Clinical practices of the management of nonvalvular atrial fibrillation and outcome of treatment: A representative prospective survey in tertiary healthcare centers across Turkey

Öz:

Objective: The goal of this study was to define clinical practice patterns for assessing stroke and bleeding risks andthromboprophylaxis in nonvalvular atrial fibrillation (NVAF)and to evaluate treatment outcomes and patient quality of life.Methods: A clinical surveillance study was conducted in 10tertiary healthcare centers across Turkey. Therapeutic approaches and persistence with initial treatment were recordedat baseline, the 6th month, and the 12th month in NVAF patients.Results: Of 210 patients (57.1% male; mean age: 64.86±12.87years), follow-up data were collected for 146 patients throughphone interviews at the 6th month and 140 patients at the 12thmonth. At baseline, most patients had high CHADS2 score(≥2: 48.3%) and CHA2DS2-VASc (≥2: 78.7%) risk scores but alow HAS-BLED (0–2: 83.1%) score. Approximately two-thirdsof the patients surveyed were using oral anticoagulants as anantithrombotic and one-third were using antiplatelet agents.The rate of persistence with initial treatment was approximately 86%. Bleeding was reported by 22.6% and 25.0% ofpatients at the 6th and 12th month, respectively. The proportion of patients with an INR of 2.0–3.0 was 41.8% at baseline,65.7% at the 6th month, and 65.9% at the 12th month. Thetime in therapeutic range was 61.0% during 1 year of followup. The median EuroQol 5-dimensional health questionnaire(EQ-5D) score of the patients at baseline and the 12th monthwas 0.827 and 0.778, respectively (p<0.001). The results indicated that patient quality of life declined over time.Conclusion: In atrial fibrillation, despite a high rate of persistence with initial treatment, the outcomes of stroke preventionand patient quality of life are not at the desired level. Nationalhealth policies should be developed and implemented to better integrate international guidelines for the management ofNVAF into clinical practice.

Anahtar Kelime:

Non-valvüler atriyum fibrilasyonu yönetiminde klinik uygulamalar ve tedavi sonuçları: Türkiye genelindeki üçüncü basamak sağlık merkezlerinde yapılan ileriye dönük anket çalışması

Öz:

Amaç: Non-valvüler atriyum fibrilasyonunda (NVAF), hastaların felç ve kanama riski ve tromboprofilaksi açısından değerlendirilmesi için klinik uygulama paternlerini belirlemek ve hastaların tedavi sonuçlarını ve yaşam kalitelerini değerlendirmek. Yöntemler: Türkiye genelinde 12 üçüncü basamak sağlık merkezinde yürütülen klinik sürveyans çalışma. Tedaviye yaklaşım ve tedaviye uyum verileri NVAF’li hastalarda çalışma başlangıcında, 6. ve 12. aylarda kaydedildi. Bulgular: Takip verileri, 210 hastanın (%57.1 erkek; ortalama yaş, 64.86±12.87 yıl) 146’sında 6. ayda ve 140’ında 12. ayda telefon görüşmesiyle toplandı. Başlangıçta, hastaların çoğunda CHADS2(≥2, %48.3) ve CHA2 DS2 -VASc (≥2, %78.7) risk skoru yüksekken HAS-BLED (0-2, %83.1) skoru düşüktü. Başlangıçta, 177 hasta (%84.3) herhangi bir AF tedavisi alıyordu. Antitrombotik tipini bildirenlerin yaklaşık üçte ikisi oral antikoagülan ve üçte biri antitrombosit ajan kullanıyordu. Başlangıç tedavisine devam oranı yaklaşık %86’ydı. Kanama 6. ayda hastaların %22.6’sında ve 12. ayda %25’inde bildirildi. Hedef INR değeri 2–3 olan hastaların yüzdesi başlangıçta %41.8 iken, 6. ayda %65.7’ye ve 12. ayda %65.9’a yükseldi. Bir yıllık takipte, terapötik aralıkta geçen zamana hastaların %61.0’ında ulaşıldı. Hastaların medyan EQ-5D skorları başlangıçta 0.827 (0.145–1.000) ve 12. ayda 0.778 (-0.040–1.000) idi (p<0.001). Sonuçlar, hasta yaşam kalitesinin zamanla azaldığını gösterdi. Sonuç: Atriyum fibrilasyonunda, tedavi ve başlangıç tedavisine devam oranlarının yüksekliğine rağmen tromboprofilaksi sonuçları ve hastaların yaşam kaliteleri istenen düzeyde değildi. Ulusal düzeyde sağlık politikaları geliştirilmelidir. NVAF’nin uluslararası kılavuzunu klinik uygulamaya daha iyi entegre etmek için ulusal sağlık politikaları geliştirilmeli ve uygulanmalıdır.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

