학술논문
The Patterns of Non-vitamin K Antagonist Oral Anticoagulants (NOACs) Use in Patients with Atrial Fibrillation in Seven Balkan Countries: a Report from the BALKAN-AF Survey
Document Type
Original Paper
Author
Potpara, Tatjana S.; Trendafilova, Elina; Dan, Gheorghe-Andrei; Goda, Artan; Kusljugic, Zumreta; Manola, Sime; Music, Ljilja; Gjini, Viktor; Pojskic, Belma; Popescu, Mircea Ioakim; Georgescu, Catalina Arsenescu; Dimitrova, Elena S.; Kamenova, Delyana; Ekmeciu, Uliks; Mrsic, Denis; Nenezic, Ana; Brusich, Sandro; Milanov, Srdjan; Zeljkovic, Ivan; Lip, Gregory Y. H.; Dan, Gheorghe-Andrei; Musetescu, Rodica; Popescu, Mircea Ioachim; Badila, Elisabeta; Arsenescu Georgescu, Catalina; Pop, Sorina; Popescu, Raluca; Neamtu, Simina; Oancea, Floriana; Dan, Anca Rodica; Potpara, Tatjana; Polovina, Marija; Milanov, Srdjan; Mitic, Gorana; Milanov, Marko; Savic, Jelena; Markovic, Snezana; Koncarevic, Ivana; Gavrilovic, Jelena; Pavlovic, Marija; Djikic, Dijana; Petrovic, Marijana; Simovic, Stefan; Malic, Semir; Hodzic, Jusuf; Stojanovic, Milovan; Gnip, Sanja; Zlatar, Milan; Matic, Dragan; Lazic, Snezana; Acimovic, Tijana; Radovic, Pavica; Peric, Vladan; Markovic, Sanja; Kovacevic, Snezana; Arandjelovic, Aleksandra; Asanin, Milika; Nedeljkovic, Milan M.; Zdravkovic, Marija; Deljanin Ilic, Marina; Trendafilova, Elina; Dimitrova, Elena; Petranov, Stanislav; Kamenova, Delyana; Kamenova, Penka; Elefterova, Svetoslava; Shterev, Valentin; Zekova, Maria; Diukiandzhieva, Stela; Goshev, Evgenii; Dimitrov, Boiko; Sotirov, Tihomir; Simeonova, Valentina; Velichkova, Anna; Drianovska, Dimitrina; Vasileva Boiadzhieva, Liliya Ivanova; Buchukova, Darina; Goda, Artan; Paparisto, Vilma; Gjini, Viktor; Ekmekciu, Uliks; Gjergo, Hortensia; Mijo, Alma; Shirka, Ervina; Refatllari, Ina; Kusljugic, Zumreta; Loncar, Daniela; Pojskic, Belma; Mrsic, Denis; Sijamija, Alma; Bijedic, Amira; Bijedic, Irma; Karamujic, Indira; Halilovic, Sanela; Tulumovic, Hazim; Sokolovic, Sekib; Manola, Sime; Brusich, Sandro; Zeljkovic, Ivan; Anic, Ante; Pavlovic, Nikola; Radeljic, Vjekoslav; Jeric, Melita; Pekic, Petar; Milas, Kresimir; Music, Ljilja; Nenezic, Ana; Bulatovic, Nebojsa; Asanovic, Dijana; On behalf of the BALKAN-AF Investigators
Source
Advances in Therapy. August 2017 34(8):2043-2057
Subject
Language
English
ISSN
0741-238X
1865-8652
1865-8652
Abstract
Introduction:Data on management of atrial fibrillation (AF) in the Balkan Region are scarce. To capture the patterns in AF management in contemporary clinical practice in the Balkan countries a prospective survey was conducted between December 2014 and February 2015, and we report results pertinent to the use of non-vitamin K antagonist oral anticoagulants (NOACs).Methods:A 14-week prospective, multicenter survey of consecutive AF patients seen by cardiologists or internal medicine specialists was conducted in Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Montenegro, Romania, and Serbia (a total of about 50 million inhabitants).Results:Of 2712 enrolled patients, 2663 (98.2%) had complete data relevant to oral anticoagulant (OAC) use (mean age 69.1 ± 10.9 years, female 44.6%). Overall, OAC was used in 1960 patients (73.6%) of whom 338 (17.2%) received NOACs. Malignancy [odds ratio (OR), 95% confidence interval (CI) 2.06, 1.20–3.56], rhythm control (OR 1.64, 1.25–2.16), and treatment by cardiologists were independent predictors of NOAC use (OR 2.32, 1.51–3.54) [all p < 0.01)], whilst heart failure and valvular disease were negatively associated with NOAC use (both p < 0.01). Individual stroke and bleeding risk were not significantly associated with NOAC use on multivariate analysis.Conclusions:NOACs are increasingly used in AF patients in the Balkan Region, but NOAC use is predominantly guided by factors other than evidence-based decision-making (e.g., drug availability on the market or reimbursement policy). Efforts are needed to establish an evidence-based approach to OAC selection and to facilitate the optimal use of OAC, thus improving the outcomes in AF patients in this large region.