Abstract
Data on the management of atrial fibrillation (AF) in the Balkan Region are limited. The Serbian AF Association (SAFA) prospectively investigated contemporary ‘real-world’ AF management in clinical practice in Albania, Bosnia&Herzegovina, Bulgaria, Croatia, Montenegro, Romania and Serbia through a 14-week (December 2014-February 2015) prospective, multicentre survey of consecutive AF patients. We report the results pertinent to stroke prevention strategies. Of 2712 enrolled patients, 2663 (98.2%) with complete data were included in this analysis (mean age 69.1 ± 10.9 years, female 44.6%). Overall, 1960 patients (73.6%) received oral anticoagulants (OAC) and 762 (28.6%) received antiplatelet drugs. Of patients given OAC, 17.2% received non-vitamin K antagonist oral anticoagulants (NOACs). CHA2DS2-VASc score was not significantly associated with OAC use. Of the ‘truly low-risk’ patients (CHA2DS2-VASc = 0 [males], or 1 [females]) 56.5% received OAC. Time in Therapeutic Range (TTR) was available in only 18.7% of patients (mean TTR: 49.5% ± 22.3%). Age ≥ 80 years, prior myocardial infarction and paroxysmal AF were independent predictors of OAC non-use. Our survey shows a relatively high overall use of OAC in AF patients, but with low quality of vitamin K antagonist therapy and insufficient adherence to AF guidelines. Additional efforts are needed to improve AF-related thromboprophylaxis in clinical practice in the Balkan Region.
Highlights
In parallel with increasing global burden of atrial fibrillation (AF), accumulating high-quality evidence from randomized clinical trials on AF management inform frequent updates of AF guidelines[1]
In the remaining cohort of 2457 patients oral anticoagulants (OAC) was prescribed to 1843 patients (75.0%), and the use of OAC was driven by broadly similar determinants as in the main cohort (Supplemental Table 5). This snapshot survey provides, for the first time, a contemporary insight into routine clinical practice in AF management from a large region of Europe where data on AF management are generally scarce, especially since countries participating in this survey were largely under-represented in recent European AF surveys[2,4,5]
Our findings suggest that the overall use of OAC for stroke prevention in the Balkan region is relatively high (~74%), but poorly associated with individual patient stroke risk as recommended by the European Society of Cardiology guidelines[1]
Summary
In parallel with increasing global burden of atrial fibrillation (AF), accumulating high-quality evidence from randomized clinical trials on AF management inform frequent updates of AF guidelines[1]. Guideline implementation into daily clinical practice might be incomplete for many reasons and monitoring of routine practice through ongoing large, well-conducted long-term registries[2,3] helps to understand and attenuate barriers for evidence-based management of AF in ‘real-world’ setting. Recent reports from contemporary European AF registries have provided important insights into AF management in clinical practice[2,3,4,5], including the observation of certain regional differences in management across Europe[6]. We investigated contemporary real-world patterns of AF management in the Balkan Region through a prospective 14-week survey of consecutive AF patients in clinical practice, and we report the results pertinent to stroke prevention
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