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No improvement in oral anticoagulation for stroke prevention in AF

The Atrial Fibrillation General Pilot Registry is part of the ESC’s EORP programme3 and includes over 3,000 patients in 9 countries. Data was collected on implementation and outcomes for catheter ablation, new antithrombotic drugs and new antiarrhythmic agents.
Atrial Fibrillation


Amsterdam, The Netherlands –Tuesday 3 September 2013: The use of oral anticoagulation for stroke prevention in atrial fibrillation (AF) has not improved in the last 10 years, according to the first results of the Atrial Fibrillation General Pilot Registry presented at ESC Congress 2013 today by Professor Gregory Lip (UK).
Professor Lip said: “A decade ago the ESC conducted a registry on AF management as part of the Euro Heart Survey. Since then new treatments have become available and the ESC has published new guidelines on the management of AF.1,2 The time was right for a new registry to assess adherence to guidelines and how management has changed over time.”

The Atrial Fibrillation General Pilot Registry is part of the ESC’s EORP programme3 and includes over 3,000 patients in 9 countries. Data was collected on implementation and outcomes for catheter ablation, new antithrombotic drugs and new antiarrhythmic agents. The data was compared to Euro Heart Survey data from 10 years ago, which was collected using a similar study design.
The baseline results of the pilot registry, presented for the first time today, provide an important snapshot of AF epidemiology and management in 9 ESC member countries.
Use of oral anticoagulation for stroke prevention remained suboptimal and was broadly similar to 10 years ago. Approximately 65% of patients with AF received oral anticoagulation for stroke prevention (usually vitamin K antagonists). Of those anticoagulated, novel oral anticoagulants were used in less than 10% of patients. Independent predictors of oral anticoagulant use were younger age, high CHA2DS2-VASc score, BMI, hyperthyroidism and prior stroke – whilst predictors of less use were older age, female gender, high systolic blood pressure, high HAS-BLED score and chronic kidney disease.
Professor Lip said: “The proportion of patients with AF who receive oral anticoagulation hasn’t increased in the last 10 years despite the introduction of new anticoagulants. The current focus is the initial identification of ‘truly low risk’ patients with AF who do not need any antithrombotic therapy; subsequent to this step, patients with AF and one or more stroke risk factors can be offered effective stroke prevention, which is oral anticoagulation.”

As with the Euro Heart survey of a decade ago, common comorbidities in AF patients remain hypertension, coronary disease and heart failure. Lone AF was evident in only <7% of patients, and importantly, asymptomatic AF is a common occurrence.
Professor Lip said: “Asymptomatic AF is common and it’s often not picked up until something bad happens. In many cases, asymptomatic AF is first diagnosed when patients present with a complication, for example stroke or heart failure.”

Other findings were that of the various antiarrhythmic drugs, amiodarone remained the most commonly used (around 25% of patients). Catheter ablation was used in approximately 20% of patients with paroxysmal AF.
Patients in the pilot registry will be followed up annually for 3 years. Professor Lip said: “The one year follow up data will be presented at ESC Congress 2014 and will show how management practices and outcomes have changed since the start of the pilot.”
He added: “The pilot is the prelude to the Atrial Fibrillation General Long Term Registry, which will start from October 2013 and has a much larger design. An invitation to participate has been sent to all ESC member countries.”
Professor Lip concluded: “Patients with asymptomatic AF need to be identified earlier so they can be treated to avoid complications such as heart failure and stroke. And doctors should be encouraged to use oral anticoagulation in patients with AF to avoid needless occurrences of stroke.”

References

  1. Guidelines for the management of atrial fibrillation. European Heart Journal. 2010;31:2369–2429.
  2. 2012 Focused update of the ESC Guidelines for the management of atrial fibrillation. European Heart Journal. 2012;33:2719–2747.
  3. About EORP: the ESC’s EURObservational Research Programme (EORP) of surveys and registries aims to provide a better understanding of medical practice based on observational data collected with more robust methodological procedures. See www.escardio.org/guidelines-surveys/eorp for more information.

This press release accompanies a presentation at the ESC Congress 2013. The press release has been approved by the Chairman of the Executive Committee of the Registry.

Notes to editor

About the European Society of Cardiology
The European Society of Cardiology (ESC) represents more than 80 000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.
About ESC Congress 2013
The ESC Congress is currently the world’s premier conference on the science, management and prevention of cardiovascular disease.  The spotlight of this year's event is "The Heart Interacting with Systemic Organs".  ESC Congress 2013 takes place from 31 August to 4 September at the RAI centre in Amsterdam, Netherlands. More information on ESC Congress 2013 contact the ESC Press Office.