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Medic-All Cardiac Electrophysiology Team, Taichung VGH 〉 Stroke Prevention in Atrial Fibrillation in Asia

Stroke Prevention in Atrial Fibrillation in Asia

Stroke Prevention in Atrial Fibrillation in Asia

Verify the applicability and adapt or strengthen international practice guidelines (recommendations) on the diagnosis and treatment of AF and facilitate im

Request for Collaboration
Overview
This is a prospective observational study on the current practice of stroke prevention for AF in Asia. We propose to recruit 5,000 patients (~1000 patients per country) from 5 countries in Asia-Pacific regions (Hong Kong, Japan, Taiwan, Singapore, Korea). Patients who are currently follow-up or newly diagnosed AF in these countries will be enrolled and follow-up for 1 year. Their clinical data on baseline, and 12 months follow-up will be recorded (based on the template of the European AF survey- in collaboration with ESC).

All patients will be treated according to the clinical practice in their hospital or clinic. Data on their baseline demographic information, including the CHADS2, CHADS2-VAS score, HAS-BLED score, clinical events, including death, ischemic and hemorrhagic stroke, major bleeding events and morality will be collected via a web-based electronic system based on Case Report form of the EurObservational Research Programme on Atrial Fibrillation General Long-Term study.
Features
The general objectives of the APHRS AF registry on clinical epidemiology and medical management of atrial fibrillation are summarized as follows: 
  1. To verify the applicability, and to adapt or strengthen international practice guidelines (recommendations) on the diagnosis and treatment of AF and facilitate implementation of such guidelines. 
  2. To investigate the applicability of the results of clinical trials in everyday practice. 
  3. To analyse the outcome of different disease management strategies. 
  4. To foster the implementation of evidence-based medicine.

Despite relatively lower prevalence of atrial fibrillation (AF) in Asians (~1%) than Caucasians (~2%) as reported in observational studies, Asia has a much higher overall disease burden, due to its proportionally larger aged population. Based on reported prevalence rates and projected population figures in Asia, there will be an estimated 49 million men and 23 million women with AF, by year 2050. Stroke is a disabling complication of AF that is of particular cause for concern in Asians patients. Implementing consensus expert recommendations for managing stroke risk in AF patients can considerably reduce stroke rates. However, caution is necessary when aligning management of Asian AF patients to that of their Caucasian counterparts. Current international guidelines and risk stratification tools for AF management are based on findings in predominantly Caucasian populations and may therefore have limited relevance, in certain respects, to Asian patients. The vitamin K antagonist (VKA), warfarin and alternative new oral anticoagulants, direct thrombin inhibitors or factor Xa inhibitors is recommended for reducing the risk of stroke and thromboembolism in high-risk patients with non-valvular AF.

However, there is very limited information about the safety and efficacy of those agents in Asian population. Therefore, further research is urgently needed to inform specific guidance on the implications of different stroke and bleeding profiles in Asians versus Caucasians.

In order to allow comparison between Asians versus Caucasians population, we propose to adopt the current study protocol and case report form of the EurObservational Research Programme on Atrial Fibrillation General Long-Term study.
Collaboration Options
Work with APHRS Practice guideline subcommittee.
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