Epidemiological approach to the atrial fibrillation patients

Year 2013, Volume: 40 Issue: 2, 332 - 339, 01.06.2013

Faruk Ertaş

https://doi.org/10.5798/diclemedj.0921.2013.02.0285

Cited By: 1

Abstract

Atrial Fibrillation (AF) is the most common arrhythmia observed in clinical practice. While the thromboembolic events are the most feared complications, these complications alone are responsible for 15% of all strokes. Anticoagulation therapy is the most effective way to prevent this significant complication caused by AF. Due to the disadvantages related to the recently launched new oral anticoagulants, warfarin still maintains its dominance as the gold standard agent. Pharmaceutical agents as well as demographic characteristics (age, sex, the type of AF, co-morbidities etc.) of the patients are crucial to provide effective coagulation. Since most of the studies on demographic characteristics of AF patients and the profile of oral anticoagulant use originate from the West and Far East, they do not reflect the real characteristics of our country. In this study, by analyzing the epidemiological studies conducted among AF patients in our country, we aimed to bring literature in data related to our society.

Keywords

Atrial fibrillation, anticoagulation, demographic characteristics, epidemiology, guidelines

Atriyal fibrilasyon hastalarına epidemiyolojik yaklaşım

Abstract

Atrial fibrilasyon (AF) klinik pratikte en sık görülen aritmidir. En korkulan komplikasyonu tromboembolik olaylar olup tüm inmelerin % 15\'inden tek başına sorumludur. AF\'nin yol açtığı bu önemli komplikasyonu önlemenin en etkin yolu antikoagulasyondur. Antikoagülasyonu sağlamak için son dönemlerde ortaya çıkan yeni oral antikoagülanlarla ilgili çekincelerden dolayı altın standart ajan olarak warfarin hala üstünlüğünü sürdürmektedir. Efektif antikoagülasyon sağlamada kullanılan farmakolojik ajanların yanı sıra hastanın demografik özellikleri de (yaş, cinsiyet, AF tipi, komorbid durumlar vb.) büyük önem taşımaktadır. AF hastalarının demografik karakteristiği ve oral antikoagülan ilaç kullanım profili ile ilgili yapılan çalışmalar çoğunlukla Batı ve Uzakdoğu kökenli olduğundan ülkemizin gerçek karakteristiğini yansıtmamaktadır. Bu çalışmayla ülkemizde AF hastalarında yapılmış olan epidemiyolojik çalışmalar analiz edilerek toplumumuz ile ilgili verileri literatüre kazandırmayı amaçladık.

Keywords

Atrial fibrilasyon, antikoagülasyon, demografik özellikler, epidemiyoloji, kılavuzlar

