what have we learned from the eorp af registries? · patient characteristics af general pilot af...

What have we learned from the EORP AF registries?

ARRHYTHMIAS UPDATE 2018Thessaloniki, Greece23-24 March 2018

Tatjana S. Potpara, MD, PhD, FESC

Assist. Professor in Cardiology, School of Medicine, Belgrade University

Head of Dept. for arrhythmia intensive care, Cardiology Clinic, CCS

President of the Serbian AF Association (SAFA)

EHRA Scientific Document Committee member

EORP-AF III Registry Chairperson

SAFASerbian AF Association

www.serbianaf.com

https://www.escardio.org/Research/Registries-&-surveys

Collecting data on cardiovascular disease in Europe

• 2000 – Euro Heart Survey programme• 2009 – EORP

EORP-AF Pilot1

2012-2014EORP-AF Long Term2

2013-2018EORP-AF III3

2018

The EORP (EuroObservational Research Program) Registries On Atrial Fibrillation

AF General Registries

AF Ablation Registries

EORP-AF Ablation Pilot4

2012-2014EORP-AF Ablation Long Term5

2013-2018

1Lip GYH, et al. Europace 2014;16:308–319; 2Boriani G, et al. Europace 2017;DOI:10.1093/europace/eux301; 3https://www.escardio.org/Research/Registries-&-surveys/Observational-registry-programme/atrial-fibrillation-3-registry; 4Arbelo E, et al. Europace 2012;14:1094–1103: 5Arbelo E, et al. Eur Heart J 2017; 38:1303–1316.

9 ESC countries:West: Belgium, Denmark, Netherlands, and Norway; East: Poland and Romania; South: Greece, Italy, Portugal.

EORP-AF General Pilot1

EORP-AF General Long-Term2

27 European countries:Northern Europe: Denmark, Estonia, Latvia, Norway, UK; Western Europe: Belgium, France, Germany, Netherlands, Switzerland;Eastern Europe: Bulgaria, Czech Republic, Georgia, Kazakhstan, Kyrgyzstan, Poland, Romania, Russia; Southern Europe: Albania, FYR Macedonia, Italy, Malta, Montenegro, Portugal, Serbia, Spain, Turkey.

1Lip GYH, et al. Europace 2014;16:308–319; 2Boriani G, et al. Europace 2017;DOI:10.1093/europace/eux301.

The EORP-AF General Registries participation

South: Greece, Italy, Spain; East: Czech Republic, Poland; West/North: Belgium, Denmark, France, Germany, the Netherlands.

EORP-AF Ablation Pilot1: 10 ESC countries

EORP-AF Ablation Long-Term2: 27 ESC countries

1Arbelo E, et al. Europace2012;14:1094–1103: 2Arbelo E, et al. EurHeart J 2017; 38:1303–1316.

PATIENT CHARACTERISTICS AF GeneralPilot

AF GeneralLong-Term

AF AblationPilot

AF AblationLong Term

N of patients 3119 11,096 1391 3593

Mean age, years 68.8 69.0 60.0 59.0

Female sex 40.4% 40.7% 27.9% 31.9%

Comorbidity

Hypertension 70.9% 62.1% 50.0% 54.6%

CAD 36.4% 29.3% 3.6% 18.9%

Congestive HF 47.5% 39.5% 2.6% 22.2%

Diabetes mellitus 20.6% 23.0% 8.3% 9.7%

Prior stroke 6.4% 6.2% 6.8% NR

Prior TE event 13.1% 11.6% 1.9% 6.4%

Chronic kidney disease 13.2% 12.5% 1.8% NR

Patient characteristics and comorbidity in the EORP-AF Registries1-4

1Lip GYH, et al. Europace 2014;16:308–319; 2Boriani G, et al. Europace 2017;DOI:10.1093/europace/eux301; 3Arbelo E, et al. Europace 2012;14:1094–1103: 4Arbelo E, et al. Eur Heart J 2017; 38:1303–1316.

