Epidemiology of Atrial Fibrillation in Europe: A Comparison of the EURObservational Research Programme Atrial Fibrillation Pilot Registry and Euro Heart Survey on Atrial Fibrillation Marco Proietti, Paul-Edouard Bouvet, Cécile Laroche, Robby Nieuwlaat, Harry J.G.M. Crijns, Aldo P. Maggioni, Deirdre A. Lane, Giuseppe Boriani, Gregory Y.H. Lip. on behalf of EORP-AF General Pilot Registry and Euro Heart Survey on AF Investigators

- Consu lting/Royalties/Owner/ Stockholder of a healthcare company (Small consulting fee from Boehringer lngelheim)

Background Atrial Fibrillation (AF) epidemiology shows significant temporal trends These changes affect both prevalence, incidence as well as major adverse events Benjamin Circulation 2017;135:e146 Chugh Circulation 2014;129:837

Background In 2005, the European Society of Cardiology (ESC) conducted the Euro Heart Survey (EHS) on AF to assess current practice on AF and adherence to clinical guidelines In 2015, ESC concluded the 1 year follow-up of the EURObservational Research Programme AF (EORP-AF) Pilot Registry, aimed to investigate similar aims after ten years from the original EHS study Nieuwlaat EHJ 2005;26:2422 Lip Europace 2014;16:308

Aims We hypothesised differences in clinical and risk profiles, therapeutic approaches and outcomes between AF patients enrolled in EORP-AF and EHS. Methods A propensity score matching (PSM) based on age, gender, type of AF, BMI, sitting blood pressure and basic cardiovascular risk factors was built to match the two cohorts. Baseline characteristics and outcomes were compared following PSM pooled analysis between patients enrolled in the EORP-AF and EHS cohorts.

Results After propensity score matching 5206 patients (mean age 68.4 years, 59.1% males) were retrieved for analysis Differences in Baseline Characteristics *All comparisons presented are statistically significant different

Results EORP-AF patients had more prevalent oral anticoagulant (OAC) use (80.4% vs. 64.9%, p<0.001), with no differences in antiplatelet drugs use Differences in Distribution for Antithrombotic Patters in High Thromboembolic Risk Patients

Results Logistic Analysis for Outcomes at 1-year Follow-Up EORP-AF Pilot vs. EHS Model 1* Model 2† OR 95% CI p Stroke/TIA 0.18 0.07-0.44 <0.001 Stroke/TIA/PE 0.21 0.09-0.48 0.09-0.49 CAD/MI 0.55 0.38-0.79 0.001 0.56 0.38-0.83 0.004 Any Bleeding 0.72 0.33-1.56 0.400 0.63 0.27-1.50 0.300 CV Death 2.32 1.15-4.68 0.019 2.54 1.20-5.40 0.015 CV Death - Stroke/TIA - Any Bleeding 0.83 0.57-1.21 0.322 0.84 0.57-1.25 0.388 CV Death - CAD/MI 0.87 0.64-1.17 0.352 0.88 0.64-1.21 0.431 All-Cause Death 1.25 0.85-1.85 0.256 1.23 0.82-1.85 0.321 Readmission for AF 0.34 0.26-0.43 0.29 0.22-0.38 Readmission for Other CV Reasons 0.44 0.32-0.61 *Adjusted for age, gender, type of AF, CHA2DS2-VASc; †Adjusted for all previous covariates plus use of any OAC

Results Kaplan-Meier Curves for Cardiovascular and All-Cause Death at 1-year Follow-Up

Multivariate Analysis Results Cox Regression Analysis for Cardiovascular and All-Cause Death at 1-year Follow-Up Multivariate Analysis HR 95% CI p Cardiovascular Death All-Cause Death Age (per year) 1.04 1.02-1.06 <0.001 1.06 1.05-1.08 Type of AF First Detected - Paroxysmal 0.35 0.53 0.19-0.64 0.33-0.84 0.007 0.55 0.59 0.37-0.81 0.41-0.84 0.002 0.003 Persistent 0.62 0.39-0.97 0.037 0.81 0.59-1.13 0.221 Permanent Diabetes Mellitus 1.84 1.28-2.65 0.001 1.61 1.22-2.11 Vascular Disease 2.32 1.60-3.36 1.79 1.36-2.34 Chronic Heart Failure 4.11 2.64-6.42 2.49 1.88-3.30 EORP-AF Pilot (vs. EHS) 1.62 1.08-2.45 0.021

Conclusions Significant temporal changes are found in AF epidemiology, with contemporary patients being older and more burdened with comorbidities. Changes are evident in patients’ management, with a greater use of OAC. Despite these changes leading to a reduction in risk in thromboembolic events, a residual excess risk of CV-related death is evident.