Variations in Etiology and Management of Atrial Fibrillation in a Prospective Registry of 15,400 Emergency Department Patients in 46 Countries: The RE-LY AF 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 J. Grinvalds, Juliet Nakamya, Paul A. Reilly, Katalin Keltai, Isabelle C. Van Gelder, Afzal Hussein Yusufali, Eiichi Watanabe, Lars Wallentin, Stuart J. Connolly and Salim Yusuf on behalf of the RE-LY Atrial Fibrillation Registry Investigators Circulation. published online January 24, 2014; Circulation is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 2014 American Heart Association, Inc. All rights reserved. Print ISSN: 0009-7322. Online ISSN: 1524-4539
The online version of this article, along with updated information and services, is located on the World Wide Web at: http://circ.ahajournals.org/content/early/2014/01/24/CIRCULATIONAHA.113.005451
Data Supplement (unedited) at: http://circ.ahajournals.org/content/suppl/2014/01/24/CIRCULATIONAHA.113.005451.DC1.html
Permissions: Requests for permissions to reproduce figures, tables, or portions of articles originally published in Circulation can be obtained via RightsLink, a service of the Copyright Clearance Center, not the Editorial Office. Once the online version of the published article for which permission is being requested is located, click Request Permissions in the middle column of the Web page under Services. Further information about this process is available in the Permissions and Rights Question and Answer document. Reprints: Information about reprints can be found online at: http://www.lww.com/reprints Subscriptions: Information about subscribing to Circulation is online at: http://circ.ahajournals.org//subscriptions/
Downloaded from http://circ.ahajournals.org/ at UNIV MASSACHUSETTS on May 10, 2014
DOI: 10.1161/CIRCULATIONAHA.113.005451
Variations in Etiology and Management of Atrial Fibrillation in a Prospective Registry of 15,400 Emergency Department Patients in 46 Countries: The RE-LY AF Registry Running title: Oldgren et al.; Atrial Fibrillation - risk factors and management Jonas Oldgren, MD, PhD1; Jeff S. Healey, MD, MSc2; Michael Ezekowitz, MD3; Patrick Commerford, MB, ChB, FCP(SA)4; Alvaro Avezum, MD, PhD5; Prem Pais, MD6; Jun Zhu, MD7; Petr Jansky, MD8; Alben Sigamani, MD6; Carlos A. Morillo, MD2; Lisheng Liu, MD7; Albertino Damasceno, MD, PhD9; Alex Grinvalds, BSc2; Juliet Nakamya, MSc, PhD2; Paul A. Reilly, PhD10; Katalin Keltai, MD, PhD11; Isabelle C. Van Gelder, MD, PhD12; Afzal Hussein Yusufali, MD, MMed13; Eiichi Watanabe, MD, PhD14; Lars Wallentin, MD, PhD1; Stuart J. Connolly, MD2; Salim Yusuf, MD, MBBS, DPhil2 on behalf of the RE-LY Atrial Fibrillation Registry Investigator Investigators rs 1