Regional differences in patient characteristics and comorbidity in the EORP-AF General Pilot Registry

Whole cohort,

N=902

WEST (Belgium, Denmark,

Netherlands, Norway), N=125

EAST(Poland, Romania),

N=462

SOUTH(Greece, Italy, Portugal), N=315

P

Age (mean±SD) 71.2±11.3 70.2±12.2 69.1±10.7 74.5±11.0 <0.0001

Female sex 41.0% 36.8% 44.2%38.1% 38.1% 0.1414

AF type

First detected 36.5% 30.5% 32.7% 44.2% <0.0001

Persistent 12.5% 9.3% 12.5% 13.8%

Long-standing persist. 2.4% 2.5% 4.0% 0.0%

Permanent 29.5% 17.0% 32.0% 30.8%

ANTIARRHYTHMIC DRUG (AAD) USE

AF GeneralPilot

AF GeneralLong-Term

N of patients 3119 11,096

Any AAD 36.0% 27.8%

Amiodarone 21.5% 17.9%

Dronedarone 0.3% 0.3%

Propafenone 5.3% 3.6%

Flecainide 5.0% 3.3%

Sotalol 4.4% 2.7%

30.30%

26.50%

21.20%

4.80% 17.20%First-detected

Paroxysmal

Persistent

Long-term persistent

Permanent

EORP-AF General Pilot Registry1

15.60%

25.70%

19.10%

4.30%

33.50%

1.70%

First-detected

Paroxysmal

Persistent

Long-term persistent

Permanent

Unknown

EORP-AF General Long-Term Registry2

AF clinical type and the rates of AADs use in the EORP-AF General Registries


Stroke and bleeding risks in the EORP-AF Registries

EORP-AF RegistryCHA2DS2-VASc

meanCHA2DS2-VASc

medianHAS-BLED

mean

General Pilot1 3.24±1.80 3.0 (2.0-4.0) 1.37±1.06

General Long-Term2 3.14±1.77 3.0 (2.0-4.0) 2.84±1.70

Ablation Pilot3 1.70±1.40 NR NR

Ablation Long-Term4 0: 23.2%1: 29.9%≥2: 46.9%

NR 0-2: 98.8%≥3: 1.2%

1Lip GYH, et al. Europace 2014;16:308–319; 2Boriani G, et al. Europace 2017;DOI:10.1093/europace/eux301; 3Arbelo E, et al. Europace 2012;14:1094–1103: 4Arbelo E, et al. Eur Heart J 2017; 38:1303–1316.

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Anyantithrombotic

VKA NOACs Dabigatran Rivaroxaban Apixaban ASA Clopidogrel No therapy

General Pilot General Long-Term

The use of antithrombotic therapies in the EORP-AF General Registries1,2


2012 2016

Proportion of NOACs use within the overall use of OAC before the enrollment visit/hospitalization (light blue) and after the enrolling visit/at discharge (dark blue).

The Patterns of Non-vitamin K Antagonist Oral Anticoagulants (NOACs) Use in Patients with Atrial Fibrillation in Seven Balkan Countries: a Report from the BALKAN-AF Survey

Potpara TS, Trendafilova E, Dan GA, Goda A, Kusljugic Z, Manola S, Music Lj, Gjini V, Pojskic B, Popescu MI, Georgesku C, Dimitrova E, Kamenova E, Ekmeciu U, Mrsic D, Nenezic A, Brusich S, Milanov S, Zeljkovic I, Lip GYH,

on behalf the BALKAN-AF InvestigatorsAdv Ther (2017) 34:2043–2057


Overall OAC use: 79.9% Overall OAC use: 84.9%

OR 95%CI P

Female sex 1.18 1.02-1.37 0.0245

VHD 0.66 0.56-0.77 <0.001

CHF 0.63 0.55-0.73 <0.001

CAD 0.18 0.15-0.21 <0.001

PAD 0.55 0.44-0.69 <0.001

DM 0.75 0.63-0.89 0.0012

AF Type* 0.85 0.73-0.99 0.0474

Factors associated with OAC prescription (OAC alone – VKA or NOAC)

