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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003ERecent large registry studies of patients with AF have found an increased use of oral anticoagulation for prevention of thromboembolic events, consistent with the most recent Professional Guidelines. Although AF management has improved in clinical practice, anticoagulation use is often inappropriate and mortality rates remain high.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eatrial fibrillation\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ebleeding\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EEORP-AF\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EGARFIELD-AF\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Emortality\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENOAC\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOAC\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eoral anticoagulation\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EORBIT-AF\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPREFER\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Estroke\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ethromboembolic events\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiology \u0026amp; cardiovascular medicine clinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecerebrovascular disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ethrombotic disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EAtrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with a heightened risk of morbidity and mortality. Many patients with occult AF are not diagnosed until they present with their first stroke. Most clinical guidelines recommend anticoagulation therapy for patients with AF except those at low risk for thromboembolic events [Jones C et al. \u003Cem\u003EBMJ\u003C\/em\u003E. 2014; Camm AJ et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E. 2012; Skanes AC et al. \u003Cem\u003ECan J Cardiol\u003C\/em\u003E. 2012; Fuster V et al. \u003Cem\u003ECirculation\u003C\/em\u003E. 2011]. The new European Society of Cardiology (ESC) guidelines suggest that treatment patterns have changed since the ESC EuroHeart survey was conducted a decade ago.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ELaurent Fauchier, MD, Universite Fran\u00e7ois Rabelais, Tours, France, discussed the EORP-AF General Registry, conducted to gain insights into current management of patients with AF [Lip GYH et al. \u003Cem\u003EEuropace\u003C\/em\u003E. 2014]. A total of 3049 patients from 9 countries were assessed at baseline and once a year for 3 years.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EAt baseline, common comorbidities included hypertension, coronary artery disease, and heart failure (HF). Oral anticoagulants (OACs) were used in \u0026gt;\u200578% of patients, most commonly vitamin K antagonists (VKAs; 71.6%). Other antithrombotics, mostly antiplatelet therapy with aspirin, were used in one-third of patients, and no antithrombotics in 4.8% of patients. The most common antiarrhythmic agent was amiodarone (21.5%). Rate control agents included \u03b2-blockers (69.2%) and digoxin (19.4%). OACs were used in 66.7% of patients with a CHA\u003Csub\u003E2\u003C\/sub\u003EDS\u003Csub\u003E2\u003C\/sub\u003E-VASc score of 9, with mostly antiplatelets in 33.3%.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EAt 1 year, 84% of patients on VKAs at baseline remained on VKAs (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [Lip GYH et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E. 2014]. Among patients on non-VKA OACs (NOACs) at baseline, 86% remained on NOACs, 11.8% had switched to a VKA, and 1.1% to antiplatelet therapy alone. By 1 year, interventions included cardioversion (electrical, 9.7%; pharmacologic, 5.1%) and catheter ablation (4.4%).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/22\/14\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Antithrombotic Use at 1 Year Based on Initial RegimenAntithrombotic therapy use at 1 year based on initial\/baseline antithrombotic regimen.ATT, antithrombotic therapy; VKA, vitamin K antagonist; AP, antiplatelet therapy (most commonly aspirin); OAC, oral anticoagulant therapy.Reprinted from Lip GY et al, Prognosis and treatment of atrial fibrillation patients by European cardiologists: One Year Follow-up of the EURObservational Research Programme-Atrial Fibrillation General Registry Pilot Phase (EORP-AF Pilot registry), Eur Heart J, 2014; Vol 35, Issue 47, Pages 3365-3376, by permission of Oxford University Press.