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Contemporary management of atrial fibrillation and the predicted vs. absolute risk of ischaemic stroke despite treatment: a report from ESC-EHRA EORP-AF Long-Term General Registry

Ding, Wern Yew ; Blomström-Lundqvist, Carina ; Fauchier, Laurent ; [et al.]

Oxford University Press (OUP) ; 2023

In: EP Europace Vol. 25, No. 2 ( 2023-02-16), p. 277-282

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In: EP Europace, Oxford University Press (OUP), Vol. 25, No. 2 ( 2023-02-16), p. 277-282

Abstract: Risk stratification in patients with atrial fibrillation (AF) is important to facilitate guideline-directed therapies. The Calculator of Absolute Stroke Risk (CARS) scheme enables an individualized estimation of 1-year absolute risk of stroke in AF. We aimed to investigate the predicted and absolute risks of ischaemic stroke, and evaluate whether CARS (and CHA2DS2-VASc score) may be useful for identifying high risk patients with AF despite contemporary treatment. Methods We utilized the EORP-AF General Long-Term Registry which prospectively enrolled patients with AF from 250 centres across 27 participating European countries. Patients with sufficient data to determine CARS and CHA2DS2-VASc score, and reported outcomes of ischaemic stroke were included in this analysis. The primary outcome of ischaemic stroke was recorded over a 2-year follow-up period. Results A total of 9444 patients were included (mean age 69.1 [±11.4] years; 3776 [40.0%] females). There was a high uptake (87.9%) of anticoagulation therapy, predominantly with vitamin K antagonist (50.0%). Over a mean follow-up period of 24 months, there were a total of 101 (1.1%) ischaemic stroke events. In the entire cohort, the median CARS and absolute annual risks of ischaemic stroke were 2.60 (IQR 1.60–4.00) and 0.53% (95%CI 0.43–0.64%), respectively. There was no statistical difference between the predictive performance of CARS and CHA2DS2-VASc score (0.621 [95%CI 0.563–0.678] vs. 0.626 [95%CI 0.573–0.680] , P = 0.725). Conclusion Contemporary management of AF was associated with a low risk of ischaemic stroke. CARS and CHA2DS2-VASc score may be useful to identify high risk patients despite treatment who may benefit from more aggressive treatment and follow-up.

Type of Medium: Online Resource

ISSN: 1099-5129 , 1532-2092

URL: Article

DOI: 10.1093/europace/euac214

Language: English

Publisher: Oxford University Press (OUP)

Publication Date: 2023

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Outcomes of digoxin vs. beta blocker in atrial fibrillation: report from ESC–EHRA EORP AF Long-Term General Registry

Ding, Wern Yew ; Boriani, Giuseppe ; Marin, Francisco ; [et al.]

Oxford University Press (OUP) ; 2022

In: European Heart Journal - Cardiovascular Pharmacotherapy Vol. 8, No. 4 ( 2022-06-08), p. 372-382

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In: European Heart Journal - Cardiovascular Pharmacotherapy, Oxford University Press (OUP), Vol. 8, No. 4 ( 2022-06-08), p. 372-382

Abstract: The safety of digoxin therapy in atrial fibrillation (AF) remains ill-defined. We aimed to evaluate the effects of digoxin over beta-blocker therapy in AF. Methods and results Patients with AF who were treated with either digoxin or a beta blocker from the ESC–EHRA EORP AF (European Society of Cardiology–European Heart Rhythm Association EURObservational Research Programme Atrial Fibrillation) General Long-Term Registry were included. Outcomes of interest were all-cause mortality, cardiovascular (CV) mortality, non-CV mortality, quality of life, and number of patients with unplanned hospitalizations. Of 6377 patients, 549 (8.6%) were treated with digoxin. Over 24 months, there were 550 (8.6%) all-cause mortality events and 1304 (23.6%) patients with unplanned emergency hospitalizations. Compared to beta blocker, digoxin therapy was associated with increased all-cause mortality [hazard ratio (HR) 1.90 (95% confidence interval, CI, 1.48–2.44)], CV mortality [HR 2.18 (95% CI 1.47–3.21)] , and non-CV mortality [HR 1.68 (95% CI 1.02–2.75)] with reduced quality of life [health utility score 0.555 (±0.406) vs. 0.705 (±0.346), P & lt; 0.001] but no differences in emergency hospitalizations [HR 1.00 (95% CI 0.56–1.80)] or AF-related hospitalizations [HR 0.95 (95% CI 0.60–1.52)]. On multivariable analysis, there were no differences in any of the outcomes between both groups, after accounting for potential confounders. Similar results were obtained in the subgroups of patients with permanent AF and coexisting heart failure. There were no differences in outcomes between AF patients receiving digoxin with and without chronic kidney disease. Conclusion Poor outcomes related to the use of digoxin over beta-blocker therapy in terms of excess mortality and reduced quality of life are associated with the presence of other risk factors rather than digoxin per se. The choice of digoxin or beta-blocker therapy had no influence on the incidence of unplanned hospitalizations.

