Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
권호 표지
DOI QR코드

DOI QR Code

A Prospective Survey of Atrial Fibrillation Management for Real-world Guideline Adherence: COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF) Registry

  • Kim, Hyeongsoo (Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Kim, Tae-Hoon (Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Cha, Myung-Jin (Department of Internal Medicine, Seoul National University Hospital) ;
  • Lee, Jung Myung (Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University) ;
  • Park, Junbeom (Department of Cardiology, School of Medicine, Ewha Womans University) ;
  • Park, Jin-Kyu (Department of Cardiology, Hanyang University Seoul Hospital) ;
  • Kang, Ki-Woon (Division of Cardiology, Eulji University Hospital) ;
  • Shim, Jaemin (Division of Cardiology, Department of Internal Medicine, Korea University Medical Center) ;
  • Uhm, Jae-Sun (Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Kim, Jun (Heart Institute, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Park, Hyung Wook (Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine) ;
  • Choi, Eue-Keun (Department of Internal Medicine, Seoul National University Hospital) ;
  • Kim, Jin-Bae (Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University) ;
  • Kim, Changsoo (Department of Preventive Medicine, Institute of Human Complexity and Systems Science, Yonsei University College of Medicine) ;
  • Lee, Young Soo (Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Catholic University of Daegu) ;
  • Joung, Boyoung (Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine)
  • Received : 2017.07.07
  • Accepted : 2017.08.16
  • Published : 2017.11.30
⟨ Previous Next ⟩

Abstract

Background and Objectives: The aging population is rapidly increasing, and atrial fibrillation (AF) is becoming a significant public health burden in Asia, including Korea. This study evaluated current treatment patterns and guideline adherence of AF treatment. Methods: In a prospective observational registry (COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation [CODE-AF] registry), 6,275 patients with nonvalvular AF were consecutively enrolled between June 2016 and April 2017 from 10 tertiary hospitals in Korea. Results: The AF type was paroxysmal, persistent, and permanent in 65.3%, 30.0%, and 2.9% of patients, respectively. Underlying structural heart disease was present in 11.9%. Mean $CHA_2DS_2-VASc$ was $2.7{\pm}1.7$. Oral anticoagulation (OAC), rate control, and rhythm control were used in 70.1%, 53.9%, and 54.4% of patients, respectively. OAC was performed in 82.7% of patients with a high stroke risk. However, antithrombotic therapy was inadequately used in 53.4% of patients with a low stroke risk. For rate control in 192 patients with low ejection fraction (<40%), ${\beta}$-blocker (65.6%), digoxin (5.2%), or both (19.3%) were adequately used in 90.1% of patients; however, a calcium channel blocker was inadequately used in 9.9%. A rhythm control strategy was chosen in 54.4% of patients. The prescribing rate of class Ic antiarrythmics, dronedarone, and sotalol was 16.9% of patients with low ejection fraction. Conclusion: This study shows how successfully guidelines can be applied in the real world. The nonadherence rate was 17.2%, 9.9%, and 22.4% for stroke prevention, rate control, and rhythm control, respectively.

