Management of atrial fibrillation still suboptimal in Europe

Results for a pilot registry on the management and treatment of atrial fibrillation (AF) in Europe were presented yesterday by the European Society of Cardiology (ESC). AF is the commonest cardiac rhythm disorder and each of us have a one-in-four lifetime risk of developing it. Statistics show that oral anticoagulant use has increased, but new oral anticoagulant (NOAC) use is still low. Authors also concluded that compliance with treatment guidelines for patients with the lowest and higher stroke risk scores remains suboptimal.

The EuroObservational Research Programme-Atrial Fibrillation (EORP-AF) Pilot General Registry results were published in Europace(1) yesterday. Corresponding author and Chairman of the EORP-AF programme, Professor Gregory Lip (Birmingham, UK) said: "New guidelines on the management of AF were recently published by the ESC (2) and we wanted to find out how clinicians were adhering to them. Our registry was a survey of their implementation as well as the uptake of catheter ablation, new antithrombotic drugs and new anti arrhythmic agents, amongst other data."

Professor Lip added: "Drug prescription patterns showed interesting changes over the last decade. Adherence to recommendations for OAC use has improved somewhat (in 80% overall), although they are significantly less used in females. Non-Vitamin K Oral Anticoagulants (NOACs) on the contrary, were used only in 8.4%, but reflected the fact that NOACs were not widely available in all countries."

For the pilot phase, nine European countries participated, with enrollment starting in February 2012 and ending in March 2013. 3119 patients with AF were enrolled, with full data on clinical subtype available for 3049 patients (40.4% female; mean age 68.8 years). Common co morbidities were hypertension, coronary disease and heart failure. Lone AF was present in only 3.9% (122 patients). Asymptomatic AF was common, particularly among those with permanent AF.

Professor Aldo Maggioni (EORP Scientific Coordinator, Sophia Antipolis, France) said: "This registry allowed a timely assessment of the clinical scenario in Europe regarding the management of AF. The follow up period of the survey will allow the evaluation of morbidity/mortality over time and also the comparison between outcomes in European regions with different patterns of practice and the dissimilar adherence to ESC guidelines."

"Atrial fibrillation is the commonest cardiac rhythm disorder. Recent projections estimate that the number of adults (55 years and older) with AF in Europe, will double between 2010 and 2060. This increase would have major public health implications, which is why having a clear picture of where we stand today regarding clinical practice among European cardiologists is so important," explained Professor Maggioni.

"The pilot registry allowed us to measure current disease management strategies. We look forward to a more comprehensive assessment of the management and treatment of AF in all ESC member countries once we have the results of the EORP-AF general long term registry. We have high hopes to be in a position to announce results from 2015 onwards," concluded Professor Lip.