Factors associated with NOAC prescription

OR 95%CI P

VHD 0.58 0.45-0.76 <0.0001

Previous stroke/TIA 1.54 1.06-2.25 0.0235

CHF 0.64 0.49-0.84 0.0010

CAD 0.49 0.35-0.66 <0.0001

PAD 0.49 0.28-0.85 0.0092

Heart rhythm strategy* 1.51 1.08-2.11 0.0153

*Reference: First detected AF

*Reference: Rhythm control only

OR 95%CI P

Age (ref <65Y) 1.59 1.30-1.93 <0.0001

Female sex 0.70 0.58-0.85 0.0002

VHD 1.96 1.60-2.41 <0.0001

Prior stroke/TIA 0.58 0.38-0.89 0.0159

CHF 2.34 1.94-2.82 <0.0001

HTN 1.81 1.45-2.25 <0.0001

CAD 8.55 6.88-10.62 <0.0001

PAD 2.51 1.95-3.21 <0.0001

DM 0.85 0.70-1.04 <0.0001

Heart rhythm strategy* 0.58 0.43-0.79 0.0004

*Reference: Rhythm control only

Factors associated with the prescription of OAC in combination with APLT

Factors associated with the prescription of APLT alone

OR 95%CI P

Female sex 1.24 1.01-1.53 0.0428

Prior stroke/TIA 0.58 0.38-0.89 0.0123

CAD 1.71 1.36-2.14 <0.0001

DM 0.75 0.57-0.99 0.0426

AF type* 1.48 1.19-1.84 0.0004

*Reference: First detected AF

Antithrombotic drug prescription at inclusion and discharge when pharmacologic cardioversion (A), electrical cardioversion (B) or AF ablation (C) was performed or planned at discharge

Whole cohort

N=902

WEST (Belgium, Denmark,

Netherlands, Norway), N=125

EAST(Poland,

Romania),

N=462

SOUTH(Greece, Italy, Portugal), N=315

P

CHA2DS2-VASc score

0 2.1% 6.4% 2.0% 0.6% <0.0001

1 5.8% 12.8% 5.0% 4.1%

≥2 92.1% 80.8% 93.0% 95.3%

HAS-BLED score

0-2 79.9% 95.2% 82.0% 70.8% <0.0001

≥3 20.1% 4.8% 18.0% 29.2%

Regional differences in presentation and treatment of patients with AF in Europe: a report from the EORP-AF Pilot General Registry Lip GYH, Laroche C, Boriani G, Dan GA, Santini M, Kalarus Z, RasmussenLH,Oliveira MM, Mairesse G, Crijns HJGM,Simantirakis E, Atar D, Maggioni AP, Tavazzi L.

Europace 2015;17:194–206.

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Prior TE Prior TIA Prior stroke CHF HTN CAD PAD DM Prior bleed Malignancy CKD

Overall WEST EAST SOUTH

P=NS

P=0.0005 P=NS

P<0.0001P<0.0001

P=NS

P<0.0001P=NS

P<0.0001

P<0.0001

P=NS


Europace 2015;17:194–206.

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

OAC alone APLT alone OAC+APLT None/Unknown Other

Overall WEST EAST SOUTH


Europace 2015;17:194–206.

