Clinical Survey on the Stroke Prevention in Atrial Fibrillation in Asia

This is a prospective observational study on the current practice of stroke prevention for AF in Asia. We propose to recruit 5,000 patients (~1000 patients per country) from 5 countries in Asia-Pacific regions (Hong Kong, Japan, Taiwan, Singapore, Korea). Patients who are currently follow-up or newly diagnosed AF in these countries will be enrolled and follow-up for 1 year. Their clinical data on baseline, and 12 months follow-up will be recorded (based on the template of the European AF survey- in collaboration with ESC). All patients will be treated according to the clinical practice in their hospital or clinic. Data on their baseline demographic information, including the CHADS2, CHADS2-VAS score, HAS-BLED score, clinical events, including death, ischemic and hemorrhagic stroke, major bleeding events and morality will be collected via a web-based electronic system based on Case Report form of the EurObservational Research Programme on Atrial Fibrillation General Long-Term study.

The general objectives of the APHRS AF registry on clinical epidemiology and medical management of atrial fibrillation are summarized as follows:

• To verify the applicability, and to adapt or strengthen international practice guidelines (recommendations) on the diagnosis and treatment of AF and facilitate implementation of such guidelines.
• To investigate the applicability of the results of clinical trials in everyday practice.
• To analyse the outcome of different disease management strategies.
• To foster the implementation of evidence-based medicine.

The specific objectives of this APHRS AF long term registry are to:

• Assess whether the diagnostic work-up of AF complies with current international guidelines.
• Evaluate appropriateness of treatment in the different subsets of AF in relation to the current clinical guidelines on AF.
• Evaluate the use of oral antithrombotic therapies, antiplatelet therapy (aspirin +/- clopidogrel); with the Vitamin K antagonists or with the new drugs (oral direct thrombin inhibitors or oral Factor Xa inhibitors) as they become available. Furthermore, the characteristics, co-morbidities, and risk factors of AF patients who receive different antithrombotic strategies will also be collected.
• For those patients who received VKA, we plan to determine what proportions of time these AF patients have achieved an INR 2.0-3.0 or INR <2.0 or >3.0. Moreover, the patients characteristics/co-morbidities are associated with different INR ranges and their clinical outcomes (stroke or major bleed) will also investigated.
• To study the persistence of antithrombotic therapies for AF in Asia. Specifically, we will determine the discontinuation and switch rates for VKA or different novel anticoagulants. Moreover, the clinical characteristics, co-morbidities and the reasons for discontinuation or switching as well as the outcomes (stroke, death, or major bleed) among discontinued and switched patients will be documented.
• To study the efficacy (stroke/death), risk (bleeding) and health resource utilization of various anti-thrombotic therapies for real-world stroke prevention in the Asian population.
• To study the utilization of different antithrombotic therapies during cardioversion and catheter ablation.
• Describe the use of new antiarrhythmic therapy options such as catheter ablation and newly available antiarrhythmic drugs.
• Estimate AF-related symptoms and AF-related changes in quality of life.
• Obtain contemporary information on the occurrence of AF-related complications. Specifically, the ischemic stroke related to AF in the Asian population as stratified by the CHADS2 and CHADS2-VAS score.
• Evaluate mortality and morbidity in relation to therapeutic decisions including adherence to guidelines in the AF cohort at 1 year.
• Assess progression of atrial fibrillation from paroxysmal (self-terminating) to persistent (non-self-terminating) atrial fibrillation. To assess the impact of validated and less well-established risk factors for progression of atrial fibrillation, including duration of history of associated diseases, blood pressure, BMI, kidney function, BNP levels and pulmonary disease.

Inclusion criteria

• Patients will be officially enrolled in the study only if ECG diagnosis of AF has been made.
• The qualifying episode of AF should have occurred within one year before the date of baseline.
• AF is the primary or secondary diagnosis, i.e. the current admission / visit may be due to other reasons.
• Patients need not be in AF at the time of enrolment.
• Signed Patient Inform Consent if applicable

Exclusion criteria

• No ECG/Holter with AF recorded.
• Only atrial flutter recorded.
• The qualifying episode of AF occurred more than one year before the date of baseline.
• Age <18 years.