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Prognosis and Treatment of Atrial Fibrillation Patients by European Cardiologists: One Year Follow-Up of the EURObservational Research Programme-Atrial Fibrillation General Registry Pilot Phase (EORP-AF Pilot Registry)
Study Questions:
What are the symptoms, use of antithrombotic therapy, and rate versus rhythm strategies, as well as determinants of mortality and/or stroke/transient ischemic attack (TIA)/peripheral embolism during 1-year follow-up in a contemporary European registry of atrial fibrillation (AF) patients?
Methods:
The EURObservational Research Programme-Atrial Fibrillation General Registry Pilot Phase (EORP-AF Pilot) registry population was comprised of consecutive in- and out-patients with AF presenting to cardiologists in participating European Society of Cardiology countries. Consecutive patients with AF documented by electrocardiogram (ECG) were enrolled. Follow-up was performed by the local investigator, initially at 1 year, as part of a long-term cohort study.
Results:
At the follow-up visit, patients were frequently asymptomatic (76.8%), but symptoms are nevertheless common among paroxysmal and persistent AF patients, especially palpitations, fatigue, and shortness of breath. Oral anticoagulant (OAC) use remains high, approximately 78% overall at follow-up, and of those on vitamin K antagonist (VKA), 84% remained on VKA during the follow-up, while of those on non-VKA oral anticoagulant (NOAC) at baseline, 86% remained on NOAC, and 11.8% had changed to a VKA and 1.1% to antiplatelet therapy. Digitalis was commonly used in paroxysmal AF patients. Of rhythm control interventions, electrical cardioversion was performed in 9.7%, pharmacological cardioversion in 5.1%, and catheter ablation in 4.4%. Despite good adherence to anticoagulation, 1-year mortality was high (5.7%), with most deaths being cardiovascular (70%). Hospital readmissions were common, especially for atrial tachyarrhythmias and heart failure. On multivariate analysis, independent baseline predictors for mortality and/or stroke/TIA/peripheral embolism were age, AF as primary presentation, previous TIA, chronic kidney disease, chronic heart failure, malignancy, and minor bleeding. Independent predictors of mortality were age, chronic kidney disease, AF as primary presentation, prior TIA, chronic obstructive pulmonary disease, malignancy, minor bleeding, and diuretic use. Statin use was predictive of lower mortality.
Conclusions:
The authors concluded that despite the high prescription of OAC, 1-year mortality and morbidity remain high in AF patients, particularly from heart failure and hospitalizations.
Perspective:
This 1-year follow-up analysis of the EORP-AF pilot general registry reports that patients are frequently asymptomatic, but symptoms are nevertheless still common among some AF patients, especially palpitations, fatigue, and shortness of breath, and that overall OAC use remains high, and at 1-year follow-up, >84% remained on anticoagulation. Rhythm control was infrequent, 1-year mortality was high in AF patients (6.4%), with 70% being cardiovascular deaths, but those classified at low risk using the CHA2DS2-VASc score had low mortality and no stroke/peripheral embolism events and hospital readmissions were common, especially for AF and heart failure. The data appear to suggest that the CHA2DS2-VASc score can also reliably predict the risk of all-cause death and not only of ischemic stroke.
Keywords: Vitamin K, Stroke, Ischemic Attack, Transient, Multivariate Analysis, Diuretics, Electric Countershock, Electrocardiography, Dyspnea, Tachycardia, Prognosis, Pulmonary Disease, Chronic Obstructive, Patient Readmission, Heart Failure, Digitalis, Embolism, Catheter Ablation, Renal Insufficiency, Chronic, ESC Congress
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