Patterns of anticoagulant underuse in European AF patients in 2012 - results from PREFER in AF registry

Abstract

Background: The last focused update of the ESC guidelines for the management of atrial fibrillation (AF) recommended to use antithrombotic therapy for the prevention of thromboembolic events for all patients with AF except in those at low risk. Nevertheless, little is known about the impact of these recommendations in clinical practice of different European countries. Methods: The PREvention oF thromboembolic events – European Registry in Atrial Fibrillation (PREFER in AF) recruited unselected patients in Austria, France, Germany, Italy, Spain, Switzerland and the United Kingdom from Jan 2012 to Jan 2013. We report the data collected at enrolment into the study. Results: 7243 consecutive patients were enrolled. 5856 of them had a transthoracic echocardiography performed in the 12 months period prior to inclusion. While the overall prevalence of patients with CHA2DS2-VASc of 0 was very low, there were 1282 (17.7%) patients who did not receive antithrombotic therapy, including 808 patients (11.2%) who received antiplatelet (AP) therapy and 474 patients (6.5%) who had no preventive treatment at all. Patients who received AP or no preventive treatment had a lower prevalence of left atrial dilation than the overall population of the study (59.0% and 48.3% respectively vs. 70.1%, p<0.01) and were more frequently affected by paroxysmal AF (51.4% for AP group and 51.0% for no treatment vs. 30% overall, p<0.01). Those with no antithrombotic treatment tended to be younger than the average (67.4±14.3 years vs. 71.5±10.7 years, p<0.01), but no differences were seen for the AP group (70.9±11.8 years, p=0.11). Conclusions: There is still a significant proportion of patients with AF who, despite a raised risk of thromboembolism, do not receive appropriate treatment in Europe. Parameters associated with under-treatment suggest that this occurs more often in patients in initial stages of AF, despite the guideline recommendation of antithrombotic treatment only according to the risk profile.