Epidemiology of atrial fibrillation in a representative sample of the European part of the Russian Federation. Analysis of EPOCH-CHF study

Aim    To study true prevalence of atrial fibrillation (AF) in a representative sample from the European part of the Russian Federation; to describe characteristics of patients with AF; and to provide the frequency of anticoagulant treatment.
Material and methods    Cross-sectional data of the EPOCH epidemiological study (2017) were used. Data were collected in 8 constituent entities of the Russian Federation; the sample size was 11 453 people. The sample included all respondents who had given their consent for participation and were older than 10 years. Statistical tests were performed in the R system for statistical data analysis.
Results    The prevalence of AF in the representative sample from the European part of the Russian Federation was 2.04 %. The AF prevalence increased with age and reached a maximum value of 9.6% in the age group of 80 to 89 years. The AF prevalence among females was 1.5 times higher than among men. With age standardization, the AF prevalence was 18.95 and 21.33 per 1,000 people for men and women, respectively. The AF prevalence increased in the presence of concurrent cardiovascular diseases (CVDs) or diabetes mellitus as well as with an increased number of comorbidities in the same person and reached 70.3 and 60.0 % in patients with 4 and 5 comorbidities, respectively. Patients with AF had a greater number of comorbidities and higher CHA2DS2VASc scores (5.0 vs. 2.0, p<0.001) compared to patients with CVDs without AF. Only 22.6 % of patients with CVD and AF took anticoagulants. Only 23.9% of patients with absolute indications for the anticoagulant treatment received anticoagulants.
Conclusion    The AF prevalence in the European part of the Russian Federation was 2.04 %; it increased with age and in patients with concurrent CVDs or diabetes mellitus. Most of AF patients (93.2 %) required a mandatory treatment with oral anticoagulants.

1. Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. European Heart Journal. 2020;42(5):373–498. DOI: 10.1093/eurheartj/ehaa612

2. Thygesen LC, Ersbøll AK. When the entire population is the sample: strengths and limitations in register-based epidemiology. European Journal of Epidemiology. 2014;29(8):551–8. DOI: 10.1007/s10654-013-9873-0

3. Polyakov D.S., Fomin I.V., Belenkov Yu.N., Mareev V.Yu., Ageev F.T., Artemjeva E.G. et al. Chronic heart failure in the Russian Federation: what has changed over 20 years of follow-up? Results of the EPOCH-CHF study. Kardiologiia. 2021;61(4):4–14. DOI: 10.18087/cardio.2021.4.n1628

4. R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. [Internet] Available at: https://www.r-project.org/

5. Sjalander S, Sjalander A, Svensson PJ, Friberg L. Atrial fibrillation patients do not benefit from acetylsalicylic acid. Europace. 2014;16(5):631–8. DOI: 10.1093/europace/eut333

6. Connolly S, Pogue J, Hart R, Pfeffer M, Hohnloser SH, Chrolavicius S et al. Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomised controlled trial. The Lancet. 2006;367(9526):1903–12. DOI: 10.1016/S0140-6736(06)68845-4

7. Lip GYH, Brechin CM, Lane DA. The Global Burden of Atrial Fibrillation and Stroke: A systematic review of the epidemiology of atrial fibrillation in regions outside North America and Europe. Chest. 2012;142(6):1489–98. DOI: 10.1378/chest.11-2888

8. Colilla S, Crow A, Petkun W, Singer DE, Simon T, Liu X. Estimates of Current and Future Incidence and Prevalence of Atrial Fibrillation in the U.S. Adult Population. The American Journal of Cardiology. 2013;112(8):1142–7. DOI: 10.1016/j.amjcard.2013.05.063

9. Heeringa J, van der Kuip DAM, Hofman A, Kors JA, van Herpen G, Stricker BHCh et al. Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. European Heart Journal. 2006;27(8):949–53. DOI: 10.1093/eurheartj/ehi825

10. Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001;285(18):2370–5. DOI: 10.1001/jama.285.18.2370

11. Schnabel RB, Yin X, Gona P, Larson MG, Beiser AS, McManus DD et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet. 2015;386(9989):154–62. DOI: 10.1016/S0140-6736(14)61774-8

12. Krijthe BP, Kunst A, Benjamin EJ, Lip GYH, Franco OH, Hofman A et al. Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. European Heart Journal. 2013;34(35):2746–51. DOI: 10.1093/eurheartj/eht280

13. Wyse DG, Van Gelder IC, Ellinor PT, Go AS, Kalman JM, Narayan SM et al. Lone Atrial Fibrillation: does it exist? Journal of the American College of Cardiology. 2014;63(17):1715–23. DOI: 10.1016/j.jacc.2014.01.023

