Variations in Etiology and Management of Atrial Fibrillation in a Prospective Registry of 15,400 Emergency Department Patients in 46 Countries: The RE-LY AF Registry
Background—Atrial fibrillation (AF) is the most common sustained arrhythmia; however little is known about patients in a primary care setting from high, middle and low-income countries.
Methods and Results—This prospective registry enrolled patients presenting to an emergency department with AF at 164 sites in 46 countries representing all inhabited continents. Patient characteristics were compared between 9 major geographic regions. Between September 2008 and April 2011, 15,400 patients were enrolled. The average age was 65.9, SD14.8 years, ranging from 57.2, SD18.8 years in Africa, to 70.1, SD13.4 years in North America, p<0.001. Hypertension was globally the most common risk factor for AF, ranging in prevalence from 41.6% in India to 80.7% in Eastern Europe, p<0.001. Rheumatic heart disease was present in only 2.2% of North American patients, compared to 21.5% in Africa and 31.5% in India, p<0.001. The use of oral anticoagulation among patients with a CHADS2 score of ≥2 was greatest in North America (65.7%) but was only 11.2% in China, p<0.001. The mean time in therapeutic range was 62.4% in Western Europe, 50.9% in North America but only between 32% and 40% in India, China, South-East Asia, and Africa, p<0.001.
Conclusions—There is a large global variation in age, risk factors, concomitant diseases and treatment of AF between regions. Improving outcomes globally requires an understanding of this variation and the conduct of research focused on AF associated with different underlying conditions and treatment of AF and predisposing conditions in different socioeconomic settings.
- Received August 12, 2013.
- Revision received January 7, 2014.
- Accepted January 13, 2014.