Advertisement

Increased burden of comorbidities and risk of cardiovascular death in atrial fibrillation patients in Europe over ten years: A comparison between EORP-AF pilot and EHS-AF registries

      Highlights

      • Temporal changes have been found in atrial fibrillation (AF) epidemiology.
      • AF patients re becoming older and more burdened with comorbidities
      • Use of oral anticoagulant (OAC) drugs increased over the last decade in Europe.
      • OAC use is associated with a reduction in thromboembolic and cardiovascular events.
      • Despite the increased OAC use, a high risk of cardiovascular death still persists.

      Abstract

      Background

      In 2002, the European Society of Cardiology conducted the Euro Heart Survey (EHS), while in 2014concluded 1-year follow-up of the EURObservational Research Programme AF (EORP-AF) Pilot Registry.

      Methods

      We analysed differences in clinical profiles, therapeutic approaches and outcomes between these two cohorts after propensity score matching (PSM).

      Results

      After PSM, 5206 patients were analysed. In EORP-AF there were more elderly patients than EHS (p < .001). EORP-AF patients were more burdened with cardiovascular (CV) and non-CV comorbidities, with a higher proportion of patients with high thromboembolic risk. EORP-AF patients used more oral-anticoagulant (OAC) (p < .001).
      At 1-year follow-up EORP-AF patients had lower risk for thromboembolic and CV events, readmission for AF and other CV reasons (all p < .001), showing conversely a higher risk for CV death (p = .015). Kaplan-Meier curves showed that EORP-AF patients had higher risk for CV death (p < .0001) and all-cause death (p = .0019). Cox regression confirmed that EORP-AF patients were at higher risk for CV death (p = .021).

