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Cited by 404Atrial Fibrillation Management and OutcomesVenous Thromboembolism Diagnosis and ManagementAcute Ischemic Stroke Management

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Management of atrial fibrillation in seven European countries after the publication of the 2010 ESC Guidelines on atrial fibrillation: primary results of the PREvention oF thromboemolic events—European Registry in Atrial Fibrillation (PREFER in AF)

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Kirchhof, Paulus, Ammentorp, Bettina, Darius, Harald, De Caterina, Raffaele, Le Heuzey, Jean-Yves, Schilling, Richard John, Schmitt, Josef, Zamorano, Jose Luis·2014·EP Europace
DOI 10.1093/europace/eut263PMC PMC3864758
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Abstract

AIMS: We sought to describe the management of patients with atrial fibrillation (AF) in Europe after the release of the 2010 AF Guidelines of the European Society of Cardiology. METHODS AND RESULTS: The PREFER in AF registry enrolled consecutive patients with AF from January 2012 to January 2013 in 461 centres in seven European countries. Seven thousand two hundred and forty-three evaluable patients were enrolled, aged 71.5 ± 11 years, 60.1% male, CHA2DS2VASc score 3.4 ± 1.8 (mean ± standard deviation). Thirty per cent patients had paroxysmal, 24.0% had persistent, 7.2% had long-standing persistent, and 38.8% had permanent AF. Oral anticoagulation was used in the majority of patients: 4799 patients (66.3%) received a vitamin K antagonist (VKA) as mono-therapy, 720 patients a combination of VKA and antiplatelet agents (9.9%), 442 patients (6.1%) a new oral anticoagulant drugs (NOAC). Antiplatelet agents alone were given to 808 patients (11.2%), no antithrombotic therapy to 474 patients (6.5%). Of 7034 evaluable patients, 5530 (78.6%) patients were adequately rate controlled (mean heart rate 60-100 bpm). Half of the patients (50.7%) received rhythm control therapy by electrical cardioversion (18.1%), pharmacological cardioversion (19.5%), antiarrhythmic drugs (amiodarone 24.1%, flecainide or propafenone 13.5%, sotalol 5.5%, dronedarone 4.0%), and catheter ablation (5.0%). CONCLUSION: The management of AF patients in 2012 has adapted to recent evidence and guideline recommendations. Oral anticoagulant therapy with VKA (majority) or NOACs is given to over 80% of eligible patients, including those at risk for bleeding. Rate is often adequately controlled, and rhythm control therapy is widely used.

