open access

Vol 80, No 4 (2022)
Original article
Published online: 2022-02-17
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Adherence to the 4S-AF Scheme in the Balkan region: Insights from the BALKAN-AF survey

Monika Kozieł-Siołkowska12, Miroslav Mihajlovic3, Milan Nedeljkovic34, Nikola Pavlovic5, Vilma Paparisto6, Ljilja Music7, Elina Trendafilova8, Anca Rodica Dan9, Zumreta Kusljugic10, Gheorghe-Andrei Dan11, Gregory YH Lip12412, Tatjana S Potpara34
DOI: 10.33963/KP.a2022.0053
·
Pubmed: 35176169
·
Kardiol Pol 2022;80(4):461-467.
Affiliations
  1. Liverpool Center for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
  2. 1st Department of Cardiology and Angiology, Silesian Center for Heart Diseases, Zabrze, Poland
  3. Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
  4. School of Medicine, Belgrade University, Belgrade, Serbia
  5. Clinical Center Sestre Milosrdnice, Zagreb, Croatia
  6. Clinic of Cardiology, University Hospital Center Mother Theresa, Tirana, Albania
  7. Cardiology Clinic, University Clinical Center of Montenegro, University of Podgorica, Medical Faculty, Podgorica, Montenegro
  8. National Heart Hospital, Coronary Care Unit, Sofia, Bulgaria
  9. Colentina University Hospital, Cardiology Department, Bucharest, Romania
  10. Clinic of Internal Medicine, Cardiology Department, University Clinical Center Tuzla, Medical Faculty, Tuzla, Bosnia and Herzegovina
  11. Medicine University “Carol Davila”, Colentina University Hospital, Bucharest, Romania
  12. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

open access

Vol 80, No 4 (2022)
Original article
Published online: 2022-02-17

Abstract

Background: The 4S-AF scheme includes stroke risk, symptoms, severity of burden, and substrate severity domain.
Aim: We aimed to assess the adherence to the 4S-AF scheme in patients classified according to stroke risk in post hoc analysis of the BALKAN-AF dataset.
Methods: A 14-week prospective enrolment of consecutive patients with electrocardiographically documented atrial fibrillation (AF) was performed in seven Balkan countries from 2014 to 2015.
Results: Low stroke risk (CHA2DS2-VASc score, 0 in males or 1 in females) was present in 162 (6.0%) patients. 2 099 (77.4%) patients had CHA2DS2-VASc score ≥3 in females or ≥2 in males (high stroke risk), and 613 (22.6%) had CHA2DS2-VASc score <3 in females or <2 in males. Seventy-five (46.3%) patients with low stroke risk and 1555 (74.1%) patients with high stroke risk were prescribed oral anticoagulants (OAC). Two thousand six hundred and seventy-seven (98.6%) had data on European Heart Rhythm Association (EHRA) class. Among 2099 patients with high stroke risk, 703 (33.4%) had EHRA class ≥3. Two hundred and seven (29.4%) patients with EHRA class ≥3 and high stroke risk were offered rhythm control; 620 (55.2%) of individuals with first-diagnosed or paroxysmal AF with high stroke risk were offered rhythm control. Two or more comorbidities occurred in 1927 (91.8%) patients with high stroke risk.
Conclusions: OAC overuse was observed in patients with low stroke risk, whilst OAC underuse was evident in those with high risk of stroke. The percentage of highly symptomatic patients with high risk of stroke who were offered a rhythm control strategy was low.

Abstract

Background: The 4S-AF scheme includes stroke risk, symptoms, severity of burden, and substrate severity domain.
Aim: We aimed to assess the adherence to the 4S-AF scheme in patients classified according to stroke risk in post hoc analysis of the BALKAN-AF dataset.
Methods: A 14-week prospective enrolment of consecutive patients with electrocardiographically documented atrial fibrillation (AF) was performed in seven Balkan countries from 2014 to 2015.
Results: Low stroke risk (CHA2DS2-VASc score, 0 in males or 1 in females) was present in 162 (6.0%) patients. 2 099 (77.4%) patients had CHA2DS2-VASc score ≥3 in females or ≥2 in males (high stroke risk), and 613 (22.6%) had CHA2DS2-VASc score <3 in females or <2 in males. Seventy-five (46.3%) patients with low stroke risk and 1555 (74.1%) patients with high stroke risk were prescribed oral anticoagulants (OAC). Two thousand six hundred and seventy-seven (98.6%) had data on European Heart Rhythm Association (EHRA) class. Among 2099 patients with high stroke risk, 703 (33.4%) had EHRA class ≥3. Two hundred and seven (29.4%) patients with EHRA class ≥3 and high stroke risk were offered rhythm control; 620 (55.2%) of individuals with first-diagnosed or paroxysmal AF with high stroke risk were offered rhythm control. Two or more comorbidities occurred in 1927 (91.8%) patients with high stroke risk.
Conclusions: OAC overuse was observed in patients with low stroke risk, whilst OAC underuse was evident in those with high risk of stroke. The percentage of highly symptomatic patients with high risk of stroke who were offered a rhythm control strategy was low.

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Keywords

atrial fibrillation, oral anticoagulants, rhythm control, risk of stroke

About this article
Title

Adherence to the 4S-AF Scheme in the Balkan region: Insights from the BALKAN-AF survey

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 80, No 4 (2022)

Article type

Original article

Pages

461-467

Published online

2022-02-17

Page views

217

Article views/downloads

71

DOI

10.33963/KP.a2022.0053

Pubmed

35176169

Bibliographic record

Kardiol Pol 2022;80(4):461-467.

Keywords

atrial fibrillation
oral anticoagulants
rhythm control
risk of stroke

Authors

Monika Kozieł-Siołkowska
Miroslav Mihajlovic
Milan Nedeljkovic
Nikola Pavlovic
Vilma Paparisto
Ljilja Music
Elina Trendafilova
Anca Rodica Dan
Zumreta Kusljugic
Gheorghe-Andrei Dan
Gregory YH Lip
Tatjana S Potpara

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