Uppsala Clinical Research Center and Dept of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; 2Population Health Research Institute, Hamilton, Ontario, Canada; 3Jefferson Medical College, Coll lleg ege, eg e, Wynnewood, Wyn ynn new wood o , PA, and Cardiovascular Research od Reseear arch c Foundation, New York, ch Yorrk, k NY; 4Dept of Medicine Medicine, 5 University Town, Cape Town, South Africa; Univ Un iver e siity ooff Ca Cape pe T own, ow n, C ap pe To Town w , So out u h Af Afri rica caa; Inst Instituto tit itut uto o Dant Dante ntte Pazz Pazzanesse zzan anessee ddee Ca Cardio Cardiologia, i lo logi gia, S Sao a ao Paulo, Brazil; P ulo, B Pa razi ra ziil; 6St. St. John’s John Jo hn’s hn ’s M Medical edic ed ical ic all C College, olle ol lege ege, B Ba Bangalore, angaalo ore, IIndia; ndia nd ia; 7Ca ia Cardiovascular ard r io iova vasscu va ularr IInstitute nsti ns titu ti tute tu te aand nd F Fuwai uwai uw aii Hospital, Beijing, Hospital, Beiji ing, China; Chin na; 8Un University Univ iversi sit ity ty Hospital Hospittal Motol, Mottol tol, Pra Prague, ragu guee, C gu Czech zecch ch Repu Republic; ublic;; 9Eduar ubl Eduardo E d rdo o Mond M Mondlane ondla laanee 100 Univ Un iversity, Ma M puto, Moz M ozamb mb biq que u ; Bo University, Maputo, Mozambique; Boehringer-Ingelheim, B eh hring ngerr-Ing ngellhe heim im m, Ri Ridg Ridgefield, gefieeld d, CT CT; T; 1111Se Semmelweis emmelw mm weiis is University, Univerrsitty, Budapest, Buda Bu dape da pest pe st,, Hungary; st Hung Hu nggary; ary; 12Th Thoraxcenter, T hor orax or a ceent n er,, Univ U University niv ver ersi sity si ty ooff Gr Gron Groningen, onnin inge gen, ge n, U University niive vers rsit rs itty Me M Medical edi diica c l Ce Cent Center nter nt er G Groningen, roni ro niing ngen en,, th en the Netherlands; Nether Ne erla land nds;; 133Du Dubai Duba bai Hospital, Hosppit Ho ital al,, Dubai Du Health Heal He alth th Authority, Aut uthori rity ty y, Du Duba Dubai, bai, i,, U United nite ni ted d Ar Arab ab E Emirates; mira mi rates;; 14De Dept p ooff pt Cardiology, Toyoake, Japan C rd Ca rdio iolo io lo ogy g , Fujita Fuji Fu j taa Health ji Heaalt l h University Univ Un iver iv ersi er s ty School si Sch choo o l of Medicine, Med edic icin ic i e, T oyoa oy oake oa k , Ja ke Japa pan pa n
Address for Correspondence: Jonas Oldgren, MD, PhD Uppsala Clinical Research Center and Department of Medical Sciences, Cardiology Uppsala University S-752 37 Uppsala, Sweden Tel: +46186112765 Fax: +4618515570 E-mail: [email protected] Journal Subject Codes: Etiology:[5] Arrhythmias, clinical electrophysiology, drugs, Anticoagulants:[184] Coumarins, Treatment:[121] Primary prevention, Treatment:[122] Secondary prevention
