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RE-LY AF: Global variations in the 1-year rates of death and stroke in 15,432 patients presenting to the emergency department with atrial fibrillation in 47 countries: The RE-LY AF Registry

Atrial Fibrillation

Presenter | see Discussant report

Jeff Healey

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List of Authors: Assoc. .Prof. Jeff Healey / Canada
Co-authors: Dr. Jonas Oldgren, Sweden/Dr. Amit Parekh, USA/Dr. Jun Zhu, China/Dr. Prem Pais, India/Dr. Patrick Commerford, South Africa/Prof. Michael Ezekowitz, USA/Prof. Lars Wallentin, Sweden/Prof. Stuart J. Connolly, Canada/Prof. Salim Yusuf, Canada



Atrial fibrillation (AF) is an important cause of morbidity and mortality in all regions of the world.  However; the predisposing conditions and management of AF differ substantially between regions.  This multinational registry is the first to report on 1-year outcomes for a large cohort of primary care patients with AF from all regions of the world, including low-income countries.

This prospective registry (164 sites in 47 countries) enrolled patients attending an emergency department (ED) with AF as either a primary or secondary diagnosis.  Follow-up was obtained at 1-year (± 4 weeks) after presentation to the ED.  Outcomes of patients in North America (Canada and USA) were compared with those from 8 major geographic regions.  P-values of <0.005 were considered significant.

A total 15,340 patients were enrolled of whom 11.5% died within 1 year.  Compared to patients in North America (11.4%), the one-year mortality rate was significantly lower in Western Europe (8.2%), but twice as high in Latin America (18.5%) and Africa (21.5%).  The rate of death was lower (5.5%) among patients who presented to the ED with AF as their primary diagnosis compared to those who presented for other reasons (16.5%).  However; rates were similar for patients with rheumatic heart disease (RHD) compared to those without (10.6% vs. 11.7%)
In North America, the one-year stroke risk was 3.2%; however the rate was significantly higher in China (7.1%), South-East Asia (7.8%) and Africa (9.1%).  The increased stroke risk in these regions was observed for all levels of CHADS2 score and was observed both in patients with and without RHD (RHD: 3.1% vs. 4.6% vs. 12.8% vs. 8.5%; No-RHD: 3.1% vs. 7.6% vs. 7.6% vs. 9.2% respectively).  Regional differences in stroke rates did not appear to be the result of variations in OAC use, as the differences in stroke rates were most pronounced among patients with a CHADS2 score > 1 or RHD who were receiving OAC (3.7% vs. 12.1% vs. 12.5% vs. 14.9% respectively).  Among patients without RHD, global stroke risk rose stepwise with increasing CHADS2 score: 0 - 1.7%; 1 – 2.7%, 2 – 3.7%, 3 – 6.9%, > 3 – 8.8%.  

More than 10% of patients who are seen in an ED with AF are dead within one year.  The rate is twice as high in Latin America and Africa.  Stroke risk is higher in China, South-East Asia and Africa than the rest of the world and this difference appears unrelated to differences in RHD, CHADS2 score and OAC use. 

Discussant | see Presenter abstract

Gregory Yh Lip


711005 - 711006


Clinical Trial & Registry Update III: Updates on Atrial Fibrillation and Valves

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.