Death and Stroke in 47 Countries After Atrial Fibrillation

Study Questions:

How do outcomes of atrial fibrillation (AF) vary in different regions of the world?


The subjects of this cohort study were 15,400 patients living in 47 countries who were enrolled in a prospective registry upon presentation with AF. The primary outcomes were death and stroke at 1 year of follow-up. Outcome in North America, western Europe, and Australia (NA/wE/A) were compared with outcomes in South America, eastern Europe, the Middle East, sub-Saharan Africa, India, China, and southeast Asia.


The overall stroke rate at 1 year was 4%. The stroke rate was 2% in NA/wE/A and varied in the other regions of the world from a low of 1% in India to a high of 8% in Africa. The overall mortality rate at 1 year was 11%, with a rate of 10% in NA/wE/A compared to 9-20% in the other regions. Heart failure was the cause of death in approximately one-third of cases in all regions.


There are large differences between regions of the world in stroke and mortality after the diagnosis of AF. Throughout the world, heart failure is a major cause of death in patients with AF.


Given the global differences in clinical characteristics, access to health care, and therapeutic options, global differences in outcomes of AF are expected. However, the differences in outcomes found in this study still were largely present after correction for clinical characteristics, treatments, and economic factors in the analysis. Factors that were not available for analysis (e.g., time in therapeutic range, efficacy of antihypertensive therapy) most likely account for the regional differences in outcomes.

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