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. 2022 Jul;26(7):567-576.
doi: 10.5152/AnatolJCardiol.2022.1597.

Oral Anticoagulant Use and Long-Term Follow-Up Results in Patients with Non-valvular Atrial Fibrillation in Turkey AFTER-2 Study

Tuncay Güzel  1 , Adem Aktan  2 , Raif Kılıç  3 , Bayram Arslan  4 , Baran Arık  5 , Merve Yentür  5 , Halil Yıldız  1 , Lokman Argun  5 , Kamran İldırımlı  5 , Bünyamin Yıldırım  5 , Muhammed Demir  5 , Mehmet Özbek  5 , Faruk Ertaş  5
Affiliations

Oral Anticoagulant Use and Long-Term Follow-Up Results in Patients with Non-valvular Atrial Fibrillation in Turkey AFTER-2 Study

Tuncay Güzel et al. Anatol J Cardiol. 2022 Jul.

Abstract

Background: The aim of this study was to investigate the frequency of oral anticoagulant drugs and time in therapeutic range in patients receiving warfarin in addition to the epi-demiological trial of non-valvular atrial fibrillation previously conducted in Turkey (The Atrial Fibrillation: Epidemiological Registry trial). Furthermore, the prevalence of major adverse events and mortality rates of the patients were evaluated during the long-term follow-up period.

Methods: We created a national data registry for non-valvular atrial fibrillation patients, reflecting all geographic regions by population density. In that context, the study included all consecutive atrial fibrillation patients older than 18 years of age who were admitted to the cardiology outpatient clinic except for patients those with prosthetic heart valvesand rheumatic mitral valve stenosis.

Results: This study included 2592 patients from 35 different centers. The mean age was 68.7 ± 11.1 years, and 55.5% of the patients were female. The most common comorbid diseases were chronic kidney disease (69%) and hypertension (65.5%). The time in ther- apeutic range rate in the general population was 40%, and the mortality rate at 5-year follow-up was 29.4%.

Conclusion: The Atrial Fibrillation: Epidemiological Registry 2 study showed higher use of anticoagulant in non-valvular atrial fibrillation patients than in previous national stud-ies. Furthermore, this study demonstrated that most of the non-valvular atrial fibrilla- tion patients are in the high-risk group and the time in therapeutic range rates are still low in Turkey. As a result, this is a significant reason for switching from warfarin to non-K vitamin-dependent new oral anticoagulant treatments.

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Figures

Figure 1.
Figure 1.
Cox regression analysis results at first-year follow-up. BMI, body mass index; HR, heart rate; EHRA, European Heart Rhythm Association; AF, atrial fibrillation; SBP, systolic blood pressure; ICMP, ischemic cardiomyopathy; DCMP, dilated cardiomyopathy; COPD, chronic obstructive pulmonary disease; PE, pulmonary embolism; TD, thyroid dysfunction; CRF, chronic renal failure; HT, hypertension; DM, diabetes mellitus; ICVD, ischemic cerebro vascular disease; HCVD, hemorrhagic cerebrovascular disease; WBC, white blood cell; HGB, hemoglobin; NOAC, new oral anticoagulant.
Figure 2.
Figure 2.
Cox regression analysis results at 5-year follow-up. BMI, body mass index; HR, heart rate; EHRA, European Heart Rhythm Association; AF, atrial fibrillation; SBP, systolic blood pressure; ICMP, ischemic cardiomyopathy; DCMP, dilated cardiomyopathy; COPD, chronic obstructive pulmonary disease; PE, pulmonary embolism; TyDis, thyroid dysfunction; CRF, chronic renal failure; HT, hypertension; DM, diabetes mellitus; ICVD, ischemic cerebrovascular disease; HCVD, hemorrhagic cerebrovascular disease; WBC, white blood cell; HGB, hemoglobin; NOAC, new oral anticoagulant.
Figure 3.
Figure 3.
Kaplan–Meier analysis between CHA2DS2-VASc score risk classification and mortality during 5-year follow-up.
Figure 4.
Figure 4.
Relationship between primary endpoints and CHA2DS2-VASc score risk classification.
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