Korean Circ J.  2017 Nov;47(6):877-887. 10.4070/kcj.2017.0146.

A Prospective Survey of Atrial Fibrillation Management for Real-world Guideline Adherence: COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF) Registry

• Kim H
• Kim TH
• Cha MJ
• Lee JM
• Park J
• Park JK
• Kang KW
• Shim J
• Uhm JS
• Kim J
• Park HW
• Choi EK
• Kim JB
• Kim C
• Lee YS
• Joung B

• KMID: 2396481
• DOI: http://doi.org/10.4070/kcj.2017.0146

Abstract

BACKGROUND AND OBJECTIVES
The aging population is rapidly increasing, and atrial fibrillation (AF) is becoming a significant public health burden in Asia, including Korea. This study evaluated current treatment patterns and guideline adherence of AF treatment.
METHODS
In a prospective observational registry (COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation [CODE-AF] registry), 6,275 patients with nonvalvular AF were consecutively enrolled between June 2016 and April 2017 from 10 tertiary hospitals in Korea.
RESULTS
The AF type was paroxysmal, persistent, and permanent in 65.3%, 30.0%, and 2.9% of patients, respectively. Underlying structural heart disease was present in 11.9%. Mean CHA2DS2-VASc was 2.7±1.7. Oral anticoagulation (OAC), rate control, and rhythm control were used in 70.1%, 53.9%, and 54.4% of patients, respectively. OAC was performed in 82.7% of patients with a high stroke risk. However, antithrombotic therapy was inadequately used in 53.4% of patients with a low stroke risk. For rate control in 192 patients with low ejection fraction (< 40%), β-blocker (65.6%), digoxin (5.2%), or both (19.3%) were adequately used in 90.1% of patients; however, a calcium channel blocker was inadequately used in 9.9%. A rhythm control strategy was chosen in 54.4% of patients. The prescribing rate of class Ic antiarrythmics, dronedarone, and sotalol was 16.9% of patients with low ejection fraction.
CONCLUSION
This study shows how successfully guidelines can be applied in the real world. The nonadherence rate was 17.2%, 9.9%, and 22.4% for stroke prevention, rate control, and rhythm control, respectively.

Keyword

Atrial fibrillation; Anticoagulant agent; Guidelines adherence; Registry

MeSH Terms

Aging
Asia
Atrial Fibrillation*
Calcium Channels
Digoxin
Guideline Adherence*
Heart Diseases
Humans
Korea
Prospective Studies*
Public Health
Sotalol
Stroke
Tertiary Care Centers
Calcium Channels
Digoxin
Sotalol

Figure

• 

  Figure 1 Anticoagulation and adherence to anticoagulation guidelines according to stroke risk: (A) number of patients and (B) percentage of patients. med = medicine; NOAC = non-vitamin K antagonist oral anticoagulation. *Patients who were non-adherent to the guidelines are marked.

• 

  Figure 2 SPAF and NOAC according to HAS-BLED score: (A) percentage of SPAF according to HAS-BLED score and (B) percentage of NOAC. HAS-BLED = hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, concomitant drugs/alcohol; NOAC = non-vitamin K antagonist oral anticoagulation; SPAF = stroke prevention for atrial fibrillation.

• 

  Figure 3 Rate control therapy according to LVEF: (A) number of patients and (B) percentage of patients. BB = β-blocker; CCB = calcium channel blocker; Dig = digoxin; LVEF = left ventricular ejection fraction. *Patients who were non-adherent to the guidelines are marked.

• 

  Figure 4 Rhythm control therapy: (A) number of patients and (B) percentage of patients. CAD = coronary artery disease; LVH = left ventricular hypertrophy; VHD = valvular heart disease. *Patients who were non-adherent to the guidelines are marked.

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