Type of Medium: Online Resource

ISSN: 2055-6837 , 2055-6845

URL: Article

DOI: 10.1093/ehjcvp/pvab076

Language: English

Publisher: Oxford University Press (OUP)

Publication Date: 2022

detail.hit.zdb_id: 2808613-2

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Clinical utility and prognostic implications of the novel 4S-AF scheme to characterize and evaluate patients with atrial fibrillation: a report from ESC-EHRA EORP-AF Long-Term General Registry

Ding, Wern Yew ; Proietti, Marco ; Boriani, Giuseppe ; [et al.]

Oxford University Press (OUP) ; 2022

In: EP Europace Vol. 24, No. 5 ( 2022-05-03), p. 721-728

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In: EP Europace, Oxford University Press (OUP), Vol. 24, No. 5 ( 2022-05-03), p. 721-728

Abstract: The 4S-AF classification scheme comprises of four domains: stroke risk (St), symptoms (Sy), severity of atrial fibrillation (AF) burden (Sb), and substrate (Su). We sought to examine the implementation of the 4S-AF scheme in the EORP-AF General Long-Term Registry and compare outcomes in AF patients according to the 4S-AF-led decision-making process. Methods and results Atrial fibrillation patients from 250 centres across 27 European countries were included. A 4S-AF score was calculated as the sum of each domain with a maximum score of 9. Of 6321 patients, 8.4% had low (St), 47.5% EHRA I (Sy), 40.5% newly diagnosed or paroxysmal AF (Sb), and 5.1% no cardiovascular risk factors or left atrial enlargement (Su). Median follow-up was 24 months. Using multivariable Cox regression analysis, independent predictors of all-cause mortality were (St) [adjusted hazard ratio (aHR) 8.21, 95% confidence interval (CI): 2.60–25.9], (Sb) (aHR 1.21, 95% CI: 1.08–1.35), and (Su) (aHR 1.27, 95% CI: 1.14–1.41). For CV mortality and any thromboembolic event, only (Su) (aHR 1.73, 95% CI: 1.45–2.06) and (Sy) (aHR 1.29, 95% CI: 1.00–1.66) were statistically significant, respectively. None of the domains were independently linked to ischaemic stroke or major bleeding. Higher 4S-AF score was related to a significant increase in all-cause mortality, CV mortality, any thromboembolic event, and ischaemic stroke but not major bleeding. Treatment of all 4S-AF domains was associated with an independent decrease in all-cause mortality (aHR 0.71, 95% CI: 0.55–0.92). For each 4S-AF domain left untreated, the risk of all-cause mortality increased substantially (aHR 1.35, 95% CI: 1.16–1.56). Conclusion Implementation of the novel 4S-AF scheme is feasible, and treatment decisions based on this scheme improve mortality rates in AF.

Type of Medium: Online Resource

ISSN: 1099-5129 , 1532-2092

URL: Article

DOI: 10.1093/europace/euab280

Language: English

Publisher: Oxford University Press (OUP)

Publication Date: 2022

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Impact of anthropometric factors on outcomes in atrial fibrillation patients: analysis on 10 220 patients from the European Society of Cardiology (ESC)-European Heart Rhythm Association (EHRA) EurObservational Research Programme on Atrial Fibrillation (EORP-AF) general long-term registry

Boriani, Giuseppe ; Vitolo, Marco ; Malavasi, Vincenzo L ; [et al.]