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-86614542\u0022 data-figure-caption=\u0022\u0026amp;lt;div xmlns=\u0026amp;quot;http:\/\/www.w3.org\/1999\/xhtml\u0026amp;quot;\u0026amp;gt;Antithrombotic Use at 1 Year Based on Initial RegimenAntithrombotic therapy use at 1 year based on initial\/baseline antithrombotic regimen.ATT, antithrombotic therapy; VKA, vitamin K antagonist; AP, antiplatelet therapy (most commonly aspirin); OAC, oral anticoagulant therapy.Reprinted from Lip GY et al, Prognosis and treatment of atrial fibrillation patients by European cardiologists: One Year Follow-up of the EURObservational Research Programme-Atrial Fibrillation General Registry Pilot Phase (EORP-AF Pilot registry), \u0026amp;lt;em\u0026amp;gt;Eur Heart J\u0026amp;lt;\/em\u0026amp;gt;, 2014; Vol 35, Issue 47, Pages 3365-3376, by permission of Oxford University Press.\u0026amp;lt;\/div\u0026amp;gt;\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/22\/14\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/22\/14\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/22\/14\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16740\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EAntithrombotic Use at 1 Year Based on Initial Regimen\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EAntithrombotic therapy use at 1 year based on initial\/baseline antithrombotic regimen.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EATT, antithrombotic therapy; VKA, vitamin K antagonist; AP, antiplatelet therapy (most commonly aspirin); OAC, oral anticoagulant therapy.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EReprinted from Lip GY et al, Prognosis and treatment of atrial fibrillation patients by European cardiologists: One Year Follow-up of the EURObservational Research Programme-Atrial Fibrillation General Registry Pilot Phase (EORP-AF Pilot registry), \u003Cem\u003EEur Heart J\u003C\/em\u003E, 2014; Vol 35, Issue 47, Pages 3365-3376, by permission of Oxford University Press.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-10\u0022\u003EAt 1 year, 5.7% of the patients had died, with 57.4% attributable to cardiac causes, most commonly HF (77.3%). One-year mortality was highest among asymptomatic vs symptomatic patients (9.4% vs 4.2%; \u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.0001) [Boriani G et al. \u003Cem\u003EAm J Med\u003C\/em\u003E. 2015]. Appropriate OAC use was less frequent among asymptomatic patients.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EThe PREFER registry collected data from patients with AF in 7 European countries [Kirchhof P et al. \u003Cem\u003EEuropace\u003C\/em\u003E. 2014]. Luis M. Rinc\u00f3n, Hospital Universitario Ram\u00f3n y Cajal, Madrid, Spain, presented the data analysis from 7243 patients enrolled between January 2012 and January 2013. The patients were assessed at baseline and 1 year later.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EThe baseline analysis found a high rate of risk factors for stroke. The mean CHA\u003Csub\u003E2\u003C\/sub\u003EDS\u003Csub\u003E2\u003C\/sub\u003E-VASc score was 3.4\u2005\u00b1\u20051.8 and was \u2265\u20052 points in 84% of patients. At baseline, 86% of patients with a CHA\u003Csub\u003E2\u003C\/sub\u003EDS\u003Csub\u003E2\u003C\/sub\u003E-VASc score \u2265\u20052 and 70% of those with a CHA\u003Csub\u003E2\u003C\/sub\u003EDS\u003Csub\u003E2\u003C\/sub\u003E-VASc score of 1 had received OAC therapy. A comparison of antithrombotic treatment at baseline and follow-up showed that most eligible patients received OACs [Rincon LM et al. ESC 2014 (poster P6266)].\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EPatients treated with NOACs were more likely to have paroxysmal AF than those treated with VKAs (43.0% vs 23.5%; \u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.01) [Rincon LM et al. ESC 2013 (poster P5138)]. Patients treated with VKAs more often had long-standing persistent or permanent AF than those treated with NOACs (45.2% vs 30.3%; \u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.01). Patients receiving NOACs were younger than those treated with VKAs (70.3\u2005\u00b1\u200510.48 vs 72.1\u2005\u00b1\u200510.12 years; \u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.01). The mean CHA\u003Csub\u003E2\u003C\/sub\u003EDS\u003Csub\u003E2\u003C\/sub\u003E-VASc and HAS-BLED scores were comparable between patients receiving NOACs and VKAs. For patients on VKAs, 24.2% were not within the therapeutic treatment range (TTR) according to the last 3 international normalized ratio (INR) measurements. Physicians tended to overestimate the level of INR control as only 17.3% were considered to have TTR out of range when questioned.\u003C\/p\u003E\u003Cp id=\u0022p-14\u0022\u003EThe goal of the ORBIT-AF registry was to characterize the treatment and outcomes of patients with AF in the United States [Piccini JP et al. \u003Cem\u003EAm Heart J\u003C\/em\u003E. 2011]. About 10\u2005000 patients from about 200 sites were enrolled, most before the availability of NOACs. The main outcomes were stroke or systemic embolism (SE), major bleeding, and other major adverse cardiovascular events, with a 3-year follow-up. Benjamin A. Steinberg, MD, Duke University Medical Center, Durham, North Carolina, USA, highlighted new data on heart rate, anticoagulation, bleeding risk, management of concurrent antithrombotics, and anticoagulation interruptions.