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Korean Circ J. 2017 Nov;47(6):877-887. doi: 10.4070/kcj.2017.0146. Epub 2017 Oct 17.

A Prospective Survey of Atrial Fibrillation Management for Real-world Guideline Adherence: COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF) Registry.

Author information

1
Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
2
Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
3
Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea.
4
Department of Cardiology, School of Medicine, Ewha Womans University, Seoul, Korea.
5
Department of Cardiology, Hanyang University Seoul Hospital, Seoul, Korea.
6
Division of Cardiology, Eulji University Hospital, Daejeon, Korea.
7
Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea.
8
Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
9
Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea.
10
Department of Preventive Medicine, Institute of Human Complexity and Systems Science, Yonsei University College of Medicine, Seoul, Korea.
11
Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Catholic University of Daegu, Daegu, Korea. mdleeys@cu.ac.kr.
12
Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea. cby6908@yuhs.ac.
#
Contributed equally

Abstract

BACKGROUND AND OBJECTIVES:

The aging population is rapidly increasing, and atrial fibrillation (AF) is becoming a significant public health burden in Asia, including Korea. This study evaluated current treatment patterns and guideline adherence of AF treatment.

METHODS:

In a prospective observational registry (COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation [CODE-AF] registry), 6,275 patients with nonvalvular AF were consecutively enrolled between June 2016 and April 2017 from 10 tertiary hospitals in Korea.

RESULTS:

The AF type was paroxysmal, persistent, and permanent in 65.3%, 30.0%, and 2.9% of patients, respectively. Underlying structural heart disease was present in 11.9%. Mean CHA₂DS₂-VASc was 2.7±1.7. Oral anticoagulation (OAC), rate control, and rhythm control were used in 70.1%, 53.9%, and 54.4% of patients, respectively. OAC was performed in 82.7% of patients with a high stroke risk. However, antithrombotic therapy was inadequately used in 53.4% of patients with a low stroke risk. For rate control in 192 patients with low ejection fraction (<40%), β-blocker (65.6%), digoxin (5.2%), or both (19.3%) were adequately used in 90.1% of patients; however, a calcium channel blocker was inadequately used in 9.9%. A rhythm control strategy was chosen in 54.4% of patients. The prescribing rate of class Ic antiarrythmics, dronedarone, and sotalol was 16.9% of patients with low ejection fraction.

CONCLUSION:

This study shows how successfully guidelines can be applied in the real world. The nonadherence rate was 17.2%, 9.9%, and 22.4% for stroke prevention, rate control, and rhythm control, respectively.

KEYWORDS:

Anticoagulant agent; Atrial fibrillation; Guidelines adherence; Registry

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