysmal in 26.5% of patients (mean age 65 years), persistent in 23.8% (mean age 66 years), and permanent in 49.6% (mean age 68 years). Among patients who met criteria for anticoagulation (CHADS2 score >1), the percentages receiving an oral anticoagulant were 38%, 54%, and 59% for the patients with paroxysmal, persistent, and permanent AF, respectively. A rhythm-control strategy was used in 74%, 56%, and 7% of patients with paroxysmal, persistent, and permanent AF, respectively. The most commonly used rhythm-control agents used for paroxysmal AF were amiodarone (30%) and propafenone (10%), and the most commonly used rhythm-control agent for persistent AF was amiodarone (33%). Approximately 60% of patients with the three categories of AF were symptomatic. The resting ventricular rate during AF was >80/minute in 20%, 41%, and 50% of patients with paroxysmal, persistent, and permanent AF, respectively.

Conclusions:

AF is paroxysmal in only approximately one-fourth of patients encountered in clinical practice. A large proportion of patients with AF are undertreated for stroke prevention and heart rate control.

Perspective:

The underutilization of oral anticoagulants has been documented in multiple prior studies, and continues to be a worldwide problem. With the increasing availability of oral anticoagulants associated with less inconvenience than warfarin, it remains to be seen whether a higher proportion of patients will receive appropriate stroke prevention therapy.

Clinical Topics: Anticoagulation Management

Keywords: Registries, Stroke, Cross-Sectional Studies, Warfarin, Propafenone, Heart Rate, Heart Ventricles


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