Clinical practices of the management of nonvalvular atrial fibrillation and outcome of treatment: A representative prospective survey in tertiary healthcare centers across Turkey [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. 2018; 46(2): 92-102 | DOI: 10.5543/tkda.2017.79367

Clinical practices of the management of nonvalvular atrial fibrillation and outcome of treatment: A representative prospective survey in tertiary healthcare centers across Turkey

Bülent Özin1, Kudret Aytemir2, Özgür Aslan3, Türkay Özcan4, Mehmet Kanadaşı5, Mesut Demir5, Mustafa Gökçe6, Mehmet Murat Sucu7, Murat Özdemir8, Zerrin Yiğit9, Mustafa Ferzeyn Yavuzkır10, Ali Oto2
1Department of Cardiology, Başkent University Faculty of Medicine, Ankara, Turkey
2Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
3Department of Cardiology, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
4Department of Cardiology, Mersin University Faculty of Medicine Hospital, Mersin, Turkey
5Department of Cardiology, Çukurova University Faculty of Medicine, Adana, Turkey
6Department of Cardiology, Karadeniz Technical University Faculty of Medicine, Farabi Hospital, Trabzon, Turkey
7Department of Cardiology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
8Department of Cardiology, Gazi University Faculty of Medicine, Ankara, Turkey
9Department of Cardiology, İstanbul University Institute of Cardiology, Istanbul, Turkey
10Department of Cardiology, Elazığ University Faculty of Medicine, Elazığ, Turkey


OBJECTIVE
The goal of this study was to define clinical practice patterns for assessing stroke and bleeding risks and thromboprophylaxis in nonvalvular atrial fibrillation (NVAF) and to evaluate treatment outcomes and patient quality of life.

METHODS
A clinical surveillance study was conducted in 10 tertiary healthcare centers across Turkey. Therapeutic approaches and persistence with initial treatment were recorded at baseline, the 6th month, and the 12th month in NVAF patients.

RESULTS
Of 210 patients (57.1% male; mean age: 64.86±12.87 years), follow-up data were collected for 146 patients through phone interviews at the 6th month and 140 patients at the 12th month. At baseline, most patients had high CHADS2 score (≥2: 48.3%) and CHA2DS2-VASc (≥2: 78.7%) risk scores but a low HAS-BLED (0–2: 83.1%) score. Approximately two-thirds of the patients surveyed were using oral anticoagulants as an antithrombotic and one-third were using antiplatelet agents. The rate of persistence with initial treatment was approximately 86%. Bleeding was reported by 22.6% and 25.0% of patients at the 6th and 12th month, respectively. The proportion of patients with an INR of 2.0–3.0 was 41.8% at baseline, 65.7% at the 6th month, and 65.9% at the 12th month. The time in therapeutic range was 61.0% during 1 year of follow-up. The median EuroQol 5-dimensional health questionnaire (EQ-5D) score of the patients at baseline and the 12th month was 0.827 and 0.778, respectively (p<0.001). The results indicated that patient quality of life declined over time.

CONCLUSION
In atrial fibrillation, despite a high rate of persistence with initial treatment, the outcomes of stroke prevention and patient quality of life are not at the desired level. National health policies should be developed and implemented to better integrate international guidelines for the management of NVAF into clinical practice.

Keywords: Anticoagulants, atrial fibrillation; quality of life in atrial fibrillation; treatment outcome in atrial fibrillation; warfarin

How to cite this article
Bülent Özin, Kudret Aytemir, Özgür Aslan, Türkay Özcan, Mehmet Kanadaşı, Mesut Demir, Mustafa Gökçe, Mehmet Murat Sucu, Murat Özdemir, Zerrin Yiğit, Mustafa Ferzeyn Yavuzkır, Ali Oto. Clinical practices of the management of nonvalvular atrial fibrillation and outcome of treatment: A representative prospective survey in tertiary healthcare centers across Turkey. Turk Kardiyol Dern Ars. 2018; 46(2): 92-102

Corresponding Author: Ali Oto, Türkiye
© Copyright 2018 Archives of the Turkish Society of Cardiology
LookUs & Online Makale