Changing Epidemiology of Lone Atrial Fibrillation and Oral - - PowerPoint PPT Presentation

Changing Epidemiology of Lone Atrial Fibrillation and Oral Anticoagulant Prescriptions over 15 years in Europe: EORP-AF General Pilot, EORP-AF General Long-Term and Euro Heart Survey on AF Registries

Marco Proietti, Cécile Laroche, Robby Nieuwlaat, Harry JGM Crijns, Aldo P Maggioni, Deirdre A Lane, Giuseppe Boriani, Gregory YH Lip

• n behalf of EORP-AF General Pilot, EORP-AF General Long-Term and Euro Heart Survey on AF Registries Investigators

Lone AF

Lone AF is defined as AF in young patients (<60 years) or in patients with minimally or no heart disease. More precisely it is the absence of clinical history or echocardiographic evidence of concomitant cardiovascular or pulmonary conditions or an acute trigger for AF.

Large variation exists in definitions among the available evidence

Camm AJ EHJ 2010;31:2369; Wyse DG JACC 2014;63:1716

Lone AF

Lone AF has been considered as a condition burdened by a low risk of adverse events and not worthy of OAC treatment.

Jahangir A Circulation 2007;115:3050; Camm AJ EHJ 2010;31:2369

AIM

Aim of this study is to describe the epidemiology, associated risk factors and prescription of OAC among Lone AF patients over 15 years across three European Society of Cardiology observational registries on AF: (i) EORP-AF Pilot Registry (ii) EORP-AF Long-Term Registry (iii) Euro Heart Survey on AF Registry

Methods

Lone AF was defined as follows: Absence of clinical or echocardiographic other cardiovascular diseases (including hypertension), associated pulmonary disease, cardiac abnormalities or congenital diseases or age <65 years.

Prevalence, Clinical Profile, Thromboembolic Risk and OAC prescription in Lone AF patients were evaluated overall and across the three registries.

EHS on AF 2005 EORP-AF Pilot 2014 EORP-AF LT 2017

Results

6.9% 93.1%

Lone AF Other

Overall Prevalence N= 19548

6.4% 93.6%

Lone AF Other

3.9% 96.1%

Lone AF Other

7.9% 92.1%

Lone AF Other

EHS on AF EORP-AF Pilot EORP-AF LT

p<0.001

Results

48.3 52.0 56.0

44.0 46.0 48.0 50.0 52.0 54.0 56.0 58.0

EHS on AF EORP-AF Pilot EORP-AF LT

Median

Age

26.7% 47.6% 0.0% 20.3% 5.5% 31.7% 46.7% 0.0% 20.8% 0.8% 24.0% 38.8% 4.5% 24.0% 8.7%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

First Detected AF Paroxysmal AF LS Persistent AF Persistent AF Permanent AF

Type of AF EHS on AF EORP-AF Pilot EORP-AF LT

Results

19.2% 28.0% 77.7% 4.4% 1.2% 18.5% 0.3% 24.6% 30.3% 71.3% 1.6% 0.0% 14.9% 0.0% 28.1% 16.7% 62.1% 7.7% 3.5% 20.2% 1.8%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Female Smoking Habit Symptomatic AF Diabetes Mellitus Stroke/TIA Hyperlipidaemia Renal Disease

EHS on AF EORP-AF Pilot EORP-AF LT

Results

2.7% 2.5% 21.1%

0% 5% 10% 15% 20% 25%

EHS on AF EORP-AF Pilot EORP-AF LT

CHA2DS2-VASc ≥2

75.8% 21.5% 2.7% 0.0% 0.0% 0.0% 0.0% 67.2% 30.3% 0.8% 1.6% 0.0% 0.0% 0.0% 51.5% 27.4% 14.3% 4.8% 1.6% 0.2% 0.2%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

1 2 3 4 5 6

CHA2DS2-VASc EHS on AF EORP-AF Pilot EORP-AF LT

Results

60.0% 52.1% 44.6% 64.8%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75%

Overall EHS on AF EORP-AF Pilot EORP-AF LT

Use of Any OAC

27.0% 20.8% 50.5% 1.6% 39.5% 16.8% 43.7% 0.0% 27.1% 8.1% 62.0% 2.8%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75%

No Antithrombotic Only Antiplatelet Only OAC Antiplatelet + OAC

EHS on AF EORP-AF Pilot EORP-AF LT

Results

OR (95% CI) Age 1.05 (1.04-1.06) Type of AF* Paroxysmal 1.34 (1.01-1.77) LS Persistent 11.60 (3.49-38.56) Persistent 4.471 (3.12-6.41) Permanent 3.13 (1.87-5.25) Diabetes Mellitus 2.40 (1.40-4.10) Hyperlipidaemia 1.58 (1.17-2.14) Symptomatic Status† Previously Symptomatic 0.55 (0.37-0.82) Currently Symptomatic 0.77 (0.55-1.08) No Physical Activity 1.35 (1.03-1.75) Smoking Habit 0.54 (0.41-0.72) Stroke/TIA 10.06 (2.40-42.18) Registry EHS on AF

• EORP-AF Pilot

0.74 (0.49-1.13) EORP-AF LT 1.69 (1.30-2.20) Univariate Logistic Regression for OAC Prescription OR (95% CI) Age 1.04 (1.03-1.05) Type of AF* Paroxysmal 1.28 (0.95-1.74) LS Persistent 9.41 (2.79-31.71) Persistent 3.94 (2.69-5.79) Permanent 2.45 (1.36-4.43) Smoking Habit 0.70 (0.51-0.95) Stroke/TIA 17.20 (2.28-129.73) Multivariate Logistic Regression for OAC Prescription

*First Detected as reference †Never Symptomatic as reference

Conclusions

• Over the last 15 years patients with Lone AF increased and were progressively more

burdened with non-cardiac stroke risk factors.

• Baseline thromboembolic risk is progressively increasing
• A significant change in treatment has been found, with OAC prescription increased
• ver time
• Among other predictors, history of Stroke/TIA is the clinical factor more strongly

associated with OAC prescription

• Future analysis on major clinical event risks and role of OAC therapy will further

elucidate the actual risk in Lone AF patients