BACKGROUND The 4S-AF scheme includes: stroke risk, symptoms, severity of burden, and substrate severity domain. AIM Our aim was to assess the adherence to 4S-AF scheme in patients classified according to stroke risk in post-hoc analysis of the BALKAN-AF dataset. METHODS A 14-week prospective enrolment of consecutive patients with electrocardiographically documented atrial fibrillation (AF) was performed in seven Balkan countries from 2014 to 2015. RESULTS Low stroke risk (CHA₂DS₂-VASc score, 0 in males or 1 in females) was present in 162 (6.0%) of the patients. 2,099 (77.4%) of patients had CHA₂DS₂-VASc score ≥3 in females or ≥2 in males (high stroke risk) and 613 (22.6%) had CHA₂DS₂-VASc score <3 in females or <2 in males. 75 (46.3%) of patients with low stroke risk and 1555 (74.1%) of patients with high stroke risk were prescribed oral anticoagulants (OAC). 2677 (98.6%) had data on European Heart Rhythm Association (EHRA) class. Among 2099 patients with high stroke risk, 703 (33.4%) had EHRA class ≥3. 207 (29.4%) of patients with EHRA class ≥3 and high stroke risk were offered rhythm control; 620 (55.2%) of individuals with first-diagnosed or paroxysmal AF with high stroke risk were offered rhythm control. Two or more comorbidities occurred in 1927 (91.8%) of patients with high stroke risk. CONCLUSIONS OAC overuse was observed in patients with low stroke risk, whilst OAC underuse was evident in those with high risk of stroke. The percentage of highly symptomatic patients with high risk of stroke who were offered rhythm control strategy was low.

Symptom‐focused management is one of the cornerstones of optimal atrial fibrillation (AF) therapy.

Abstract Objective We investigated the impact of multimorbidity and polypharmacy on the management of atrial fibrillation (AF) patients in clinical practice and assessed factors associated with polypharmacy and oral anticoagulation (OAC) use in AF patients with multimorbidity and polypharmacy. Methods A 14-week prospective study of consecutive non-valvular AF patients was performed in seven Balkan countries. Results Of 2712 consecutive patients, 2263 patients (83.4%) had multimorbidity (AF + ≥2 concomitant diseases) and 1505 patients (55.5%) had polypharmacy. 1416 (52.2%) patients had both multimorbidity and polypharmacy. Overall, 1164 (82.2%) patients received OAC, 200 (14.1%) patients received antiplatelet drugs alone and 52 (3.7%) patients had no antithrombotic therapy (AT). Non-emergency centre and paroxysmal AF were significantly associated with OAC non-use in patients with multimorbidity, whilst age ≥80 years and non-emergency centre were identified to be independent predictors of OAC non-use in patients with polypharmacy. Conclusions Multimorbidity and polypharmacy were common among AF patients in our study. AT was suboptimal and approximately 18% of multimorbid patients with polypharmacy were not anticoagulated. Pattern of AF and non-emergency centre were associated with OAC non-use in AF patients with multimorbidity, whilst non-emergency centre and age ≥80 years were associated with OAC non-use in AF patients with polypharmacy. Key Message Multimorbidity and polypharmacy are common among patients with AF. Antithrombotic therapy was suboptimal in AF patients with multimorbidity and polypharmacy. Approximately, 18% of multimorbid patients with polypharmacy were not anticoagulated.

Atrial fibrillation (AF) often co‐exists with renal function (RF) impairment. We investigated the characteristics and management of AF patients across creatinine clearance strata and potential changes in the use of nonvitamin K oral anticoagulants (NOAC) according to different equations for estimation of RF.