Prognosis and treatment of atrial fibrillation patients by European cardiologists: one year follow-up of the EURObservational Research Programme-Atrial Fibrillation General Registry Pilot Phase (EORP-AF Pilot registry)
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BACKGROUND: The EURObservational Research Programme-Atrial Fibrillation General Registry Pilot Phase (EORP-AF Pilot) provides systematic collection of contemporary data regarding the management and treatment of 3119 subjects with AF from 9 member European Society of Cardiology (ESC) countries. In this analysis, we report the development of symptoms, use of antithrombotic therapy and rate vs. rhythm strategies, as well as determinants of mortality and/or stroke/transient ischaemic attack (TIA)/peripheral embolism during 1-year follow-up in this contemporary European registry of AF patients. METHODS: The registry population comprised consecutive in- and out-patients with AF presenting to cardiologists in participating ESC countries. Consecutive patients with AF documented by ECG were enrolled. Follow-up was performed by the local investigator, initially at 1 year, as part of a long-term cohort study. RESULTS: At the follow-up, patients were frequently asymptomatic (76.8%), but symptoms are nevertheless common among paroxysmal and persistent AF patients, especially palpitations, fatigue, and shortness of breath. Oral anticoagulant (OAC) use remains high, ∼78% overall at follow-up, and of those on vitamin K antagonist (VKA), 84% remained on VKA during the follow-up, while of those on non-VKA oral anticoagulant (NOAC) at baseline, 86% remained on NOAC, and 11.8% had changed to a VKA and 1.1% to antiplatelet therapy. Digitalis was commonly used in paroxysmal AF patients. Of rhythm control interventions, electrical cardioversion was performed in 9.7%, pharmacological cardioversion in 5.1%, and catheter ablation in 4.4%. Despite good adherence to anticoagulation, 1-year mortality was high (5.7%), with most deaths were cardiovascular (70%). Hospital readmissions were common, especially for atrial tachyarrhythmias and heart failure. On multivariate analysis, independent baseline predictors for mortality and/or stroke/TIA/peripheral embolism were age, AF as primary presentation, previous TIA, chronic kidney disease, chronic heart failure, malignancy, and minor bleeding. Independent predictors of mortality were age, chronic kidney disease, AF as primary presentation, prior TIA, chronic obstructive pulmonary disease, malignancy, minor bleeding, and diuretic use. Statin use was predictive of lower mortality. CONCLUSION: In this 1-year follow-up analysis of the EORP-AF pilot general registry, we provide data on the first contemporary registry focused on management practices among European cardiologists, conducted since the publication of the new ESC guidelines. Overall OAC use remains high, although persistence with therapy may be problematic. Nonetheless, continued OAC use was more common than in prior reports. Despite the high prescription of OAC, 1-year mortality and morbidity remain high in AF patients, particularly from heart failure and hospitalizations.
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AF-related symptoms are most commonly fatigue/tiredness and exertional shortness of breath, or less frequently palpitations and chest pain.
“AF-related symptoms are most commonly fatigue/tiredness and exertional shortness of breath, or less frequently palpitations and chest pain.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [42]
OAC therapy can prevent the majority of ischaemic strokes in AF patients and can prolong life.
“OAC therapy can prevent the majority of ischaemic strokes in AF patients and can prolong life.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [42]
There is strong evidence that patients with a CHA2DS2-VASc risk score of 2 or more in men, and 3 or more in women, benefit from oral anticoagulation.
“and hence there is strong evidence that patients with a CHA 2 DS 2 -VASc risk score of 2 or more in men, and 3 or more in women benefit from OAC.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [42]
Controlled trials studying oral anticoagulation in AF patients have been enriched for patients at high risk of stroke.
