The Patterns of Non-vitamin K Antagonist Oral Anticoagulants (NOACs) Use in Patients with Atrial Fibrillation in Seven Balkan Countries: a Report from the BALKAN-AF Survey

Abstract

IntroductionData on management of atrial fibrillation (AF) in the Balkan Region are scarce. To capture the patterns in AF management in contemporary clinical practice in the Balkan countries a prospective survey was conducted between December 2014 and February 2015, and we report results pertinent to the use of non-vitamin K antagonist oral anticoagulants (NOACs).MethodsA 14-week prospective, multicenter survey of consecutive AF patients seen by cardiologists or internal medicine specialists was conducted in Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Montenegro, Romania, and Serbia (a total of about 50 million inhabitants).ResultsOf 2712 enrolled patients, 2663 (98.2%) had complete data relevant to oral anticoagulant (OAC) use (mean age 69.1 ± 10.9 years, female 44.6%). Overall, OAC was used in 1960 patients (73.6%) of whom 338 (17.2%) received NOACs. Malignancy [odds ratio (OR), 95% confidence interval (CI) 2.06, 1.20–3.56], rhythm control (OR 1.64, 1.25–2.16), and treatment by cardiologists were independent predictors of NOAC use (OR 2.32, 1.51–3.54) [all p < 0.01)], whilst heart failure and valvular disease were negatively associated with NOAC use (both p < 0.01). Individual stroke and bleeding risk were not significantly associated with NOAC use on multivariate analysis.ConclusionsNOACs are increasingly used in AF patients in the Balkan Region, but NOAC use is predominantly guided by factors other than evidence-based decision-making (e.g., drug availability on the market or reimbursement policy). Efforts are needed to establish an evidence-based approach to OAC selection and to facilitate the optimal use of OAC, thus improving the outcomes in AF patients in this large region.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-017-0589-5) contains supplementary material, which is available to authorized users.

Profiling Clinical Characteristics and Treatment Patterns Among Non-Valvular Atrial Fibrillation Patients: A Real-World Analysis in Dubai, United Arab Emirates

“…Although our current analysis was subject to loss of almost 50% of the patients due to lack of complete demographic information, the mean ages of patients were ten years younger compared to US studies [20 -22] as well as European studies [21,22]. Prior studies have found that around 30-80% of AF patients are comorbid with several severe conditions such as chronic kidney disease, obesity, coronary arterial disease, diabetes mellitus, hypertension, congestive heart failure, and hyperlipidemia, to name a few [4,15,23].…”

Trends in the Prescription of Non-Vitamin K Antagonist Oral Anticoagulants for Atrial Fibrillation: Results of the Polish Atrial Fibrillation (POL-AF) Registry

“…The highest proportion of patients treated with apixaban was also declared in The Norwegian Patient Registry [19]. In the present study, a reduced NOAC dose was most often administered to patients treated with dabigatran, just as in the Norwegian Patient Registry [20].…”

Stroke prevention in elderly patients with non‐valvular atrial fibrillation in the BALKAN‐AF survey

“…Nonetheless, our survey found that NOACs were only used in approximately 13%, and this was not different whether in elderly or nonelderly subgroups. Of note, other factors such as drug availability on the market or reimbursement policy were shown to guide the use of NOACs for stroke prevention in AF patients in the Balkan Region …”