Adherence to the 4S-AF Scheme in the Balkan region: Insights from the BALKAN-AF survey

Area of Science:

• Cardiology
• Clinical Research
• Public Health

Background:

• The 4S-AF scheme is a framework for assessing atrial fibrillation (AF) management, encompassing stroke risk, symptoms, burden severity, and substrate severity.
• Effective AF management requires adherence to established guidelines for stroke risk stratification and treatment.

Purpose of the Study:

• To evaluate adherence to the 4S-AF scheme in patients with atrial fibrillation (AF).
• To analyze adherence based on categorized stroke risk within the BALKAN-AF dataset.
• To identify potential gaps in oral anticoagulant (OAC) prescription and rhythm control strategies.

Main Methods:

• A post hoc analysis of the BALKAN-AF dataset was conducted.
• 14-week prospective enrollment of consecutive patients with electrocardiographically documented atrial fibrillation (AF) from seven Balkan countries (2014-2015).
• Patients were classified by stroke risk using CHA2DS2-VASc scores and assessed for European Heart Rhythm Association (EHRA) class and treatment strategies.

Main Results:

• High stroke risk (CHA2DS2-VASc ≥2/3) was identified in 77.4% of patients; low stroke risk (CHA2DS2-VASc 0/1) in 6.0%.
• Oral anticoagulant (OAC) prescription rates were 46.3% for low-risk and 74.1% for high-risk patients.
• Among high-risk patients, 33.4% had significant symptoms (EHRA class ≥3), but only 29.4% with EHRA ≥3 and 55.2% with paroxysmal AF were offered rhythm control.

Conclusions:

• Oral anticoagulant (OAC) overuse was noted in low-stroke-risk AF patients, contrasting with OAC underuse in high-stroke-risk individuals.
• Adherence to the 4S-AF scheme appears suboptimal, particularly regarding OAC management and rhythm control strategy implementation.
• A low percentage of highly symptomatic, high-stroke-risk AF patients received rhythm control interventions, indicating a potential area for improved clinical practice.