Oxford University Press (OUP) ; 2022

In: European Journal of Preventive Cardiology Vol. 29, No. 15 ( 2022-11-08), p. 1967-1981

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In: European Journal of Preventive Cardiology, Oxford University Press (OUP), Vol. 29, No. 15 ( 2022-11-08), p. 1967-1981

Abstract: To investigate the association of anthropometric parameters [height, weight, body mass index (BMI), body surface area (BSA), and lean body mass (LBM)] with outcomes in atrial fibrillation (AF). Methods and results Ten-thousand two-hundred twenty patients were enrolled [40.3% females, median age 70 (62–77) years, followed for 728 (interquartile range 653–745) days]. Sex-specific tertiles were considered for the five anthropometric variables. At the end of follow-up, survival free from all-cause death was worse in the lowest tertiles for all the anthropometric variables analyzed. On multivariable Cox regression analysis, an independent association with all-cause death was found for the lowest vs. middle tertile when body weight (hazard ratio [HR] 1.66, 95%CI 1.23–2.23), BMI (HR 1.65, 95%CI 1.23–2.21), and BSA (HR 1.49, 95%CI 1.11–2.01) were analysed in female sex, as well as for body weight in male patients (HR 1.61, 95%CI 1.25–2.07). Conversely, the risk of MACE was lower for the highest tertile (vs. middle tertile) of BSA and LBM in males and for the highest tertile of weight and BSA in female patients. A higher occurrence of haemorrhagic events was found for female patients in the lowest tertile of height [odds ratio (OR) 1.90, 95%CI 1.23–2.94] and LBM (OR 2.13, 95%CI 1.40–3.26). Conclusions In AF patients height, weight, BMI, BSA, and LBM were associated with clinical outcomes, with all-cause death being higher for patients presenting lower values of these variables, i.e. in the lowest tertiles of distribution. The anthropometric variables independently associated with other outcomes were also different between male and female subjects.

Type of Medium: Online Resource

ISSN: 2047-4873 , 2047-4881

URL: Article

DOI: 10.1093/eurjpc/zwac115

Language: English

Publisher: Oxford University Press (OUP)

Publication Date: 2022

detail.hit.zdb_id: 2646239-4

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Epidemiology and impact of frailty in patients with atrial fibrillation in Europe

Proietti, Marco ; Romiti, Giulio Francesco ; Vitolo, Marco ; [et al.]

Oxford University Press (OUP) ; 2022

In: Age and Ageing Vol. 51, No. 8 ( 2022-08-02)

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In: Age and Ageing, Oxford University Press (OUP), Vol. 51, No. 8 ( 2022-08-02)

Abstract: Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent. Objectives We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients. Methods A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined. Results Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55–0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty. Conclusions In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.

Type of Medium: Online Resource

ISSN: 0002-0729 , 1468-2834

URL: Article

DOI: 10.1093/ageing/afac192

Language: English

Publisher: Oxford University Press (OUP)

Publication Date: 2022

detail.hit.zdb_id: 2065766-3

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Cohort profile: the ESC EURObservational Research Programme Atrial Fibrillation III (AF III) Registry

Potpara, Tatjana S ; Lip, Gregory Y H ; Dagres, Nikolaos ; [et al.]

Oxford University Press (OUP) ; 2021

In: European Heart Journal - Quality of Care and Clinical Outcomes Vol. 7, No. 3 ( 2021-05-03), p. 229-237

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In: European Heart Journal - Quality of Care and Clinical Outcomes, Oxford University Press (OUP), Vol. 7, No. 3 ( 2021-05-03), p. 229-237