Keywords

Acknowledgement

Supported by : Ministry of Health and Welfare

References

  1. Lee H, Kim TH, Baek YS, et al. The trends of atrial fibrillation-related hospital visit and cost, treatment pattern and mortality in Korea: 10-year nationwide sample cohort data. Korean Circ J 2017;47:56-64. https://doi.org/10.4070/kcj.2016.0045
  2. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation 2014;130:e199-267.
  3. Park J, Park CH, Uhm JS, Pak HN, Lee MH, Joung B. A thin left atrial antral wall around the pulmonary vein reflects structural remodeling by atrial fibrillation and is associated with stroke. Yonsei Med J 2017;58:282-9. https://doi.org/10.3349/ymj.2017.58.2.282
  4. Kim TH, Yang PS, Uhm JS, et al. Cha2ds2-vasc score (congestive heart failure, hypertension, age $\geq$75 [doubled], diabetes mellitus, prior stroke or transient ischemic attack [doubled], vascular disease, age 65-74, female) for stroke in Asian patients with atrial fibrillation: a Korean nationwide sample cohort study. Stroke 2017;48:1524-30. https://doi.org/10.1161/STROKEAHA.117.016926
  5. Lip GY, Al-Khatib SM, Cosio FG, et al. Contemporary management of atrial fibrillation: what can clinical registries tell us about stroke prevention and current therapeutic approaches? J Am Heart Assoc 2014;3:e001179.
  6. Hart RG, Pearce LA, Aguilar MI. Adjusted-dose warfarin versus aspirin for preventing stroke in patients with atrial fibrillation. Ann Intern Med 2007;147:590-2.
  7. Gorst-Rasmussen A, Skjoth F, Larsen TB, Rasmussen LH, Lip GY, Lane DA. Dabigatran adherence in atrial fibrillation patients during the first year after diagnosis: a nationwide cohort study. J Thromb Haemost 2015;13:495-504. https://doi.org/10.1111/jth.12845
  8. Donze J, Clair C, Hug B, et al. Risk of falls and major bleeds in patients on oral anticoagulation therapy. Am J Med 2012;125:773-8. https://doi.org/10.1016/j.amjmed.2012.01.033
  9. Al-Khatib SM, Allen LaPointe NM, Chatterjee R, et al. Rate- and rhythm-control therapies in patients with atrial fibrillation: a systematic review. Ann Intern Med 2014;160:760-73. https://doi.org/10.7326/M13-1467
  10. Nikolaidou T, Channer KS. Chronic atrial fibrillation: a systematic review of medical heart rate control management. Postgrad Med J 2009;85:303-12. https://doi.org/10.1136/pgmj.2008.068908
  11. Lafuente-Lafuente C, Mouly S, Longas-Tejero MA, Bergmann JF. Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation. Cochrane Database Syst Rev 2007:CD005049.
  12. Anselmino M, Matta M, D'Ascenzo F, et al. Catheter ablation of atrial fibrillation in patients with left ventricular systolic dysfunction: a systematic review and meta-analysis. Circ Arrhythm Electrophysiol 2014;7:1011-8. https://doi.org/10.1161/CIRCEP.114.001938
  13. Cosedis Nielsen J, Johannessen A, Raatikainen P, et al. Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation. N Engl J Med 2012;367:1587-95. https://doi.org/10.1056/NEJMoa1113566
  14. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016;37:2893-962. https://doi.org/10.1093/eurheartj/ehw210
  15. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation 2014;130:2071-104. https://doi.org/10.1161/CIR.0000000000000040
  16. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College Of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2014;64:e1-76. https://doi.org/10.1016/j.jacc.2014.03.022
  17. Huisman MV, Ma CS, Diener HC, et al. Antithrombotic therapy use in patients with atrial fibrillation before the era of non-vitamin K antagonist oral anticoagulants: the Global Registry on Long-term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF) Phase I cohort. Europace 2016;18:1308-18. https://doi.org/10.1093/europace/euw073
  18. Huisman MV, Rothman KJ, Paquette M, et al. The changing landscape for stroke prevention in AF: findings from the GLORIA-AF Registry Phase 2. J Am Coll Cardiol 2017;69:777-85.
  19. Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009;361:1139-51. https://doi.org/10.1056/NEJMoa0905561
  20. Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 2011;365:883-91. https://doi.org/10.1056/NEJMoa1009638
  21. Granger CB, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2011;365:981-92. https://doi.org/10.1056/NEJMoa1107039
  22. Giugliano RP, Ruff CT, Braunwald E, et al. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2013;369:2093-104. https://doi.org/10.1056/NEJMoa1310907
  23. Chao TF, Wang KL, Liu CJ, et al. Age threshold for increased stroke risk among patients with atrial fibrillation: a nationwide cohort study from Taiwan. J Am Coll Cardiol 2015;66:1339-47. https://doi.org/10.1016/j.jacc.2015.07.026
  24. Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med 2007;146:857-67. https://doi.org/10.7326/0003-4819-146-12-200706190-00007
  25. Birman-Deych E, Radford MJ, Nilasena DS, Gage BF. Use and effectiveness of warfarin in medicare beneficiaries with atrial fibrillation. Stroke 2006;37:1070-4. https://doi.org/10.1161/01.STR.0000208294.46968.a4
  26. Indredavik B, Rohweder G, Lydersen S. Frequency and effect of optimal anticoagulation before onset of ischaemic stroke in patients with known atrial fibrillation. J Intern Med 2005;258:133-44. https://doi.org/10.1111/j.1365-2796.2005.01512.x
  27. Sandhu RK, Bakal JA, Ezekowitz JA, McAlister FA. Risk stratification schemes, anticoagulation use and outcomes: the risk--treatment paradox in patients with newly diagnosed non-valvular atrial fibrillation. Heart 2011;97:2046-50. https://doi.org/10.1136/heartjnl-2011-300901
  28. Van Gelder IC, Groenveld HF, Crijns HJ, et al. Lenient versus strict rate control in patients with atrial fibrillation. N Engl J Med 2010;362:1363-73. https://doi.org/10.1056/NEJMoa1001337
  29. Piccini JP, Mi X, DeWald TA, Go AS, Hernandez AF, Curtis LH. Pharmacotherapy in Medicare beneficiaries with atrial fibrillation. Heart Rhythm 2012;9:1403-8. https://doi.org/10.1016/j.hrthm.2012.04.031
  30. Le Heuzey JY, Breithardt G, Camm J, et al. The RecordAF study: design, baseline data, and profile of patients according to chosen treatment strategy for atrial fibrillation. Am J Cardiol 2010;105:687-93. https://doi.org/10.1016/j.amjcard.2009.10.012

