Introduction: In 2003, European Society of Cardiology conducted the Euro Heart Survey (EHS) on AF to describe AF management in Europe. With similar aims the EURObservational Research Programme in AF Pilot and Long-Term (LT) registries were conducted in 2012 and 2015.
Hypothesis: We hypothesised temporal changes across the three cohorts in baseline characteristics, thromboembolic/bleeding risks and use of antithrombotic drugs.
Methods: Direct comparison of the three cohorts after datasets merging.
Results: The three cohorts comprised 19,549 patients; AF patients were progressively older in the EHS, EORP-AF Pilot and LT cohorts [mean (SD) age 66.6 (12.8) vs. 68.8 (11.5) vs. 69.2 (11.4) years; p<0.001). Mean (SD) CHA2DS2-VASc was significantly higher in EORP-AF Pilot and LT compared to EHS [3.2 (1.8) and 3.1 (1.8) vs. 2.8 (1.7); p<0.001]. Accordingly, the proportion of patients with high thromboembolic risk (CHA2DS2-VASc ≥2) was higher in EORP-AF Pilot (81.7%) and LT (80.8%) vs. EHS (74.8%) (p<0.001). In EORP-AF LT there was larger a proportion of patients with high bleeding risk (HAS-BLED ≥3) than EORP-AF Pilot (17.4% vs. 14.0%, p<0.001). Bleeding risk factors were less prevalent in EHS than EORP-AF Pilot and LT, chronic kidney disease (5.8% vs. 13.1% vs. 12.7%; p<0.001), previous bleeding (3.3% vs. 5.8% vs. 5.2%; p<0.001) and alcohol excess (5.6% vs. 7.8% vs. 7.3%; p<0.001); conversely blood pressure ≥160 mmHg was more prevalent in EHS (p<0.001). Antiplatelet drugs use has decreased (32.3% vs. 34.2% vs. 20.0%; p<0.001), while oral anticoagulant (OAC) use has progressively increased (64.8% vs. 80.0% vs. 85.0%; p<0.001). Among OAC users, vitamin K antagonist (VKA) use increased from EHS to EORP-AF Pilot, and subsequently decreased in EORP-AF LT (64.8% vs. 71.6% vs. 50.4%; p<0.001). The latter matched with an increase in non-vitamin K antagonist oral anticoagulants (NOACs) use (8.4% vs. 35.0%; p<0.001).
Conclusions: Significant temporal changes in baseline characteristics of AF patients and changes in thromboembolic and bleeding risk have been demonstrated in the last 13 years, with increased uptake of OAC over time, and increased growth in NOACs use recently.