Distribution and Risk Profile of Paroxysmal, Persistent, and Permanent Atrial Fibrillation in Routine Clinical Practice: Insight From the Real-Life Global Survey Evaluating Patients With Atrial Fibrillation International Registry
Abstract
Background—: There is a paucity of international data on the various types of atrial fibrillation (AF) outside the highly selected populations from randomized trials. This study aimed to describe patient characteristics, risk factors, comorbidities, symptoms, management strategy, and control of different types of AF in real-life practice. Methods and Results—: Real-life global survey evaluating patients with atrial fibrillation (RealiseAF) was a contemporary, large-scale, cross-sectional international survey of patients with AF who had ≥1 episode in the past 12 months. Investigators were randomly selected to avoid bias. Among 9816 eligible patients from 831 sites in 26 countries, 2606 (26.5%) had paroxysmal, 2341 (23.8%) had persistent, and 4869 (49.6%) had permanent AF. As AF progressed from paroxysmal to persistent and permanent forms, the prevalence of comorbidities, such as heart failure (32.9%, 44.3%, and 55.6%), coronary artery disease (30.0%, 32.9%, and 34.3%), cerebrovascular disease (11.7%, 10.8%, and 17.6%), and valvular disease (16.7%, 21.2%, and 35.8%), increased, and the prevalence of lone AF decreased. Similarly, there was an increase in mean CHADS 2 [cardiac failure, hypertension, age, diabetes, stroke (doubled)] score (1.7, 1.8, and 2.2), and more than half of patients (51.0%, 56.7%, and 67.3%) qualified for oral anticoagulants. Almost 90% of patients received ≥1 antiarrhythmic drug, but >60% had European Heart Rhythm Association symptom scores from II to IV. Furthermore, 40.7% of persistent and 49.8% of permanent AF patients were still in AF with a heart rate >80 beats per minute. Conclusions—: This survey disclosed high cardiovascular risks and an unmet need in daily practice for patients with any type of AF, especially those with the permanent form.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Globally, the prevalence of valvular heart disease among individuals with AF is still greater than 25%, largely caused by the higher incidence of rheumatic heart disease in low-income and middle-income countries.
“However, globally, the prevalence of valvular heart disease among individuals with AF is still greater than 25%,38,39 largely caused by the higher incidence of rheumatic heart disease in low-income and middle-income countries.”
From Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis (2016) · cites this paper as [39]
Cites
Dabigatran versus warfarin in patients with atrial fibrillation
Connolly, S. J., Ezekowitz, M. D., Yusuf, S., Eikelboom, J., Oldgren, J., Parekh, A., Pogue, J., Reilly, P. A., Themeles, E., Varrone, J., et al. (2009) · New England Journal of Medicine · doi:10.1056/nejmoa0905561 · Cited by 11,215 · see citing works
Apixaban versus warfarin in patients with atrial fibrillation
Granger, C. B., Alexander, J. H., McMurray, J. J. V., Lopes, R. D., Hylek, E. M., Hanna, M., Al-Khalidi, H. R., Ansell, J., Atar, D., Avezum, A., et al. (2011) · New England Journal of Medicine · doi:10.1056/nejmoa1107039 · Cited by 8,943 · see citing works
Go, A. S., Hylek, E. M., Phillips, K. A., Chang, Y., Henault, L. E., Selby, J. V., & Singer, D. E. (2001) · JAMA · doi:10.1001/jama.285.18.2370 · Cited by 6,205 · see citing works
Guidelines for the management of atrial fibrillation
Authors/Task Force Members, Camm, A. J., Kirchhof, P. F., Lip, G. Y. H., Schotten, U., Savelieva, I., Ernst, S., Gelder, I. C. V., Al‐Attar, N., Hindricks, G., et al. (2010) · European Heart Journal · doi:10.1093/eurheartj/ehq278 · Cited by 5,875 · see citing works
Self-citationA comparison of rate control and rhythm control in patients with atrial fibrillation
(2002) · New England Journal of Medicine · doi:10.1056/nejmoa021328 · Cited by 4,405 · see citing works
Fuster, V., Rydén, L. E., Cannom, D. S., Crijns, H. J., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., Le Heuzey, J.-Y., Kay, G. N., Lowe, J. E., et al. (2006) · Circulation · doi:10.1161/circulationaha.106.177292 · Cited by 2,805 · see citing works
Effect of clopidogrel added to aspirin in patients with atrial fibrillation
