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NOAC in “real world” patients with atrial fibrillation in Italy: results from the ISPAF-2 (Indagine Sicoa Paziente Con Fibrillazione Atriale) survey study

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Abstract

In the past few years, new oral anticoagulants (NOACs) targeting directly a single activated clotting factor, have been developed for the treatment of non-valvular atrial fibrillation (AF), which are currently recommended as first-line therapy in AF. The aim of this study is to provide an overall picture on the extent to which oral anticoagulation (OAC) with NOACs correspond to actually prescribed OAC therapy in an unselected, real world, population of consecutive patients with AF in Italy. Compliance with the therapy and quality of life were also assessed. A 50 cardiology unit network located in different geographic areas of Italy enrolled a total of 1742 consecutive outpatients with AF (54.6% males, 45.4% females, mean age 72.5 years). NOACs were prescribed in 56.1% patients and VKA in 43.9% (P < 0.0001). NOACs were significantly more prescribed than VKA in patients with high thrombo-embolic risk score (i.e., CHA2DS2-VASc > 2) (78.2 vs 67.3%, P < 0.0001), but also patients at low risk (i.e., CHA2DS2-VASc < 1 and HAS-BLED < 3) were still under OAC therapy with either NOACs (27%) or VKA (73%). Adherence to therapy (Morisky test) was greater in patients taking NOACs as was the quality of life. The ISPAF-2 study shows that in an Italian population of real-world patients with AF the prescription of OAC according to current guidelines and stroke-risk scoring system is rather high although it still needs to be improved. Contrary to recommendations, in a high proportion of low-risk patients, anticoagulation therapy, with either NOACs and VKA is still prescribed, and this exposes patients to unjustified risks.

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Acknowledgements

List of SICOA (Società Italiana CardiologiaOspedalità Accreditata) Investigators: Caiazza Francesco, Casa di Cura Trusso, Ottaviano, Campania; Fazio Giovanni, Casa di Cura Triolo Zancla, Palermo, Sicilia; Esposito Nicolino, Fondazione Evangelica Villa Betania, Napoli, Campania; Guarini Pasquale, Ospedale Villa dei Fiori-Acerra, Napoli, Campania; Lai Ornella; Azienda Ospedaliera Universitaria di Cagliari, Sardegna; Margonato Alberto Ospadale San Raffaele, Milano, Lombardia; Marullo Luciano, casa di Cura Pineta Grande, Castel Volturno, Campania; Mascioli Giosuè, Humanitas Gavazzeni, Bergamo, Lombardia; Morace Nicola Antonio, Istituti Fisioterapici Ospitalieri, Roma, Lazio; Mori Francesca, Centro Cardio toracico Istituto Clinico San Ambrogio, Milano, Lombardia; Proto Alessandro, Ospedali Civili, Brescia, Lombaria; Severino Salvatore, Casa di Cura San Michele, Maddaloni Caserta, Campania; Sposato Barbara, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Pisana, Roma, Lazio; Storti Cesare, Casa di Cura Città di Pavia, Pavia, Lombardia; Vizzardi Enrico, Università degli Studi di Brescia, Brescia, Lombardia.

Author information

Authors and Affiliations

  1. Istituto di Ricovero e Cura a Carttere Scientifico San Raffaele Pisana, Rome, Italy

    Maurizio Volterrani & Ferdinando Iellamo

  2. Dipartimento Scienze Cliniche e Medicina traslazionale, Università Tor Vergata, Rome, Italy

    Ferdinando Iellamo

  3. San Raffaele University Hospital, Milan, Italy

    Cappelletti Alberto

  4. Casa di Cura Triolo Zancla, Palermo, Italy

    Alcamo Pasquale

  5. Ospedale Villa dei Fiori-Acerra, Naples, Italy

    Pezzullo Salvatore

  6. Casa di Cura Salus, Alessandria, Italy

    Piccinini Massimo

  7. Clinica del Mediterraneo, Ragusa, Italy

    Miano Marco

  8. Casa di Cura Petrucciani, Lecce, Italy

    Urso Lucia

  9. Istituto Clinico Sant’Anna, Brescia, Italy

    Proto Cesare

  10. Clinica Mediterranea, Naples, Italy

    Ricciardelli Bruno

  11. Centro Cardio toracico Istituto Clinico San Ambrogio, Milan, Italy

    Pusineri Enrico

  12. Cardiology Department, IRCCS San Raffaele Pisana, Rome, Italy

    Ferdinando Iellamo

Authors
  1. Maurizio Volterrani
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  3. Cappelletti Alberto
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  4. Alcamo Pasquale
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  6. Piccinini Massimo
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  7. Miano Marco
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  8. Urso Lucia
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  9. Proto Cesare
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  10. Ricciardelli Bruno
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  11. Pusineri Enrico
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Consortia

SICOA (Società Italiana Cardiologia Ospedalità Accreditata) Investigators

  • Caiazza Francesco
  • , Fazio Giovanni
  • , Esposito Nicolino
  • , Guarini Pasquale
  • , Lai Ornella
  • , Margonato Alberto
  • , Marullo Luciano
  • , Mascioli Giosuè
  • , Morace Nicola Antonio
  • , Mori Francesca
  • , Proto Alessandro
  • , Severino Salvatore
  • , Sposato Barbara
  • , Storti Cesare
  •  & Vizzardi Enrico

Corresponding author

Correspondence to Ferdinando Iellamo.

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Statement of human and animal rights

The procedure followed were in accordance with the ethical standards on human experimentation and with the Helsinki Declaration of 1975.

Informed consent

All patients gave written informed consent.

Additional information

The Members of SICOA (Società Italiana Cardiologia Ospedalità Accreditata) Investigators are listed in acknowledgements.

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Volterrani, M., Iellamo, F., Alberto, C. et al. NOAC in “real world” patients with atrial fibrillation in Italy: results from the ISPAF-2 (Indagine Sicoa Paziente Con Fibrillazione Atriale) survey study. Intern Emerg Med 13, 1069–1075 (2018). https://doi.org/10.1007/s11739-018-1896-9

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  • DOI: https://doi.org/10.1007/s11739-018-1896-9

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