RE-LY AF Registry: Hypertension Most Common Risk Factor Worldwide

March 5, 2014
Payal Kohli, MD

Comprising 15,400 patients from 46 countries, the RE-LY AF registry offers a notable opportunity to study variations in presentation of atrial fibrillation and its risk factors.

The RE-LY AF registry consists of 15,400 patients from 46 countries, who presented to the emergency room for any reason between September 2008 and April 2011 and were found to be in atrial fibrillation (AF). As a result of its unselective nature, this registry provides a real-world representation of patterns in AF clinical presentation and disease management. Therefore, it can shed some light on and help us characterize and better understand differences in AF presentation and comorbid disease so that we can improve prevention and treatment.

Baseline characteristics of patients in the registry varied widely across the different countries. The mean age of patients at presentation was 66 years (range, 57 years in Africa to 70 years in North America), and approximately 65% of patients had a previous history of AF. Hypertension was the most common risk factor for AF, with the highest incidence in Eastern Europe (81%) and the lowest incidence in India (42%). There was also a wide range in the incidence of rheumatic heart disease as a risk factor for AF, from a low of 2% in North America to 32% in India.

Similarly, there were some provocative differences in the use of evidence-based therapies for AF. Oral anticoagulation for patients with a CHADS2 score of 2 or greater was common in North America (66%) but highly uncommon in China (11%). Notably, even in North America, one-third of patients with CHADS2 of 2 or greater were not anticoagulated. And among those patients who were anticoagulated, the time in INR therapeutic range was quite poor for all parts of the world. It varied between 32% and 40% in India, China, Southeast Asia, and Africa to 51% in North America and 62% in Western Europe.

The RE-LY AF registry results point to significant variation in age, risk factors, comorbidities, and treatment associated with AF and lay the groundwork to better understand geographic and socioeconomic differences in the epidemiology and management of the disease. They also highlight the global nature of the AF epidemic. Finally, these results emphasize the need to improve risk factor management and therapeutic interventions in AF.

References:

Oldgren J, Healey JS, Ezekowitz M, et al. Variations in etiology and management of atrial fibrillation in a prospective registry of 15,400 emergency department patients in 46 countries: the RE-LY AF registry. Circulation. [Epub ahead of print January 24, 2014]. DOI: CIRCULATIONAHA.113.005451