Management of patients with newly-diagnosed atrial fibrillation: Insights from the BALKAN-AF survey

Monika Kozieł; Stefan Simovic; Nikola Pavlovic; Milan Nedeljkovic; Vilma Paparisto; Ljilja Music; Evgenii Goshev; Anca Rodica Dan; Sime Manola; Zumreta Kusljugic; Elina Trendafilova; Dobromir Dobrev; Gheorghe-Andrei Dan; Gregory Y H Lip; Tatjana S Potpara; BALKAN-AF investigators

doi:10.1016/j.ijcha.2019.100461

Management of patients with newly-diagnosed atrial fibrillation: Insights from the BALKAN-AF survey

Int J Cardiol Heart Vasc. 2019 Dec 28:26:100461. doi: 10.1016/j.ijcha.2019.100461. eCollection 2020 Feb.

Authors

Monika Kozieł^{1

2}, Stefan Simovic³, Nikola Pavlovic⁴, Milan Nedeljkovic^{5

6}, Vilma Paparisto⁷, Ljilja Music⁸, Evgenii Goshev⁹, Anca Rodica Dan¹⁰, Sime Manola⁴, Zumreta Kusljugic¹¹, Elina Trendafilova⁹, Dobromir Dobrev¹², Gheorghe-Andrei Dan¹³, Gregory Y H Lip^{1

2

6

14}, Tatjana S Potpara^{5

6}; BALKAN-AF investigators

Affiliations

¹ Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.
² Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland.
³ Cardiology Clinic, University Clinical Center of Kragujevac, Kragujevac, Serbia.
⁴ Clinical Center Sestre Milosrdnice, Zagreb, Croatia.
⁵ Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia.
⁶ School of Medicine, Belgrade University, Belgrade, Serbia.
⁷ Clinic of Cardiology, University Hospital Center Mother Theresa, Tirana, Albania.
⁸ Cardiology Clinic, University Clinical Center of Montenegro, University of Podgorica, Medical Faculty, Podgorica, Montenegro.
⁹ National Heart Hospital, Coronary Care Unit, Sofia, Bulgaria.
¹⁰ Colentina University Hospital, Cardiology Department, Bucharest, Romania.
¹¹ Clinic of Internal Medicine, Cardiology Department, University Clinical Center Tuzla, Medical Faculty, Tuzla, Bosnia and Herzegovina.
¹² Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany.
¹³ Medicine University "Carol Davila", Colentina University Hospital, Bucharest, Romania.
¹⁴ Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.

Abstract

Background: BALKAN-AF evaluated patterns of atrial fibrillation (AF) management in real-world clinical practice in the Balkans. The objectives were: to assess the proportion of patients with first-diagnosed AF in the BALKAN-AF cohort and to compare the management of patients with newly-diagnosed AF and those with previously known AF in clinical practice.

Methods: Consecutive patients from 7 Balkan countries were enrolled prospectively to the snapshot BALKAN-AF survey.

Results: Of 2712 enrolled patients, 2677 (98.7%) with complete data were included. 631 (23.6%) patients had newly-diagnosed AF and 2046 (76.4%) patients had known AF. Patients with newly-diagnosed AF were more likely to be hospitalized for AF and to receive single antiplatelet therapy (SAPT) alone and less likely to receive OACs than those with known AF (all p < 0.001). The use of OAC was not significantly associated with the CHA₂DS₂-VASc (p = 0.624) or HAS-BLED score (p = 0.225) on univariate analysis. Treatment in capital city, hypertension, dilated cardiomyopathy, mitral valve disease, country of residence or rate control strategy were independent predictors of OAC use, whilst non-emergency centre, treatment by cardiologist, paroxysmal AF, palpitations, symptoms attributable to AF (as judged by physician), mean heart rate and AF as the main reason for hospitalization were independent predictors of rhythm control strategy use.

Conclusions: In BALKAN-AF survey, patients with newly-diagnosed AF were more often hospitalized, less often received OAC and were more likely to receive SAPT alone. The use of OAC for stroke prevention has not been driven by the individual patient stroke risk.

Keywords: Atrial fibrillation; BALKAN-AF survey; First-diagnosed atrial fibrillation; Oral anticoagulants; Rate control; Rhythm control.