The ACTIVE Investigators (2009) · New England Journal of Medicine · doi:10.1056/nejmoa0901301 · Cited by 2,102 · see citing works
Effect of Dronedarone on Cardiovascular Events in Atrial Fibrillation
Hohnloser, S. H., Crijns, H. J. G. M., van Eickels, M., Gaudin, C., Page, R. L., Torp-Pedersen, C. T., & Connolly, S. J. (2009) · New England Journal of Medicine · doi:10.1056/nejmoa0803778 · Cited by 1,125 · see citing works
Lenient versus strict rate control in patients with atrial fibrillation
Van Gelder, I. C., Groenveld, H. F., Crijns, H. J. G. M., Tuininga, Y. S., Tijssen, J. G. P., Alings, A. M., Hillege, H. L., Bergsma-Kadijk, J. A., Cornel, J. H., Kamp, O., et al. (2010) · New England Journal of Medicine · doi:10.1056/nejmoa1001337 · Cited by 1,033 · see citing works
Atrial fibrillation management: a prospective survey in ESC Member Countries
Nieuwlaat, R., Capucci, A., Camm, A. J., Olsson, S. B., Andresen, D., Davies, D. W., Cobbe, S. M., BREITHARDT, G. E., Heuzey, J. L., Prins, M. H., et al. (2005) · European Heart Journal · doi:10.1093/eurheartj/ehi505 · Cited by 825 · see citing works
The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study
Olshansky, B., Rosenfeld, L. E., Warner, A. L., Solomon, A. J., O’Neill, G., Sharma, A. D., Platia, E. V., Feld, G. K., Akiyama, T., Brodsky, M. A., et al. (2004) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2003.11.032 · Cited by 590 · see citing works
Nabauer, M., Gerth, A., Limbourg, T., Schneider, S., Oeff, M., Kirchhof, P., Goette, A., Lewalter, T., Ravens, U., Meinertz, T., et al. (2008) · Europace · doi:10.1093/europace/eun369 · Cited by 427 · see citing works
Self-citationGladstone, D. J., Bui, E., Fang, J., Laupacis, A., Lindsay, M. P., Tu, J. V., Silver, F. L., & Kapral, M. K. (2008) · Stroke · doi:10.1161/strokeaha.108.516344 · Cited by 402 · see citing works
Nieuwlaat, R., Prins, M. H., Heuzey, J. Y. L., Vardas, P. E., Aliot, E., Santini, M., Cobbe, S. M., Widdershoven, J. W. M. G., Baur, L. H. B., Lévy, S., et al. (2008) · European Heart Journal · doi:10.1093/eurheartj/ehn139 · Cited by 283 · see citing works
Camm, A. J., BREITHARDT, G. E., Crijns, H. J. G. M., Dorian, P., Kowey, P. R., Heuzey, J. L., Merioua, I., Pedrazzini, L., Prystowsky, E. N., Schwartz, P. J., et al. (2011) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2011.03.034 · Cited by 177 · see citing works
Steg, P. G., Alam, S., Chiang, C., Gamra, H., Goethals, M., Inoue, H., Krapf, L., Lewalter, T., Merioua, I., Murín, J., et al. (2011) · Heart · doi:10.1136/heartjnl-2011-300550 · Cited by 137 · see citing works
Self-citationPikto−Pietkiewicz, W. (2009) · PubMed · Cited by 113 · see citing works
Heuzey, J. L., BREITHARDT, G. E., Camm, A. J., Crijns, H. J. G. M., Dorian, P., Kowey, P. R., Merioua, I., Prystowsky, E. N., Schwartz, P. J., Torp-Pedersen, C. T., et al. (2009) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2009.10.012 · Cited by 109 · see citing works
Meiltz, A., Zimmermann, M., Urban, P. M., & Bloch, A. (2008) · EP Europace · doi:10.1093/europace/eun086 · Cited by 63 · see citing works
Lenient Versus Strict Rate Control in Atrial Fibrillation
Wyse, D. G. (2011) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2011.04.028 · Cited by 15 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
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-citation2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation
January, C. T., Wann, L. S., Alpert, J. S., Calkins, H., Cigarroa, J. E., Cleveland, J. C., Conti, J. B., Ellinor, P. T., Ezekowitz, M. D., Field, M. E., et al. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.03.022 · Cited by 2,955 · see citing works
January, C. T., Wann, L. S., Calkins, H., Chen, L. Y., Cigarroa, J. E., Cleveland, J. C., Ellinor, P. T., Ezekowitz, M. D., Field, M. E., Furie, K. L., et al. (2019) · Circulation · doi:10.1161/cir.0000000000000665 · Cited by 2,744 · see citing works
January, C. T., Wann, L. S., Alpert, J. S., Calkins, H., Cigarroa, J. E., Cleveland, J. C., Conti, J. B., Ellinor, P. T., Ezekowitz, M. D., Field, M. E., et al. (2014) · Circulation · doi:10.1161/cir.0000000000000040 · Cited by 2,056 · see citing works
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 Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezw313 · Cited by 1,403 · see citing works