      Conclusions

      We found significant changes in AF epidemiology over a decade in Europe, with older patients, more burdened with comorbidities. A greater use of OAC was found. Despite a reduction in risk for thromboembolic events, a high risk of CV-related death was still evident.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Internal Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Kirchhof P.
        • Benussi S.
        • Kotecha D.
        • Ahlsson A.
        • Atar D.
        • Casadei B.
        • et al.
        2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS.
        Europace. 2016; 18: 1609-1678https://doi.org/10.1093/europace/euw295
        • Chugh S.S.
        • Havmoeller R.
        • Narayanan K.
        • Singh D.
        • Rienstra M.
        • Benjamin E.J.
        • et al.
        Worldwide epidemiology of atrial fibrillation: a global burden of disease 2010 study.
        Circulation. 2014; 129: 837-847https://doi.org/10.1161/CIRCULATIONAHA.113.005119
        • Odutayo A.
        • Wong C.X.
        • Hsiao A.J.
        • Hopewell S.
        • Altman D.G.
        • Emdin C.A.
        Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: systematic review and meta-analysis.
        BMJ. 2016; 354i4482
        • Freeman J.V.
        • Wang Y.
        • Akar J.G.
        • Desai N.
        • Krumholz H.M.
        National trends in atrial fibrillation hospitalization, readmission, and mortality for medicare beneficiaries, 1999-2013.
        Circulation. 2017; 135: 1999-2013https://doi.org/10.1161/CIRCULATIONAHA.116.022388
        • Mazurek M.M.
        • Huisman M.V.
        • Lip G.Y.H.
        Registries in atrial fibrillation: from trials to real-life clinical practice.
        Am J Med. 2017; 130: 135-145https://doi.org/10.1016/j.amjmed.2016.09.012
        • Nieuwlaat R.
        • Capucci A.
        • Camm A.J.
        • Olsson S.B.
        • Andresen D.
        • Davies D.W.
        • et al.
        Atrial fibrillation management: a prospective survey in ESC member countries: the Euro Heart Survey on Atrial Fibrillation.
        Eur Heart J. 2005; 26: 2422-2434https://doi.org/10.1093/eurheartj/ehi505
        • Lip G.Y.H.
        • Laroche C.
        • Dan G.-A.
        • Santini M.
        • Kalarus Z.
        • Rasmussen L.H.
        • et al.
        A prospective survey in European Society of Cardiology member countries of atrial fibrillation management: baseline results of EURObservational research Programme atrial fibrillation (EORP-AF) pilot general registry.
        Europace. 2014; 16: 308-319https://doi.org/10.1093/europace/eut373
        • Lip G.Y.H.
        • Laroche C.
        • Ioachim P.M.
        • Rasmussen L.H.
        • Vitali-Serdoz L.
        • Petrescu L.
        • et al.
        Prognosis and treatment of atrial fibrillation patients by European cardiologists: one year follow-up of the EURObservational research programme-atrial fibrillation general registry pilot phase (EORP-AF pilot registry).
        Eur Heart J. 2014; 35: 3365-3376https://doi.org/10.1093/eurheartj/ehu374
        • Proietti M.
        • Laroche C.
        • Opolski G.
        • Maggioni A.P.A.P.
        • Boriani G.
        • Lip G.Y.H.G.Y.H.
        • et al.
        “Real-world” atrial fibrillation management in Europe: observations from the 2-year follow-up of the EURObservational research programme-atrial fibrillation general registry pilot phase.
        Europace. 2017; 19: 722-733https://doi.org/10.1093/europace/euw112
        • Nieuwlaat R.
        • Prins M.H.
        • Le Heuzey J.-Y.Y.
        • Vardas P.E.
        • Aliot E.
        • Santini M.
        • et al.
        Prognosis, disease progression, and treatment of atrial fibrillation patients during 1 year: follow-up of the euro heart survey on atrial fibrillation.
        Eur Heart J. 2008; 29: 1181https://doi.org/10.1093/eurheartj/ehn139
        • Lip G.Y.H.
        • Nieuwlaat R.
        • Pisters R.
        • Lane D.A.
        • Crijns H.J.G.M.
        Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation.
        Chest. 2010; 137: 263-272https://doi.org/10.1378/chest.09-1584
        • Marinigh R.
        • Lip G.Y.H.
        • Fiotti N.
        • Giansante C.
        • Lane D.A.
        Age as a risk factor for stroke in atrial fibrillation patients: implications for thromboprophylaxis.
        J Am Coll Cardiol. 2010; 56: 827-837https://doi.org/10.1016/j.jacc.2010.05.028
        • Fauchier L.
        • Villejoubert O.
        • Clementy N.
        • Bernard A.
        • Pierre B.
        • Angoulvant D.
        • et al.
        Causes of death and influencing factors in patients with atrial fibrillation.
        Am J Med. 2016; 129: 1278-1287https://doi.org/10.1016/j.amjmed.2016.06.045
        • Proietti M.
        • Raparelli V.
        • Olshansky B.
        • Lip G.Y.H.G.Y.H.
        Polypharmacy and major adverse events in atrial fibrillation: observations from the AFFIRM trial.
        Clin Res Cardiol. 2016; 105: 412-420https://doi.org/10.1007/s00392-015-0936-y
        • Jaspers Focks J.
        • Brouwer M.A.
        • Wojdyla D.M.
        • Thomas L.
        • Lopes R.D.
        • Washam J.B.
        • et al.
        Polypharmacy and effects of apixaban versus warfarin in patients with atrial fibrillation: post hoc analysis of the ARISTOTLE trial.
        BMJ. 2016; 353i2868
        • Anandasundaram B.
        • Lane D.A.
        • Apostolakis S.
        • Lip G.Y.H.
        The impact of atherosclerotic vascular disease in predicting a stroke, thromboembolism and mortality in atrial fibrillation patients: a systematic review.
        J Thromb Haemost. 2013; 11: 975-987https://doi.org/10.1111/jth.12177
        • Violi F.
        • Davì G.
        • Proietti M.
        • Pastori D.
        • Hiatt W.R.
        • Corazza G.R.
        • et al.
        Ankle-brachial index and cardiovascular events in atrial fibrillation: the ARAPACIS study.
        Thromb Haemost. 2016; 115: 856-863https://doi.org/10.1160/TH15-07-0612
        • Camm A.J.
        • Accetta G.
        • Ambrosio G.
        • Atar D.
        • Bassand J.-P.
        • Berge E.
        • et al.
        Evolving antithrombotic treatment patterns for patients with newly diagnosed atrial fibrillation.
        Heart. 2017; 103: 307-314https://doi.org/10.1136/heartjnl-2016-309832
        • Gadsbøll K.
        • Staerk L.
        • Loldrup Fosbøl E.
        • Sindet-Pedersen C.
        • Gundlund A.
        • Lip G.Y.
        • et al.
        Increased use of oral anticoagulants in patients with atrial fibrillation: temporal trends from 2005 to 2015 in Denmark.
        Eur Heart J. 2017; 38: 899-906https://doi.org/10.1093/eurheartj/ehw658
        • Gallagher C.
        • Elliott A.D.
        • Wong C.X.
        • Rangnekar G.
        • Middeldorp M.E.
        • Mahajan R.
        • et al.
        Integrated care in atrial fibrillation: a systematic review and meta-analysis.
        Heart. 2017; heartjnl-2016-310952https://doi.org/10.1136/heartjnl-2016-310952
        • Lip G.Y.H.
        The ABC pathway: an integrated approach to improve AF management.
        Nat Rev Cardiol. 2017; https://doi.org/10.1038/nrcardio.2017.153