The First Brazilian Cardiovascular Registry of Atrial Fibrillation: Primary Results of the RECALL Study - 13/09/23
, Pedro G.M. de Barros e Silva, MD, MHS, PhD a, c, d, Conrado Roberto Hoffmann Filho, MD, MSc e, Margaret Assad Cavalvante, MD, MSc f, Claudia Madeira Miranda, MD, MSc g, Rodrigo Barbosa Esper, MD, PhD h, Gustavo Glotz de Lima, MD, PhD i, Luiz Eduardo Fonteles Ritt, MD, PhD j, k, Rose Mary Ferreira Lisboa da Silva, MD, PhD l, Marcelo A. Nakazone, MD, PhD m, Adail Paixão Almeida, MD n, Ricardo Pavanello, MD, PhD c, Carlos Eduardo Batista de Lima, MD, PhD o, Luciano Marcelo Backes, MD p, Lucas Hollanda Oliveira, MD, MSc q, Olga Ferreira de Souza, MD, PhD r, Adalberto Menezes Lorga Filho, MD, PhD s, Epotamenides Maria Good God, MD, PhD t, José Carlos Moura Jorge, MD, PhD u, Alcirley de Almeida Luiz, MD v, w, Simone Fialho Pereira Pimentel Martins, MD x, Rogério Carregoza Dantas, MD, MSc y, Ricardo D´Oliveira Vieira, MD, PhD z, Leandro Ioschpe Zimerman, MD, PhD aa, Álvaro Rabelo Alves Júnior, MD bb, Márcio Jansen de Oliveira Figueiredo, MD, PhD cc, Samara Pinheiro do Carmo Gomes, BSc c, Lucas Martins de Lima, RMD c, Lucas Petri Damiani, PhD a, c, Ricardo Alkmim Teixeira, MD, PhD dd, ee, ff, Alexandro Alves Fagundes, MD dd, Eduardo Benchimol Saad, MD, PhD dd, gg, hhon behalf of the
RECALL Investigators
Résumé |
Background |
It is estimated that atrial fibrillation (AF) affects approximately 1.5 million people in Brazil; however, epidemiological data are limited. We sought to evaluate the characteristics, treatment patterns, and clinical outcomes in patients with AF in Brazil by creating the first nationwide prospective registry.
Methods |
RECALL was a multicenter, prospective registry that included and followed for 1 year 4,585 patients with AF at 89 sites across Brazil from April 2012 to August 2019. Patient characteristics, concomitant medication use, and clinical outcomes were analyzed using descriptive statistics and multivariable models.
Results |
Of 4,585 patients enrolled, the median age was 70 (61, 78) years, 46% were women, and 53.8% had permanent AF. Only 4.4% of patients had a history of previous AF ablation and 25.2% had a previous cardioversion. The mean (SD) CHA2DS2-VASc score was 3.2 (1.6); median HAS-BLED score was 2 (2, 3). At baseline, 22% were not on anticoagulants. Of those taking anticoagulants, 62.6% were taking vitamin K antagonists and 37.4% were taking direct oral anticoagulants. The primary reasons for not using an oral anticoagulant were physician judgment (24.6%) and difficulty in controlling (14.7%) or performing (9.9%) INR. Mean (SD) TTR for the study period was 49.5% (27.5). During follow-up, the use of anticoagulants and INR in the therapeutic range increased to 87.1% and 59.1%, respectively. The rates/100 patient-years of death, hospitalization due to AF, AF ablation, cardioversion, stroke, systemic embolism, and major bleeding were 5.76 (5.12-6.47), 15.8 (14.6-17.0), 5.0 (4.4-5.7), 1.8 (1.4-2.2), 2.77 (2.32-3.32), 1.01 (0.75-1.36), and 2.21 (1.81-2.70). Older age, permanent AF, New York Heart Association class III/IV, chronic kidney disease, peripheral arterial disease, stroke, chronic obstructive pulmonary disease, and dementia were independently associated with increased mortality while the use of anticoagulant was associated with lower risk of death.
Conclusions |
RECALL represents the largest prospective registry of patients with AF in Latin America. Our findings highlight important gaps in treatment, which can inform clinical practice and guide future interventions to improve the care of these patients.
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Vol 264
P. 97-105 - octobre 2023 Retour au numéro
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