\u003C\/p\u003E\u003Cp id=\u0022p-15\u0022\u003EAt baseline, 30% of patients had a resting heart rate of \u0026gt;\u200580 bpm, and heart rate increased with increasing symptom severity [Steinberg BA et al. ACC. 2015 (poster 247)]. Adjusted data based on time-variable covariates showed a lower risk of all-cause and cardiovascular death at heart rates of about 60 to 70 bpm, with increased risk at lower and higher rates.\u003C\/p\u003E\u003Cp id=\u0022p-16\u0022\u003EAt least 1 contraindication to anticoagulation was present in 13% of patients, with the most common contraindications of prior bleeding (28%), patient refusal (28%), high bleeding risk (18%), and frequent falls or frailty (18%) [O\u2019Brien EC et al. \u003Cem\u003EAm Heart J\u003C\/em\u003E. 2014]. Mean CHADS\u003Csub\u003E2\u003C\/sub\u003E scores were higher among patients with contraindications to anticoagulation (2.53 vs 2.22 without contraindications). Comparison of ATRIA bleeding risk scores with subjective physician bleeding assessment showed 63% physician agreement with ATRIA\u2005\u2264\u20053, 33% agreement with ATRIA\u2005=\u20054, and 13% agreement with ATRIA\u2005\u2265\u20055 [Steinberg BA et al. \u003Cem\u003ECirculation\u003C\/em\u003E. 2014]. Anticoagulation use by bleeding risk according to ATRIA score and physician assessment is shown in \u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E.\u003C\/p\u003E\u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/22\/14\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022ORBIT-AF Registry: Anticoagulation According to Bleeding RiskATRIA indicates Anticoagulation and Risk Factors in Atrial Fibrillation; CHADS2, congestive heart failure, hypertension, age \u0026#x2265;75 years, diabetes mellitus, and previous stroke or transient ischemic attack; and OAC, oral anticoagulation.Reprinted from Steinberg BA et al. Lack of concordance between empirical scores and physician assessments of stroke and bleeding risk in atrial fibrillation: results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry, Circulation, 2014, Vol 129, Issue 20, Pages 2005-12, with permission from American Heart Association, Inc.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-86614542\u0022 data-figure-caption=\u0022\u0026amp;lt;div xmlns=\u0026amp;quot;http:\/\/www.w3.org\/1999\/xhtml\u0026amp;quot;\u0026amp;gt;ORBIT-AF Registry: Anticoagulation According to Bleeding RiskATRIA indicates Anticoagulation and Risk Factors in Atrial Fibrillation; CHADS2, congestive heart failure, hypertension, age \u0026#x2265;75 years, diabetes mellitus, and previous stroke or transient ischemic attack; and OAC, oral anticoagulation.Reprinted from Steinberg BA et al. Lack of concordance between empirical scores and physician assessments of stroke and bleeding risk in atrial fibrillation: results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry, \u0026amp;lt;em\u0026amp;gt;Circulation\u0026amp;lt;\/em\u0026amp;gt;, 2014, Vol 129, Issue 20, Pages 2005-12, with permission from American Heart Association, Inc.\u0026amp;lt;\/div\u0026amp;gt;\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/22\/14\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/22\/14\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/22\/14\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16741\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \u003Cp id=\u0022p-17\u0022 class=\u0022first-child\u0022\u003EORBIT-AF Registry: Anticoagulation According to Bleeding Risk\u003C\/p\u003E\u003Cp id=\u0022p-18\u0022\u003EATRIA indicates Anticoagulation and Risk Factors in Atrial Fibrillation; CHADS2, congestive heart failure, hypertension, age \u226575 years, diabetes mellitus, and previous stroke or transient ischemic attack; and OAC, oral anticoagulation.\u003C\/p\u003E\u003Cp id=\u0022p-19\u0022\u003EReprinted from Steinberg BA et al. Lack of concordance between empirical scores and physician assessments of stroke and bleeding risk in atrial fibrillation: results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry, \u003Cem\u003ECirculation\u003C\/em\u003E, 2014, Vol 129, Issue 20, Pages 2005-12, with permission from American Heart Association, Inc.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-20\u0022\u003EAmong patients prescribed OACs plus aspirin, 39% did not have vascular disease [Steinberg BA et al. \u003Cem\u003ECirculation\u003C\/em\u003E. 2013]. These patients had a significantly higher risk than those on OACs alone for major bleeding (HR, 1.53; 95% CI, 1.20 to 1.96; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.0006).\u003C\/p\u003E\u003Cp id=\u0022p-21\u0022\u003EBridging anticoagulation was used in 24% of patients requiring OAC interruption for procedures and was associated with a higher risk for bleeding and cardiovascular events [Steinberg BA et al. \u003Cem\u003ECirculation\u003C\/em\u003E. 2014].