1 Downloaded from http://circ.ahajournals.org/ at UNIV MASSACHUSETTS on May 10, 2014
DOI: 10.1161/CIRCULATIONAHA.113.005451
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 between 9 major geographic regions. Between September 2008 and April 2011, 15,400 patients were enrolled. The average age was 65.9, SD14.8 years, ranging from 57.2, SD18.8 years in Africa, to 70.1, SD13.4 years in North America, p160/100mmHg - HTN and and n L LVH V † VH 221.7 1.77 21.1 21 . .1 20.4 20 0.4 330.8ȗ 30 0.88ȗ 111.7ȗ 1.7ȗ . ȗ 446.2ȗ 6.2ȗ 6.2 6.6 .66ȗ 111.1ȗ 1.11ȗ 10.9 10 .9ȗȗ 6.6ȗ 10.9ȗ 38.1ȗ † okee or TIA 113.8 3.88 15.4 15 .44 114.6 4.6 12 12.0 2.00 112.5 2.5 2.5 111.5 11 .5 14.1 Prior Stroke 7.4* 4 118.8* 8 8* 8. 8 222.1* 2 1* 2. 1* † Prior MI 114.4 4.44 115.7 5.7 15.5 5 17.2 7 17.2* 1 .2* 17 18 18.2* .2* 118.1* 18 .1** .1 7. 7.3* 3* 3* 10. 10.9* 0 9* 9 5.5* Heart Failure ailur ure re† 334.7 4.77 35.3 35 5.33 337.4 37 .44 27.8* 277.8* 8* 21.2* 21 1.2 . * 58.5 58 58.5* 8.5 .5** 117.7* 17 .7* 7* 26.3* 26.3 26 .3* 28.4* 28.4 28 . * .4 63.8* LV Systolic olicc Dysfunction Dysffunnct Dy ctio i n† 223.7 3.7 21.8 21 .8 24.1 24 15 .1* 1* 29 .5* 5* 16.1* 16 31.9 31 .9** 19 9.2** 117.2* 17 .2* 2* 15.1* 29.5* 31.9* 19.2* 46.1* † Rheumatic tic Heart Diseas Disease se 11.6 11. 1.66 2.2* 2. 2 66.7* .7* .7 1.5* 1. 33.8* .8* .8 331.5* 31 .55* 115.7* 15 .77* 3.6* 3. 6 15.3* 21.5* † Valvularr Heart Disease 221.7 1.77 224.9 24 .99 23.7 16.2* 16 .2* .2 2* 8.8* 8. 8* 110.7* 0 7* 0. 446.7* 6.7** 116.7* 6.7* 6. 7* 116.6* 6.6* 6. 6 6* 32.6* † Pacemaker 4.7 4.1 3.8 8.6* 7.9* 6.9* 1.6* 3.2* 2.6* 1.1* Congenital Heart Disease† 2.2 2.0 2.5 1.6 1.8 2.0 1.9 4.3* 1.2* 2.1* † 1.2 0.9 1.4 0.7 0.7 1.5 1.3 Recent Cardiac Surgery 3.3* 0.3* 0.4* † CHADS2 Score, mean (SD) 1.8 (1.4) 2.0* (1.4) 2.0* (1.3) 1.6* (1.3) 2.3* (1.2) 1.1* (1.1) 1.8 (1.4) 2.0* (1.5) 1.6* (1.4) 1.8 (1.3) † 3.8 3.4 3.9 2.6 2.4 History of Major Bleeding 7.9* 5.6* 1.5* 2.3* 5.7* ‡ † Lone Atrial Fibrillation 10.7 13.1* 8.2* 19.2* 4.4* 6.3* 13.0* 13.6* 17.9* 5.6* Other Concomitant Conditions Diabetes Mellitus† 21.8 24.4 20.2 18.1* 17.1* 26.7* 15.5* 29.2* 36.2* 14.0* Region
Over all
21 Downloaded from http://circ.ahajournals.org/ at UNIV MASSACHUSETTS on May 10, 2014
DOI: 10.1161/CIRCULATIONAHA.113.005451
COPD† Obesity (BMI 35)† OSA† Hyperthyroidism† Pericarditis† Tuberculosis† HIV† Endomyocardial Fibrosis† Other risk factors History of Tobacco Use† Alcohol mean/week†>14/week†
11.5 7.2 3.9 3.7 0.8 1.4 0.3 0.2
16.9* 15.2* 10.1* 2.8 0.6 0.3* 0.2 0.0
17.0 3.0 1.4
20.9* 4.1*1.8
10.2 7.2 4.1 1.2* 0.8 1.1 0.0 0.2
9.8 9.0 4.0 3.8 0.5 0.2* 0.0 0.1
23.4* 12.5* 5.8* 7.0* 0.9 2.2* 0.0* 0.0
17.0 16.0 17.3 0.8*0.3* 5.6*4.4* 2.1*1.1
4.8* 2.2* 0.8* 2.2* 0.7 0.4* 0.0* 0.0
11.7 0.6* 3.5 3.3 0.4 3.9* 0.0 0.0
6.6* 1.3* 0.7* 5.4* 0.3 2.4* 0.0 0.1
6.4* 11.4* 3.3 2.6 0.3 0.2* 0.0 0.0
4.7* 6.4 1.3* 3.1 3.1* 1.8 4.0* 2.3*
7.5* 0.9*0.2*
21.6* 2.81.3
24.5* 24 24.5 .55* 11.7*0.8 1. .7*0. *0. 08
20.6* 20 20.6 .6** 00.9*0.2* 0. .9* 9 0. 9* 0 2* 2
12.6* 3.61.9
All numbers ers are percentages, except where stated. *Significantly ntly different from the rest of the world, p
The online version of this article, along with updated information and services, is located on the World Wide Web at: http://circ.ahajournals.org/content/early/2014/01/24/CIRCULATIONAHA.113.005451
Data Supplement (unedited) at: http://circ.ahajournals.org/content/suppl/2014/01/24/CIRCULATIONAHA.113.005451.DC1.html
Permissions: Requests for permissions to reproduce figures, tables, or portions of articles originally published in Circulation can be obtained via RightsLink, a service of the Copyright Clearance Center, not the Editorial Office. Once the online version of the published article for which permission is being requested is located, click Request Permissions in the middle column of the Web page under Services. Further information about this process is available in the Permissions and Rights Question and Answer document. Reprints: Information about reprints can be found online at: http://www.lww.com/reprints Subscriptions: Information about subscribing to Circulation is online at: http://circ.ahajournals.org//subscriptions/
Downloaded from http://circ.ahajournals.org/ at UNIV MASSACHUSETTS on May 10, 2014
DOI: 10.1161/CIRCULATIONAHA.113.005451
Variations in Etiology and Management of Atrial Fibrillation in a Prospective Registry of 15,400 Emergency Department Patients in 46 Countries: The RE-LY AF Registry Running title: Oldgren et al.; Atrial Fibrillation - risk factors and management Jonas Oldgren, MD, PhD1; Jeff S. Healey, MD, MSc2; Michael Ezekowitz, MD3; Patrick Commerford, MB, ChB, FCP(SA)4; Alvaro Avezum, MD, PhD5; Prem Pais, MD6; Jun Zhu, MD7; Petr Jansky, MD8; Alben Sigamani, MD6; Carlos A. Morillo, MD2; Lisheng Liu, MD7; Albertino Damasceno, MD, PhD9; Alex Grinvalds, BSc2; Juliet Nakamya, MSc, PhD2; Paul A. Reilly, PhD10; Katalin Keltai, MD, PhD11; Isabelle C. Van Gelder, MD, PhD12; Afzal Hussein Yusufali, MD, MMed13; Eiichi Watanabe, MD, PhD14; Lars Wallentin, MD, PhD1; Stuart J. Connolly, MD2; Salim Yusuf, MD, MBBS, DPhil2 on behalf of the RE-LY Atrial Fibrillation Registry Investigator Investigators rs 1
