title: [Management of thromboembolic risk in patients with atrial fibrillation in Italy: follow-up data from the PREFER in AF European Registry].
abstract: BACKGROUND
  Baseline data of the PREFER in AF (PREvention oF thromboembolic events - European Registry in Atrial Fibrillation) Registry have shown undertreatment of patients with atrial fibrillation (AF), particularly in Italy, where greater difficulties in the management of antithrombotic drugs compared with other European countries were also observed. The aim of the follow-up evaluation was to verify the trends of examined variables after 1 year.
  
  
  METHODS
  Clinical features, patterns of prescriptions and patient adherence to guidelines, quality-of-life and treatment satisfaction variables were evaluated at follow-up, similarly to baseline.
  
  
  RESULTS
  In Italy, 88% of patients originally enrolled completed the 1-year follow-up. The incidence of major cardiovascular events was lower than at baseline (12.6 vs 30.8%, p<0.0001), but was higher compared with the European mean (12.6 vs 10.4%, p=0.0006). In particular, the incidence of heart failure (5.1 vs 3.6%, p=0.0003) and transient ischemic attacks (1.4 vs 0.7%, p<0.0001) were more frequent in Italy; on the other hand, the incidence of major bleeding was lower in Italy compared with the European mean (1.6 vs 2.4, p=0.0168). Patients with a high thromboembolic risk (CHA 2DS2-VASc ≥2) were >80%, similarly to baseline, with a mean CHA2DS2-VASc score of 3.3. However, about one fourth of high-risk patients continued not to be treated with anticoagulant drugs, and treated patients at follow-up were fewer than at baseline (65.1 vs 72.6%, p<0.0001). The percentage of patients treated with non-vitamin K antagonist oral anticoagulants (NOACs) was increased at follow-up compared with baseline (3.3 vs 0.3%, p<0.0001), although lower than the European mean (12.6 vs 6.1%, p<0.0001). The number of INR measurements was higher and related to a higher time in therapeutic range (TTR), compared with baseline, and exceeded the European mean TTR. However, similarly to baseline, a higher difficulty in managing anticoagulant therapy and a lower level of satisfaction for treatment was reported in Italian patients compared with the rest of Europe.
  
  
  CONCLUSIONS
  The Italian data of the PREFER in AF Registry at 1-year follow-up continue to demonstrate undertreatment of patients with AF at increased risk of stroke and a high grade of unsatisfaction for anticoagulant treatment. The low percentage of patients treated with NOACs did not allow the evaluation of their impact on clinical events and acceptance of therapy.
authors.affiliation: Istituto di Cardiologia, Università degli Studi "G. d'Annunzio", Chieti.
authors.forename: Giulia
authors.initials: G
authors.lastname: Renda
authors.affiliation: U.O.S. Servizi Cardiologici, Policlinico Universitario Campus Bio-Medico, Roma.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Patti
authors.affiliation: U.O.C. Cardiologia-UTIC, Ospedale Buon Consiglio Fatebenefratelli, Napoli.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Sangiuolo
authors.affiliation: U.O.C. Cardiologia-UTIC, Ospedale Buon Consiglio Fatebenefratelli, Napoli.
authors.forename: Emilio
authors.initials: E
authors.lastname: Attena
authors.affiliation: Direzione Medica, Daiichi-Sankyo Italia, Roma.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Malpezzi
authors.affiliation: Istituto di Cardiologia, Università degli Studi "G. d'Annunzio", Chieti.
authors.forename: Raffaele
authors.initials: R
authors.lastname: De Caterina
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D019934:International Normalized Ratio; D002546:Ischemic Attack, Transient / Q000453:epidemiology / Q000209:etiology; D007558:Italy; D008297:Male; D017060:Patient Satisfaction; D012042:Registries; D012306:Risk; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants