Atrial Fibrillation Management Strategies in Routine Clinical Practice: Insights from the International RealiseAF Survey

Abstract

BackgroundAtrial fibrillation (AF) can be managed with rhythm- or rate-control strategies. There are few data from routine clinical practice on the frequency with which each strategy is used and their correlates in terms of patients’ clinical characteristics, AF control, and symptom burden.MethodsRealiseAF was an international, cross-sectional, observational survey of 11,198 patients with AF. The aim of this analysis was to describe patient profiles and symptoms according to the AF management strategy used. A multivariate logistic regression identified factors associated with AF management strategy at the end of the visit.ResultsAmong 10,497 eligible patients, 53.7% used a rate-control strategy, compared with 34.5% who used a rhythm-control strategy. In 11.8% of patients, no clear strategy was stated. The proportion of patients with AF-related symptoms (EHRA Class > = II) was 78.1% (n = 4396/5630) for those using a rate-control strategy vs. 67.8% for those using a rhythm-control strategy (p<0.001). Multivariate logistic regression analysis revealed that age <75 years or the paroxysmal or persistent form of AF favored the choice of a rhythm-control strategy. A change in strategy was infrequent, even in patients with European Heart Rhythm Association (EHRA) Class > = II.ConclusionsIn the RealiseAF routine clinical practice survey, rate control was more commonly used than rhythm control, and a change in strategy was uncommon, even in symptomatic patients. In almost 12% of patients, no clear strategy was stated. Physician awareness regarding optimal management strategies for AF may be improved.

Epidemiological characteristics, management, and outcomes of atrial fibrillation in TUNISIA: Results from the National Tunisian Registry of Atrial Fibrillation (NATURE‐AF)

“…Only two published studies describing the epidemiological data in Tunisia are available 5,7,18 . In 2003, Drissa et al 5 conducted a multicenter study involving 1134 patients presenting with a first episode of AF between January 1985 and December 2000.…”

“…In fact, the proportion of patients not receiving antithrombotic therapy ranges from 11.4% in the Middle East and Africa to 27.6% in Latin America. Conversely, the use of oral anticoagulants is the highest in the Middle East and Africa (66.7%) and the lowest in Asia (31.7%) 7,18 …”

<p>CHA2DS2-VASc score can guide the screening of atrial fibrillation - cross-sectional study in a geriatric ward</p>

“…A detailed screening is not always possible in all patients of the primary health care settings. The obstacles indicated include also organizational barriers, like the lack of time, staff, and capacity 21. It is still not decided when, or how often, ECG/Holter ECG in the high-risk population should be done.…”

Design and Rationale of the National Tunisian Registry of Atrial Fibrillation: Protocol for a Prospective, Multicenter Trial

“…Recently, geographic differences have been highlighted by Gamra et al [ 16 , 17 ]. The RealiseAF international cross-sectional survey enrolled 10,523 patients (with at least 1 documented AF episode in the preceding 12 months) from 831 sites; 26 countries from 4 continents participated in the study with Middle East and North Africa participation from Algeria (n=310), Egypt (n=458), Lebanon (n=191), Morocco (n=250), and Tunisia (n=471).…”

“…Among those patients with a CHADS 2 score ≥2, there were also important geographical differences with respect to the use of antithrombotics: the proportion of patients not receiving any antithrombotic therapy ranged from 11.4% in the Middle East and Africa to 27.6% in Latin America. Conversely, the use of oral anticoagulants was highest in the Middle East and Africa (66.7%) and lowest in Asia (31.7%) [ 16 , 17 ].…”