The Patterns of Non-vitamin K Antagonist Oral Anticoagulants (NOACs) Use in Patients with Atrial Fibrillation in Seven Balkan Countries: a Report from the BALKAN-AF Survey.

Tatjana Potpara ,Delyana Kamenova,Uliks Ekmeciu,Elina Trendafilova,Viktor Gjini,Sandro Brusich,Denis Mršić ,Zumreta Kušljugić ,Cătălina Arsenescu-Georgescu ,Ana Nenezić ,Elena Dimitrova ,Ljilja Musić ,Ivan Zeljković ,Gheorghe‐Andrei Dan ,S Milanov ,Raluca Popescu ,A Goda ,Šime Manola ,Belma Pojskić ,Gregory Y.h Lip

doi:10.1007/s12325-017-0589-5

Abstract

IntroductionData on management of atrial fibrillation (AF) in the Balkan Region are scarce. To capture the patterns in AF management in contemporary clinical practice in the Balkan countries a prospective survey was conducted between December 2014 and February 2015, and we report results pertinent to the use of non-vitamin K antagonist oral anticoagulants (NOACs).MethodsA 14-week prospective, multicenter survey of consecutive AF patients seen by cardiologists or internal medicine specialists was conducted in Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Montenegro, Romania, and Serbia (a total of about 50 million inhabitants).ResultsOf 2712 enrolled patients, 2663 (98.2%) had complete data relevant to oral anticoagulant (OAC) use (mean age 69.1 ± 10.9 years, female 44.6%). Overall, OAC was used in 1960 patients (73.6%) of whom 338 (17.2%) received NOACs. Malignancy [odds ratio (OR), 95% confidence interval (CI) 2.06, 1.20–3.56], rhythm control (OR 1.64, 1.25–2.16), and treatment by cardiologists were independent predictors of NOAC use (OR 2.32, 1.51–3.54) [all p < 0.01)], whilst heart failure and valvular disease were negatively associated with NOAC use (both p < 0.01). Individual stroke and bleeding risk were not significantly associated with NOAC use on multivariate analysis.ConclusionsNOACs are increasingly used in AF patients in the Balkan Region, but NOAC use is predominantly guided by factors other than evidence-based decision-making (e.g., drug availability on the market or reimbursement policy). Efforts are needed to establish an evidence-based approach to OAC selection and to facilitate the optimal use of OAC, thus improving the outcomes in AF patients in this large region.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-017-0589-5) contains supplementary material, which is available to authorized users.

Highlights

Data on management of atrial fibrillation (AF) in the Balkan Region are scarce
Oral anticoagulants (OAC), either non-vitamin K antagonist oral anticoagulants (NOACs) or vitamin K antagonists (VKAs), effectively reduce thromboembolism associated with atrial fibrillation (AF), and long-term OAC treatment is recommended to all AF patients with one or more additional stroke risk factors [1, 2]
Our results show that NOACs are increasingly used for stroke prevention in AF patients in the Balkan Region

Summary

Introduction

Data on management of atrial fibrillation (AF) in the Balkan Region are scarce. To capture the patterns in AF management in contemporary clinical practice in the BalkanThe members of BALKAN-AF Survey investigators are listed in Acknowledgements section.Enhanced content To view enhanced content for this article go to http://www.medengine.com/Redeem/ 00E8F06071EFA7AA.Electronic supplementary material The online version of this article (doi:10.1007/s12325-017-0589-5) contains supplementary material, which is available to authorized users.countries a prospective survey was conducted between December 2014 and February 2015, and we report results pertinent to the use of non-vitamin K antagonist oral anticoagulants (NOACs). Data on management of atrial fibrillation (AF) in the Balkan Region are scarce. To capture the patterns in AF management in contemporary clinical practice in the Balkan. Countries a prospective survey was conducted between December 2014 and February 2015, and we report results pertinent to the use of non-vitamin K antagonist oral anticoagulants (NOACs). Accumulating data from real-world observational registry-based studies offer insights into the uptake and patterns of NOAC use in routine clinical practice [4, 5]. To capture the patterns of AF management in routine practice in the Balkan Region, the Serbian Atrial Fibrillation Association (SAFA) conducted a prospective 3-month survey of consecutive AF patients in clinical practice in seven Balkan countries. We report results pertinent to the uptake and patterns of NOAC use in participating Balkan countries

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