Age* Female sex VHD Prior stroke /

TIA

CHF HTN CAD PAD DM AF type# Heart rhythm

strategy§

Any OAC

WEST 1.250.91-1.72

1.04 0.75-1.45

0.810.58-1.13

1.070.62-1.84

0.750.51-1.11

1.421.04-1.95

0.200.14-0.30

0.580.25-1.33

0.980.64-1.52

0.750.52-1.08

0.800.55-1.17

EAST 0.710.57-0.89

1.331.07-1.65

0.700.55-0.90

1.410.95-2.11

0.700.55-0.90

0.980.76-1.27

0.230.18-0.30

0.470.32-0.67

0.840.65-1.08

1.100.87-1.40

1.711.16-2.53

SOUTH 1.080.82-1.41

1.321.03-1.70

0.790.60-1.04

1.190.80-1.79

0.880.68-1.14

1.07081-1.41

0.130.10-0.18

0.750.53-1.05

0.660.49-0.90

0.760.59-0.98

0.820.57-1.18

NOAC

WEST 1.100.73-1.66

1.170.77-1.76

1.130.75-2.60

1.401.75-2.60

0.850.51-1.42

1.230.82-1.85

0.610.36-1.06

1.310.44-3.95

1.120.65-1.92

1.591.03-2.47

0.740.44-1.25

EAST 0.980.64-1.49

1.110.74-1.68

0.660.43-1.03

2.121.17-3.82

0.720.47-1.11

1.260.75-2.12

0.500.31-0.82

0.590.27-1.31

0.970.60-1.58

1.751.15-2.66

2.071.17-3.67

SOUTH 0.350.20-0.62

0.950.53-1.71

0.290.15-0.53

1.160.48-2.78

0.570.28-1.14

0.640.35-1.16

0.330.13-0.85

0.350.11-1.13

0.530.22-1.27

0.510.26-1.01

2.341.19-4.61

*Reference: ≤65y; #Reference: First detected; §Reference: Others.

Regional differences in presentation and treatment of patients with AF in Europe: a report from the EORP-AF Pilot General Registry

Lip GYH, Laroche C, Boriani G, Dan GA, Santini M, Kalarus Z, RasmussenLH,Oliveira MM, Mairesse G, Crijns HJGM,Simantirakis E, Atar D, Maggioni AP, Tavazzi L.

Europace 2015;17:194–206.

Regional differences in presentation and treatment of patients with AF in Europe: a report from the EORP-AF Pilot General Registry

Lip GYH, Laroche C, Boriani G, Dan GA, Santini M, Kalarus Z, RasmussenLH,Oliveira MM, Mairesse G, Crijns HJGM,Simantirakis E, Atar D, Maggioni AP, Tavazzi L.

Europace 2015;17:194–206.

Age* Female sex VHD Prior stroke / TIA

CHF HTN CAD PAD DM AF type# Heart rhythm

strategy§

APLT

WEST 0.580.33-1.02

1.190.66-2.14

1.350.72-2.54

0.590.18-1.93

1.100.53-2.29

0.460.26-0.82

2.811.45-5.41

0.550.07-4.17

0.730.30-1.75

1.040.53-2.03

1.520.80-2.89

EAST 1.831.31-2.54

1.240.91-1.68

0.830.60-1.17

0.670.36-1.25

0.960.69-1.33

0.930.65-1.32

1.731.25-2.41

0.660.38-1.14

0.700.48-1.02

1.721.26-2.35

1.290.79-2.10

SOUTH 0.630.44-0.91

1.110.78-1.57

0.820.57-1.20

0.480.24-0.98

0.300.19-0.47

1.030.70-1.53

1.110.76-1.64

0.980.61-1.59

0.700.44-1.11

1.201.03-2.61

1.641.03-2.61

OAC+ASA

WEST 1.941.19-3.16

0.880.55-1.41

1.410.91-2.19

1.180.58-2.38

1.540.94-2.52

1.991.24-3.19

6.403.97-10.3

4.611.93-11.0

1.510.87-2.61

0.910.54-1.55

1.160.69-1.95

EAST 1.331.02-1.73

0.690.54-0.90

2.051.49-2.81

0.990.63-1.57

1.881.39-2.54

1.451.06-1.99

5.153.80-6.97

2.491.74-3.56

1.601.21-2.13

0.740.55-0.98

0.450.30-0.77

SOUTH 2.551.65-3.93

0.480.33-0.69

1.741.19-2.53

1.601.00-2.57

2.581.85-3.59

1.731.15-2.60

19.812.8-30.6

2.161.46-3.20

2.081.44-2.99

0.950.68-1.34

0.560.31-1.00

*Reference: ≤65y; #Reference: First detected; §Reference: Rhythm control only.

69.2%

80.0%

66.6% 69.2%

54.4%

70.2%74.3%

US NCDRPINNACLE

EORP-Pilot CAPR (China) Brasil PINNACLE FUSHIMI (Japan) KICS (Japan) BALKAN-AF

J Am Heart Assoc. 2016;5:e004037

PROGNOSIS AND TREATMENT OF AF PATIENTS BY EUROPEAN CARDIOLOGISTS: 1-year follow-up of the EORP-AF Pilot Registry

Lip GYH, Laroche C, Ioacim M, Rasmussen LH, Vitali-Serdoz L, Petrescu L, Darabantiu D, Crijns HJGM, Kirchhof P, Vardas P, Tavazzi L, Maggioni AP, Boriani G.

