Epidemiology, comorbidity profiles, and oral anticoagulation patterns among patients with atrial fibrillation in Turkey: a meta-analysis of national registry-based and multicenter observational studies.
- 1Department of Cardiology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey.
- 2Department of Biostatistics and Medical Informatics, Faculty of Medicine, Dokuz Eylül University, 15 July Medicine Campus, Inciralti-Balcova 35340, Izmir, Türkiye. [email protected].
- 3Department of Cardiology, Faculty of Medicine, Ege University, Izmir, Turkey.
Abstract
Background
Atrial fibrillation (AF) is a major public health burden globally, associated with increased risk of stroke and mortality. While real-world data on AF management have expanded globally, comprehensive syntheses from developing countries such as Turkey remain limited. The objective of this study was to systematically evaluates the epidemiological characteristics, comorbidity profiles, and patterns of oral anticoagulant (OAC) use among patients with AF in Turkey based on national registry-based and multicenter observational studies.Methods
A systematic search of PubMed, Scopus, Web of Science, and Embase was conducted on 15 November 2025, and subsequently updated on 8 July 2026 to identify studies of Turkish AF patients. Included registries were conducted between 2013 and 2024. Data were extracted on demographics, clinical risk scores (CHA₂DS₂-VASc, HAS-BLED), comorbidities, AF type, and OAC patterns. Pooled estimates were calculated using random-effects meta-analyses with restricted maximum likelihood (REML) estimation and Knapp-Hartung adjustments.Results
Six registries comprising 18,219 Turkish AF patients were included. The pooled mean age was 69 years (95% CI: 66.9-71.2), with 58% (95% CI: 0.56-0.60) female representation. Hypertension (0.76, 95% CI: 0.71-0.80) and diabetes mellitus (0.25, 95% CI: 0.21-0.28) were the most common comorbidities. The mean CHA₂DS₂-VASc and HAS-BLED scores were 3.67 (95% CI: 2.99-4.35) and 1.72 (95% CI: 1.36-2.08), respectively, reflecting moderate-to-high thromboembolic risk and moderate bleeding risk. Persistent/permanent AF accounted for 0.73 (95% CI: 0.57-0.89) of cases, although the very high heterogeneity warrants caution. Because three registries enrolled patients on the basis of NOAC therapy by design, treatment-pattern estimates were stratified by registry type. Among all-comer registries, pooled NOAC use was 0.60 (95% CI: 0.20-0.90) and overall OAC use was 0.88 (95% CI: 0.49-0.98), whereas pooling all registries produced inflated estimates (NOAC 0.97, OAC 0.99); VKA use was correspondingly higher in all-comer registries (0.24, 95% CI: 0.10-0.47). Procedural interventions such as ablation (3%) and cardioversion (9%) remained infrequent.Conclusions
This meta-analysis of registry-based and multicenter observational studies suggests progress in pharmacological stroke prevention among AF patients in Turkey, with greater NOAC use in later and all-comer registries. However, the low use of rhythm-control strategies and the substantial inter-registry heterogeneity indicate ongoing gaps in AF management that warrant cautious interpretation and system-level improvements.
Related
- Stage 1 Registered Report: sex differences in anticoagulation and stroke outcomes among patients with atrial fibrillation: a registry-based cohort study
- Left atrial appendage occlusion: an alternative to anticoagulation in atrial fibrillation
- 2026 Asia Pacific Heart Rhythm Society (APHRS) Guidelines (Part IV) on Comprehensive Lifestyle Risk Factor and Comorbidity Management in Atrial Fibrillation.
- Pharmacist management of oral anticoagulation for atrial fibrillation in the community: The APOTHECARY AF study.
- Percutaneous Left Atrial Appendage Occlusion Versus Oral Anticoagulation in Atrial Fibrillation: A Systematic Review and Bayesian Meta-analysis
BibTeX
@article{kıs2026epidemiology,
title = {{Epidemiology, comorbidity profiles, and oral anticoagulation patterns among patients with atrial fibrillation in Turkey: a meta-analysis of national registry-based and multicenter observational studies.}},
author = {Mehmet Kış and Mehmet Emin Arayici and Bihter Şentürk and Mehdi Zoghi},
journal = {BMC cardiovascular disorders},
year = {2026},
month = jul,
doi = {10.1186/s12872-026-06342-2},
url = {https://europepmc.org/article/MED/42902140},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Epidemiology, comorbidity profiles, and oral anticoagulation patterns among patients with atrial fibrillation in Turkey: a meta-analysis of national registry-based and multicenter observational studies.
AU - Mehmet Kış
AU - Mehmet Emin Arayici
AU - Bihter Şentürk
AU - Mehdi Zoghi
PY - 2026
DA - 2026/07/01
JO - BMC cardiovascular disorders
DO - 10.1186/s12872-026-06342-2
UR - https://europepmc.org/article/MED/42902140
AB - Background Atrial fibrillation (AF) is a major public health burden globally, associated with increased risk of stroke and mortality. While real-world data on AF management have expanded globally, comprehensive syntheses from developing countries such as Turkey remain limited. The objective of this study was to systematically evaluates the epidemiological characteristics, comorbidity profiles, and patterns of oral anticoagulant (OAC) use among patients with AF in Turkey based on national registry-based and multicenter observational studies.Methods A systematic search of PubMed, Scopus, Web of Science, and Embase was conducted on 15 November 2025, and subsequently updated on 8 July 2026 to identify studies of Turkish AF patients. Included registries were conducted between 2013 and 2024. Data were extracted on demographics, clinical risk scores (CHA₂DS₂-VASc, HAS-BLED), comorbidities, AF type, and OAC patterns. Pooled estimates were calculated using random-effects meta-analyses with restricted maximum likelihood (REML) estimation and Knapp-Hartung adjustments.Results Six registries comprising 18,219 Turkish AF patients were included. The pooled mean age was 69 years (95% CI: 66.9-71.2), with 58% (95% CI: 0.56-0.60) female representation. Hypertension (0.76, 95% CI: 0.71-0.80) and diabetes mellitus (0.25, 95% CI: 0.21-0.28) were the most common comorbidities. The mean CHA₂DS₂-VASc and HAS-BLED scores were 3.67 (95% CI: 2.99-4.35) and 1.72 (95% CI: 1.36-2.08), respectively, reflecting moderate-to-high thromboembolic risk and moderate bleeding risk. Persistent/permanent AF accounted for 0.73 (95% CI: 0.57-0.89) of cases, although the very high heterogeneity warrants caution. Because three registries enrolled patients on the basis of NOAC therapy by design, treatment-pattern estimates were stratified by registry type. Among all-comer registries, pooled NOAC use was 0.60 (95% CI: 0.20-0.90) and overall OAC use was 0.88 (95% CI: 0.49-0.98), whereas pooling all registries produced inflated estimates (NOAC 0.97, OAC 0.99); VKA use was correspondingly higher in all-comer registries (0.24, 95% CI: 0.10-0.47). Procedural interventions such as ablation (3%) and cardioversion (9%) remained infrequent.Conclusions This meta-analysis of registry-based and multicenter observational studies suggests progress in pharmacological stroke prevention among AF patients in Turkey, with greater NOAC use in later and all-comer registries. However, the low use of rhythm-control strategies and the substantial inter-registry heterogeneity indicate ongoing gaps in AF management that warrant cautious interpretation and system-level improvements.
SN - 1471-2261
ER -