Improved outcomes with European Society of Cardiology guideline-adherent antithrombotic treatment in high-risk patients with atrial fibrillation: a report from the EORP-AF General Pilot Registry
Open accessAbstract
AIMS: Guideline-adherent therapy for stroke prevention in atrial fibrillation has been associated with better outcomes, in terms of thromboembolism (TE) and bleeding. METHODS AND RESULTS: In this report from the EuroObservational Research Programme-Atrial Fibrillation (EORP-AF) Pilot General Registry, we describe the associated baseline features of 'high risk' AF patients in relation to guideline-adherent antithrombotic treatment, i.e. whether they were adherent, over-treated, or under-treated based on the 2012 European Society of Cardiology (ESC) guidelines. Secondly, we assessed the predictors of guideline-adherent antithrombotic treatment. Thirdly, we evaluated outcomes for all-cause mortality, TE, bleeding, and the composite endpoint of 'any TE, cardiovascular death or bleeding' in relation to whether they were ESC guideline-adherent treatment. From the EORP-AF cohort, the follow-up dataset of 2634 subjects was used to assess the impact of guideline adherence or non-adherence. Of these, 1602 (60.6%) were guideline adherent, whilst 458 (17.3%) were under-treated, and 574 (21.7%) were over-treated. Non-guideline-adherent treatment can be related to region of Europe as well as associated clinical features, but not age, AF type, symptoms, or echocardiography indices. Over-treatment per se was associated with symptoms, using the EHRA score, as well as other comorbidities. Guideline-adherent antithrombotic management based on the ESC guidelines is associated with significantly better outcomes. Specifically, the endpoint of 'all cause death and any TE' is increased by >60% by undertreatment [hazard ratio (HR) 1.679 (95% confidence interval (CI) 1.202-2.347)] or over-treatment [HR 1.622 (95% CI 1.173-2.23)]. For the composite endpoint of 'cardiovascular death, any TE or bleeding', over-treatment increased risk by >70% [HR 1.722 (95% CI 1.200-2.470)]. CONCLUSION: Even in this cohort with high overall rates of oral anticoagulation use, ESC guideline-adherent antithrombotic management is associated with significantly better outcomes, including those related to mortality and TE, as well as the composite endpoint of 'cardiovascular death, any TE or bleeding'. These contemporary observations emphasize the importance of guideline implementation, and adherence to the 2012 ESC guidelines for stroke prevention in AF.
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The EHRA scale has been used and validated.
“The EHRA scale has been used and validated.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [195]
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Cites
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“%) by OAC.9 Thus, effective thromboprophylaxis means OAC, which reduces stroke and saves lives.”
BackgroundInfluential2012 focused update of the ESC Guidelines for the management of atrial fibrillation
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Self-citationPatient outcomes using the European label for dabigatran
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw210 · Cited by 6,418 · see citing works
Self-citation2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezw313 · Cited by 1,403 · see citing works
Self-citationFanaroff, A. C., Califf, R. M., Windecker, S., Smith, S. C., & Lopes, R. D. (2019) · JAMA · doi:10.1001/jama.2019.1122 · Cited by 228 · see citing works
- Authors
- Lip, G. Y. H., Laroche, C., Popescu, M. I., Rasmussen, L. H., Vitali-Serdoz, L., Dan, G.-A., Kalarus, Z., Crijns, H. J. G. M., Oliveira, M. M., Tavazzi, L., Maggioni, A. P., & Boriani, G.
- Affiliations
- Birmingham City Hospital (GB)
- European Society of Cardiology (FR)
- Aalborg University Hospital (DK)
- Carol Davila University of Medicine and Pharmacy (RO)
- Silesian Center for Heart Disease (PL)
- Maastricht University Medical Centre (NL)
- Maria Cecilia Hospital (IT)
- IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola (IT)
- Corresponding author
- Lip, Gregory Y.H.
- ORCID
- Venue
- Europace
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-08-30
- Volume
- 17
- Issue
- 12
- Pages
- 1777-1786
- ISSN
- 1099-5129 (ISSN-L)
- 1532-2092
- OpenAlex
- W2163427738
- Cited by
- 151
- References
- 25
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 11 · 2023: 9 · 2022: 12 · 2021: 14 · 2020: 15 · 2019: 11 · 2018: 20 · 2017: 25 · 2016: 26 · 2015: 2
- FWCI
- 17.67
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- EP Europace (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion, cc-by)
- HighWire Press Open Archive (submittedVersion)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
- INFM-OAR (INFN Catania) (submittedVersion, other-oa)
- Funders
- National Institutes of Health
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Keywords
- atrial fibrillation, antithrombotic therapy, guideline adherence, ESC guidelines, stroke prevention, oral anticoagulation, overtreatment, undertreatment, thromboembolism, hemorrhage, all-cause mortality, cardiovascular mortality, predictors of treatment adherence, high-risk patients, comorbidities
- MeSH terms
- Administration, Oral, Aged, Aged, 80 and over, Anticoagulants, Atrial Fibrillation, Cause of Death, Europe, Female, Fibrinolytic Agents, Hemorrhage, Humans, Male, Middle Aged, Practice Patterns, Physicians', Pilot Projects, Registries, Risk Factors, Thromboembolism, Chi-Square Distribution, Logistic Models, Odds Ratio, Treatment Outcome, Practice Guidelines as Topic, Risk Assessment, Unnecessary Procedures, Guideline Adherence, Stroke
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