A Prospective Survey in European Society of Cardiology Member Countries of Atrial Fibrillation Management: Baseline Results of EuroObservational Research Programme Atrial Fibrillation (EORP-AF) Pilot General Registry

Study Questions:

What are the characteristics of patients with atrial fibrillation (AF), and how are these patients being treated in contemporary practice?

Methods:

A total of 3,049 consecutive patients (mean age 68.8 years) with AF (paroxysmal in 26.5%) being cared for by a broad array of hospital- and office-based cardiologists in nine European countries were enrolled in a registry.

Results:

The commonest comorbidities were hypertension (70.9%) and heart failure (47.5%). Only 3.9% of patients had lone AF. The most frequently used rhythm-control agents were amiodarone (21.5%), propafenone (5.3%), and flecainide (5%), and the most frequently used rate-control agents were beta-blockers (69.2%) and digoxin (19.4%). The mean CHA2DS2-VASc score was 3.2. Approximately 80% of patients received an oral anticoagulant (OAC)—a vitamin K antagonist in 72% of patients, dabigatran in 6.8%, and rivaroxaban in 1.6%. An OAC was used in 72.5-85.1% of patients with a score of 2-8, and in 66.7% of patients with a score of 9.

Conclusions:

The authors concluded that a fairly high percentage (approximately 80%) of AF patients who are at risk of stroke are being anticoagulated in contemporary practice. However, approximately one-third of patients at highest risk of stroke (CHA2DS2-VASc score 9) are not being anticoagulated.

Perspective:

Other studies have indicated that 30-40% of patients with CHA2DS2-VASc scores >1 are not being anticoagulated in general practice. The larger percentage of patients appropriately anticoagulated in this registry may be because only patients cared for by a cardiologist were enrolled. Regarding patients with a CHA2DS2-VASc score of 9, the lower percentage of anticoagulation could be because these patients had a higher bleeding risk.

Clinical Topics: Anticoagulation Management, Heart Failure and Cardiomyopathies, Prevention, Novel Agents, Acute Heart Failure, Hypertension

Keywords: Vitamin K, Stroke, Morpholines, Digoxin, Europe, beta-Alanine, Benzimidazoles, Heart Failure, Propafenone, Flecainide, Hypertension


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