Registries in Atrial Fibrillation: From Trials to Real-Life Clinical Practice

Recent improvements in atrial fibrillation diagnosis and management have prompted the initiation of various registries, predominantly to assess adherence to new guidelines but also to address the pending questions of safety and effectiveness of newly introduced management options in "real-world" clinical practice settings. In this review, we appraise antithrombotic treatment patterns for stroke prevention in atrial fibrillation registries.

We searched PubMed, Science Direct, and the Cochrane databases for registries focusing on stroke thromboprophylaxis in atrial fibrillation.

Registry data show that over the last decade, the proportion of patients receiving oral anticoagulation has increased (from ∼67% to >80%), whereas the proportion of those treated with aspirin only or untreated has diminished. Vitamin K antagonists are being replaced gradually by non-vitamin K antagonist oral anticoagulants as the more prevalent option. Regional and country differences in anticoagulation are evident, with its highest uptake in Europe (90.2%) and lowest in Asia (57.4%). Moreover, oral anticoagulation is given to approximately 50% of patients with no stroke risk factors, whereas more than one third of high-risk subjects are not anticoagulated but often prescribed antiplatelet therapy alone or untreated. Guideline-nonadherent thromboprophylaxis results in an increase in all-cause mortality and thromboembolism.

Registry data show that despite an increase in anticoagulation rates over the last decade, management gaps in stroke prevention are still evident with approximately one third of patients not treated in line with the guidelines. Mortality rates of atrial fibrillation patients remain relatively high, mostly because of the comorbid disease.