References

• Go AS, Hylek EM, Phillips KA, et al. Prevalence of diag- nosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the An Tico- agulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 2001;285:2370-2375.
• European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery, Camm AJ, Kirchhof P, Lip GY, et al. Guidelines for the management of atrial fibril- lation: the Task Force for the Management of Atrial Fibril- lation of the European Society of Cardiology (ESC). Eur Heart J 2010;31:2369-2429.
• Warfarin versus aspirin for prevention of thromboembolism in atrial fibrillation: Stroke Prevention in Atrial Fibrillation II Study. Lancet 1994;343:687-691.
• Rockson SG, Albers GW. Comparing the guidelines: antico- agulation therapy to optimize stroke prevention in patients with atrial fibrillation. J Am Coll Cardio.l 2004;43: 929- 935.
• Atarashi H, Inoue H, Okumura K, et al. J-RHYTHM Reg- istry Investigators. Present status of anticoagulation treat- ment in Japanese patients with atrial fibrillation: a report from the J-RHYTHM Registry. Circ J 2011;75:1328-1333.
• Waldo AL, Becker RC, Tapson VF, Colgan KJ; NABOR Steering Committee. Hospitalized patients with atrial fibril- lation and a high risk of stroke are not being provided with adequate anticoagulation. J Am Coll Cardiol 2005;46:1729- 1736.
• Nabauer M, Gerth A, Limbourg T, et al. The Registry of the German Competence NETwork on Atrial Fibrillation: patient characteristics and initial management. Europace
• Shin HW, Kim YN, Bae HJ, et al. KORAF Investigator. Trends in Oral Anticoagulation Therapy Among Korean Patients With Atrial Fibrillation: The KORean Atrial Fibril- lation Investigation. Korean Circ J 2012;42:113-117.
• Goto S, Bhatt DL, Röther J, et al. REACH Registry Investi- gators.Prevalence, clinical profile, and cardiovascular out- comes of atrial fibrillation patients with atherothrombosis. Am Heart J 2008;156:855-863
• Benjamin EJ, Levy D, Vaziri SM, et al. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA 1994;271:840-844.
• Psaty BM, Manolio TA, Kuller LH, et al. Incidence of and risk factors for atrial fibrillation in older adults. Circulation 1997;96:2455-2461.
• Inoue H, Fujiki A, Origasa H, et al. Prevalence of atrial fibrillation in the general population of Japan: an analysis based on periodic health examination. Int J Cardiol 2009; 137:102-107
• Lok NS, Lau CP. Prevalence of palpitations, cardiac ar- rhythmias and their associated risk factors in ambulant el- derly. Int J Car-diol 1996;54:231-236.
• Uyarel H, Onat A, Yüksel H, Can G, Ordu S, Dursunoğlu D. Incidence, prevalence, and mortality estimates for chronic atrial fibrillation in Turkish adults. Turk Kardiyol Dern Ars 2008;36:214-222.
• Karaçağlar E, Atar I, Yetiş B, et al. The frequency of em- bolic risk factors and adequacy of anti-embolic treatment in patients with atrial fibrillation: a single tertiary center expe- rience. Anadolu Kardiyol Derg 2012;12:384-390.
• Buse JB, Ginsberg HN, Bakris GL, et al. American Diabetes Association. Primary prevention of cardiovascular diseases in people with diabetes mellitus: a scientific statement from the American Heart Association and the American Diabetes Association. Circulation 2007;1151:114-126
• Ertaş F, Kaya H, Kaya Z, et al. Epidemiology of Atrial Fi- brillation in Turkey: Preliminary Results of the Multicenter AFTER (Atrial Fibrillation in Turkey: Epidemiologic Registry) Study. Turk Kardiyol Dern Ars doi: 10.5543/ tkda.2013.18488
• Ertaş F, Kaya H, Yüksel M, et al. Atrial Fibrillation in Tur- key: Epidemiologic Registry (AFTER) Study Design. An- adolu Kardiyol Derg (in press)
• Saksena S, Slee A, Waldo AL, et al. Cardiovascular out- comes in the AFFIRM Trial (Atrial Fibrillation Follow-Up Investigation of Rhythm Management). An assessment of individual antiarrhythmic drug therapies compared with rate control with propensity score-matched analyses. J Am Coll Cardiol 2011;58:1975-1985
• Nieuwlaat R, Capucci A, Camm AJ, et al. European Heart Survey Investigators. Atrial fibrillation management: a pro- spective survey in ESC member countries: the Euro Heart Survey on Atrial Fibrillation. Eur Heart J 2005;26:2422- 2434.
• Ertaş F, Duygu H, Acet H, Eren NK, Nazli C, Ergene AO. Oral anticoagulant use in patients with atrial fibrillation. Turk Kardiyol Dern Ars 2009;37:161-167.
• Ertaş F, Kaya H, Atılgan ZA, et al. Predictors of warfa- rin use in patients with non-valvular atrial fibrillation who presented to the cardiology outpatient clinic of a tertiary hospital in Turkey: an observational study. Turk J Med Sci 2012;42:1172-1179.
• Falk RH. Etiology and complications of atrial fibrillation: insights from pathology studies. Am J Cardiol 1998;82: 10N-17N. Review.
• TAF Araştırıcıları adına Z. Yiğit. Türk Atriyal Fibrilasyon (TAF) Çalışması Non-valvüler Atriyal Fibrilasyonlu Has- talarda Antikoagülan ve Aspirin’in Tromboembolik Risk Üzerine Etkilerinin Karşılaştırıldığı Çok Merkezli, Rando- mize Çalışma Türk Kardiyol Dern Arş 2000;28:8-1.
• Schnabel RB, Wilde S, Wild PS, et al. Atrial fibrillation: its prevalence and risk factor profile in the German general population. Dtsch Arztebl Int 2012;109:293-299.
• Bover R, Pérez-Gómez F, Maluenda MP, et al. Long-term follow-up of atrial fibrillation patients in the NASPEAF study. Prospective evaluation of different antiplatelet treat- ments. Rev Esp Cardiol 2009;62:992-1000.
• Connolly SJ, Ezekowitz MD, Yusuf S, et al. RE-LY Steer- ing Committee and Investigators. Dabigatran versus war- farin in patients with atrial fibrillation. N Engl J Med 2009;361:1139-1151.
• Paikin JS, Manolakos JJ, Eikelboom JW.Rivaroxaban for stroke prevention in atrial fibrillation: a critical review of the ROCK-ET AF trial. Expert Rev Cardiovasc Ther
• Lopes RD, Al-Khatib SM, et al. Efficacy and safety of apixaban compared with warfarin according to patient risk of stroke and of bleeding in atrial fibrillation: a sec- ondary analysis of a randomised controlled trial. Lancet 2012;380:1749-1758.
• J-RHYTHM Registry Investigators. Determinants of warfa- rin use and international normalized ratio levels in atrial fi- brillation patients in Japan. Subanalysis of the J-RHYTHM Registry. Circ J 2011;75:2357-2362.
• Baczek VL, Chen WT, Kluger J, Coleman CI. Predictors of warfarin use in atrial fibrillation in the United States: a systematic review and meta-analysis. BMC Fam Pract 2012;3:13-15.