International Collaborative Partnership for the Study of Atrial Fibrillation (INTERAF): Rationale, Design, and Initial Descriptives

A trial fibrillation (AF) is a global problem with a significant impact on health outcomes, affecting up to 1% to 2% of the global adult population, and is projected to increase in both developed and developing countries over the coming decades. AF is associated with higher mortality and morbidity, as well as decreased quality of life, and increases the risk of thromboembolic events (including stroke), heart failure (HF), myocardial infarction, dementia, and chronic kidney disease. The mainstays of AF treatment are arrhythmia management (with pharmacologic or mechanical rate or rhythm control) and prevention of thromboembolism. The field of AF treatment is dynamic, with the recent development of new procedures to restore sinus rhythm (catheter and surgical ablation) and new treatments to reduce thromboembolism (target-specific oral anticoagulants and catheter-based exclusion of the left atrial appendage). However, there is significant global variation in use of these therapies, particularly in developing countries, and the global implementation, diffusion, and anticipated real-world effectiveness of these technologies is uncertain. Therefore, a better understanding of global AF treatments, barriers and facilitators to its optimal use, and its subsequent outcomes is needed. As AF incidence and its arsenal of treatments continue to expand globally, the longitudinal and comprehensive nature of clinical registries can provide important insights into the clinical management of AF. Registries are observational databases of clinical conditions and/or therapies in which there are no mandated approaches to therapy and relatively few inclusion or exclusion criteria. In addition, registries can continuously collect longitudinal data on their target population, which allows them to monitor current and emerging clinical practices over time and associate them with clinical outcomes. Accordingly, current AF management practices and their associated outcomes can be measured, benchmarked to current best practices and clinical practice guidelines, and compared across different countries, populations, and healthcare systems. As novel AF treatments emerge, their dissemination globally and effect on outcomes, both intended and unintended, can be assessed. Currently, multiple AF databases and registries spanning a variety of countries, patients, treatments, and outcomes exist. However, coordination among these data sources is minimal. In addition, the variations in patient enrollment, data definitions, and characterization of AF therapies in each of the registries prevent effective comparison between registries and limit their ability to track changes over time. Finally, many of the current registries are sponsored by pharmaceutical or device companies, which can limit their focus on those patients and treatments associated with their products. The potential value of coordinating these disparate registry efforts is significant. More accurate and complete From the Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Diego, La Jolla, CA (J.C.H.); Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan (M. Akao, M. Abe); Kanai Hospital, Kyoto, Japan (M. Abe); American College of Cardiology, Washington, DC (K.L.A., N.G., J.S.R.); Instituto Dante Pazzanese de Cardiologia Fundac ~ao Adib Jatene, Sao Paulo, Brazil (A.A.); Keio University, Tokyo, Japan (S.K.); University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, United Kingdom (D.A.L., G.Y.H.L.); Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.); Beijing Anzhen Hospital, Beijing, China (C.-S.M.); Department of Medicine (Cardiology), University of Colorado School of Medicine, Denver, CO (F.A.M., J.S.R., T.M.M.); Colorado Cardiovascular Outcomes Research (CCOR) Consortium, Denver, CO (F.A.M., J.S.R., T.M.M.); School of Medicine, Clinical Center of Serbia, Belgrade University, Belgrade, Serbia (T.S.P.); The Heart Specialist Clinic, Singapore (T.W.S.); VA Palo Alto Health Care System, Palo Alto, CA (M.P.T.); Stanford University School of Medicine, Stanford, CA (M.P.T.); Cardiology Department, Department of Medicine, University of Hong Kong, HKSAR, China (H.-F.T.); Cardiology Section, VA Eastern Colorado Health Care System, Denver, CO (T.M.M.). Correspondence to: Thomas M. Maddox, MD, MSc, Cardiology Section 111B, VA Eastern Colorado Health Care System, 1055 Clermont St, Denver, CO 80220. E-mail: [email protected] J Am Heart Assoc. 2016;5:e004037 doi: 10.1161/JAHA.116.004037. a 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.