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Published on: February 26, 2013
Management of atrial fibrillation in Greece: the MANAGE-AF study
George Andrikopoulos1, Sokratis Pastromas, Ioannis Mantas
1Department of Cardiology, Henry Dunant Hospital, Athens, 0Department of Cardiology, KAT General Hospital, Athens, 1Department of Cardiology, Sismanogleio General Hospital, Athens, 2Department of Cardiology, Heraklion University Hospital.
Insights
Management of atrial fibrillation (AF) in Greece shows gaps in guideline adherence. The MANAGEAF study highlights suboptimal anticoagulant use, indicating a need to improve stroke prevention strategies for Greek AF patients.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Atrial fibrillation (AF) is a prevalent condition associated with significant morbidity and mortality.
- Limited data exists on AF clinical characteristics and management within the Greek population.
- The MANAGEAF study was initiated to address this data gap.
Purpose of the Study:
- To assess the epidemiological features of AF in Greece.
- To evaluate the current clinical practice in managing Greek patients with AF.
- To identify areas for improvement in AF management strategies.
Main Methods:
- A cohort of 603 consecutive patients aged over 18 with any type of AF was recruited.
- Patients were enrolled from emergency departments and outpatient clinics across 27 centers in Greece.
- Data collection focused on demographics, AF type, comorbidities, and current treatments.
Main Results:
- The average patient age was 68.5 years, with 52.5% males.
- Non-paroxysmal AF was the most common type (60%); hypertension was the most frequent comorbidity (70.3%).
- Only 49.3% received anticoagulants, with sub-therapeutic INR levels (1.7 ± 0.8), despite elevated stroke risk scores (CHADS2: 1.6, CHA2DS2-VASc: 3.0).
Conclusions:
- MANAGEAF baseline findings reveal inadequate adherence to current AF management guidelines in Greece.
- The study underscores the critical need to optimize therapeutic strategies for managing cardioembolic stroke risk in AF patients.
- Improved implementation of evidence-based anticoagulant therapy is essential for reducing AF-related strokes.
Background:
Although atrial fibrillation (AF) is a highly prevalent health problem with high morbidity and mortality, data regarding the clinical characteristics and management of AF in the Greek population are scarce. The "Current Clinical Practice in the MANAGEment of Atrial Fibrillation in Greece" study (MANAGEAF) aimed to assess the epidemiological features as well as the daily clinical practice in the management of Greek patients with AF.
Methods:
Taking into consideration the distribution of the Greek population, 603 consecutive patients over 18 years of age, with any type of AF, presenting at the emergency departments or outpatient clinics of 27 different centers, were included in our study.
Results:
The mean age of the patients was 68.5 ± 12.1 years, with male patients representing 52.5% of the study population. The most common AF type in our cohort was non-paroxysmal AF (60%), including the patients with permanent (24.1%), persistent (17.4%), long-standing (4.8%) and first diagnosed AF (13.8%). Hypertension was the most common comorbidity (70.3%). A history of stroke or transient ischemic attack was detected in 9.2% of the patients, while 6.2% had a history of gastrointestinal bleeding. About half of the patients (49.3%) were treated with anticoagulant drugs, mainly vitamin K antagonists (46.9%), while 34.2% were on antiplatelet drugs, aspirin and/or clopidogrel. The mean INR level (1.7 ± 0.8) was sub-therapeutic, although the mean values for CHADS2 and CHA2DS2-VASc scores were 1.6 ± 1.2 and 3.0 ± 1.7, respectively.
Conclusion:
The MANAGE-AF baseline results indicate unsatisfactory levels of compliance with the current guidelines for the management of AF in Greece. Considering the undisputed effectiveness of anticoagulant treatment for preventing AF-related strokes, MANAGE-AF demonstrates the need for optimization of our therapeutic strategies for the management of cardioembolic stroke risk.
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