title: 'Real-world' management and outcomes of patients with paroxysmal vs. non-paroxysmal atrial fibrillation in Europe: the EURObservational Research Programme-Atrial Fibrillation (EORP-AF) General Pilot Registry.
abstract: OBJECTIVE
  Atrial fibrillation (AF) has different presentations (first detected, paroxysmal, persistent, permanent), with uncertain impact on outcome. The aim of this study was to investigate clinical presentation, management, and outcome of paroxysmal and non-paroxysmal AFs within the EURObservational Research Programme-Atrial Fibrillation General Pilot Registry.
  
  
  RESULTS
  Overall 2589 patients with available 1-year follow-up data were evaluated according to AF type. Patients with paroxysmal AF (26.8%) were younger, had lower prevalence of heart disease (particularly valvular), and major co-morbidities, as well as lower CHADS2, CHA2DS2-VASc, and HAS-BLED scores. Patients with first-detected AF (29.9%) had characteristics similar to persistent AF patients (25.9%), but lower use of oral anticoagulants. Patients with permanent AF represented 17.4% of the cohort. At 1 year, the rate of stroke/transient ischaemic attack and thromboembolism was low (0.6-1.0%) and did not differ between paroxysmal and non-paroxysmal AFs. All-cause mortality was higher in non-paroxysmal vs. paroxysmal AF (log rank test, P = 0.0018). Using a multivariable Cox model, non-paroxysmal AF was not an independent predictor of death during follow-up. Independent predictors of death were age, chronic heart failure, chronic kidney disease, diabetes, restrictive cardiomyopathy, and physical activity.
  
  
  CONCLUSIONS
  In this 'real-world' contemporary observational registry, patients with non-paroxysmal AF had a worse outcome, in terms of all-cause mortality, which was related to a more severe clinical profile. The risk of stroke at 1 year was relatively low, perhaps reflecting the high rates of anticoagulation use in this cohort.
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, S. Orsola-Malpighi University Hospital, Via Massarenti 9, Bologna 40138, Italy Cardiology Department, University of Modena and Reggio Emilia, Policlinico di Modena, Viale del Pozzo, 71, 41124 Modena, Italy giuseppe.boriani@unimore.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
authors.affiliation: EURObservational Research Programme Department, European Society of Cardiology, Sophia Antipolis, France.
authors.forename: Cecile
authors.initials: C
authors.lastname: Laroche
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, S. Orsola-Malpighi University Hospital, Via Massarenti 9, Bologna 40138, Italy.
authors.forename: Igor
authors.initials: I
authors.lastname: Diemberger
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, S. Orsola-Malpighi University Hospital, Via Massarenti 9, Bologna 40138, Italy Cardiology Department, University of Modena and Reggio Emilia, Policlinico di Modena, Viale del Pozzo, 71, 41124 Modena, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Fantecchi
authors.affiliation: Department of Cardiology, Faculty of Medicine, Oradea, Romania.
authors.forename: Mircea Ioachim
authors.initials: MI
authors.lastname: Popescu
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: 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: 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: Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
authors.affiliation: EURObservational Research Programme Department, European Society of Cardiology, Sophia Antipolis, France ANMCO Research Center, Firenze, Italy.
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.affiliation: Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham B18 7QH, UK.
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000145:classification / Q000401:mortality / Q000628:therapy*; D017115:Catheter Ablation; D002423:Cause of Death; D015897:Comorbidity; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000453:epidemiology*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010865:Pilot Projects; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*; D013923:Thromboembolism / Q000453:epidemiology*
chemical_list: D000925:Anticoagulants
keywords: Atrial fibrillation; Mortality; Prognosis; Registry; Stroke