TRDizin Dışındaki Atıf Sayıları

OpenCitations: 0

OpenAlex: 0

Crossref: 0

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APA	Özin M, AYTEMIR K, Aslan Ö, ÖZCAN T, KANADAŞI M, Demir M, Gökçe M, SUCU M, Özdemir M, Yigit Z, YAVUZKIR M, Oto A (2018). Clinical practices of the management of nonvalvular atrial fibrillation and outcome of treatment: A representative prospective survey in tertiary healthcare centers across Turkey. , 92 - 102. 10.5543/tkda.2017.79367
Chicago	Özin Mehmet Bülent,AYTEMIR KUDRET,Aslan Özgür,ÖZCAN Türkay,KANADAŞI Mehmet,Demir Mesut,Gökçe Mustafa,SUCU Mehmet Murat,Özdemir Murat,Yigit Zerrin,YAVUZKIR Mustafa Ferzeyn,Oto Ali Clinical practices of the management of nonvalvular atrial fibrillation and outcome of treatment: A representative prospective survey in tertiary healthcare centers across Turkey. (2018): 92 - 102. 10.5543/tkda.2017.79367
MLA	Özin Mehmet Bülent,AYTEMIR KUDRET,Aslan Özgür,ÖZCAN Türkay,KANADAŞI Mehmet,Demir Mesut,Gökçe Mustafa,SUCU Mehmet Murat,Özdemir Murat,Yigit Zerrin,YAVUZKIR Mustafa Ferzeyn,Oto Ali Clinical practices of the management of nonvalvular atrial fibrillation and outcome of treatment: A representative prospective survey in tertiary healthcare centers across Turkey. , 2018, ss.92 - 102. 10.5543/tkda.2017.79367
AMA	Özin M,AYTEMIR K,Aslan Ö,ÖZCAN T,KANADAŞI M,Demir M,Gökçe M,SUCU M,Özdemir M,Yigit Z,YAVUZKIR M,Oto A Clinical practices of the management of nonvalvular atrial fibrillation and outcome of treatment: A representative prospective survey in tertiary healthcare centers across Turkey. . 2018; 92 - 102. 10.5543/tkda.2017.79367
Vancouver	Özin M,AYTEMIR K,Aslan Ö,ÖZCAN T,KANADAŞI M,Demir M,Gökçe M,SUCU M,Özdemir M,Yigit Z,YAVUZKIR M,Oto A Clinical practices of the management of nonvalvular atrial fibrillation and outcome of treatment: A representative prospective survey in tertiary healthcare centers across Turkey. . 2018; 92 - 102. 10.5543/tkda.2017.79367
IEEE	Özin M,AYTEMIR K,Aslan Ö,ÖZCAN T,KANADAŞI M,Demir M,Gökçe M,SUCU M,Özdemir M,Yigit Z,YAVUZKIR M,Oto A "Clinical practices of the management of nonvalvular atrial fibrillation and outcome of treatment: A representative prospective survey in tertiary healthcare centers across Turkey." , ss.92 - 102, 2018. 10.5543/tkda.2017.79367
ISNAD	Özin, Mehmet Bülent vd. "Clinical practices of the management of nonvalvular atrial fibrillation and outcome of treatment: A representative prospective survey in tertiary healthcare centers across Turkey". (2018), 92-102. https://doi.org/10.5543/tkda.2017.79367

