Variations in cause and management of atrial fibrillation in a prospective registry of 15 400 emergency department patients in 46 countries

The RE-LY atrial fibrillation registry

Jonas Oldgren, Jeff S. Healey, Michael Ezekowitz, Patrick Commerford, Alvaro Avezum, Prem Pais, Jun Zhu, Petr Jansky, Alben Sigamani, Carlos A. Morillo, Lisheng Liu, Albertino Damasceno, Alex Grinvalds, Juliet Nakamya, Paul A. Reilly, Katalin Keltai, Isabelle C. Van Gelder, Afzal Hussein Yusufali, Eiichi Watanabe, Lars Wallentin & 2 others Stuart J. Connolly, Salim Yusuf

Research output: Contribution to journalArticle

155 Citations (Scopus)

Abstract

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 among 9 major geographic regions. Between September 2008 and April 2011, 15 400 patients were enrolled. The average age was 65.9, standard deviation 14.8 years, ranging from 57.2, standard deviation 18.8 years in Africa, to 70.1, standard deviation 13.4 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, in comparison with 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 the therapeutic range was 62.4% in Western Europe, 50.9% in North America, but only between 32% and 40% in India, China, Southeast Asia, and Africa, P<0.001. Conclusions: There is a large global variation in age, risk factors, concomitant diseases, and treatment of AF among 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.

Original languageEnglish
Pages (from-to)1568-1576
Number of pages9
JournalCirculation
Volume129
Issue number15
DOIs
Publication statusPublished - 01-01-2014

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Atrial Fibrillation
Registries
Hospital Emergency Service
North America
India
China
Rheumatic Heart Disease
Eastern Europe
Southeastern Asia
Age Factors
Cardiac Arrhythmias
Primary Health Care
Therapeutics
Hypertension
Research

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Oldgren, Jonas ; Healey, Jeff S. ; Ezekowitz, Michael ; Commerford, Patrick ; Avezum, Alvaro ; Pais, Prem ; Zhu, Jun ; Jansky, Petr ; Sigamani, Alben ; Morillo, Carlos A. ; Liu, Lisheng ; Damasceno, Albertino ; Grinvalds, Alex ; Nakamya, Juliet ; Reilly, Paul A. ; Keltai, Katalin ; Van Gelder, Isabelle C. ; Yusufali, Afzal Hussein ; Watanabe, Eiichi ; Wallentin, Lars ; Connolly, Stuart J. ; Yusuf, Salim. / Variations in cause and management of atrial fibrillation in a prospective registry of 15 400 emergency department patients in 46 countries : The RE-LY atrial fibrillation registry. In: Circulation. 2014 ; Vol. 129, No. 15. pp. 1568-1576.
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title = "Variations in cause and management of atrial fibrillation in a prospective registry of 15 400 emergency department patients in 46 countries: The RE-LY atrial fibrillation registry",
abstract = "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 among 9 major geographic regions. Between September 2008 and April 2011, 15 400 patients were enrolled. The average age was 65.9, standard deviation 14.8 years, ranging from 57.2, standard deviation 18.8 years in Africa, to 70.1, standard deviation 13.4 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, in comparison with 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 the therapeutic range was 62.4{\%} in Western Europe, 50.9{\%} in North America, but only between 32{\%} and 40{\%} in India, China, Southeast Asia, and Africa, P<0.001. Conclusions: There is a large global variation in age, risk factors, concomitant diseases, and treatment of AF among 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.",
author = "Jonas Oldgren and Healey, {Jeff S.} and Michael Ezekowitz and Patrick Commerford and Alvaro Avezum and Prem Pais and Jun Zhu and Petr Jansky and Alben Sigamani and Morillo, {Carlos A.} and Lisheng Liu and Albertino Damasceno and Alex Grinvalds and Juliet Nakamya and Reilly, {Paul A.} and Katalin Keltai and {Van Gelder}, {Isabelle C.} and Yusufali, {Afzal Hussein} and Eiichi Watanabe and Lars Wallentin and Connolly, {Stuart J.} and Salim Yusuf",
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Oldgren, J, Healey, JS, Ezekowitz, M, Commerford, P, Avezum, A, Pais, P, Zhu, J, Jansky, P, Sigamani, A, Morillo, CA, Liu, L, Damasceno, A, Grinvalds, A, Nakamya, J, Reilly, PA, Keltai, K, Van Gelder, IC, Yusufali, AH, Watanabe, E, Wallentin, L, Connolly, SJ & Yusuf, S 2014, 'Variations in cause and management of atrial fibrillation in a prospective registry of 15 400 emergency department patients in 46 countries: The RE-LY atrial fibrillation registry', Circulation, vol. 129, no. 15, pp. 1568-1576. https://doi.org/10.1161/CIRCULATIONAHA.113.005451

