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Variations in Cause and Management of Atrial Fibrillation in a Prospective Registry of 15,400 Emergency Department Patients in 46 Countries: The RE-LY Atrial Fibrillation Registry
Study Questions:
What is the extent of geographic differences in the characteristics of patients with atrial fibrillation (AF) and in their anticoagulation therapy?
Methods:
The data in this study were obtained from an international registry of 15,400 patients (mean age 65.9 years) with AF who presented to an emergency department at 164 sites in 46 countries in 2008-2011. The mean patient age was highest in North America (70.1 years) and lowest in India (57.9 years) and Africa (57.2 years).
Results:
The most common risk factor was hypertension, present in 62% of patients overall. Hypertension was most prevalent in Eastern Europe (80.7%) and least prevalent in India (41.6%). Rheumatic heart disease was significantly more prevalent in India (31.5%) and China (21.5%) than in Western Europe (1.5%) and North America (2.2%). Patients with ≥2 risk factors for stroke were treated with an oral anticoagulant most often in North America (65.7%) and least often in China (11.2%). Mean time in therapeutic range was highest in Western Europe (62.4%) and North America (50.9%) and lowest in India, China, Southeast Asia, and Africa (32-40%).
Conclusions:
The authors concluded that there are major international differences in the characteristics of patients with AF who present to an emergency department and in their anticoagulation therapy.
Perspective:
The most striking difference is the much higher prevalence of rheumatic heart disease in third-world countries such as India and China, and the much lower utilization of an oral anticoagulant in these countries. However, there continues to be a major degree of underutilization of oral anticoagulants in high-risk patients in all regions, including North America.
Keywords: North America, Rheumatic Heart Disease, Stroke, Europe, Emergency Service, Hospital, Developing Countries, China, India, Europe, Eastern, Hypertension
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