The management of patients with atrial fibrillation (AF) has rapidly changed with increasing use of non-vitamin K antagonist oral anticoagulants (NOACs) and changes in the use of rhythm control therapy. The prevention of thromboembolic events European Registry in Atrial Fibrillation Prolongation Registry (PREFER Prolongation) enrolled consecutive patients with AF on NOACs between 2014 and 2016 in a multicentre, prospective, observational study with one-year follow-up, focusing on the time of introduction of NOACs. Overall, 3783 patients were enrolled, with follow-up information available in 3223 (85%). Mean age was 72.2 ± 9.4 years, 40% were women, mean CHA2DS2VASc score was 3.4 ± 1.6, and 2587 (88.6%) had a CHA2DS2VASc score ≥ 2. Rivaroxaban was used in half of patients, and dabigatran and apixaban were used in about a quarter of patients each; edoxaban was not available for use in Europe at the time. Major cardiovascular event rate was low: serious events occurred in 74 patients (84 events, 2%), including 24 strokes (1%), 62 major bleeds (2%), of which 30 were life-threatening (1%) and 3 intracranial (0.1%), and 28 acute coronary syndromes (1%). Mortality was 2%. Antiarrhythmic drugs were used in about 50% of patients, catheter ablation in 5%. Adverse events were low in this contemporary European cohort of unselected AF patients treated with NOACs already at the time of their first introduction, despite high thromboembolic risk.

1st Department of Cardiology Poznan University of Medical Sciences Poznan Poland

3rd Medical Department Cardiology and Intensive Care Medicine Wilhelminen Hospital and Sigmund Freud University Medical School Vienna Austria

3rd Medical Department Cardiology and Intensive Care Medicine Wilhelminen Hospital Vienna Austria

Chair of Cardiology University Cardiology Division University of Pisa Pisa University Hospital Pisa and Fondazione VillaSerena Per La Ricerca Città Sant'Angelo Pescara Italy

Clinic and Policlinic for Cardiology University Hospital Leipzig Leipzig Germany

Daiichi Sankyo Europe Munich Germany

Department for General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany

Department of Cardiology Medical University of Vienna Vienna Austria

Department of Cardiology Sint Jan Hospital Bruges Bruges Belgium

Department of Cardiology University Hospital of Nancy Nancy France

Department of Cardiology University Hospital Ramo´N Y Cajal Madrid Spain

Department of Neuroscience Imaging and Clinical Science G D'Annunzio University of Chieti Pescara Chieti Italy

Department of Translational Medicine University of Eastern Piedmont and Maggiore Della Carità Hospital Novara Italy

DZHK Partner site Göttingen Germany

Emeritus Professor of Cardiology Amsterdam The Netherlands

Georges Pompidou Hospital René Descartes University Paris France

German Center for Cardiovascular Research Partner Site Hamburg Kiel Lübeck Hamburg Germany

Institute for Health Economics Steinbeis University Berlin Germany

Institute of Computer Science Academy of Sciences of the Czech Republic Prague Czech Republic

London Bridge Hospital London UK

University of Birmingham Institute of Cardiovascular Sciences and UHB and SWBH NHS Trusts Birmingham UK

Vivantes Hospital Neukölln Berlin Germany

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