Eur Heart J 2014; 35:336—3376.

All-cause mortality: 5.7% (177/3119)



Eur Heart J 2014; 35:336—3376.

Stroke/TIA/peripheral embolism and/or mortality



Eur Heart J 2014; 35:336—3376.

• 5 fatal strokes• 15 non-fatal strokes



Eur Heart J 2014; 35:336—3376.

Contemporary stroke prevention strategies in 11 096 European patients with AF: a report from the EORP-AF Long-Term General Registry

Boriani G, Proietti M, Laroche C, Fauchier L, Marin F, Nabauer M, Potpara T, Dan GA, Kalarus Z, Diemberger I, Tavazzi L, Maggioni AP, Lip GYH.

Europace 2017; doi:10.1093/europace/eux301

OR 95%CI P

Age 1.02 1.01-1.02 <0.0001

HTN 1.36 1.17-1.58 <0.0001

MI 0.75 0.61-0.91 0.0046

Lone AF 0.32 0.26-0.40 <0.0001

Prior stroke 1.63 1.19-2.24 0.0024

Prior bleed 0.42 0.33-0.54 <0.0001

CKD 0.78 0.64-0.95 0.0152

Malignancy 0.72 0.57-0.91 0.0063

OR 95%CI P

Pharmacological CV 0.81 0.69-0.96 0.0126

ECV 1.82 1.46-2.26 <0.0001

AF Catheter ablation 1.64 1.14-2.26 0.0075

First-detected AF Ref Ref Ref

Parox AF 0.92 0.76-1.11 0.389

Persist AF 2.21 1.75-2.79 <0.0001

LS Pers AF 2.60 1.72-3.94 <0.0001

Permanent AF 2.21 1.80-2.73 <0.0001

Multivariable predictors of anticoagulant therapy

Contemporary stroke prevention strategies in 11 096 European patients with AF: a report from the EORP-AF Long-Term General Registry

Boriani G, Proietti M, Laroche C, Fauchier L, Marin F, Nabauer M, Potpara T, Dan GA, Kalarus Z, Diemberger I, Tavazzi L, Maggioni AP, Lip GYH.

Europace 2017; doi:10.1093/europace/eux301

Region OR 95%CI P

Eastern Europe (reference)

Southern Europe 1.44 1.21-1.72 <0.0001

Northern Europe 1.69 1.33-2.14 <0.0001

Western Europe 2.84 2.31-3.50 <0.0001

VKA/NOAC ratio at discharge by region

Regional differences in OAC use

Northern Europe: Denmark, Estonia, Latvia, Norway, UK; Western Europe: Belgium, France, Germany, Netherlands, Switzerland;Eastern Europe: Bulgaria, Czech Republic, Georgia, Kazakhstan, Kyrgyzstan, Poland, Romania, Russia; Southern Europe: Albania, FYR Macedonia, Italy, Malta, Montenegro, Portugal, Serbia, Spain, Turkey.

CONCLUSIONS

• The overall use of OAC for stroke prevention in Europe is relatively high and still increasing, but is driven by other factors in addition to conventional stroke risk factors.

• The use of NOACs is rapidly increasing, especially in Northern and Western Europe.

• There are substantial regional differences in the OAC use in various AF populations among European countries.

• The overall management of AF patients at risk of stroke needs further improvement.

The National Coordinator for Greece:Vassilios P. Vassilikos, MD, FACC, FESCProfessor in CardiologyMedical School, Aristotle University of Thessaloniki

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

Paroxysmal Persistent LS-persistent Not defined

Pilot Long Term

AF clinical type in the EORP-AF Ablation Registries

1Arbelo E, et al. Europace 2012;14:1094–1103: 2Arbelo E, et al. Eur Heart J 2017; 38:1303–1316.

what have we learned from the eorp af registries? · patient characteristics af general pilot af...

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