Characteristics, treatment and outcomes of contemporary AF patients in West-Europe

Contemporary management of patients with atrial fibrillation in the Netherlands and Belgium: a report from the EORP-AF long-term general registry

Literature - Erküner Ö, van Eck M, Xhaet O, et al., - Neth Heart J 2021, doi.org/10.1007/s12471-021-01634-y

Introduction and methods

Aim of the study

Registries are used to examine characteristics, treatment and outcomes of contemporary patients with atrial fibrillation (AF). Also, using data of registries, guideline adherence can be studied and awareness can be raised to improve treatment of AF patients. In this study, these aspects were examined in patients from the EURObservational Research Programme on Atrial Fibrillation long-term general (EORP-AF LTG) registry included in the Netherlands and Belgium.

Study design

The EORP-AF LTG registry is conducted in 27 countries and includes 11,096 patients from 2013 to 2016. For this analysis, 967 patients from the Netherlands and Belgium were included. Baseline characteristics and 1-year follow-up data were reported.

Outcomes

MACCE was defined as a composite of CV death, ischemic stroke/transient ischemic attach (TIA), systemic thromboembolism, myocardial infarction and major bleeding. AF progression was defined as paroxysmal AF at baseline becoming persistent/permanent AF at follow-up, whereas AF regression was defined as persistent/permanent AF at baseline becoming paroxysmal AF at follow-up.

Main results

Baseline characteristics

Hypertension was the most frequent comorbidity with a prevalence of 49%.
These was a higher prevalence of heart failure, obstructive sleep apnea, T2DM and hyperlipidemia in Belgian patients. Belgian patients also had a higher BMI than the Dutch patients.

Rate vs. rhythm control therapy

At baseline, the majority of patients was on a rhythm control strategy (58.6%), whereas 33.8% was on a rate control strategy.
36.7% Of patients were on an anti-arrhythmic drug (AAD) and 67.7% on a rate control drug.
Belgian patients were more often on AAD therapy than Dutch patients (47.5% vs. 31.4%, P<0.001) with more amiodarone users, whereas Dutch patients more often used sotalol.
For rate control drugs, digoxin use was different between the 2 countries, with more frequent use in the Netherlands than in Belgium (19.5% vs. 4.7%, P<0.001).
Of the 565 patients on rhythm control, 55.4% was on daily AAD, 5.6% was planned for electrical cardioversion and 0.4% for AF ablation, leaving 41.9% of patients without daily AAD use of planned rhythm intervention.
Of the 326 patients with rate control strategy, 86.2% were on rate control drug, whereas 13.8% were not. 11.8% were wrongly classified as rate control.

Anticoagulant therapy

91.9% of Patients received anticoagulation, with a larger proportion of patients using NOACs in Belgium than in the Netherlands (54.4% vs. 38.4%).
For men with CHA2DS2-VASc 0 and for women with a score of 1, anticoagulation rates were 71.6% and 66.7%, respectively. Of these patients was in 66.2% of men and in 35% of women a rhythm intervention performed or planned. The remaining patients were on anticoagulation without a clear indication.
14 Patients were overdosed with a NOAC, underdosing occurred in 49 patients. Thus, 63 patients (16.7%) of 372 patients on NOACs were not correctly dosed.

Follow-up

MACCE occurred in 4.2% of patients.
3.1% Of patients died, 0.9% with a CV cause. Ischemic stroke occurred in 0.8% and TIA in 0.3% of patients. Two patients (0.2%) had intracranial hemorrhage, and 14 (1.6%) had a major extracranial bleeding. MI occurred in 5 patient (0.6%).
Of the 16 patients with a major bleeding during follow-up, they all had anticoagulant therapy at baseline, 14 patients were still on anticoagulant therapy.
Of the patients with MACCE during follow-up, only 1 was underdosed and 3 patients were not on anticoagulant therapy at baseline, but were at follow-up. No overtreatment was observed.
The most frequent new diagnosis during follow-up was heart failure, followed by CKD and hypertension.

Rhythm follow-up and interventions

AF progression and AF regression occurred at a similar rate; 17.3% and 17.6% respectively.
26.4% of Patients had at least 1 rhythm intervention during follow-up; 17.6% underwent electrical cardioversion, 3.7% pharmacological cardioversion, 3.7% pharmacological cardioversion, 8.7% catheter ablation for AF, 1.6% underwent surgery for AF, 2.2% underwent ablation for atrial flutter.

Conclusion

This analysis of the EORP-AF LTG registry showed the characteristics, treatment and outcomes of contemporary AF patients in Belgium and the Netherlands. The most common comorbidity was hypertension. Almost 17% of patients was incorrectly dosed for a NOAC. And MACCE occurred at a rate of 4.2% after 1 year, which is relatively low.

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