14. Jahangir A, Lee V, Friedman PA, Trusty JM, Hodge DO, Kopecky SL et al. Long-Term Progression and Outcomes With Aging in Patients with Lone Atrial Fibrillation: A 30-Year Follow-Up Study. Circulation. 2007;115(24):3050–6. DOI: 10.1161/CIRCULATIONAHA.106.644484

15. Weijs B, Pisters R, Nieuwlaat R, Breithardt G, Le Heuzey J-Y, Vardas PE et al. Idiopathic atrial fibrillation revisited in a large longitudinal clinical cohort. Europace. 2012;14(2):184–90. DOI: 10.1093/europace/eur379

16. Lin K, Marine JE, Calkins H, Nazarian S, Wei M, Huang D et al. Should we abandon the term “lone atrial fibrillation”? Hellenic Journal of Cardiology. 2019;60(4):216–23. DOI: 10.1016/j.hjc.2019.04.005

17. Ko D, Rahman F, Schnabel RB, Yin X, Benjamin EJ, Christophersen IE. Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis. Nature Reviews Cardiology. 2016;13(6):321–32. DOI: 10.1038/nrcardio.2016.45

18. Lloyd-Jones DM, Wang TJ, Leip EP, Larson MG, Levy D, Vasan RS et al. Lifetime Risk for Development of Atrial Fibrillation: The Framingham Heart Study. Circulation. 2004;110(9):1042–6. DOI: 10.1161/01.CIR.0000140263.20897.42

19. Vyas V, Lambiase P. Obesity and Atrial Fibrillation: Epidemiology, Pathophysiology and Novel Therapeutic Opportunities. Arrhythmia & Electrophysiology Review. 2019;8(1):28–36. DOI: 10.15420/aer.2018.76.2

20. Chamberlain AM, Agarwal SK, Folsom AR, Duval S, Soliman EZ, Ambrose M et al. Smoking and incidence of atrial fibrillation: Results from the Atherosclerosis Risk in Communities (ARIC) Study. Heart Rhythm. 2011;8(8):1160–6. DOI: 10.1016/j.hrthm.2011.03.038

21. Csengeri D, Sprünker N-A, Di Castelnuovo A, Niiranen T, Vishram-Nielsen JK, Costanzo S et al. Alcohol consumption, cardiac biomarkers, and risk of atrial fibrillation and adverse outcomes. European Heart Journal. 2021;42(12):1170–7. DOI: 10.1093/eurheartj/ehaa953

22. Allan V, Honarbakhsh S, Casas J-P, Wallace J, Hunter R, Schilling R et al. Are cardiovascular risk factors also associated with the incidence of atrial fibrillation?: A systematic review and field synopsis of 23 factors in 32 population-based cohorts of 20 million participants. Thrombosis and Haemostasis. 2017;117(05):837–50. DOI: 10.1160/TH16-11-0825

23. Loukianov M.M., Martsevich S.Yu., Drapkina O.M., Yakushin S.S., Vorobyev A.N., Pereverzeva K.G. et al. The Therapy with Oral Anticoagulants in Patients with Atrial Fibrillation in Outpatient and Hospital Settings (Data from RECVASA Registries). Rational Pharmacotherapy in Cardiology. 2019;15(4):538–45. DOI: 10.20996/1819-6446-2019-15-4-538-545

24. Tereshchenko S.N., Romanova N.V., Zhirov I.V., Osmolovskaya Yu.F., Golitsyn S.P. Russian Registry of Patients with Chronic Heart Failure and Atrial Fibrillation (RIF-CHF): Clinical and demographic characteristics of the sample upon inclusion into the Registry. Russian Heart Failure Journal. 2016;17(6):418–26. DOI: 10.18087/rhfj.2016.6.2276

25. Stepina E.V., Lukyanov M.M., Boytsov S.A., Bichurina M.A., Belova E.N., Kudryashov E.V. et al. Prescription of medications influencing prognosis in atrial fibrillation with arterial hypertension, coronary heart disease, chronic heart failure, by the registry REKVAZACLINIC. Cardiovascular Therapy and Prevention. 2017;16(2):33–8. DOI: 10.15829/1728-8800-2017-2-33-38

26. Belenkov Yu.N., Mareev V.Yu., Ageev F.T., Fomin I.V., Badin Yu.V., Polyakov D.S. et al. Veritable prevalence of CHF in the European part of Russian Federation (EPOCHA trial, hospital stage). Russian Heart Failure Journal. 2011;12(2):63–8.