\u003C\/p\u003E\u003Cp id=\u0022p-22\u0022\u003EThe GARFIELD-AF registry [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01090362\u0026amp;atom=%2Fspmdc%2F15%2F22%2F14.atom\u0022\u003ENCT01090362\u003C\/a\u003E] is a large ongoing international prospective study of risk and outcomes in patients with newly diagnosed nonvalvular AF and \u2265\u20051 additional stroke risk factor. The study consists of 5 sequential cohorts, with the first beginning enrollment in 2010 and cohort 5 starting in 2015. A total of 42\u2005536 patients have been enrolled. John Camm, MD, St George\u2019s University, London, United Kingdom, presented the 1-year results from cohorts 1 and 2 (n\u2005=\u200517\u2005168).\u003C\/p\u003E\u003Cp id=\u0022p-23\u0022\u003EThe 1-year event rates per person per year were mortality at 4.06%, stroke or SE at 1.37%, and major bleeding at 0.85%.\u003C\/p\u003E\u003Cp id=\u0022p-24\u0022\u003EFactors associated with increased risk of death, stroke, or SE in the first year were age \u2265\u200575 years, current smoking, no anticoagulant therapy, renal failure, cardiac failure, diabetes, and time to therapeutic range \u0026lt;\u200560%. Current or previous hypertension, type of AF, and previous stroke or SE did not appear to increase risk. There was a trend for CHA\u003Csub\u003E2\u003C\/sub\u003EDS\u003Csub\u003E2\u003C\/sub\u003E-VASc and HAS-BLED risk scores to predict death, stroke or SE, and major bleeding events.\u003C\/p\u003E\u003Cp id=\u0022p-25\u0022\u003EPatients who did not receive anticoagulation therapy had a higher risk of death (HR, 1.55; 95% CI, 1.32 to 1.81) and stroke or SE (HR, 1.71; 95% CI, 1.31 to 2.24) and a lower risk of major bleeding at 1 year (HR, 0.44; 95% CI, 0.29 to 0.67).\u003C\/p\u003E\u003Cp id=\u0022p-26\u0022\u003EJohannes Brachmann, Klinikum Coburg, Coburg, Germany, focused on the detection of AF among stroke survivors. The risk of stroke can be decreased with anticoagulation therapy, but AF often is asymptomatic and only diagnosed after an index stroke [Keach JW et al. \u003Cem\u003EHeart\u003C\/em\u003E. 2015]. Clinical risk scores for identifying stroke patients at risk for AF have demonstrated high sensitivity and specificity in single studies [Fujii S et al. \u003Cem\u003EJ Neurol Sci\u003C\/em\u003E. 2013; Suissa L et al. \u003Cem\u003EStroke\u003C\/em\u003E. 2009] but have not been prospectively studied in large populations.\u003C\/p\u003E\u003Cp id=\u0022p-27\u0022\u003EIn a 2004 study of patients with acute stroke or transient ischemic attack (TIA), AF was diagnosed in 2.7% after 1 electrocardiogram (ECG), 11.5% after multiple ECGs, and 1.4% after 24-hour Holter ECG. Another study reported a 5-fold increase in AF detection after stroke or TIA with 30-day ECG vs short-duration ECG [Gladstone DJ et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E. 2014]. In the SURPRISE study, asymptomatic AF was detected by implantable loop recorder in 16.1% of patients at an average of 109 days after cryptogenic stroke [Christensen LM et al. \u003Cem\u003EEur J Neurol\u003C\/em\u003E. 2014].\u003C\/p\u003E\u003Cp id=\u0022p-28\u0022\u003ELong-term monitoring with an implantable cardiac monitor (ICM) was compared with conventional monitoring after cryptogenic stroke in 441 patients [Sanna T et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E. 2014]. The ICM significantly improved AF detection after 6 months (HR, 6.4; 95% CI, 1.9 to 21.7; \u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.001), 12 months (HR, 7.3; 95% CI, 2.6 to 20.8; \u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.001), and 36 months (HR, 8.8; 95% CI, 3.5 to 22.2; \u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.001).\u003C\/p\u003E\u003Cp id=\u0022p-29\u0022\u003EThe evidence indicates that cryptogenic stroke is frequently associated with a time-dependent high rate of AF detection. The high AF rate in this population led to a switch to OACs for most patients. Patients with cryptogenic stroke should be monitored with long-term continuous ECG by an insertable cardiac monitor.\u003C\/p\u003E\u003Cp id=\u0022p-30\u0022\u003EThese recent studies of patients with AF reported that OAC use is high and has increased since implementation of the latest ESC guidelines. Despite this increase, 1-year mortality and morbidity remain high. Inappropriate use of OACs for patients with few or no risk factors is common, and assessment of contraindications to OACs is a challenge. VKAs remain the most commonly used antithrombotic therapy, but INR control is often inadequate. Antiplatelet agents are widely used, but often inappropriately. NOAC use is most common among younger patients but is still low. Concomitant use of aspirin with OACs is associated with increased bleeding risk and no clear evidence of benefit.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/22\/14.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzl3ve\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzl3ve\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}