Uppsala Clinical Research Center and Dept of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; 2Population Health Research Institute, Hamilton, Ontario, Canada; 3Jefferson Medical College, Coll lleg ege, eg e, Wynnewood, Wyn ynn new wood o , PA, and Cardiovascular Research od Reseear arch c Foundation, New York, ch Yorrk, k NY; 4Dept of Medicine Medicine, 5 University Town, Cape Town, South Africa; Univ Un iver e siity ooff Ca Cape pe T own, ow n, C ap pe To Town w , So out u h Af Afri rica caa; Inst Instituto tit itut uto o Dant Dante ntte Pazz Pazzanesse zzan anessee ddee Ca Cardio Cardiologia, i lo logi gia, S Sao a ao Paulo, Brazil; P ulo, B Pa razi ra ziil; 6St. St. John’s John Jo hn’s hn ’s M Medical edic ed ical ic all C College, olle ol lege ege, B Ba Bangalore, angaalo ore, IIndia; ndia nd ia; 7Ca ia Cardiovascular ard r io iova vasscu va ularr IInstitute nsti ns titu ti tute tu te aand nd F Fuwai uwai uw aii Hospital, Beijing, Hospital, Beiji ing, China; Chin na; 8Un University Univ iversi sit ity ty Hospital Hospittal Motol, Mottol tol, Pra Prague, ragu guee, C gu Czech zecch ch Repu Republic; ublic;; 9Eduar ubl Eduardo E d rdo o Mond M Mondlane ondla laanee 100 Univ Un iversity, Ma M puto, Moz M ozamb mb biq que u ; Bo University, Maputo, Mozambique; Boehringer-Ingelheim, B eh hring ngerr-Ing ngellhe heim im m, Ri Ridg Ridgefield, gefieeld d, CT CT; T; 1111Se Semmelweis emmelw mm weiis is University, Univerrsitty, Budapest, Buda Bu dape da pest pe st,, Hungary; st Hung Hu nggary; ary; 12Th Thoraxcenter, T hor orax or a ceent n er,, Univ U University niv ver ersi sity si ty ooff Gr Gron Groningen, onnin inge gen, ge n, U University niive vers rsit rs itty Me M Medical edi diica c l Ce Cent Center nter nt er G Groningen, roni ro niing ngen en,, th en the Netherlands; Nether Ne erla land nds;; 133Du Dubai Duba bai Hospital, Hosppit Ho ital al,, Dubai Du Health Heal He alth th Authority, Aut uthori rity ty y, Du Duba Dubai, bai, i,, U United nite ni ted d Ar Arab ab E Emirates; mira mi rates;; 14De Dept p ooff pt Cardiology, Toyoake, Japan C rd Ca rdio iolo io lo ogy g , Fujita Fuji Fu j taa Health ji Heaalt l h University Univ Un iver iv ersi er s ty School si Sch choo o l of Medicine, Med edic icin ic i e, T oyoa oy oake oa k , Ja ke Japa pan pa n
Address for Correspondence: Jonas Oldgren, MD, PhD Uppsala Clinical Research Center and Department of Medical Sciences, Cardiology Uppsala University S-752 37 Uppsala, Sweden Tel: +46186112765 Fax: +4618515570 E-mail: [email protected] Journal Subject Codes: Etiology:[5] Arrhythmias, clinical electrophysiology, drugs, Anticoagulants:[184] Coumarins, Treatment:[121] Primary prevention, Treatment:[122] Secondary prevention
1 Downloaded from http://circ.ahajournals.org/ at UNIV MASSACHUSETTS on May 10, 2014
DOI: 10.1161/CIRCULATIONAHA.113.005451