APA	Özin M, AYTEMIR K, Aslan Ö, ÖZCAN T, KANADAŞI M, Demir M, Gökçe M, SUCU M, Özdemir M, Yigit Z, YAVUZKIR M, Oto A (2018). Clinical practices of the management of nonvalvular atrial fibrillation and outcome of treatment: A representative prospective survey in tertiary healthcare centers across Turkey. Türk Kardiyoloji Derneği Arşivi, 46(2), 92 - 102. 10.5543/tkda.2017.79367
Chicago	Özin Mehmet Bülent,AYTEMIR KUDRET,Aslan Özgür,ÖZCAN Türkay,KANADAŞI Mehmet,Demir Mesut,Gökçe Mustafa,SUCU Mehmet Murat,Özdemir Murat,Yigit Zerrin,YAVUZKIR Mustafa Ferzeyn,Oto Ali Clinical practices of the management of nonvalvular atrial fibrillation and outcome of treatment: A representative prospective survey in tertiary healthcare centers across Turkey. Türk Kardiyoloji Derneği Arşivi 46, no.2 (2018): 92 - 102. 10.5543/tkda.2017.79367
MLA	Özin Mehmet Bülent,AYTEMIR KUDRET,Aslan Özgür,ÖZCAN Türkay,KANADAŞI Mehmet,Demir Mesut,Gökçe Mustafa,SUCU Mehmet Murat,Özdemir Murat,Yigit Zerrin,YAVUZKIR Mustafa Ferzeyn,Oto Ali Clinical practices of the management of nonvalvular atrial fibrillation and outcome of treatment: A representative prospective survey in tertiary healthcare centers across Turkey. Türk Kardiyoloji Derneği Arşivi, vol.46, no.2, 2018, ss.92 - 102. 10.5543/tkda.2017.79367
AMA	Özin M,AYTEMIR K,Aslan Ö,ÖZCAN T,KANADAŞI M,Demir M,Gökçe M,SUCU M,Özdemir M,Yigit Z,YAVUZKIR M,Oto A Clinical practices of the management of nonvalvular atrial fibrillation and outcome of treatment: A representative prospective survey in tertiary healthcare centers across Turkey. Türk Kardiyoloji Derneği Arşivi. 2018; 46(2): 92 - 102. 10.5543/tkda.2017.79367
Vancouver	Özin M,AYTEMIR K,Aslan Ö,ÖZCAN T,KANADAŞI M,Demir M,Gökçe M,SUCU M,Özdemir M,Yigit Z,YAVUZKIR M,Oto A Clinical practices of the management of nonvalvular atrial fibrillation and outcome of treatment: A representative prospective survey in tertiary healthcare centers across Turkey. Türk Kardiyoloji Derneği Arşivi. 2018; 46(2): 92 - 102. 10.5543/tkda.2017.79367
IEEE	Özin M,AYTEMIR K,Aslan Ö,ÖZCAN T,KANADAŞI M,Demir M,Gökçe M,SUCU M,Özdemir M,Yigit Z,YAVUZKIR M,Oto A "Clinical practices of the management of nonvalvular atrial fibrillation and outcome of treatment: A representative prospective survey in tertiary healthcare centers across Turkey." Türk Kardiyoloji Derneği Arşivi, 46, ss.92 - 102, 2018. 10.5543/tkda.2017.79367
ISNAD	Özin, Mehmet Bülent vd. "Clinical practices of the management of nonvalvular atrial fibrillation and outcome of treatment: A representative prospective survey in tertiary healthcare centers across Turkey". Türk Kardiyoloji Derneği Arşivi 46/2 (2018), 92-102. https://doi.org/10.5543/tkda.2017.79367