Registries in Atrial Fibrillation: From Trials to Real-Life Clinical Practice

Michał Mazurek, Menno V Huisman, Gregory Y H Lip

Research output: Contribution to journalReview articlepeer-review

35 Citations (Scopus)

Abstract

BACKGROUND: Recent improvements in atrial fibrillation diagnosis and management have prompted the initiation of various registries, predominantly to assess adherence to new guidelines, but also to address the pending questions of safety and effectiveness of newly introduced management options in 'real world' clinical practice settings. In this review we appraise antithrombotic treatment patterns for stroke prevention in atrial fibrillation registries.

METHODS AND RESULTS: We searched PubMed, Science Direct and the Cochrane databases for registries focusing on stroke thromboprophylaxis in atrial fibrillation. Registry data show that over the last decade, the proportion of patients receiving oral anticoagulation has increased (from about 67% to over 80%), while the proportion of those treated with aspirin only or untreated has diminished. Vitamin K antagonists (VKAs) are being gradually replaced by non-VKA oral anticoagulants (NOACs) as the more prevalent option. Regional and country differences in anticoagulation are evident, with its highest uptake in Europe (90.2%) and lowest in Asia (57.4%). Moreover, oral anticoagulation is given to approximately 50% of patients with no stroke risk factors, whereas over a third of high-risk subjects are not anticoagulated but often prescribed antiplatelet therapy alone or untreated. Guideline non-adherent thromboprophylaxis results in an increase in all-cause mortality and thromboembolism.

CONCLUSIONS: Registry data show that despite an increase in anticoagulation rates over the last decade, management gaps in stroke prevention are still evident with about third of patients not treated in line with the guidelines. Mortality rates of atrial fibrillation patients remain relatively high, mostly due to the comorbid disease.

Original languageEnglish
JournalThe American Journal of Medicine
Volume130
Issue number2
Pages (from-to)135-145
Number of pages11
ISSN0002-9343
DOIs
Publication statusPublished - 2017

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