“Controlled trials studying OAC in AF patients have been enriched for patients at high risk of stroke, 38,39,42,194,201,329,351,352”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [42]
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- 7% of patients at baseline were on no antithrombotic therapy. P-values for among-group comparisons are from Pearson's x 2 test. Cardiac 57.4 (66/115) 51.0 (25/49) 50.0 (9/18) 58.8 (10/17) 55.6 (5/9) 77.3 (17/22) 0.0288* Vascular 13.0 (15/115) 8.2 (4/49) 22.2 (4/18) 11.8 (2/17) 44.4 (4/9) 4.5 (1/22) Non-cardiovascular 29.6 (34/115) 40.8 (20/49) 27.8 (5/18) 29.4 (5/17) 0.0 (0/9) 18.2 (4/22) Cardiac (%) Acute myocardial infarction 7.6 (5/66) 0.0 (0/25) 11.1 (1/9) 20.0 (2/10) 40.0 (2/5) 0.0 (0/17) 0.0186* Heart failure 77.3 (51/66) 84.0 (21/25) 77.8 (7/9) 50.0 (5/10) 40.0 (2/5) 94.1 (16/17) Arrhythmia 7.6 (5/66) 8.0 (2/25) 11.1 (1/9) 10.0 (1/10) 20.0 (1/5) 0.0 (0/17) Other 7.6 (5/66) 8.0 (2/25) 0.0 (0/9) 20.0 (2/10) 0.0 (0/5) 5.9 (1/17) Vascular (%) Ischaemic stroke 20.0 (3/15) 0.0 (0/4) 0.0 (0/4) 0.0 (0/2) 50.0 (2/4) 100.0 (1/1) 0.5684* Haemorrhagic stroke 53.3 (8/15) 75.0 (3/4) 50.0 (2/4) 50.0 (1/2) 50.0 (2/4) 0.0 (0/1) Pulmonary embolism 20.0 (3/15) 25.0 (1/4) 25.0 (1/4) 50.0 (1/2) 0.0 (0/4) 0.0 (0/1) Aorto-oesophageal fistula 6.7 (1/15) 0.0 (0/4) 25.0 (1/4) 0.0 (0/2) 0.0 (0/4) 0.0 (0/1) (b) Readmissions Readmission for AF/atrial flutter/atrial tachycardia (%) 17.9 (400/2238) 12.8 (87/679) 21.9 (137/627) 28.7 (137/477) 23.3 (17/73) 5.8 (22/382) ,0.0001* Readmission: other cardiovascular events (%) 11.7 (265/2258) 15.1 (104/689) 7.4 (47/631) 10.2 (48/470) 10.5 (8/76) 14.8 (58/392) 0.0001* ACS (%) 7.2 (19/264) 4.8 (5/104) 21.3 (10/47) 4.2 (2/48) 0.0 (0/7) 3.4 (2/58) 0.0098* Heart failure (%) 42.8 (113/264) 42.3 (44/104) 29.8 (14/47) 35.4 (17/48) 28.6 (2/7) 62.1 (36/58) 0.0083* Coronary intervention (%) 20.1 (53/264) 21.2 (22/104) 34.0 (16/47) 18.8 (9/48) 14.3 (1/7) 8.6 (5/58)
- ACS, acute coronary syndrome; TIA, transient ischaemic attack. *P-values for among-group comparisons are from Pearson's x 2 test. References
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
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Self-citation2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
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- Authors
- Lip, G. Y. H., Laroche, C., Ioachim, P. M., Rasmussen, L. H., Vitali-Serdoz, L., Petrescu, L., Darabantiu, D., Crijns, H. J. G. M., Kirchhof, P., Vardas, P., Tavazzi, L., Maggioni, A. P., & Boriani, G.
- Affiliations
- Birmingham City Hospital (GB)
- European Society of Cardiology (FR)
- University of Oradea (RO)
- Aalborg University (DK)
- Maastricht University Medical Centre (NL)
- University of Birmingham (GB)
- University Hospital of Heraklion (GR)
- Maria Cecilia Hospital (IT)
- IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola (IT)
- Corresponding author
- Lip, Gregory Y.H.
- ORCID
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-08-31
- Volume
- 35
- Issue
- 47
- Pages
- 3365-3376
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W2169793874
- Cited by
- 237
- References
- 35
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 13 · 2023: 10 · 2022: 12 · 2021: 28 · 2020: 24 · 2019: 13 · 2018: 23 · 2017: 34 · 2016: 34 · 2015: 29 · 2014: 10
- FWCI
- 24.51
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, other-oa)
- IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion, cc-by)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion, other-oa)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
- Keywords
- atrial fibrillation, antithrombotic therapy, oral anticoagulants, vitamin K antagonists, non-VKA oral anticoagulants, antiplatelet therapy, rate control, rhythm control, catheter ablation, electrical cardioversion, digitalis, hospital readmission, cardiovascular mortality
- MeSH terms
- Administration, Oral, Aged, Anti-Arrhythmia Agents, Atrial Fibrillation, Cardiology, Epidemiologic Methods, Europe, Female, Fibrinolytic Agents, Humans, Male, Prognosis, Vitamin K
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