Analysis of geographical variations in the epidemiology and management of non-valvular atrial fibrillation: results from the RAMSES registry

OBJECTIVE This study aimed to determine the differences in terms of demographic characteristics and preferred stroke prevention strategies for patients with non-valvular atrial fibrillation living in seven geographical regions of Turkey. METHODS In total, 6273 patients were enrolled to this prospective, observational RAMSES study. The patients were divided into seven groups based on the geographical region of residence. RESULTS In terms of the geographical distribution of the overall Turkish population, the highest number of patients were enrolled from Marmara (1677, 26.7%). All demographic characteristics were significantly different among regions. Preferred oral anticoagulants (OACs) also differed between geographical regions; non-vitamin K OACs were preceded by warfarin in East Anatolia, Aegean, Southeast Anatolia, and Black Sea. Nearly one-third of the patients (28%) did not receive any OAC therapy. However, the number of patients not receiving any OAC therapy was higher in Southeast Anatolia (51.1%) and East Anatolia (46.8%) compared with other geographical regions of Turkey. Inappropriate use of OACs was also more common in East and Southeast Anatolia. CONCLUSION This study was the first to show that the demographic differences among the geographical regions may result in different preferences of stroke prevention strategies in Turkey. OACs are still under- or inappropriately utilized, particularly in the eastern provinces of Turkey.