Turk Kardiyol Dern Ars. Ahead of Print: TKDA-79367 | 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
, Kudret Aytemir2
, Özgür Aslan3
, Türkay Özcan4
, Mehmet Kanadaşı5
, Mesut Demir5
, Mustafa Gökçe6
, Mehmet Murat Sucu7
, Murat Özdemir8
, Zerrin Yiğit9
, Mustafa Ferzeyn Yavuzkır10
, Ali Oto21
Başkent University Faculty of Medicine, Department of Cardiology, Ankara, Turkey2
Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey3
Dokuz Eylül University Faculty of Medicine, Department of Cardiology, Izmir, Turkey4
Mersin University Medical Faculty Hospital, Mersin, Turkey5
Çukurova University Faculty of Medicine, Department of Cardiology, Adana, Turkey6
Karadeniz Technical University Faculty of Medicine, Farabi Hospital, Department of Cardiology, Trabzon, Turkey7
Gaziantep University Faculty of Medicine, Department of Cardiology, Gaziantep, Turkey8
Gazi University Faculty of Medicine, Department of Cardiology, Ankara, Turkey9
Istanbul University, Institute of Cardiology, Istanbul, Turkey10
Elazığ University Faculty of Medicine, Department of Cardiology, Elazığ, Turkey
OBJECTIVES To define clinical practice patterns for assessing stroke and bleeding risks and thromboprophylaxis in nonvalvular atrial fibrillation (NVAF) and to evaluate treatment outcomes and patients quality of life.
METHODS A clinical surveillance study conducted in 10 tertiary healthcare centers across Turkey. Therapeutic approaches and persistence to initial treatment were recorded at baseline, 6th month, and 12th month in NVAF patients.
RESULTS Of 210 patients (57.1% males; mean age, 64.86±12.87 years), follow-up data were collected through phone interviews for 146 patients at 6th month and 140 patients at 12th month. At baseline, most patients had high CHADS2 (≥2, 48.3%) and CHA2DS2-VASc (≥2, 78.7%) risk scores but low HAS-BLED (0-2, 83.1%) score. Patients reporting their antithrombotic type, around two-thirds were using oral anticoagulants and one-third using antiplatelet agents. The rate of persistence to initial treatment was approximately 86%. Bleeding was reported by 22.6% and 25.0% of patients at 6th and 12th months, respectively. The proportion of patients with INR of 2.0-3.0, was 41.8% at baseline 65.7% at 6th month and 65.9% at 12th month. Time in therapeutic range was 61.0% during one-year follow-up. The median EQ-5D scores of the patients at baseline and 12th month were 0.827 and 0.778 (p<0.001), respectively. Thus, patients quality of life worsened in time.
CONCLUSION In atrial fibrillation, despite high rates of persistence to initial treatment, the outcome of stroke prevention and patients quality of life are not at the desired level. Thus, national health policies should be developed.
Atrial fibrillation, warfarin, anticoagulants, treatment outcome in atrial fibrillation, quality of life in atrial fibrillation
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Corresponding Author: Ali Oto, Türkiye