Guideline-Adherent Treatment for Stroke and Death in Atrial Fibrillation Patients From UK and Japanese AF Registries

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  • Miyazawa Kazuo
    Institute of Cardiovascular Sciences, University of Birmingham
  • Ogawa Hisashi
    Department of Cardiology, National Hospital Organization Kyoto Medical Center
  • Mazurek Michał
    Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases
  • Shantsila Eduard
    Institute of Cardiovascular Sciences, University of Birmingham
  • Lane Deirdre A.
    Institute of Cardiovascular Sciences, University of Birmingham Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University
  • Wolff Andreas
    Whinfield Medical Practice Division of Family Practice, Chilliwack General Hospital
  • Akao Masaharu
    Department of Cardiology, National Hospital Organization Kyoto Medical Center
  • Lip Gregory Y.H.
    Institute of Cardiovascular Sciences, University of Birmingham Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University

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<p>Background:Guideline-adherent antithrombotic treatment (ATT) reduces the risk of stroke and death in patients with atrial fibrillation (AF). However, the effect of ATT adherence among different ethnicities remains uncertain. We compared the prognosis of AF patients in Japan and the UK according to guideline adherence status.</p><p>Methods and Results:We compared the clinical characteristics and outcomes of AF patients from the Fushimi AF registry (Japan; n=4,239) and the Darlington AF registry (UK; n=2,259). ATT adherence was assessed against the Japanese Circulation Society Guidelines and UK National Institute for Health and Care Excellence guidelines. The rates of guideline-adherent ATT were 58.6% and 50.8% in the Fushimi and Darlington registries, respectively. There was no significant difference in 1-year stroke rates between Fushimi and Darlington (2.6% vs. 3.0%, P=0.342). On multivariate logistic regression analysis, non-guideline adherent-ATT was significantly associated with an increased risk of stroke (odds ratio [OR]: 1.69, 95% confidence interval [CI]: 1.21–2.34, P=0.002 for undertreatment, OR: 2.13, 95% CI: 1.19–3.80, P=0.010 for overtreatment). No significant interaction for ATT and the 2 populations was found in the incidence of stroke, all-cause death, and the composite outcome.</p><p>Conclusions:Approximately half of the AF patients received optimal ATT according to guideline recommendations, which was associated with a lower risk of stroke. Furthermore, there was no interaction for the 2 populations and the influence of ATT adherence.</p>

収録刊行物

  • Circulation Journal

    Circulation Journal 83 (12), 2434-2442, 2019-11-25

    一般社団法人 日本循環器学会

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