University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
EORP Department, European Society of Cardiology, Sophia Antipolis, France.
Europace. 2015 Feb;17(2):194-206. doi: 10.1093/europace/euu201. Epub 2014 Aug 21.
Country differences in management practices are evident, and the publication of management guidelines by the European Society of Cardiology (ESC) and other learned societies has tried to recommend a uniform evidence-based approach to management. Despite the availability of guidelines and efforts to improve implementation, differences in guideline adherence are evident, and differences between countries and regions within Europe are therefore likely.
In this analysis from the baseline dataset of the EORP-AF Pilot survey, we examined regional differences in presentation and treatment of contemporary patients with atrial fibrillation (AF) in Europe, as managed by European cardiologists. We focused on a subgroup of 902 hospital admitted patients in whom no rhythm control was performed or planned. Chronic heart failure was more common in East countries (P < 0.0001) while hypertension and peripheral artery disease were more common in South countries (both P < 0.0001). Previous bleeding and chronic kidney disease were more common in South countries (both P < 0.0001). A CHA2DS2-VASc score of ≥2 was highest in East and South countries (93.0 and 95.3%, respectively) compared with 80.8% in West countries (P < 0.0001). A HAS-BLED score of ≥3 was also highest in East and South countries (18.0 and 29.2% respectively) compared with 4.8% in West countries (P < 0.0001). Oral anticoagulation (OAC) use (either as OAC or OAC plus antiplatelet therapy) in West, East, and South countries was 72.0, 74.7, and 76.2%, respectively. Only antiplatelet therapy was used in 13.6, 15.4, and 12.4%, respectively. An initial rate control strategy only was most common in South countries (77.8%) (P < 0.0001).
From the systematic collection of contemporary data regarding the management and treatment of AF in nine participating member ESC countries, we provide hypothesis-generating insights into regional management practices in Europe with regard to patient characteristics and treatment options.
管理实践中的国家差异显而易见，欧洲心脏病学会（ESC）和其他学术学会发布的管理指南试图推荐一种统一的基于证据的管理方法。尽管有指南和努力提高实施率，但指南的遵循率仍存在差异，因此欧洲各国和地区之间存在差异。
在这项来自 EORP-AF Pilot 调查基线数据集的分析中，我们检查了欧洲心脏病专家管理的当代心房颤动（AF）患者的临床表现和治疗方面的区域差异。我们专注于一个亚组，即 902 名住院患者，他们没有进行或计划进行节律控制。东国家的慢性心力衰竭更为常见（P < 0.0001），而南国家的高血压和外周动脉疾病更为常见（均 P < 0.0001）。南国家的既往出血和慢性肾脏病更为常见（均 P < 0.0001）。CHA2DS2-VASc 评分≥2 的患者在东和南国家最高（分别为 93.0%和 95.3%），而西国家为 80.8%（P < 0.0001）。HAS-BLED 评分≥3 的患者在东和南国家也最高（分别为 18.0%和 29.2%），而西国家为 4.8%（P < 0.0001）。西、东和南国家的口服抗凝剂（OAC）使用率（OAC 或 OAC 加抗血小板治疗）分别为 72.0%、74.7%和 76.2%。仅使用抗血小板治疗的比例分别为 13.6%、15.4%和 12.4%。初始的心率控制策略最为常见的是南国家（77.8%）（P < 0.0001）。
从对九个参与 ESC 成员国的 AF 管理和治疗的当代数据的系统收集，我们对欧洲的区域管理实践提供了假设生成的见解，涉及患者特征和治疗选择。
