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Death, stroke after onset of AF vary by region
In a global cohort study of patients in 47 countries, researchers discovered unexplained inter-regional variations in death and stroke after onset of atrial fibrillation.
Researchers evaluated patients who presented to an ED at 164 centers in 47 countries with AF or atrial flutter between December 2007 and October 2011. Follow-up lasted 12 months. Patients from South America, Eastern Europe, the Middle East and Mediterranean crescent, sub-Saharan Africa, India, China, and Southeast Asia were compared with patients from North America, Western Europe and Australia.
Of the 15,400 patients initially enrolled in the study, 15,361 completed the follow-up and 604 (4%) of these patients experienced stroke at 1 year. More patients with a secondary diagnosis of AF had a stroke compared with patients with a primary diagnosis (5% vs. 3%; P < .0001). Stroke occurrence at 1 year also varied between regions (P < .0001), with India having the lowest occurrence (0.8%) and Africa the highest (8%). The 1-year stroke rate in North America, Western Europe and Australia was 3%.
Overall mortality at 1 year was 11%. Patients with AF as a secondary diagnosis also had a higher 1-year mortality rate than patients with a primary diagnosis (16% vs. 6%; P < .0001). Mortality at 1 year also varied among regions, ranging from 17% in South America and 20% in Africa to 10% in North America, Western Europe and Australia (P < .0001).
The most common causes of death were HF, infection and stroke. HF was the leading cause of death in every region except South America and Southeast Asia, where infectious causes were more prevalent.
“There are opportunities to improve outcomes in most countries by fuller use of proven therapies, such as oral anticoagulation, and pharmacotherapies for hypertension and [HF]. Prevention of [HF] death should be a major priority in the treatment of patients with [AF],” the researchers wrote.
Torben Bjerregaard Larsen, MD, PhD, FESC, and Peter Brønnum Nielsen, PhD, both from the departments of clinical medicine and cardiology at Aalborg University Hospital in Denmark, wrote in a related editorial that 7,032 (46%) of 15,400 patients in the registry did not receive treatment with an oral anticoagulant according to guideline recommendations. “If these recommendations are not followed, patients with AF are left unprotected with a high risk of stroke,” they wrote.
“Caregivers and health care professionals around the globe should be urged to appropriately take part in the attempt to reduce the burden from [AF] by reducing stroke and mortality risk through offering oral anticoagulant treatment,” Larsen and Nielsen wrote. – by Tracey Romero
Disclosure: The study was funded by Boehringer Ingelheim. The researchers report no relevant financial disclosures. Larsen reports receiving speaker fees from Bayer, Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, Roche Diagnostics and Takeda Pharma. Nielsen reports receiving speaker fees from Boehringer Ingelheim.