Cited by

  1. Physician’s Adherence to Clinical Guidelines for in-Hospital Anticoagulant Prescribing vol.14, pp.4, 2017, https://doi.org/10.20996/1819-6446-2018-14-4-501-508
  2. CHA 2 DS 2 -VASc score predicts exercise intolerance in young and middle-aged male patients with asymptomatic atrial fibrillation vol.8, pp.None, 2017, https://doi.org/10.1038/s41598-018-36185-7
  3. The difference of burden of ectopic beats in different types of atrial fibrillation and the effect of atrial fibrillation type on stroke risk in a prospective cohort of patients with atrial fibrillati vol.10, pp.None, 2017, https://doi.org/10.1038/s41598-020-63370-4
  4. Chronic disease management in emergency department patients presenting with dyspnoea vol.32, pp.6, 2017, https://doi.org/10.1111/1742-6723.13625
  5. Characteristics of symptom burden in atrial fibrillation with concomitant heart failure vol.21, pp.1, 2020, https://doi.org/10.1186/s42444-019-0009-9
  6. Differences in anticoagulation strategy and outcome in atrial fibrillation patients with chronic kidney disease: a CODE-AF registry study vol.21, pp.1, 2017, https://doi.org/10.1186/s42444-020-0011-2
  7. 2020 Clinical guidelines for Atrial fibrillation and atrial flutter vol.26, pp.7, 2017, https://doi.org/10.15829/1560-4071-2021-4594
  8. Clinical impact of left atrial enlargement in Korean patients with atrial fibrillation vol.11, pp.1, 2017, https://doi.org/10.1038/s41598-021-03266-z
  9. Catheter ablation of atrial fibrillation in Korea: results from the Korean Heart Rhythm Society Ablation Registry for Atrial Fibrillation (KARA) vol.22, pp.1, 2017, https://doi.org/10.1186/s42444-021-00047-7