open access

Vol 74, No 4 (2016)
Original articles
Published online: 2015-09-09
Submitted: 2014-11-27
Accepted: 2015-06-29
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Stroke prevention in atrial fibrillation patients in Poland and other European countries: insights from the GARFIELD-AF registry

Janina Stępińska, Elżbieta Kremis, Anna Konopka, Beata Wożakowska-Kapłon, Piotr Ruszkowski, Piotr Kukla, Gloria Kayani
DOI: 10.5603/KP.a2015.0173
·
Kardiol Pol 2016;74(4):362-371.

open access

Vol 74, No 4 (2016)
Original articles
Published online: 2015-09-09
Submitted: 2014-11-27
Accepted: 2015-06-29

Abstract

Background: Atrial fibrillation (AF) is the most common clinically-significant arrhythmia in the adult population, and it is a strong independent risk factor for cerebrovascular accidents. Patients with non-valvular AF are five times more likely to suffer a stroke. Despite the clear recommendations for anticoagulant therapy, many clinicians are still reluctant to provide routine oral anticoagulation to patients with AF, despite the potential clinical benefits.

Aim: To compare Polish and European populations of patients with AF and the every-day practice of stroke prevention in Poland and in the rest of Europe.

Methods: We analysed the baseline data from the two first cohorts of patients enrolled in the GARFIELD-AF registry (an ongo­ing prospective, multicentre, international registry of patients newly diagnosed with AF) in Poland and in the rest of Europe.

Results: Polish AF patients are generally younger (median age 67 years in both cohorts vs. 73 in cohort 1 in the rest of Eu­rope and 72 in cohort 2), but they carry a burden of more concomitant diseases. There are some noticeable differences in stroke prevention between Poland and the rest of Europe. The use of vitamin K antagonists (VKAs) is generally higher in other European countries in both cohorts (in Poland 41.7% in cohort 1 and 36.9% in cohort 2 vs. 55.5% in cohort 1 and 41.9% in cohort 2 in the rest of Europe). Meanwhile, it is generally more common in Poland to treat patients with both VKAs and antiplatelets (in cohort 1 20.4% of patients in Poland received vs. 12.0% in the rest of Europe). A total of 5.6% of patients in cohort 1 in Poland receive no antithrombotic treatment (it means: no VKA, oral factor Xa or thrombin inhibitors, antiplate­lets), meanwhile in other countries it amounts to 8.5%. The usage of non-vitamin K oral anticoagulants is growing in Poland similarly to the other European countries.

Conclusions: The GARFIELD-AF registry data shows how distant everyday clinical practice is from the guidelines. It shows that still in Poland, as well as in the rest of Europe, too many patients with low stroke risk are treated with anticoagulants, while too frequently patients at high stroke risk are left with no stroke prevention. Although the tendency to use non-vitamin K oral anticoagulants is growing comparably in Poland and in the rest of Europe, the proportion of patients with intermediate and high stroke risk is not growing and more patients at low stroke risk are treated with anticoagulants.

Abstract

Background: Atrial fibrillation (AF) is the most common clinically-significant arrhythmia in the adult population, and it is a strong independent risk factor for cerebrovascular accidents. Patients with non-valvular AF are five times more likely to suffer a stroke. Despite the clear recommendations for anticoagulant therapy, many clinicians are still reluctant to provide routine oral anticoagulation to patients with AF, despite the potential clinical benefits.

Aim: To compare Polish and European populations of patients with AF and the every-day practice of stroke prevention in Poland and in the rest of Europe.

Methods: We analysed the baseline data from the two first cohorts of patients enrolled in the GARFIELD-AF registry (an ongo­ing prospective, multicentre, international registry of patients newly diagnosed with AF) in Poland and in the rest of Europe.

Results: Polish AF patients are generally younger (median age 67 years in both cohorts vs. 73 in cohort 1 in the rest of Eu­rope and 72 in cohort 2), but they carry a burden of more concomitant diseases. There are some noticeable differences in stroke prevention between Poland and the rest of Europe. The use of vitamin K antagonists (VKAs) is generally higher in other European countries in both cohorts (in Poland 41.7% in cohort 1 and 36.9% in cohort 2 vs. 55.5% in cohort 1 and 41.9% in cohort 2 in the rest of Europe). Meanwhile, it is generally more common in Poland to treat patients with both VKAs and antiplatelets (in cohort 1 20.4% of patients in Poland received vs. 12.0% in the rest of Europe). A total of 5.6% of patients in cohort 1 in Poland receive no antithrombotic treatment (it means: no VKA, oral factor Xa or thrombin inhibitors, antiplate­lets), meanwhile in other countries it amounts to 8.5%. The usage of non-vitamin K oral anticoagulants is growing in Poland similarly to the other European countries.

Conclusions: The GARFIELD-AF registry data shows how distant everyday clinical practice is from the guidelines. It shows that still in Poland, as well as in the rest of Europe, too many patients with low stroke risk are treated with anticoagulants, while too frequently patients at high stroke risk are left with no stroke prevention. Although the tendency to use non-vitamin K oral anticoagulants is growing comparably in Poland and in the rest of Europe, the proportion of patients with intermediate and high stroke risk is not growing and more patients at low stroke risk are treated with anticoagulants.

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Keywords

atrial fibrillation, stroke prevention, oral anticoagulants

About this article
Title

Stroke prevention in atrial fibrillation patients in Poland and other European countries: insights from the GARFIELD-AF registry

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 74, No 4 (2016)

Pages

362-371

Published online

2015-09-09

DOI

10.5603/KP.a2015.0173

Bibliographic record

Kardiol Pol 2016;74(4):362-371.

Keywords

atrial fibrillation
stroke prevention
oral anticoagulants

Authors

Janina Stępińska
Elżbieta Kremis
Anna Konopka
Beata Wożakowska-Kapłon
Piotr Ruszkowski
Piotr Kukla
Gloria Kayani

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