Cardiology Letters 2012, 21(2):98-110

Thromboembolic risk profile in patients with atrial fibrillation in internal and cardiologic outpatient clinics in Slovakia: Data from REgistry of AtriaL FIBrillation in real life practice (REALFIB*)

Hatala R¹, Hlivák P¹, Urban L¹, Chroust K²

¹ Oddelenia arytmií a kardiostimulácie, Kardiologická klinika, Národný ústav srdcových a cievnych chorôb, a. s. a Lekárska fakulta Slovenskej zdravotníckej univerzita v Bratislave, Slovenská republika

² DSC Services, s.r.o., v Tišnově, Česká republika

The REALFIB registry is a cross-sectional multicenter study of the management of atrial fibrillation (AF) in real-life clinical practice in outpatient internal and cardiologic clinics in Slovakia.

Aim: The main aim of this analysis of the registry entry data was to map therapeutic approaches used in outpatient practice in the prevention of thromboembolic (TE) complications, in particular stroke. At the same time the aim was to obtain basic data on demographics and clinical profile of patients with all forms of AF in Slovakia.

Patients and methods: One thousand thirty two patients with AF managed on an outpatient basis by 51 internists and cardiologists in Slovakia were prospectively and consecutively included into the registry. Patient management was entirely up to the discretion of specialists. The data were entered online and centrally evaluated by a specialized statistical research center.

Results: The mean age of patients was 69.2 ± 9.4 years, 52% were men, age at the time of initial AF diagnosis was 62.8 ± 9.5 years. The mean value of the CHADS2 score at the time of entry into the registry was 2.3 ± 1.3. The representation of the various forms of AF was as follows: paroxysmal in 32%, persistent in 21%, permanent in 47%, and first-diagnosed in 18% of patients. The leading cardiovascular comorbidity was arterial hypertension (91%), 44% of patients were treated for heart failure and 21% had a history of stroke/TIA. As antithrombotic therapy warfarin was used in 67%, acetylsalicylic acid in 21%, thienopyridines in 12% and low-molecular weight heparins in 2% of the patients. The TE risk profile of patients on warfarin compared to those not on warfarin did not significantly differ (CHADS2 score 2.3 ± 1.3 and 2.4 ± 1.5, respectively). The proportion of patients with CHADS2 score ≥2 was comparable in the groups of patients on warfarin and not on warfarin (66.4% and 71.3% respectively). The proportion of patients with very high TE risk (CHADS2 score ≥4) was higher in the group not on warfarin than in the group on warfarin (23% and 16,8%, respectively). Out of the 217 patients with stroke/TIA history, warfarin therapy was administered to 126 patients (58%). On the other hand, from 311 patients with low TE risk (score 0-1) 196 were on warfarin (58%).

Conclusion: AF patients managed on an outpatient basis in Slovakia show high cardiovascular risk profile, arterial hypertension and heart failure being the leading comorbidities. Warfarin therapy is used in approximately 60% of patients irrespective of their CHADS2 score. Thus, the prevention of TE complications in high risk AF patients with warfarin as the current prevailing treatment is in the reallife suboptimal, possibly reflecting 1. unfavorable warfarin profile with its perceived risks outweighing its benefits, especially in high-risk patients and/or 2. insufficient acceptance of the European (ESC) clinical practice guidelines.

Keywords: atrial fibrillation; cardiovascular risk; thromboembolic risk; antithrombotic therapy; warfarin

Published: February 1, 2012  Show citation