Abstract: The European Society of Cardiology (ESC) EURObservational Research Programme (EORP)-Atrial Fibrillation (AF) III Registry aims to identify contemporary patterns in AF management in clinical practice, assess their compliance with the 2016 ESC AF Guidelines, identify major gaps in guideline implementation, characterize the clinical practice settings associated with good vs. poor guideline implementation and assess and compare the 1-year outcome of guideline-adherent vs. guideline non-adherent management strategies. Methods and results Consecutive adult AF patients (n = 8306) were enrolled between 1 July 2018 and 15 July 2019, and individual patient data were prospectively collected across 192 centres and 31 participating countries during the 3-month enrolment period per centre. The Registry collected baseline and 1-year follow-up data in the eight main domains: patient demographic/enrolment setting, AF diagnosis/characterization, diagnostic assessment, stroke prevention treatments, arrhythmia-directed therapies, integrated AF management, major outcomes (death, non-fatal stroke or systemic embolic event, and non-fatal bleeding event), and the quality of life questionnaire. Conclusion The EORP-AF III Registry is an international, prospective registry of care and outcomes of patients treated for AF, which will provide insights into the contemporary patterns in AF management, ESC AF Guidelines implementation in routine practice and barriers to optimal management of this highly prevalent arrhythmia.

Type of Medium: Online Resource

ISSN: 2058-5225 , 2058-1742

URL: Article

DOI: 10.1093/ehjqcco/qcaa050

Language: English

Publisher: Oxford University Press (OUP)

Publication Date: 2021

detail.hit.zdb_id: 2823451-0

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Yield of diagnosis and risk of stroke with screening strategies for atrial fibrillation: a comprehensive review of current evidence

Corica, Bernadette ; Bonini, Niccolò ; Imberti, Jacopo Francesco ; [et al.]

Oxford University Press (OUP) ; 2023

In: European Heart Journal Open Vol. 3, No. 2 ( 2023-03-02)

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In: European Heart Journal Open, Oxford University Press (OUP), Vol. 3, No. 2 ( 2023-03-02)

Abstract: Atrial fibrillation (AF) is the most prevalent arrhythmia worldwide. The presence of AF is associated with increased risk of systemic thromboembolism, but with the uptake of oral anticoagulant (OAC) and implementation of a holistic and integrated care management, this risk is substantially reduced. The diagnosis of AF requires a 30-s-long electrocardiographic (ECG) trace, irrespective of the presence of symptoms, which may represent the main indication for an ECG tracing. However, almost half patients are asymptomatic at the time of incidental AF diagnosis, with similar risk of stroke of those with clinical AF. This has led to a crucial role of screening for AF, to increase the diagnosis of population at risk of clinical events. The aim of this review is to give a comprehensive overview about the epidemiology of asymptomatic AF, the different screening technologies, the yield of diagnosis in asymptomatic population, and the benefit derived from screening in terms of reduction of clinical adverse events, such as stroke, cardiovascular, and all-cause death. We aim to underline the importance of implementing AF screening programmes and reporting about the debate between scientific societies’ clinical guidelines recommendations and the concerns expressed by the regulatory authorities, which still do not recommend population-wide screening. This review summarizes data on the ongoing trials specifically designed to investigate the benefit of screening in terms of risk of adverse events which will further elucidate the importance of screening in reducing risk of outcomes and influence and inform clinical practice in the next future.

Type of Medium: Online Resource

ISSN: 2752-4191

URL: Article

DOI: 10.1093/ehjopen/oead031

Language: English

Publisher: Oxford University Press (OUP)

Publication Date: 2023

detail.hit.zdb_id: 3112907-9

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Early diagnosis and better rhythm management to improve outcomes in patients with atrial fibrillation: the 8th AFNET/EHRA consensus conference

Schnabel, Renate B ; Marinelli, Elena Andreassi ; Arbelo, Elena ; [et al.]

