Dataset Information

Analysis of geographical variations in the epidemiology and management of non-valvular atrial fibrillation: results from the RAMSES registry.

ABSTRACT: OBJECTIVE:This study aimed to determine the differences in terms of demographic characteristics and preferred stroke prevention strategies for patients with non-valvular atrial fibrillation living in seven geographical regions of Turkey. METHODS:In total, 6273 patients were enrolled to this prospective, observational RAMSES study. The patients were divided into seven groups based on the geographical region of residence. RESULTS:In terms of the geographical distribution of the overall Turkish population, the highest number of patients were enrolled from Marmara (1677, 26.7%). All demographic characteristics were significantly different among regions. Preferred oral anticoagulants (OACs) also differed between geographical regions; non-vitamin K OACs were preceded by warfarin in East Anatolia, Aegean, Southeast Anatolia, and Black Sea. Nearly one-third of the patients (28%) did not receive any OAC therapy. However, the number of patients not receiving any OAC therapy was higher in Southeast Anatolia (51.1%) and East Anatolia (46.8%) compared with other geographical regions of Turkey. Inappropriate use of OACs was also more common in East and Southeast Anatolia. CONCLUSION:This study was the first to show that the demographic differences among the geographical regions may result in different preferences of stroke prevention strategies in Turkey. OACs are still under- or inappropriately utilized, particularly in the eastern provinces of Turkey.

SUBMITTER: Dogan V

PROVIDER: S-EPMC5731523 | biostudies-literature | 2017 Oct

REPOSITORIES: biostudies-literature

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Analysis of geographical variations in the epidemiology and management of non-valvular atrial fibrillation: results from the RAMSES registry.

Doğan Volkan V Başaran Özcan Ö Biteker Murat M Özpamuk Karadeniz Fatma F Tekkesin Ahmet İlker Aİ Çakıllı Yasin Y Türkkan Ceyhan C Hamidi Mehmet M Demir Vahit V Gürsoy Mustafa Ozan MO Tek Öztürk Müjgan M Aksan Gökhan G Seyis Sabri S Ballı Mehmet M Alıcı Mehmet Hayri MH Bozyel Serdar S Kırma Cevat C

Anatolian journal of cardiology 20170811 4

<h4>Objective</h4>This study aimed to determine the differences in terms of demographic characteristics and preferred stroke prevention strategies for patients with non-valvular atrial fibrillation living in seven geographical regions of Turkey.<h4>Methods</h4>In total, 6273 patients were enrolled to this prospective, observational RAMSES study. The patients were divided into seven groups based on the geographical region of residence.<h4>Results</h4>In terms of the geographical distribution of t ...[more]

PMID: 28811393

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Project description:BackgroundPatients with atrial fibrillation (AF) underwent a high risk of hospitalization, which has not been paid much attention to in practice. Therefore, we aimed to assess the incidence, causes and predictors of hospitalization in AF patients.MethodsFrom August 2011 to December 2017, a total number of 20,172 AF patients from the Chinese Atrial Fibrillation Registry (China-AF) Study were prospectively selected for this study. We described the incidence, causes of hospitalization by age groups and sex. The Fine-Gray competing risk model was employed to identify predictors of first all-cause and first cause-specific hospitalization.ResultsAfter a mean follow-up of 37.3 ± 20.4 months, 7,512 (37.2%) AF patients experienced one or more hospitalizations. The overall incidence of all-cause hospitalization was 24.0 per 100 patient-years. Patients aged < 65 years were predominantly hospitalized for AF (42.1% of the total hospitalizations); while patients aged 65-74 and ≥ 75 years were mainly hospitalized for non-cardiovascular diseases (43.6% and 49.3%, respectively). We found patients complicated with heart failure (HF)[hazard ratio (HR) 1.10, 95% confidence interval (CI) 1.02-1.18], established coronary artery disease (CAD) (HR 1.24, 95%CI 1.17-1.33), ischemic stroke/transient ischemic attack (TIA) (HR 1.22, 95%CI 1.15-1.30), diabetes (HR 1.14, 95%CI 1.08-1.20), chronic obstructive pulmonary disease (COPD) (HR 1.28, 95%CI 1.02-1.62), gastrointestinal disorder (HR 1.37, 95%CI 1.21-1.55), and renal dysfunction (HR 1.24, 95%CI 1.09-1.42) had higher risks of hospitalization.ConclusionsMore than one-third of AF patients included in this study were hospitalized at least once during over 3-year follow-up. The main cause for hospitalization among the elderly patients (≥ 65 years) is non-cardiovascular diseases rather than AF. Multidisciplinary management of comorbidities should be advocated to reduce hospitalization in AF patients older than 65 years old. Clinical Registry http://www.chictr.org.cn/showproj.aspx?proj=5831 . Unique identifier: ChiCTR-OCH-13003729. The registration date is October 22, 2013.

Project description:ObjectiveTo investigate the clinical outcomes of patients who underwent cardioversion compared with those who did not have cardioverson in a large dataset of patients with recent onset non-valvular atrial fibrillation.DesignObservational study using prospectively collected registry data (Global Anticoagulant Registry in the FIELD-AF-GARFIELD-AF).Setting1317 participating sites in 35 countries.Participants52 057 patients aged 18 years and older with newly diagnosed atrial fibrillation (up to six weeks' duration) and at least one investigator determined stroke risk factor.Main outcome measuresComparisons were made between patients who received cardioversion and those who had no cardioversion at baseline, and between patients who received direct current cardioversion and those who had pharmacological cardioversion. Overlap propensity weighting with Cox proportional hazards models was used to evaluate the effect of cardioversion on clinical endpoints (all cause mortality, non-haemorrhagic stroke or systemic embolism, and major bleeding), adjusting for baseline risk and patient selection.Results44 201 patients were included in the analysis comparing cardioversion and no cardioversion, and of these, 6595 (14.9%) underwent cardioversion at baseline. The propensity score weighted hazard ratio for all cause mortality in the cardioversion group was 0.74 (95% confidence interval 0.63 to 0.86) from baseline to one year follow-up and 0.77 (0.64 to 0.93) from one year to two year follow-up. Of the 6595 patients who had cardioversion at baseline, 299 had a follow-up cardioversion more than 48 days after enrolment. 7175 patients were assessed in the analysis comparing type of cardioversion: 2427 (33.8%) received pharmacological cardioversion and 4748 (66.2%) had direct current cardioversion. During one year follow-up, event rates (per 100 patient years) for all cause mortality in patients who received direct current and pharmacological cardioversion were 1.36 (1.13 to 1.64) and 1.70 (1.35 to 2.14), respectively.ConclusionIn this large dataset of patients with recent onset non-valvular atrial fibrillation, a small proportion were treated with cardioversion. Direct current cardioversion was performed twice as often as pharmacological cardioversion, and there appeared to be no major difference in outcome events for these two cardioversion modalities. For the overall cardioversion group, after adjustments for confounders, a significantly lower risk of mortality was found in patients who received early cardioversion compared with those who did not receive early cardioversion.Study registrationClinicalTrials.gov NCT01090362.

Dataset Information

Analysis of geographical variations in the epidemiology and management of non-valvular atrial fibrillation: results from the RAMSES registry.

Publications

Analysis of geographical variations in the epidemiology and management of non-valvular atrial fibrillation: results from the RAMSES registry.

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