Variations in cause and management of atrial fibrillation in a prospective registry of 15 400 emergency department patients in 46 countries : The RE-LY atrial fibrillation registry. / Oldgren, Jonas; Healey, Jeff S.; Ezekowitz, Michael; Commerford, Patrick; Avezum, Alvaro; Pais, Prem; Zhu, Jun; Jansky, Petr; Sigamani, Alben; Morillo, Carlos A.; Liu, Lisheng; Damasceno, Albertino; Grinvalds, Alex; Nakamya, Juliet; Reilly, Paul A.; Keltai, Katalin; Van Gelder, Isabelle C.; Yusufali, Afzal Hussein; Watanabe, Eiichi; Wallentin, Lars; Connolly, Stuart J.; Yusuf, Salim.

In: Circulation, Vol. 129, No. 15, 01.01.2014, p. 1568-1576.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Variations in cause and management of atrial fibrillation in a prospective registry of 15 400 emergency department patients in 46 countries

T2 - The RE-LY atrial fibrillation registry

AU - Oldgren, Jonas

AU - Healey, Jeff S.

AU - Ezekowitz, Michael

AU - Commerford, Patrick

AU - Avezum, Alvaro

AU - Pais, Prem

AU - Zhu, Jun

AU - Jansky, Petr

AU - Sigamani, Alben

AU - Morillo, Carlos A.

AU - Liu, Lisheng

AU - Damasceno, Albertino

AU - Grinvalds, Alex

AU - Nakamya, Juliet

AU - Reilly, Paul A.

AU - Keltai, Katalin

AU - Van Gelder, Isabelle C.

AU - Yusufali, Afzal Hussein

AU - Watanabe, Eiichi

AU - Wallentin, Lars

AU - Connolly, Stuart J.

AU - Yusuf, Salim

PY - 2014/1/1

Y1 - 2014/1/1

N2 - 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 among 9 major geographic regions. Between September 2008 and April 2011, 15 400 patients were enrolled. The average age was 65.9, standard deviation 14.8 years, ranging from 57.2, standard deviation 18.8 years in Africa, to 70.1, standard deviation 13.4 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, in comparison with 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 the therapeutic range was 62.4% in Western Europe, 50.9% in North America, but only between 32% and 40% in India, China, Southeast Asia, and Africa, P<0.001. Conclusions: There is a large global variation in age, risk factors, concomitant diseases, and treatment of AF among 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.

AB - 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 among 9 major geographic regions. Between September 2008 and April 2011, 15 400 patients were enrolled. The average age was 65.9, standard deviation 14.8 years, ranging from 57.2, standard deviation 18.8 years in Africa, to 70.1, standard deviation 13.4 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, in comparison with 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 the therapeutic range was 62.4% in Western Europe, 50.9% in North America, but only between 32% and 40% in India, China, Southeast Asia, and Africa, P<0.001. Conclusions: There is a large global variation in age, risk factors, concomitant diseases, and treatment of AF among 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.

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DO - 10.1161/CIRCULATIONAHA.113.005451

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JO - Circulation

JF - Circulation

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