Use of Oral Anticoagulants in Patients with Atrial Fibrillation: Preliminary Data from the Italian Atrial Fibrillation (ITALY-AF) Registry

Fabio Angeli; Gianpaolo Reboldi; Giancarlo Agnelli; Giuseppe Ambrosio; Alessandro Capucci; Giovanni Carreras; Claudio Cavallini; Adriano Murrone; Gaetano Vaudo; Gianluca Zingarini; Paolo Verdecchia

doi:10.3390/clinpract13050105

Use of Oral Anticoagulants in Patients with Atrial Fibrillation: Preliminary Data from the Italian Atrial Fibrillation (ITALY-AF) Registry

Clin Pract. 2023 Sep 27;13(5):1173-1181. doi: 10.3390/clinpract13050105.

Authors

Fabio Angeli^{1

2}, Gianpaolo Reboldi³, Giancarlo Agnelli^{4

5}, Giuseppe Ambrosio⁶, Alessandro Capucci⁷, Giovanni Carreras⁸, Claudio Cavallini⁹, Adriano Murrone¹⁰, Gaetano Vaudo^{3

11}, Gianluca Zingarini⁹, Paolo Verdecchia^{9

12}

Affiliations

¹ Department of Medicine and Technological Innovation (DiMIT), University of Insubria, 21100 Varese, Italy.
² Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, 21049 Varese, Italy.
³ Department of Medicine, University of Perugia, 06123 Perugia, Italy.
⁴ Internal Vascular and Emergency Medicine-Stroke Unit, University of Perugia, 06123 Perugia, Italy.
⁵ Maugeri Scientific Clinical Institutes-IRCCS, 27100 Pavia, Italy.
⁶ Division of Cardiology, School of Medicine, University of Perugia, 06123 Perugia, Italy.
⁷ Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital Umberto I, Lancisi-Salesi, 60123 Ancona, Italy.
⁸ Arrhythmology Unit, Cardiology Department, Terni University Hospital, 05100 Terni, Italy.
⁹ Struttura Complessa di Cardiologia, Hospital S. Maria della Misericordia, 06129 Perugia, Italy.
¹⁰ Struttura Complessa di Cardiologia, Hospital of Città di Castello, Città di Castello, 06012 Perugia, Italy.
¹¹ Unit of Internal Medicine, Terni University Hospital, 05100 Terni, Italy.
¹² Fondazione Umbra Cuore e Ipertensione-ONLUS, 06124 Perugia, Italy.

Abstract

Background: Atrial fibrillation (AFIB), the most frequent cardiac arrhythmia, is a major risk factor for stroke, heart failure, and death. Because of the recent advances in AFIB management and the availability of new oral anticoagulants (OACs), there is a need for a systematic and predefined collection of contemporary data regarding its management and treatment.

Methods: The objective of the ongoing ITALY-AFIB registry is to evaluate the long-term morbidity and mortality in patients with AFIB and to verify the implementation of the current guidelines for stroke prevention in these patients. The registry includes consecutive in- and out-patients with first diagnosed, paroxysmal, persistent, or permanent AFIB. In patients in sinus rhythm at entry, the qualifying episode of AFIB, confirmed by ECG diagnosis, had to have occurred within 1 year before entry. The clinical record form is web-based and accessible by personal keyword.

Results: Enrolment into the registry started in the year 2013. In a current cohort of 2470 patients (mean age 75 ± 11 years, males 56%), the mean CHA₂DS₂-VASc score was 3.7 ± 1.8, and the mean HAS-BLED was 1.6 ± 0.9. There were no significant sex differences in the AFIB subtypes. At the end of the inclusion visit and after receiving knowledge of the web-based electronic estimate of risk for stroke and bleeding, the proportion of patients discharged with OACs was 80%. After exclusion of patients with first diagnosed AFIB (n = 397), the proportion of patients with prescription of OACs rose from 66% before the visit to 82% on discharge (p < 0.0001). Prescription of aspirin or other antiplatelet drugs fell from 18% before the visit to 10% on discharge (p < 0.0001).

Conclusions: A web-based management of AFIB with automated estimation of risk profiles appears to favorably affect adherence to AFIB guidelines, based on a high proportion of patients treated with OACs and a substantial decline in the use of antiplatelet drugs.

Keywords: atrial fibrillation; guidelines; oral anticoagulants; registry; therapy.

Grants and funding

The authors acknowledge the support provided by the Fondazione Umbra Cuore e Ipertensione—ONLUS, Perugia, Italy (no-profit sponsor of the study).