Regional Lack of Consistency in the Management of Atrial Fibrillation (from the RECORD-AF Trial).
American and European society guidelines for atrial fibrillation management mostly agree on the utilization of rate and rhythm control strategies and the indications for oral anticoagulant (OAC) use. However, the level of adherence to guidelines in clinical practice may vary by region. In this study, data analysis from The Registry on Cardiac rhythm disorders assessing the control of Atrial Fibrillation (RECORD-AF) registry, an international registry in patients with newly diagnosed atrial fibrillation of <1 year, shows that differences in practice exist between 3 regions, namely Western Europe, Eastern Europe, and North America. Data analyzed included major cardiovascular outcomes at 12 months, choice of rhythm versus rate control strategy and the use of OAC according to CHADS2 score between regions, and the cost incurred according to management strategy. In conclusion, there is preference for rhythm control strategy in Europe compared to North America without a significant impact on major cardiovascular outcomes; there is significant discrepancy in the use of OAC in Eastern Europe compared to the 2 other regions; and rate control was found to be more costly in all regions.
Division of Cardiovascular Medicine, Department of Internal Medicine, University of Kentucky, Lexington, Kentucky. Electronic address: yhda222@uky.edu.
Yousef H
YH
Darrat
Cardiac Electrophsyiology, Boulder Heart, Longmont, Colorado.
Jignesh
J
Shah
Division of Cardiovascular Medicine, Department of Internal Medicine, University of Kentucky, Lexington, Kentucky.
Claude-Samy
CS
Elayi
Division of Cardiovascular Medicine, Department of Internal Medicine, University of Kentucky, Lexington, Kentucky.
Gustavo X
GX
Morales
Sanofi, Paris, France.
Lisa
L
Naditch-Brûlé
Lincoln, Boulogne-Billancourt, France.
Sandrine
S
Brette
Experis IT, Nanterre, France.
Christine
C
Taniou
The Lankenau Institute for Medical Research, Wynnewood, Pennsylvania; Jefferson Medical College, Philadelphia, Pennsylvania.
Peter R
PR
Kowey
Center for Cardiac Arrhythmias of Genetic Origin-IRCCS Instituto Auxologico Italiano, Milan, Italy.
Peter J
PJ
Schwartz
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D005260:Female; D019983:Guideline Adherence; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009656:North America / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants