Habib Gamra1, Jan Murin2, Chern-En Chiang3, Lisa Naditch-Brûlé4, Sandrine Brette5, Philippe Gabriel Steg6. 1. University of Monastir, UR 04SP28 Cardiothrombose, Cardiology A Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia. Electronic address: hgamra@rns.tn. 2. Department of Internal Medicine and Cardiology, Comenius University, Bratislava, Slovakia. 3. General Clinical Research Center and Division of Cardiology, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan. 4. Global Strategic Unit Cardio-Thrombosis, Sanofi, Paris, France. 5. Statistics, Lincoln, Boulogne-Billancourt, France. 6. Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France; INSERM U-1148, Paris, France; Département Hospitalo-Universitaire FIRE, Hôpital Bichat, AP-HP, Paris, France; NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK.
Abstract
BACKGROUND: The implementation of international guidelines for antithrombotic use in atrial fibrillation (AF) in routine practice is not well known, particularly, in some parts of the world, such as the Middle East and Africa. AIM: To describe and analyse the use of antithrombotics in patients with AF in routine practice. METHODS: The RealiseAF international cross-sectional survey enrolled 10,523 patients (with at least one documented AF episode in the preceding 12 months) from 831 sites. Participating physicians were randomly selected from physician list forms. RESULTS: Mean age was 66.6 ± 12.2 years. In 47.4% of the patients with a CHADS2 score ≥ 2, oral anticoagulants were not prescribed. Patients who had a CHADS2 score ≥ 2, permanent or persistent AF, valvular heart disease, a stroke leading to hospitalization in the previous year or treatment by a cardiologist (rather than an internist) were most likely to receive oral anticoagulants. Patients aged ≥ 75 years and those with coronary heart disease; major bleeding leading to hospitalization in the previous year or a rhythm control strategy was least likely to receive oral anticoagulants. Appropriate antithrombotic treatment was prescribed in 66.7% of the patients with a CHADS2 score ≥ 2 in the Middle East/Africa, 55.3% in Europe, 43.9% in Latin America and 31.7% in Asia. CONCLUSION: There is substantial deviation from international guidelines in antithrombotic use for AF in routine clinical practice, with overuse and underuse of antithrombotics in about 50% of the cases and important geographical differences. These findings emphasize the need for improved medical education worldwide and a better understanding of geographical disparities in the implementation of guidelines.
BACKGROUND: The implementation of international guidelines for antithrombotic use in atrial fibrillation (AF) in routine practice is not well known, particularly, in some parts of the world, such as the Middle East and Africa. AIM: To describe and analyse the use of antithrombotics in patients with AF in routine practice. METHODS: The RealiseAF international cross-sectional survey enrolled 10,523 patients (with at least one documented AF episode in the preceding 12 months) from 831 sites. Participating physicians were randomly selected from physician list forms. RESULTS: Mean age was 66.6 ± 12.2 years. In 47.4% of the patients with a CHADS2 score ≥ 2, oral anticoagulants were not prescribed. Patients who had a CHADS2 score ≥ 2, permanent or persistent AF, valvular heart disease, a stroke leading to hospitalization in the previous year or treatment by a cardiologist (rather than an internist) were most likely to receive oral anticoagulants. Patients aged ≥ 75 years and those with coronary heart disease; major bleeding leading to hospitalization in the previous year or a rhythm control strategy was least likely to receive oral anticoagulants. Appropriate antithrombotic treatment was prescribed in 66.7% of the patients with a CHADS2 score ≥ 2 in the Middle East/Africa, 55.3% in Europe, 43.9% in Latin America and 31.7% in Asia. CONCLUSION: There is substantial deviation from international guidelines in antithrombotic use for AF in routine clinical practice, with overuse and underuse of antithrombotics in about 50% of the cases and important geographical differences. These findings emphasize the need for improved medical education worldwide and a better understanding of geographical disparities in the implementation of guidelines.
Authors: Emelia J Benjamin; Michael J Blaha; Stephanie E Chiuve; Mary Cushman; Sandeep R Das; Rajat Deo; Sarah D de Ferranti; James Floyd; Myriam Fornage; Cathleen Gillespie; Carmen R Isasi; Monik C Jiménez; Lori Chaffin Jordan; Suzanne E Judd; Daniel Lackland; Judith H Lichtman; Lynda Lisabeth; Simin Liu; Chris T Longenecker; Rachel H Mackey; Kunihiro Matsushita; Dariush Mozaffarian; Michael E Mussolino; Khurram Nasir; Robert W Neumar; Latha Palaniappan; Dilip K Pandey; Ravi R Thiagarajan; Mathew J Reeves; Matthew Ritchey; Carlos J Rodriguez; Gregory A Roth; Wayne D Rosamond; Comilla Sasson; Amytis Towfighi; Connie W Tsao; Melanie B Turner; Salim S Virani; Jenifer H Voeks; Joshua Z Willey; John T Wilkins; Jason Hy Wu; Heather M Alger; Sally S Wong; Paul Muntner Journal: Circulation Date: 2017-01-25 Impact factor: 29.690
Authors: Christina Sommerauer; Lisa Schlender; Marc Krause; Sabine Weißbach; Anja Rieckert; Yolanda V Martinez; David Reeves; Anna Renom-Guiteras; Ilkka Kunnamo; Andreas Sönnichsen Journal: BMC Geriatr Date: 2017-10-16 Impact factor: 3.921
Authors: Antonio Arauz; Francisco Ruiz-Navarro; Miguel A Barboza; Angelica Ruiz; Jonathan Colin; Marisela Reyes; Humberto Silos; Carlos Cantu-Brito; Luis Murillo-Bonilla; Fernando Barinagarrementeria Journal: J Vasc Interv Neurol Date: 2017-12