Purpose: The 2012 focused update of the ESC guidelines for the management of atrial fibrillation (AF) recommended the use of anticoagulant therapy for the prevention of thromboembolic events for all patients with AF except in those at low risk. However, implementation tends to be incomplete or only applied to a subset of patients. We evaluated the impact of these recommendations in clinical practice of different European countries

Methods: The PREvention oF thromboembolic events – European Registry in Atrial Fibrillation (PREFER in AF) recruited unselected patients diagnosed of AF in Austria, France, Germany, Italy, Spain, Switzerland and the United Kingdom from Jan 2012 to Jan 2013. We report the data collected at enrolment into the study and follow-up performed 1 year later.

Results: 7243 patients were enrolled from 461 sites. The mean age was 71.5±11 years, 60.1% were male and the mean CHA2DS2-VASc score was 3.4±1.8. Anticoagulation rate reached 85.6% of those with CHA2DS2-VASc score ≥2 (4793 of 5600), and 70.1% of those with CHA2DS2-VASc score of 1 (468 of 668) at the baseline visit. The overall anticoagulation rate at follow up was slightly lower as compared with baseline (from 82.3 to 80.0%). There was a significant reduction in the use of vitamin K antagonists (VKA) alone (from 66.3 to 61.8%). In parallel, the use of novel oral anticoagulants (NOACs) raised from 6.1 to 12.6%, mainly due to a marked increase of oral factor Xa inhibitors [rivaroxaban, apixaban] (from 1.9 to 6.0%), and in lesser amount due to oral thrombin inhibitors [dabigatran] (from 4.0 to 6.5%). Substantial inter-country differences were noted with higher uptake of NOACs in Germany, France and Spain. Most of the combination treatments judged inappropriate according to the last ESC guidelines were progressively discontinued, such as the combined long-term use of VKA and antiplatelet (AP) agents (from 9.9 to 5.7%), and the use of APs agents as monotherapy (from 11.2 to 8.0%).

Conclusions: The antithrombotic management of AF patients in 2013 in Europe has been substantially adapted to guideline recommendations, and oral anticoagulants are administered to a majority of eligible patients. However, implementation is not complete and there are still prescription patterns that should be adequately targeted.