Contemporary Characteristics, Management, and Outcomes of Patients Hospitalized for Atrial Fibrillation in China: Results from the Real-World Study of Chinese Atrial Fibrillation Registry
Atrial fibrillation (AF) is a significant and growing public health concern, particularly in the context of the global epidemiologic transition from communicable to non-communicable diseases. In China, AF has been identified as a major contributor to in-hospital mortality, underscoring the need for a deeper understanding of its clinical characteristics, management, and outcomes in this population. While much of the existing knowledge about AF is derived from clinical trials and observational studies conducted in North America and Western Europe, there is a paucity of data specific to China. This study aims to fill this gap by providing a comprehensive analysis of AF patients hospitalized in China, utilizing data from the Real-World Study of Chinese Atrial Fibrillation (RWS-CAF) registry.
The RWS-CAF registry is a multicenter, observational, prospective cohort study that includes consecutive patients requiring hospitalization with a diagnosis of AF, as per the Chinese AF guidelines. The study spanned from November 1, 2017, to October 31, 2018, and involved 362 grade A class three hospitals across China. Patients aged 18 years or older with a primary discharge diagnosis of AF were recruited. Data were collected using case report forms and entered into an internet-based system. The collected data encompassed a wide range of variables, including age, sex, type of AF, body mass index, valvular or non-valvular AF, hypertension, coronary heart disease (CHD), heart failure, diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), CHA2DS2-VASc score, and HAS-BLED score. Treatment-related data, including medications and ablation procedures, were also collected during hospitalization.
The study sample comprised 170,646 hospitalized patients with AF as the primary discharge diagnosis. The mean age of the patients was 68.7 years, with 55.9% being male. The type of AF was available for 151,457 patients (88.8%), with 54.3% having paroxysmal AF, 25.3% having persistent AF, and 9.2% having long-standing persistent and permanent AF. The most common comorbidities among AF patients were hypertension (42.7%), followed by CHD (25.9%), heart failure (21.4%), DM (14.3%), cardiomyopathy (4.7%), and COPD (2.9%).
The CHA2DS2-VASc score, which is used to assess the risk of stroke in AF patients, was available for 137,181 patients (80.4%). Of these, 64.8% received anticoagulant treatment, 4.9% received antiplatelet treatment, and 30.3% received no anticoagulant therapy. Notably, 66% of patients had a CHA2DS2-VASc score of 2 or more, indicating a higher risk of stroke. Among these high-risk patients, 79.1% received anticoagulant treatment, while 21.9% did not. Conversely, 51.8% of patients with a CHA2DS2-VASc score of 0 or 1, indicating a lower risk of stroke, received anticoagulant treatment. New oral anticoagulants were more commonly used than warfarin in patients with a CHA2DS2-VASc score of 2 or more (53.6% vs. 46.4%), whereas warfarin was more commonly used in patients with a CHA2DS2-VASc score of 0 or 1 (56.7% vs. 43.6%).
In terms of ablation procedures, pulmonary vein isolation was the most commonly performed procedure, either alone or in combination with additional ablation techniques. Among patients who underwent radiofrequency ablation, 77.6% had pulmonary vein isolation alone, while 22.4% had it combined with other ablation procedures. Pulmonary vein isolation alone was also more frequently used in patients with long-standing persistent AF (67.7% vs. 32.3%). However, 15.4% of patients with paroxysmal AF underwent pulmonary vein isolation combined with additional ablation procedures. For patients who did not undergo ablation, only 30.7% received anti-arrhythmic drug therapy. The most commonly used anti-arrhythmic drugs were beta-blockers (31.0%), followed by amiodarone (21.5%), propafenone (14.7%), sotalol (15.1%), and moricizine (1.0%).
The findings of this study highlight several key points regarding the clinical characteristics, management, and outcomes of AF patients in China. First, hypertension and CHD are the most common comorbidities of AF in Chinese patients, with a lower prevalence of comorbid DM and COPD. The high prevalence of hypertension and CHD among AF patients may be related to atrial hypertension and atrial ischemia, respectively. Second, there is a significant gap in the use of anticoagulant therapy among AF patients in China. While the majority of high-risk patients (CHA2DS2-VASc score ≥2) received anticoagulant treatment, a substantial proportion (21.9%) did not. Conversely, a considerable number of low-risk patients (CHA2DS2-VASc score 0 or 1) received anticoagulant treatment, suggesting a need for more precise evaluation of anticoagulant therapy indications by clinicians in China. Third, the use of anti-arrhythmic drug therapy among non-ablation patients is relatively low, with only 30.7% receiving such treatment.
The study also sheds light on the preference for new oral anticoagulants over warfarin in high-risk patients, likely due to their ease of use and fewer monitoring requirements. However, the continued use of warfarin in some patients, particularly those with lower stroke risk, may be attributed to its lower cost. The findings underscore the need for further optimization of anticoagulant and anti-arrhythmic drug therapy for AF patients in China.
In conclusion, the RWS-CAF registry provides valuable insights into the contemporary characteristics, management, and outcomes of AF patients hospitalized in China. The study highlights the high prevalence of hypertension and CHD among AF patients, the gaps in anticoagulant therapy, and the relatively low use of anti-arrhythmic drug therapy. These findings underscore the need for continued efforts to improve the management of AF in China, particularly in the areas of anticoagulant and anti-arrhythmic therapy. The data from this study can inform clinical practice and guide future research aimed at improving outcomes for AF patients in China.
doi.org/10.1097/CM9.0000000000001151
Was this helpful?
0 / 0