title: 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).
abstract: BACKGROUND
  The EURObservational Research Programme-Atrial Fibrillation General Registry Pilot Phase (EORP-AF Pilot) provides systematic collection of contemporary data regarding the management and treatment of 3119 subjects with AF from 9 member European Society of Cardiology (ESC) countries. In this analysis, we report the development of symptoms, use of antithrombotic therapy and rate vs. rhythm strategies, as well as determinants of mortality and/or stroke/transient ischaemic attack (TIA)/peripheral embolism during 1-year follow-up in this contemporary European registry of AF patients.
  
  
  METHODS
  The registry population comprised consecutive in- and out-patients with AF presenting to cardiologists in participating ESC countries. Consecutive patients with AF documented by ECG were enrolled. Follow-up was performed by the local investigator, initially at 1 year, as part of a long-term cohort study.
  
  
  RESULTS
  At the follow-up, patients were frequently asymptomatic (76.8%), but symptoms are nevertheless common among paroxysmal and persistent AF patients, especially palpitations, fatigue, and shortness of breath. Oral anticoagulant (OAC) use remains high, ∼78% overall at follow-up, and of those on vitamin K antagonist (VKA), 84% remained on VKA during the follow-up, while of those on non-VKA oral anticoagulant (NOAC) at baseline, 86% remained on NOAC, and 11.8% had changed to a VKA and 1.1% to antiplatelet therapy. Digitalis was commonly used in paroxysmal AF patients. Of rhythm control interventions, electrical cardioversion was performed in 9.7%, pharmacological cardioversion in 5.1%, and catheter ablation in 4.4%. Despite good adherence to anticoagulation, 1-year mortality was high (5.7%), with most deaths were cardiovascular (70%). Hospital readmissions were common, especially for atrial tachyarrhythmias and heart failure. On multivariate analysis, independent baseline predictors for mortality and/or stroke/TIA/peripheral embolism were age, AF as primary presentation, previous TIA, chronic kidney disease, chronic heart failure, malignancy, and minor bleeding. Independent predictors of mortality were age, chronic kidney disease, AF as primary presentation, prior TIA, chronic obstructive pulmonary disease, malignancy, minor bleeding, and diuretic use. Statin use was predictive of lower mortality.
  
  
  CONCLUSIONS
  In this 1-year follow-up analysis of the EORP-AF pilot general registry, we provide data on the first contemporary registry focused on management practices among European cardiologists, conducted since the publication of the new ESC guidelines. Overall OAC use remains high, although persistence with therapy may be problematic. Nonetheless, continued OAC use was more common than in prior reports. Despite the high prescription of OAC, 1-year mortality and morbidity remain high in AF patients, particularly from heart failure and hospitalizations.
authors.affiliation: University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham B18 7QH, UK g.y.h.lip@bham.ac.uk.
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.affiliation: EURObservational Research Programme Department, European Society of Cardiology, Sophia Antipolis, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Laroche
authors.affiliation: Cardiology Department, Faculty of Medicine Oradea, Emergency Clinical County Hospital of Oradea, Oradea, Romania.
authors.forename: Popescu Mircea
authors.initials: PM
authors.lastname: Ioachim
authors.affiliation: Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Medicine Aalborg University, Aalborg, Denmark.
authors.forename: Lars Hvilsted
authors.initials: LH
authors.lastname: Rasmussen
authors.affiliation: University of Trieste, Ospedale di Cattinara, AOU Ospedali Riuniti SC Cardiologia, Strada Fiume 447 IT-34100, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Vitali-Serdoz
authors.affiliation: Coronary Unit and Cardiology 1, Institute of Cardiovascular Diseases, Gheorghe Adam Street 13A 300310, Romania.
authors.forename: Lucian
authors.initials: L
authors.lastname: Petrescu
authors.affiliation: Cardiology Department, Clinica de Cardiologie Spital Judetean, County Hospital, strGB. A. Karoly nr. 2-4, Arad 310037, Romania.
authors.forename: Dan
authors.initials: D
authors.lastname: Darabantiu
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: University of Birmingham, Edgbaston, Birmingham, UK.
authors.forename: Paulus
authors.initials: P
authors.lastname: Kirchhof
authors.affiliation: Department of Cardiology, Heraklion University Hospital, PO Box 1352 Stavrakia, Heraklion, (Crete) 71110, Greece.
authors.forename: Panos
authors.initials: P
authors.lastname: Vardas
authors.affiliation: GVM Care and Research, Ettore Sansavini Health Science Foundation, Maria Cecilia Hospital, Cotignola, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
authors.affiliation: ANMCO Research Center, Firenze, Italy EORP, European Society of Cardiology, Sophia Antipolis, France.
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000401:mortality / Q000628:therapy*; D002309:Cardiology / Q000706:statistics & numerical data; D004812:Epidemiologic Methods; D005060:Europe / Q000453:epidemiology; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D011379:Prognosis; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D000889:Anti-Arrhythmia Agents; D005343:Fibrinolytic Agents; D014812:Vitamin K
keywords: Atrial fibrillation; Mortality; Prognosis; Registry; Stroke