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Figure 1 Proportion of patients with a given AF pattern (paroxysmal, persistent, long-standing persistent, or permanent, plotted as percentage, y axis) in the study population plotted by the number of concomitant cardiovascular diseases and age as summarized in the CHA2DS2VASc score (x axis). The proportion of patients with permanent AF increases in each CHA2DS2VASc stratum, while the proportion of patients with paroxysmal AF decreases.
Figure 1 Proportion of patients with a given AF pattern (paroxysmal, persistent, long-standing persistent, or permanent, plotted as percentage, y axis) in the study population plotted by the number of concomitant cardiovascular diseases and age as summarized in the CHA2DS2VASc score (x axis). The proportion of patients with permanent AF increases in each CHA2DS2VASc stratum, while the proportion of patients with paroxysmal AF decreases.CC BY-NC · PubMed Central
Figure 2 Use of antithrombotic therapy by stroke risk. Most patients with a high stroke risk received adequate anticoagulation, mainly delivered as vitamin K antagonist therapy, antiplatelet agent. VKA vitamin K antagonist, NOAC new oral anticoagulant, OAC oral anticoagulation (either VKA or NOAC).
Figure 2 Use of antithrombotic therapy by stroke risk. Most patients with a high stroke risk received adequate anticoagulation, mainly delivered as vitamin K antagonist therapy, antiplatelet agent. VKA vitamin K antagonist, NOAC new oral anticoagulant, OAC oral anticoagulation (either VKA or NOAC).CC BY-NC · PubMed Central
Figure 3 Therapeutic effect of vitamin K antagonist therapy, expressed as the number of the last three INR values prior to enrolment that were within the therapeutic range, split by the different vitamin K antagonists used. INR, international normalized ratio.
Figure 3 Therapeutic effect of vitamin K antagonist therapy, expressed as the number of the last three INR values prior to enrolment that were within the therapeutic range, split by the different vitamin K antagonists used. INR, international normalized ratio.CC BY-NC · PubMed Central
Figure 4 Use of rhythm control therapy options by patient symptoms. Following clinical reasoning and the recommendations in the ESC guidelines, rhythm control therapy was rarely used in asymptomatic patients. The EHRA score is calculated as the maximum of the six symptoms score (palpitations, fatigue, dizziness, dyspnea, chest pain, anxiety) as explained in the legend to Table 3.
Figure 4 Use of rhythm control therapy options by patient symptoms. Following clinical reasoning and the recommendations in the ESC guidelines, rhythm control therapy was rarely used in asymptomatic patients. The EHRA score is calculated as the maximum of the six symptoms score (palpitations, fatigue, dizziness, dyspnea, chest pain, anxiety) as explained in the legend to Table 3.CC BY-NC · PubMed Central
Figure 5 Type of rhythm control therapy by type of heart disease. (A) Stacked column graph depicting the use of the different antiarrhythmic drugs and catheter ablation in patients with different types of heart disease (coronary artery disease, heart failure, no structural heart disease). (B) Illustration of the use of rhythm control therapies in patients with different types of heart disease in a flow chart illustrating the recommendations of the ESC 2010 guidelines for AF. All numbers reflect the actual patient number.
Figure 5 Type of rhythm control therapy by type of heart disease. (A) Stacked column graph depicting the use of the different antiarrhythmic drugs and catheter ablation in patients with different types of heart disease (coronary artery disease, heart failure, no structural heart disease). (B) Illustration of the use of rhythm control therapies in patients with different types of heart disease in a flow chart illustrating the recommendations of the ESC 2010 guidelines for AF. All numbers reflect the actual patient number.CC BY-NC · PubMed Central

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  1. Lip, 2013, EUR Observational research programme: atrial fibrillation general registry pilot phase, Eur H J, 34, 794

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Metadata

Authors
Kirchhof, P., Ammentorp, B., Darius, H., De Caterina, R., Le Heuzey, J.-Y., Schilling, R. J., Schmitt, J., & Zamorano, J. L.
Affiliations
  • University of Münster (DE)
  • Daiichi Sankyo (Germany) (DE)
  • Vivantes Klinikum (DE)
  • St Thomas' Hospital (GB)
Corresponding author
Kirchhof, Paulus
ORCID
Venue
EP Europace
Publisher
Oxford University Press (OUP)
Published
2013-10-01
Volume
16
Issue
1
Pages
6-14
ISSN
  • 1099-5129 (ISSN-L)
  • 1532-2092
DOI
10.1093/europace/eut263
PMC
PMC3864758
OpenAlex
W1973416160
Cited by
404
References
24
Citations by year
2026: 3 · 2025: 8 · 2024: 16 · 2023: 15 · 2022: 20 · 2021: 31 · 2020: 46 · 2019: 27 · 2018: 36 · 2017: 59 · 2016: 44 · 2015: 56 · 2014: 36 · 2013: 6
FWCI
32.15
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • EP Europace (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
Funders
Daiichi Sankyo Europe
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
  • Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
  • Health Sciences › Medicine › Clinical Neurology › Acute Ischemic Stroke Management
Keywords
atrial fibrillation, clinical management, oral anticoagulation, vitamin K antagonists, direct oral anticoagulants, antiplatelet therapy, rate control, rhythm control, cardioversion, antiarrhythmic drugs, catheter ablation, guideline adherence, bleeding risk, CHA2DS2-VASc score
MeSH terms
Aged, Anticoagulants, Atrial Fibrillation, Cardiology, Europe, Female, Humans, Male, Practice Patterns, Physicians', Platelet Aggregation Inhibitors, Registries, Thromboembolism, Vitamin K, Comorbidity, Causality, Prevalence, Practice Guidelines as Topic, Guideline Adherence

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