Oxford University Press (OUP) ; 2023

In: EP Europace Vol. 25, No. 1 ( 2023-02-08), p. 6-27

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In: EP Europace, Oxford University Press (OUP), Vol. 25, No. 1 ( 2023-02-08), p. 6-27

Abstract: Despite marked progress in the management of atrial fibrillation (AF), detecting AF remains difficult and AF-related complications cause unacceptable morbidity and mortality even on optimal current therapy. This document summarizes the key outcomes of the 8th AFNET/EHRA Consensus Conference of the Atrial Fibrillation NETwork (AFNET) and the European Heart Rhythm Association (EHRA). Eighty-three international experts met in Hamburg for 2 days in October 2021. Results of the interdisciplinary, hybrid discussions in breakout groups and the plenary based on recently published and unpublished observations are summarized in this consensus paper to support improved care for patients with AF by guiding prevention, individualized management, and research strategies. The main outcomes are (i) new evidence supports a simple, scalable, and pragmatic population-based AF screening pathway; (ii) rhythm management is evolving from therapy aimed at improving symptoms to an integrated domain in the prevention of AF-related outcomes, especially in patients with recently diagnosed AF; (iii) improved characterization of atrial cardiomyopathy may help to identify patients in need for therapy; (iv) standardized assessment of cognitive function in patients with AF could lead to improvement in patient outcomes; and (v) artificial intelligence (AI) can support all of the above aims, but requires advanced interdisciplinary knowledge and collaboration as well as a better medico-legal framework. Implementation of new evidence-based approaches to AF screening and rhythm management can improve outcomes in patients with AF. Additional benefits are possible with further efforts to identify and target atrial cardiomyopathy and cognitive impairment, which can be facilitated by AI.

Type of Medium: Online Resource

ISSN: 1099-5129 , 1532-2092

URL: Article

DOI: 10.1093/europace/euac062

Language: English

Publisher: Oxford University Press (OUP)

Publication Date: 2023

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9

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What do we do about atrial high rate episodes?

Boriani, Giuseppe ; Vitolo, Marco ; Imberti, Jacopo Francesco ; [et al.]

Oxford University Press (OUP) ; 2020

In: European Heart Journal Supplements Vol. 22, No. Supplement_O ( 2020-12-22), p. O42-O52

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In: European Heart Journal Supplements, Oxford University Press (OUP), Vol. 22, No. Supplement_O ( 2020-12-22), p. O42-O52

Abstract: Atrial high rate episodes (AHREs) are defined as asymptomatic atrial tachyarrhythmias detected by cardiac implantable electronic devices with atrial sensing, providing automated continuous monitoring and tracings storage, occurring in subjects with no previous clinical atrial fibrillation (AF) and with no AF detected at conventional electrocardiogram recordings. AHREs are associated with an increased thrombo-embolic risk, which is not negligible, although lower than that of clinical AF. The thrombo-embolic risk increases with increasing burden of AHREs, and moreover, AHREs burden shows a dynamic pattern, with tendency to progression along with time, with potential transition to clinical AF. The clinical management of AHREs, in particular with regard to prophylactic treatment with oral anticoagulants (OACs), remains uncertain and heterogeneous. At present, in patients with confirmed AHREs, as a result of device tracing analysis, an integrated, individual and clinically-guided assessment should be applied, taking into account the patients’ risk of stroke (to be reassessed regularly) and the AHREs burden. The use of OACs, preferentially non-vitamin K antagonists OACs, may be justified in selected patients, such as those with longer AHREs durations (in the range of several hours or ≥24 h), with no doubts on AF diagnosis after device tracing analysis and with an estimated high/very high individual risk of stroke, accounting for the anticipated net clinical benefit, and informed patient’s preferences. Two randomized clinical trials on this topic are currently ongoing and are likely to better define the role of anticoagulant therapy in patients with AHREs.

Type of Medium: Online Resource

ISSN: 1520-765X , 1554-2815

URL: Article

DOI: 10.1093/eurheartj/suaa179

Language: English

Publisher: Oxford University Press (OUP)

Publication Date: 2020

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The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: executive summary

Steffel, Jan ; Verhamme, Peter ; Potpara, Tatjana S ; [et al.]

Oxford University Press (OUP) ; 2018

In: EP Europace Vol. 20, No. 8 ( 2018-08-01), p. 1231-1242

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In: EP Europace, Oxford University Press (OUP), Vol. 20, No. 8 ( 2018-08-01), p. 1231-1242

Type of Medium: Online Resource

ISSN: 1099-5129 , 1532-2092

URL: Article

DOI: 10.1093/europace/euy054

Language: English

Publisher: Oxford University Press (OUP)

Publication Date: 2018

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