Stroke prevention in atrial fibrillation and ‘real world’ adherence to guidelines in the Balkan Region: The BALKAN-AF Survey
Authors: Potpara Tatjana S. , Dan Gheorghe-Andrei , Trendafilova Elina , Goda Artan , Kusljugic Zumreta , Manola Sime , Music Ljilja , Musetescu Rodica , Badila Elisabeta , Mitic Gorana , Paparisto Vilma , Dimitrova Elena S. , Polovina Marija M. , Petranov Stanislav L. , Djergo Hortensia , Loncar Daniela , Bijedic Amira , Brusich Sandro , Lip Gregory Y. H. ,   The BALKAN-AF Investigators, Potpara Tatjana S. , Polovina Marija , Milanov Srdjan , Pavlovic Marija , Petrovic Marijana , Simovic Stefan , Mitic Gorana , Milanov Marko , Savic Jelena , Gnip Sanja , Radovic Pavica , Markovic Snezana , Koncarevic Ivana , Gavrilovic Jelena , Acimovic Tijana , Djikic Dijana , Malic Semir , Hodzic Jusuf , Stojanovic Milovan , Ilic Marina Deljanin , Zlatar Milan , Matic Dragan , Lazic Snezana , Peric Vladan , Markovic Sanja , Kovacevic Snezana , Arandjelovic Aleksandra , Asanin Milika , Zdravkovic Marija , Dan Gheorghe-Andrei , Breha Anca , Dan Anca Rodica , Musetescu Rodica , Popescu Mircea Ioachim , Badila Elisabeta , Georgescu Catalina Arsenescu , Pop Sorina , Popescu Raluca , Neamtu Simina , Oancea Floriana , Trendafilova Elina , Dimitrova Elena , Goshev Evgenii , Velichkova Anna , Petranov Stanislav , Kamenova Delyana , Kamenova Penka , Elefterova Svetoslava , Shterev Valentin , Zekova Maria , Diukiandzhieva Stela , Dimitrov Boiko , Sotirov Tihomir , Simeonova Valentina , Drianovska Dimitrina , Boiadzhieva Liliya Ivanova Vasileva , Buchukova Darina , Goda Artan , Paparisto Vilma , Gjergo Hortensia , Mijo Alma , Shirka Ervina , Gjini Viktor , Ekmekciu Uliks , Refatllari Ina , Kusljugic Zumreta , Loncar Daniela , Mrsic Denis , Tulumovic Hazim , Pojskic Belma , Sijamija Alma , Bijedic Amira , Karamujic Indira , Bijedic Irma , Halilovic Sanela , Sokolovic Sekib , Manola Sime , Zeljkovic Ivan , Pavlovic Nikola , Radeljic Vjekoslav , Brusich Sandro , Anic Ante , Jeric Melita , Pekic Petar , Milas Kresimir , Music Ljilja , Bulatovic Nebojsa , Nenezic Ana , Asanovic Dijana 
Published: February 2016

Data on the management of atrial fibrillation (AF) in the Balkan Region are limited. The Serbian AF Association (SAFA) prospectively investigated contemporary ‘real-world’ AF management in clinical practice in Albania, Bosnia&Herzegovina, Bulgaria, Croatia, Montenegro, Romania and Serbia through a 14-week (December 2014-February 2015) prospective, multicentre survey of consecutive AF patients. We report the results pertinent to stroke prevention strategies. Of 2712 enrolled patients, 2663 (98.2%) with complete data were included in this analysis (mean age 69.1 ± 10.9 years, female 44.6%). Overall, 1960 patients (73.6%) received oral anticoagulants (OAC) and 762 (28.6%) received antiplatelet drugs. Of patients given OAC, 17.2% received non-vitamin K antagonist oral anticoagulants (NOACs). CHA2DS2-VASc score was not significantly associated with OAC use. Of the ‘truly low-risk’ patients (CHA2DS2-VASc = 0 [males], or 1 [females]) 56.5% received OAC. Time in Therapeutic Range (TTR) was available in only 18.7% of patients (mean TTR: 49.5% ± 22.3%). Age ≥ 80 years, prior myocardial infarction and paroxysmal AF were independent predictors of OAC non-use. Our survey shows a relatively high overall use of OAC in AF patients, but with low quality of vitamin K antagonist therapy and insufficient adherence to AF guidelines. Additional efforts are needed to improve AF-related thromboprophylaxis in clinical practice in the Balkan Region.