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 between 9 major geographic regions. Between September 2008 and April 2011, 15,400 patients were enrolled. The average age was 65.9, SD14.8 years, ranging from 57.2, SD18.8 years in Africa, to 70.1, SD13.4 years in North America, p160/100mmHg - HTN and and n L LVH V † VH 221.7 1.77 21.1 21 . .1 20.4 20 0.4 330.8ȗ 30 0.88ȗ 111.7ȗ 1.7ȗ . ȗ 446.2ȗ 6.2ȗ 6.2 6.6 .66ȗ 111.1ȗ 1.11ȗ 10.9 10 .9ȗȗ 6.6ȗ 10.9ȗ 38.1ȗ † okee or TIA 113.8 3.88 15.4 15 .44 114.6 4.6 12 12.0 2.00 112.5 2.5 2.5 111.5 11 .5 14.1 Prior Stroke 7.4* 4 118.8* 8 8* 8. 8 222.1* 2 1* 2. 1* † Prior MI 114.4 4.44 115.7 5.7 15.5 5 17.2 7 17.2* 1 .2* 17 18 18.2* .2* 118.1* 18 .1** .1 7. 7.3* 3* 3* 10. 10.9* 0 9* 9 5.5* Heart Failure ailur ure re† 334.7 4.77 35.3 35 5.33 337.4 37 .44 27.8* 277.8* 8* 21.2* 21 1.2 . * 58.5 58 58.5* 8.5 .5** 117.7* 17 .7* 7* 26.3* 26.3 26 .3* 28.4* 28.4 28 . * .4 63.8* LV Systolic olicc Dysfunction Dysffunnct Dy ctio i n† 223.7 3.7 21.8 21 .8 24.1 24 15 .1* 1* 29 .5* 5* 16.1* 16 31.9 31 .9** 19 9.2** 117.2* 17 .2* 2* 15.1* 29.5* 31.9* 19.2* 46.1* † Rheumatic tic Heart Diseas Disease se 11.6 11. 1.66 2.2* 2. 2 66.7* .7* .7 1.5* 1. 33.8* .8* .8 331.5* 31 .55* 115.7* 15 .77* 3.6* 3. 6 15.3* 21.5* † Valvularr Heart Disease 221.7 1.77 224.9 24 .99 23.7 16.2* 16 .2* .2 2* 8.8* 8. 8* 110.7* 0 7* 0. 446.7* 6.7** 116.7* 6.7* 6. 7* 116.6* 6.6* 6. 6 6* 32.6* † Pacemaker 4.7 4.1 3.8 8.6* 7.9* 6.9* 1.6* 3.2* 2.6* 1.1* Congenital Heart Disease† 2.2 2.0 2.5 1.6 1.8 2.0 1.9 4.3* 1.2* 2.1* † 1.2 0.9 1.4 0.7 0.7 1.5 1.3 Recent Cardiac Surgery 3.3* 0.3* 0.4* † CHADS2 Score, mean (SD) 1.8 (1.4) 2.0* (1.4) 2.0* (1.3) 1.6* (1.3) 2.3* (1.2) 1.1* (1.1) 1.8 (1.4) 2.0* (1.5) 1.6* (1.4) 1.8 (1.3) † 3.8 3.4 3.9 2.6 2.4 History of Major Bleeding 7.9* 5.6* 1.5* 2.3* 5.7* ‡ † Lone Atrial Fibrillation 10.7 13.1* 8.2* 19.2* 4.4* 6.3* 13.0* 13.6* 17.9* 5.6* Other Concomitant Conditions Diabetes Mellitus† 21.8 24.4 20.2 18.1* 17.1* 26.7* 15.5* 29.2* 36.2* 14.0* Region
Over all
21 Downloaded from http://circ.ahajournals.org/ at UNIV MASSACHUSETTS on May 10, 2014
DOI: 10.1161/CIRCULATIONAHA.113.005451
COPD† Obesity (BMI 35)† OSA† Hyperthyroidism† Pericarditis† Tuberculosis† HIV† Endomyocardial Fibrosis† Other risk factors History of Tobacco Use† Alcohol mean/week†>14/week†
11.5 7.2 3.9 3.7 0.8 1.4 0.3 0.2
16.9* 15.2* 10.1* 2.8 0.6 0.3* 0.2 0.0
17.0 3.0 1.4
20.9* 4.1*1.8
10.2 7.2 4.1 1.2* 0.8 1.1 0.0 0.2
9.8 9.0 4.0 3.8 0.5 0.2* 0.0 0.1
23.4* 12.5* 5.8* 7.0* 0.9 2.2* 0.0* 0.0
17.0 16.0 17.3 0.8*0.3* 5.6*4.4* 2.1*1.1
4.8* 2.2* 0.8* 2.2* 0.7 0.4* 0.0* 0.0
11.7 0.6* 3.5 3.3 0.4 3.9* 0.0 0.0
6.6* 1.3* 0.7* 5.4* 0.3 2.4* 0.0 0.1
6.4* 11.4* 3.3 2.6 0.3 0.2* 0.0 0.0
4.7* 6.4 1.3* 3.1 3.1* 1.8 4.0* 2.3*
7.5* 0.9*0.2*
21.6* 2.81.3
24.5* 24 24.5 .55* 11.7*0.8 1. .7*0. *0. 08
20.6* 20 20.6 .6** 00.9*0.2* 0. .9* 9 0. 9* 0 2* 2
12.6* 3.61.9
All numbers ers are percentages, except where stated. *Significantly ntly different from the rest of the world, p
