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Observational Study
. 2025 Jan;114(1):138-149.
doi: 10.1007/s00392-024-02510-6. Epub 2024 Aug 8.

Community-based analysis of stroke prevention and effect of public interventions in atrial fibrillation: results from the ARENA project

Maura M Zylla  1   2   3 , Belgin Özdemir  4 , Matthias Hochadel  4 , U Zeymer  4   5 , Ibrahim Akin  6   7 , Armin Grau  8 , Steffen Schneider  4 , Angelika Alonso  9 , Bernd Waldecker  10 , Tim Süselbeck  11 , Harald Schwacke  12 , Markus Haass  13 , Ralf Zahn  5 , Martin Borggrefe  6   7 , Jochen Senges  4 , Norbert Frey  14   15   6 , Dierk Thomas  14   15   6
Affiliations
Observational Study

Community-based analysis of stroke prevention and effect of public interventions in atrial fibrillation: results from the ARENA project

Maura M Zylla et al. Clin Res Cardiol. 2025 Jan.

Abstract

Background: Community-based interventions may promote awareness and adherence to atrial fibrillation (AF)-related therapies, potentially reducing adverse events. The ARENA project investigated the health status, therapies and events in AF patients in the Rhein-Neckar Region, Germany. The subproject "ARENA intervention" studied the effect of community-based interventions on AF-associated outcomes.

Methods: From 2016 onward, patients with diagnosed AF were recruited for the observational ARENA registry. In 2018, an intervention period was initiated involving population-based information campaigns on AF diagnosis and therapies. The "control group" was recruited prior to initiation, and the "intervention group" afterward. Patients underwent standardized follow-up > 1 year after recruitment. Clinical outcomes, therapy and quality of life were compared between the two groups.

Results: A total of 2769 patients were included. This real-world cohort showed high adherence to oral anticoagulation therapy (OAC) and an increased use of NOACs over vitamin K antagonists over time. In the intervention group (n = 1362), more patients continued OAC at follow-up (87.1% vs. 81.5%, P = 0.002). However, this difference was not significant in the patient subgroup with class I/IIa indications for OAC (90.1% vs. 87.5%, P = 0.11). AF-related re-hospitalization was lower in the intervention group (6.8% vs. 12.3%, P < 0.001). There was no significant difference in quality of life. AF-related anxiety was reduced at follow-up. Of note, nearly a quarter of all patients stated that ARENA had influenced their health perception.

Conclusion: Tailored community-based campaigns may raise awareness for AF-related health issues, supporting therapy adherence. Future public strategies to improve quality of life in AF patients should be investigated, as the ARENA project hints at a potential benefit of population-based campaigns.

Trial registration: ClinicalTrials.gov (Identifier: NCT02978248).

Keywords: Atrial fibrillation; Community-based intervention; Oral anticoagulation; Patient-reported outcomes; Quality of life.

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Conflict of interest statement

Declarations. Conflict of interest: M.M.Z. reports lecture fees/honoraria and travel support by Medtronic, Boston Scientific, Abbott, Bayer Vital, Pfizer, ZOLL CMS. U.Z. reports lecture fees from AstraZeneca, Bayer, Boehringer Ingelheim, BMS, Daiichi Sankyo, Pfizer. J.S. has received honoraria fees for research presentations of ARENA Registry. N. F. reports lecture fees from Astra Zeneca, Bayer Vital, Boehringer Ingelheim, Daiichi Sankyo and Pfizer. D.T. reports receiving lecture fees/honoraria from Abbott, AstraZeneca, Bayer Vital, Boehringer Ingelheim Pharma, Bristol-Myers Squibb, Daiichi Sankyo, Johnson and Johnson Medical, Medtronic, Novartis, Pfizer Pharma, Sanofi-Aventis, and ZOLL CMS.

