title: Improved outcomes with European Society of Cardiology guideline-adherent antithrombotic treatment in high-risk patients with atrial fibrillation: a report from the EORP-AF General Pilot Registry.
abstract: OBJECTIVE
  Guideline-adherent therapy for stroke prevention in atrial fibrillation has been associated with better outcomes, in terms of thromboembolism (TE) and bleeding.
  
  
  RESULTS
  In this report from the EuroObservational Research Programme-Atrial Fibrillation (EORP-AF) Pilot General Registry, we describe the associated baseline features of 'high risk' AF patients in relation to guideline-adherent antithrombotic treatment, i.e. whether they were adherent, over-treated, or under-treated based on the 2012 European Society of Cardiology (ESC) guidelines. Secondly, we assessed the predictors of guideline-adherent antithrombotic treatment. Thirdly, we evaluated outcomes for all-cause mortality, TE, bleeding, and the composite endpoint of 'any TE, cardiovascular death or bleeding' in relation to whether they were ESC guideline-adherent treatment. From the EORP-AF cohort, the follow-up dataset of 2634 subjects was used to assess the impact of guideline adherence or non-adherence. Of these, 1602 (60.6%) were guideline adherent, whilst 458 (17.3%) were under-treated, and 574 (21.7%) were over-treated. Non-guideline-adherent treatment can be related to region of Europe as well as associated clinical features, but not age, AF type, symptoms, or echocardiography indices. Over-treatment per se was associated with symptoms, using the EHRA score, as well as other comorbidities. Guideline-adherent antithrombotic management based on the ESC guidelines is associated with significantly better outcomes. Specifically, the endpoint of 'all cause death and any TE' is increased by >60% by undertreatment [hazard ratio (HR) 1.679 (95% confidence interval (CI) 1.202-2.347)] or over-treatment [HR 1.622 (95% CI 1.173-2.23)]. For the composite endpoint of 'cardiovascular death, any TE or bleeding', over-treatment increased risk by >70% [HR 1.722 (95% CI 1.200-2.470)].
  
  
  CONCLUSIONS
  Even in this cohort with high overall rates of oral anticoagulation use, ESC guideline-adherent antithrombotic management is associated with significantly better outcomes, including those related to mortality and TE, as well as the composite endpoint of 'cardiovascular death, any TE or bleeding'. These contemporary observations emphasize the importance of guideline implementation, and adherence to the 2012 ESC guidelines for stroke prevention in AF.
authors: University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham B18 7QH, UK Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark g.y.h.lip@bham.ac.uk.
authors: Gregory Y H
authors: GY
authors: Lip
authors: EURObservational Research Programme Department, European Society of Cardiology, Sophia Antipolis, France.
authors: Cécile
authors: C
authors: Laroche
authors: Cardiology Department, Faculty of Medicine Oradea, Emergency Clinical County Hospital of Oradea, Romania.
authors: Mircea Iaochim
authors: MI
authors: Popescu
authors: Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark Department of Cardiology, Cardiovascular Research Centre, Aalborg University Hospital, Aalborg, Denmark.
authors: Lars Hvilsted
authors: LH
authors: Rasmussen
authors: University of Trieste, Ospedale di Cattinara, AOU Ospedali Riuniti SC Cardiologia, Trieste, Italy.
authors: Laura
authors: L
authors: Vitali-Serdoz
authors: University of Medicine, "Carol Davila", Colentina University Hospital, Bucharest, Romania.
authors: Gheorghe-Andrei
authors: GA
authors: Dan
authors: Department of Cardiology, Silesian Center for Heart Disease, ul. M Curie-Sklodowskiej 9, 41-800 Zabrze, Poland.
authors: Zbigniew
authors: Z
authors: Kalarus
authors: Department of Cardiology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
authors: Harry J G M
authors: HJ
authors: Crijns
authors: Cardiology Department, Santa Marta Hospital and Institute of Physiology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
authors: Mario Martins
authors: MM
authors: Oliveira
authors: GVM Care and Research, Ettore Sansavini Health Science Foundation, Maria Cecilia Hospital, Cotignola, Italy.
authors: Luigi
authors: L
authors: Tavazzi
authors: EURObservational Research Programme Department, European Society of Cardiology, Sophia Antipolis, France.
authors: Aldo P
authors: AP
authors: Maggioni
authors: Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy.
authors: Giuseppe
authors: G
authors: Boriani
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D002423:Cause of Death; D016009:Chi-Square Distribution; D005060:Europe; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D019983:Guideline Adherence / Q000592:standards*; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010865:Pilot Projects; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control*; D013923:Thromboembolism / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control*; D016896:Treatment Outcome; D019564:Unnecessary Procedures
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents
keywords: Anticoagulation; Atrial fibrillation; Guidelines; Mortality; Outcome; Stroke; Thromboembolism