Cardiovascular risk profile and management of atrial fibrillation in India: Real world data from RealiseAF survey

Abstract

Background: Atrial fibrillation (AF) is the most common sustained arrhythmia with high risk for many cardiovascular (CV) complications. Adherence to recommended management guidelines is important to avoid complications. In India, there is little knowledge on how AF is managed in real world.

Methods: This is a cross-sectional study of patients in India enrolled in RealiseAF survey between February 2010 and March 2010 with a diagnosis of AF within the last 12 months.

Results: From 15 centers, 301 patients {mean age 59.9 years (14.4); 52.5% males} were recruited. AF was controlled in 50% of patients with 77 (26.7%) in sinus rhythm and 67 (23.3%) with heart rate <80beats/min. Hypertension (50.8%), valvular heart disease (40.7%), heart failure (25.9%), and diabetes (20.4%) were the most common underlying CV diseases. Increased risk for stroke (CHADS₂ score≥2) was present in 36.6%. Most of the patients (85%) were symptomatic. AF was paroxysmal, persistent, and permanent in 28.7%, 22.7%, and 34.3% respectively. In 14%, AF was diagnosed as first episode. Forty-six percent of patients had rate control, 35.2% rhythm control, 0.3% both strategies, and 18.4% received no therapy for AF before the visit. At the end of the visit, adoption to rate control strategy increased to 52.3% and patients with no therapy decreased to 7%.

Conclusion: AF in India is not adequately controlled. Concomitant CV risk factors and risk of stroke are high. The study underscores the need for improved adoption of guideline-directed management for optimal control of AF and reducing the risk of stroke.

Keywords: Atrial fibrillation; Cardiovascular risk factors; Guidelines; India; Stroke.

Fig. 1

Major cardiovascular events leading to hospitalization. Abbreviations: ACS, acute coronary syndrome; HF, heart failure (decompensated); CNS, central nervous system; TIA, transient ischemic attack.

Fig. 2

Major cardiovascular risk factors/diseases in global and Indian patients in RealiseAF study. Reference: Steg et al. Abbreviations: CAD, coronary artery disease; CV, cardiovascular; HF, heart failure; VHD, valvular heart disease.

Fig. 3

Type of therapeutic strategy used for management of atrial fibrillation.

Fig. 4

Prescription pattern of antithrombotic agents on the day of the visit according to CHADS₂ score. n = 287. CHADS₂ score is calculated as 1 point for ‘history of heart failure’, 1 point for ‘arterial hypertension’, 1 point for ‘age > 75 years’, 1 point for ‘history of diabetes’, 2 points for ‘history of stroke’ or ‘history of TIA’.

Fig. 5

Response to EQ5D questionnaire. X axis shows the five dimensions on the health-related quality of life state and Y axis the percentage of responses given by the patients. Levels of scoring: 1 = no problem, 2 = some to moderate problems, 3 = severe problem.