‘Real-World’ Antithrombotic Treatment in Atrial Fibrillation: the EURObservational Research Programme Atrial Fibrillation General Pilot Survey

Study Questions:

Has the introduction of updated guidelines by the European Society of Cardiology (ESC) translated into improved antithrombotic treatment of patients with atrial fibrillation (AF) in Europe?


In this pilot survey, consecutive in- and outpatients (N = 3,119) with a primary or secondary diagnosis of AF who were treated by a cardiologist at European medical centers were included. The antithrombotic prescription patterns with respect to the patient’s risk profile were examined.


Among the survey patients, 89% of patients with a CHADS2 score ≥1, and 96% with a CHA2DS2-VASc score ≥1 received antithrombotic therapy, with 76% and 81% of patients receiving oral anticoagulation (OAC; either warfarin [90%] or a novel oral anticoagulant [10%]), respectively. Patients with paroxysmal AF were less likely to receive OAC, compared to those with persistent forms of the arrhythmia. In patients undergoing pharmacologic, or electrical cardioversion, or catheter ablation, OAC was prescribed at discharge in 67%, 86%, and 88% of patients, respectively. Antiplatelet therapy was more commonly prescribed in patients with a high HAS-BLED score (≥2). Coronary artery disease was strongly associated with combination treatment with an oral anticoagulant and an antiplatelet agent.


Since the publication of the updated guidelines, the investigators noted an improvement in adherence to proposed guidelines in the antithrombotic treatment of patients with AF.


The Euro Heart Survey, published in 2006, revealed that there was suboptimal adherence to guidelines when prescribing OAC. After its publication, the ESC updated its guidelines and recommended the usage of the CHA2DS2-VASc and HAS-BLED scores to assist clinicians in identifying patients at high and low risk of events, and to streamline treatment with OAC. This study nicely shows that introduction of clear and concise guidelines can have a positive impact on the care of patients with AF. Nonetheless, there is still room for improvement. For example, the authors suggest that antithrombotic treatment was at times based on the AF type rather than the patient’s risk profile.

Clinical Topics: Arrhythmias and Clinical EP, Atherosclerotic Disease (CAD/PAD), SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Coronary Artery Disease, Platelet Aggregation Inhibitors, Europe, Catheter Ablation

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