Figures

Fig. 1
Fig. 1
Oral anticoagulation in the control vs. intervention group. NOACs constituted the preferred agent for OAC therapy in both subgroups with a decline in use of vitamin K antagonists over the course of the observation period. Other therapies for stroke prevention include subcutaneous heparin administration, which was applied in a minority of cases. Rates of OAC prescription did not differ significantly between the subgroups at baseline (P = 0.63). At follow-up, there was a higher adherence to OAC-therapy in the intervention group in comparison to the control group. VKA vitamin k antagonist ** = P < 0.01
Fig. 2
Fig. 2
One-year survival in the control vs. intervention group. Kaplan–Meier analysis of all-cause mortality. There was no statistically significant difference between the two groups
Fig. 3
Fig. 3
Clinical follow-up in the control vs. intervention group. A Thrombembolic and bleeding complications at long-term follow-up. Severe adverse events were rare and without statistically significant difference between the two groups. TIA transient ischemic attack. B Hospitalization rates during follow-up. Overall hospitalization rates (left columns) and the respective underlying diagnoses leading to hospitalization are shown. Patients in the control group were more often affected by AF-related hospitalization, whereas patients in the intervention group were more often hospitalized for non-cardiac reasons. AF atrial fibrillation, CV cardiovascular, FU follow-up
Fig. 4
Fig. 4
Cardiac symptoms and health-related psychological burden at follow-up. A AF-related symptoms characterized by EHRA states (left columns) and physical capacity classified by NYHA states (right column) in the control vs. intervention group at follow-up. Symptoms showed no significant difference between the two groups. EHRA European Heart Rhythm Association; NYHA New York Heart Association. B Patient-reported cardiac anxiety and nervousness in the control vs. intervention group. In both subgroups, comparable levels of anxiety were reported
See this image and copyright information in PMC

References

    1. Reading SR, Go AS, Fang MC, Singer DE, Liu IA, Black MH, Udaltsova N, Reynolds K, Anticoagulation, Risk Factors in Atrial Fibrillation-Cardiovascular Research Network I (2017) Health literacy and awareness of atrial fibrillation. J Am Heart Assoc. 10.1161/JAHA.116.005128 - DOI - PMC - PubMed
    1. Wendelboe AM, Raskob GE, Angchaisuksiri P, Blanco AN, Buller H, Ddungu H, Dvorak JD, Hunt BJ, Hylek EM, Kakkar A, Konstantinides SV, McCumber M, McLintock C, Urano T, Weitz JI (2018) Global public awareness about atrial fibrillation. Res Pract Thromb Haemost 2(1):49–57. 10.1002/rth2.12051 - DOI - PMC - PubMed
    1. Hassen HY, Ndejjo R, Musinguzi G, Van Geertruyden JP, Abrams S, Bastiaens H (2021) Effectiveness of community-based cardiovascular disease prevention interventions to improve physical activity: a systematic review and meta-regression. Prev Med 153:106797. 10.1016/j.ypmed.2021.106797 - DOI - PubMed
    1. Victor RG, Lynch K, Li N, Blyler C, Muhammad E, Handler J, Brettler J, Rashid M, Hsu B, Foxx-Drew D, Moy N, Reid AE, Elashoff RM (2018) A cluster-randomized trial of blood-pressure reduction in black barbershops. N Engl J Med 378(14):1291–1301. 10.1056/NEJMoa1717250 - DOI - PMC - PubMed
    1. Luepker RV, Raczynski JM, Osganian S, Goldberg RJ, Finnegan JR Jr, Hedges JR, Goff DC Jr, Eisenberg MS, Zapka JG, Feldman HA, Labarthe DR, McGovern PG, Cornell CE, Proschan MA, Simons-Morton DG (2000) Effect of a community intervention on patient delay and emergency medical service use in acute coronary heart disease: the rapid early action for coronary treatment (REACT) trial. JAMA 284(1):60–67. 10.1001/jama.284.1.60 - DOI - PubMed

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