title: Regional differences in presentation and treatment of patients with atrial fibrillation in Europe: a report from the EURObservational Research Programme Atrial Fibrillation (EORP-AF) Pilot General Registry.
abstract: OBJECTIVE
  Country differences in management practices are evident, and the publication of management guidelines by the European Society of Cardiology (ESC) and other learned societies has tried to recommend a uniform evidence-based approach to management. Despite the availability of guidelines and efforts to improve implementation, differences in guideline adherence are evident, and differences between countries and regions within Europe are therefore likely.
  
  
  RESULTS
  In this analysis from the baseline dataset of the EORP-AF Pilot survey, we examined regional differences in presentation and treatment of contemporary patients with atrial fibrillation (AF) in Europe, as managed by European cardiologists. We focused on a subgroup of 902 hospital admitted patients in whom no rhythm control was performed or planned. Chronic heart failure was more common in East countries (P < 0.0001) while hypertension and peripheral artery disease were more common in South countries (both P < 0.0001). Previous bleeding and chronic kidney disease were more common in South countries (both P < 0.0001). A CHA2DS2-VASc score of ≥2 was highest in East and South countries (93.0 and 95.3%, respectively) compared with 80.8% in West countries (P < 0.0001). A HAS-BLED score of ≥3 was also highest in East and South countries (18.0 and 29.2% respectively) compared with 4.8% in West countries (P < 0.0001). Oral anticoagulation (OAC) use (either as OAC or OAC plus antiplatelet therapy) in West, East, and South countries was 72.0, 74.7, and 76.2%, respectively. Only antiplatelet therapy was used in 13.6, 15.4, and 12.4%, respectively. An initial rate control strategy only was most common in South countries (77.8%) (P < 0.0001).
  
  
  CONCLUSIONS
  From the systematic collection of contemporary data regarding the management and treatment of AF in nine participating member ESC countries, we provide hypothesis-generating insights into regional management practices in Europe with regard to patient characteristics and treatment options.
authors.affiliation: University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK g.y.h.lip@bham.ac.uk.
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.affiliation: EORP Department, European Society of Cardiology, Sophia Antipolis, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Laroche
authors.affiliation: Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S.Orsola-Malpighi University Hospital, Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
authors.affiliation: Department of Cardiology, Colentina University Hospital, Stefan cel Mare 19-21, Sector 2, Bucharest, Romania.
authors.forename: Gheorghe-Andrei
authors.initials: GA
authors.lastname: Dan
authors.affiliation: Cardiovascular Department, S. Filippo Neri Hospital Rome, Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Santini
authors.affiliation: Department of Cardiology, Silesian Center for Heart Disease, ul. M Curie-Sklodowskiej 9, Zabrze 41-800, Poland.
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Kalarus
authors.affiliation: Department of Cardiology, Aalborg University Hospital and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Sondre Skovvej 15, Aalborg DK-9000, Denmark.
authors.forename: Lars Hvilsted
authors.initials: LH
authors.lastname: Rasmussen
authors.affiliation: Cardiology Department, Santa Marta Hospital and Institute of Physiology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
authors.forename: Mário Martins
authors.initials: MM
authors.lastname: Oliveira
authors.affiliation: Cliniques du Sud Luxembourg, Vivalia, rue des Deportes 137, Arlon BE-6700, Belgium.
authors.forename: Georges
authors.initials: G
authors.lastname: Mairesse
authors.affiliation: Department of Cardiology, Maastricht University Medical Centre, PO Box 5800, Maastricht 6202 AZ, The Netherlands.
authors.forename: Harry J G M
authors.initials: HJ
authors.lastname: Crijns
authors.affiliation: Department of Cardiology, Heraklion University Hospital, PO Box 1352 Stavrakia, Heraklion, Crete 71110, Greece.
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Simantirakis
authors.affiliation: Department of Cardiology, Oslo University Hospital, Institute of Clinical Sciences, University of Oslo, Oslo, Norway.
authors.forename: Dan
authors.initials: D
authors.lastname: Atar
authors.affiliation: EORP Department, European Society of Cardiology, Sophia Antipolis, France.
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.affiliation: GVM Care&Research, E.S. Health Science Foundation, Maria Cecilia Hospital, Cotignola, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D005060:Europe; D005260:Female; D005843:Geography; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012042:Registries; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
keywords: Atrial fibrillation; Geographical differences; Guidelines