Distribution and risk profile of paroxysmal, persistent, and permanent atrial fibrillation in routine clinical practice: insight from the real-life global survey evaluating patients with atrial fibrillation international registry.
BACKGROUND
There is a paucity of international data on the various types of atrial fibrillation (AF) outside the highly selected populations from randomized trials. This study aimed to describe patient characteristics, risk factors, comorbidities, symptoms, management strategy, and control of different types of AF in real-life practice.


RESULTS
Real-life global survey evaluating patients with atrial fibrillation (RealiseAF) was a contemporary, large-scale, cross-sectional international survey of patients with AF who had ≥1 episode in the past 12 months. Investigators were randomly selected to avoid bias. Among 9816 eligible patients from 831 sites in 26 countries, 2606 (26.5%) had paroxysmal, 2341 (23.8%) had persistent, and 4869 (49.6%) had permanent AF. As AF progressed from paroxysmal to persistent and permanent forms, the prevalence of comorbidities, such as heart failure (32.9%, 44.3%, and 55.6%), coronary artery disease (30.0%, 32.9%, and 34.3%), cerebrovascular disease (11.7%, 10.8%, and 17.6%), and valvular disease (16.7%, 21.2%, and 35.8%), increased, and the prevalence of lone AF decreased. Similarly, there was an increase in mean CHADS(2) [cardiac failure, hypertension, age, diabetes, stroke (doubled)] score (1.7, 1.8, and 2.2), and more than half of patients (51.0%, 56.7%, and 67.3%) qualified for oral anticoagulants. Almost 90% of patients received ≥1 antiarrhythmic drug, but >60% had European Heart Rhythm Association symptom scores from II to IV. Furthermore, 40.7% of persistent and 49.8% of permanent AF patients were still in AF with a heart rate >80 beats per minute.


CONCLUSIONS
This survey disclosed high cardiovascular risks and an unmet need in daily practice for patients with any type of AF, especially those with the permanent form.
General Clinical Research Center and Division of Cardiology, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan. cechiang@vghtpe.gov.tw
Chern-En
CE
Chiang
Lisa
L
Naditch-Brûlé
Jan
J
Murin
Marnix
M
Goethals
Hiroshi
H
Inoue
James
J
O'Neill
Jose
J
Silva-Cardoso
Oleg
O
Zharinov
Habib
H
Gamra
Samir
S
Alam
Piotr
P
Ponikowski
Thorsten
T
Lewalter
Mårten
M
Rosenqvist
Philippe Gabriel
PG
Steg
D000352:Africa, Northern / Q000453:epidemiology; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001208:Asia / Q000453:epidemiology; D001281:Atrial Fibrillation / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D016009:Chi-Square Distribution; D015897:Comorbidity; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005060:Europe / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D006339:Heart Rate / Q000187:drug effects; D006760:Hospitalization; D006801:Humans; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014687:Venezuela / Q000453:epidemiology
D000889:Anti-Arrhythmia Agents