title: [Nonvalvular atrial fibrillation: data from the Observatory of Cardiovascular Diseases in the province of Trieste (Italy)].
abstract: BACKGROUND
  Nonvalvular atrial fibrillation (NVAF) is the most common arrhythmia in outpatients and is associated with increased mortality, thromboembolic and hemorrhagic events. Although several international studies have evaluated its prognostic impact in the real world, Italian data are still lacking. Our aim was to define the prevalence, comorbidity, treatment and outcome in a population of "real-life" outpatients with NVAF.
  
  
  METHODS
  From 2009 to 2013, 21 282 consecutive patients referred to the Cardiovascular Center of Trieste were enrolled in the study. NVAF was defined in the absence of moderate-to-severe valvular disease, valvular interventions, rheumatic heart disease. Events evaluated in the follow-up included mortality, hospitalizations, thromboembolism and hemorrhage. Clinical data and events were derived from the cardiac regional electronic patient records and the ICD-9 hospital discharge records.
  
  
  RESULTS
  3379 patients (15.8%) had NVAF (35.6% paroxysmal, 34.5% persistent, 29.9% permanent); compared to the general population these patients were older, predominantly male, with hypertension, diabetes and history of stroke/transient ischemic attack and heart failure. Oral anticoagulant therapy was prescribed in 54% of cases, above all in persistent or permanent forms, in patients with higher CHA2DS2-VASc score and younger age. The rate of all-cause mortality, cardiovascular hospitalization, thromboembolic and hemorrhagic events during follow-up was higher in patients with NVAF than in the general population. The use of oral anticoagulant therapy reduced the incidence of thromboembolic events. CHA2DS2-VASc score emerged as an independent predictor of thromboembolic events in patients with paroxysmal (35% higher risk), persistent (40% higher risk) and permanent atrial fibrillation (34% higher risk than patients without atrial fibrillation).
  
  
  CONCLUSIONS
  In "real-life" outpatients NVAF is associated with older age, more comorbidities and increased cardiovascular events. CHA2DS2-VASc and HAS-BLED scores predict accurately the risk for thromboembolic and hemorrhagic events. Oral anticoagulation reduces thromboembolic events, but its use is limited to just half of the patients.
authors.affiliation: Centro Cardiovascolare, Azienda per l'Assistenza Sanitaria n. 1, Ospedale Maggiore e Università degli Studi, Trieste.
authors.forename: Carmine
authors.initials: C
authors.lastname: Mazzone
authors.affiliation: Dipartimento Cardiovascolare, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" e Università degli Studi, Trieste.
authors.forename: Cosimo
authors.initials: C
authors.lastname: Carriere
authors.affiliation: Centro Cardiovascolare, Azienda per l'Assistenza Sanitaria n. 1, Ospedale Maggiore e Università degli Studi, Trieste.
authors.forename: Eliana
authors.initials: E
authors.lastname: Grande
authors.affiliation: Centro Cardiovascolare, Azienda per l'Assistenza Sanitaria n. 1, Ospedale Maggiore e Università degli Studi, Trieste.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Iorio
authors.affiliation: Centro Cardiovascolare, Azienda per l'Assistenza Sanitaria n. 1, Ospedale Maggiore e Università degli Studi, Trieste.
authors.forename: Giulia
authors.initials: G
authors.lastname: Barbati
authors.affiliation: Dipartimento Cardiovascolare, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" e Università degli Studi, Trieste.
authors.forename: Massimo
authors.initials: M
authors.lastname: Zecchin
authors.affiliation: Oberarztin II, Medizinische Klinik Klinikum, Coburg, Germania.
authors.forename: Laura Vitali
authors.initials: LV
authors.lastname: Serdoz
authors.affiliation: Dipartimento di Cardiologia, Ospedale Villa Bianca, Trento.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cioffi
authors.affiliation: Dipartimento di Cardiologia, Ospedale San Martino, Belluno.
authors.forename: Luigi
authors.initials: L
authors.lastname: Tarantini
authors.affiliation: Dipartimento Cardiovascolare, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" e Università degli Studi, Trieste.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Sinagra
authors.affiliation: Scuola di Specialità in Cardiologia, Università degli Studi, Trieste.
authors.forename: Sabino
authors.initials: S
authors.lastname: Scardi
authors.affiliation: Centro Cardiovascolare, Azienda per l'Assistenza Sanitaria n. 1, Ospedale Maggiore e Università degli Studi, Trieste.
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Lenarda
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D002423:Cause of Death; D065427:Factor Xa Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D013923:Thromboembolism / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D019851:Thrombophilia / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors