ESC: Real-life AF management does little more than relieve symptoms

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Control of atrial fibrillation (AF) was not achieved in more than 40 percent of the AF patients included in a 10,000 patient REALISE-AF registry, according to a study presented Sept. 1 at the European Society of Cardiology (ESC) congress in Stockholm.

The epidemiology and management of AF vary according to geography, prevalence and type of comorbidities, physician specialties and types of AF, which motivated the creation of the registry. Also, most of the data available pertain to North America and Western Europe; so Philippe Gabriel Steg, MD, director of the coronary care unit at the Hopital Bichat-Claude BernadService de Cardiologie in Paris, and steering committee said they sought a global representation.

The REALISE-AF (REAl-LIfe global Survey Evaluating patients with Atrial Fibrillation) registry is a cross-sectional AF registry with approximately 10,000 patients with history of AF (treated or not) with at least one AF episode documented by standard ECG or by ECG-Holter monitoring in the previous 12 months, or documented current AF, and recruited from 859 sites in 26 countries on four continents.

The registry revealed that a majority of patients complained of symptoms, even when their AF is controlled (55.7 percent).

Also, cardiovascular (CV) events were very frequent in this population, with a high rate of concomitant CV risk factors (72.2 percent of patients were hypertensive and 46.3 percent of patients had dyslipidemia). The registry also revealed that 28.7 percent of AF patients suffered from CV events, such as acute coronary syndrome, acute heart failure or stroke, leading to an unplanned hospitalization during the previous 12 months, and 12.4 percent of patients requiring major CV interventions such as PCI, CABG or valvular surgery.

According to the researchers, management of AF in a real-life setting showed that the disease state is not treated according to the 2006 ACC/AHA/ESC AF guidelines, such as:

  • 20 percent of AF patients with structural heart disease received Class Ic anti-arrhythmic drugs, despite their contraindication in this patient population.
  • 49.9 percent of evaluated paroxysmal and persistent AF patients without congestive heart failure or hypertension with significant left ventricular hypertrophy received amiodarone (Cordarone, Wyeth/Pfizer) as a first-line treatment, despite guideline recommendations that it be used as a second-line agent.
  • In addition, patients with a CHADS2 who should receive anti-coagulant agents only received these agents in 52 percent of cases.

"The REALISE-AF registry shows that patients suffering from AF not only require symptom relief but management, which goes beyond heart rate or rhythm control, and addresses event-driven hospitalizations," said Steg. "The data suggest a need for new therapies and an increased focus on cardiovascular outcomes, as well as a more stringent adherence to guidelines."

The registry is sponsored by Sanofi-Aventis of Paris.