One-year clinical events and management of patients with atrial fibrillation hospitalized in cardiology centers: Data from the BLITZ-AF study

Published:January 14, 2020DOI:


      • The BLITZ-AF has a high 1-year mortality rate due to heart failure.
      • Thromboembolic and hemorrhagic events were few at 1 year follow-up.
      • Persistence on oral anticoagulant therapy at 1 year was high.
      • The increase in prescription of DOACs contributes to the persistence of treatment.

      Structured abstract


      The management of atrial fibrillation (AF) has changed with the introduction of direct anticoagulants (DOACs) and new techniques such as catheter ablation. An update collection of data from “real world” AF patients followed by cardiologists is useful to obtain information on both management, outcomes and guideline adherence in clinical practice.


      Follow-up information on survival, embolic and bleeding events and hospital readmission, persistence of oral anticoagulant (OAC) therapy was collected in 84 centers participating to the BLITZ-AF study.


      Patients were followed for a median of 366 days (IQR: 356–378) and vital status was available for 2159 patients. Mortality was 9.2%. Heart failure was the most common cardiovascular cause of death (70%) followed by arrhythmias (6.7%), acute coronary syndrome (5.0%) and ischemic stroke (2.5%). During follow-up 18.1% of the patients were readmitted, mainly (81.3%) for cardiovascular causes. Patients on OAC were 83.4%, 9.1% were on antiplatelets and 7.5% did not receive antithrombotic therapy. The use of DOACs increased from 42.1% to 46.4% during the follow-up, OAC discontinuation occurred in 9.1%. AF recurrences occurred in 23.4% of the patients discharged in sinus rhythm. Rate control strategy was adopted in 55.9% and beta-blockers were the most used drugs (81.9%). Amiodarone (22%) and flecainide (9.7%) were the most frequent used antiahrrythmic drugs.


      The follow-up of the BLITZ-AF study provide an up to date picture of the clinical course of patients with AF, who appear frequently affected by heart failure and severe comorbidities which might have led to the high mortality rate.


      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 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


        • Kirchhof P.
        • Benussi S.
        • Kotheca D.
        • et al.
        ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS.
        Eur Heart J 2016. 2016; 37: 2893-2962
        • Chugh SS
        • Havmoeller R
        • Narayanan K
        • et al.
        Worldwide epidemiology of atrial fibrillation: a global burden of disease 2010 study.
        Circulation. 2014; 129: 837-847
        • 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; 354: i4482
        • Connolly S.J.
        • Ezekowitz M.D.
        • Yusuf S.
        • et al.
        Dabigatran versus warfarin in patient with atrial fibrillation.
        N Eng J Med. 2009; 361: 1139-1151
        • Patel M.R.
        • Mahaffey K.W.
        • Garg J.
        • et al.
        Rivaroxaban versus warfarin in nonvalvular atrial fibrillation.
        N Eng J Med. 2011; 365: 883-891
        • Granger G.B.
        • Alexander J.H.
        • McMurray J.J.
        • et al.
        Apixaban versus warfarin in patients with atrial fibrillation.
        N Eng J Med. 2011; 365: 981-992
        • Giugliano R.P.
        • Ruff C.T.
        • Braunwald E.
        • et al.
        Edoxaban versus warfarin in patients with atrial fibrillation.
        N Eng J Med. 2013; 369: 2093-2104
        • Gulizia M.M.
        • Cemin R.
        • Colivicchi F.
        • et al.
        Management of atrial fibrillation in the emergency room and in the cardiology ward: the BLITZ-AF study.
        Europace. 2019; 21: 230-238
        • Steffel J.
        • Verhamme P.
        • Potpara T.S.
        • et al.
        The 2018 European heart rhythm association practical guide on the use of non-vitamin K oral anticoagulants in patients with atrial fibrillation: executive summary.
        Europace. 2018; 20: 1231-1242
        • De Luca L.
        • Temporelli P.L.
        • Riccio C.
        • et al.
        START investigators. clinical outcomes, pharmacologic treatment and quality of life of patients with stable coronary artery diseases managed by cardiologists: 1-Year results of the start study.
        Eur Heart J Qual Care Clin Outcomes. 2019; (Jan 14Epub ahead of print)
        • Chioncel O.
        • Lainscak M.
        • Seferovic P.M.
        • et al.
        Epidemiology and one-year outcomes in patients with chronic heart failure and preserved, mid-range and reduced ejection fraction: an analysis of the ESC heart failure long-term registry.
        Eur J Heart Failure. 2017; 19: 1574-1585
        • Lip G.
        • Laroche C.
        • Popescu M.I.
        • 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: 3365-3376
        • Bassand J.P.
        • Accetta G.
        • Camm A.J.
        • et al.
        GARFIELD-AF investigators. two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.
        Eur Heart J. 2016; 37: 2882-2889
        • Fauchier L.
        • Villejoubert O.
        • Clementy N.
        • et al.
        Causes of death and influencing factors in patients with atrial fibrillation.
        Am J Med. 2016; 129: 1278-1287
        • Boriani G.
        • Laroche C.
        • Diemberger I.
        • et al.
        Asymptomatic atrial fibrillation: clinical correlation, management and outocomes in the EORP-AF pilot general registry.
        Am J Med. 2015; 128: 509-518
        • Huisman M.V.
        • Rothmann K.J.
        • Paquette M.
        • et al.
        The changing landscape for stroke prevention in AF. Findings from the GLORIA-AF registry phase 2.
        J Am Coll Cardiol. 2017; 69: 777-785
        • Nieuwlaat R.
        • Capucci A.
        • Camm A.J.
        • et al.
        European heart survey investigators. atrial fibrillation management: a prospective survey in ESC member countries: the Euro heart survey on atrial fibrillation.
        Eur Heart J. 2005; 26: 2422-2434
        • Mazurek M.
        • Huisman M.V.
        • Lip G.Y.H
        Registries in atrial fibrillation: from trials to real-life clinical practice.
        Am J Med. 2017; 130: 135-145
        • Steinberg B.
        • GAO H.
        • Pieper K.
        • et al.
        International trends in clinical characteristics and oral anticoagulation treatment for patients with atrial fibrillation: results from the GARFIELD-AF, ORBIT-AF I and ORBIT-AF II registries.
        Am Heart J. 2017; 194: 132-140