Self-citationGlobal epidemiology of atrial fibrillation
Rahman, F., Kwan, G. F., & Benjamin, E. J. (2014) · Nature Reviews Cardiology · doi:10.1038/nrcardio.2014.118 · Cited by 731 · see citing works
Ezekowitz, J. A., O'Meara, E., McDonald, M. A., Abrams, H., Chan, M., Ducharme, A., Giannetti, N., Grzeslo, A., Hamilton, P. G., Heckman, G. A., et al. (2017) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2017.08.022 · Cited by 676 · see citing works
Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis
Ko, D., Rahman, F., Schnabel, R. B., Yin, X., Benjamin, E. J., & Christophersen, I. E. (2016) · Nature Reviews Cardiology · doi:10.1038/nrcardio.2016.45 · Cited by 353 · see citing works
Ziff, O. J., Lane, D. A., Samra, M., Griffith, M., Kirchhof, P., Lip, G. Y. H., Steeds, R. P., Townend, J., & Kotecha, D. (2015) · BMJ · doi:10.1136/bmj.h4451 · Cited by 341 · see citing works
Vanassche, T., Lauw, M. N., Eikelboom, J. W., Healey, J. S., Hart, R. G., Alings, M., Avezum, A., Diaz, R., Hohnloser, S. H., Lewis, B. S., et al. (2015) · European Heart Journal · doi:10.1093/eurheartj/ehu307 · Cited by 313 · see citing works
Wynn, G. J., Todd, D. M., Webber, M., Bonnett, L., McShane, J., Kirchhof, P., & Gupta, D. (2014) · Europace · doi:10.1093/europace/eut395 · Cited by 254 · see citing works
Breithardt, G., Baumgartner, H., Berkowitz, S. D., Hellkamp, A. S., Piccini, J. P., Stevens, S. R., Lokhnygina, Y., Patel, M. R., Halperin, J. L., Singer, D. E., et al. (2014) · European Heart Journal · doi:10.1093/eurheartj/ehu305 · Cited by 196 · see citing works
Overvad, T. F., Skjøth, F., Lip, G. Y. H., Lane, D. A., Albertsen, I. E., Rasmussen, L. H., & Larsen, T. B. (2015) · Stroke · doi:10.1161/strokeaha.115.009371 · Cited by 87 · see citing works
Senoo, K., Lip, G. Y. H., Lane, D. A., Büller, H. R., & Kotecha, D. (2015) · Stroke · doi:10.1161/strokeaha.115.009487 · Cited by 64 · see citing works
Fangel, M. V., Nielsen, P. B., Kristensen, J. K., Larsen, T. B., Overvad, T. F., Lip, G. Y. H., & Jensen, M. B. (2019) · Circulation: Arrhythmia and Electrophysiology · doi:10.1161/circep.118.007030 · Cited by 49 · see citing works
- Authors
- Chiang, C.-E., Naditch-Brûlé, L., Murin, J., Goethals, M., Inoue, H., O’Neill, J., Silva-Cardoso, J., Zharinov, O., Gamra, H., Alam, S., Ponikowski, P., Lewalter, T., Rosenqvist, M., & Steg, P. G.
- Affiliations
- Taipei Veterans General Hospital (TW)
- From the General Clinical Research Center and Division of Cardiology, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (C-E.C.); Sanofi, Paris, France (L.N-B.); Department of Internal Medicine and Cardiology, Comenius University, Bratislava, Slovakia (J.M.); Department of Cardiology-Electrophysiology, H.-Hartziekenhuis Roeselare-Menen, Roeselare, Belgium (M.G.); Second Department of Internal Med, University of Toyama, Toyama, Japan (H.I.); Connolly/Mater Hospitals/RCSI...
- ORCID
- Venue
- Circulation: Arrhythmia and Electrophysiology
- Published
- 2012-08
- Volume
- 5
- Issue
- 4
- Pages
- 632-639
- ISSN
- 1941-3084 (ISSN-L)
- 1941-3149
- OpenAlex
- W2102014314
- Cited by
- 327
- References
- 20
- Citations by year
- 2026: 16 · 2025: 23 · 2024: 23 · 2023: 30 · 2022: 21 · 2021: 36 · 2020: 29 · 2019: 21 · 2018: 27 · 2017: 27 · 2016: 16 · 2015: 19 · 2014: 23 · 2013: 13 · 2012: 3
- FWCI
- 11.94
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation Arrhythmia and Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Sanofi
- 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, paroxysmal atrial fibrillation, persistent atrial fibrillation, permanent atrial fibrillation, atrial fibrillation progression, comorbidities, heart failure, valvular heart disease, CHADS2 score, oral anticoagulation, antiarrhythmic drugs, clinical symptoms, rate control, real-world patient characteristics
- MeSH terms
- Africa, Northern, Aged, Aged, 80 and over, Analysis of Variance, Anti-Arrhythmia Agents, Asia, Atrial Fibrillation, Cardiovascular Diseases, Cross-Sectional Studies, Europe, Female, Health Surveys, Heart Rate, Hospitalization, Humans, Male, Mexico, Middle Aged, Prognosis, Registries, Risk Factors, Severity of Illness Index, Time Factors, Venezuela, Comorbidity, Prevalence, Chi-Square Distribution, Disease Progression, Risk Assessment
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
