Turkish real-life atrial fibrillation in clinical practice: 2-year clinical outcomes of the TRAFFIC study

Abstract

Background: Atrial fibrillation (AF) is a major public health issue associated with thromboembolism and mortality. Real-world data from Tü rkiye are limited despite expanding use of non-vitamin K antagonist oral anticoagulants (NOACs). The Turkish Real Life Atrial Fibrillation in Clinical Practice (TRAFFIC) study aimed to characterize the demographic features, risk profiles, treatment patterns, and 2-year clinical outcomes of patients with non-valvular AF (NVAF) in Tü rkiye. Methods: TRAFFIC was a national, prospective, multicenter, observational registry enrolling 1659 NVAF patients from 36 centers with 6-monthly follow-up for 24 months. Baseline data included demographics, comorbidities, CHA2DS2-VASc, HAS-BLED, AF subtype, European Heart Rhythm Association (EHRA) score, and antithrombotictherapy. Outcomes were ischemic stroke/systemic embolism (SE), major bleeding, and all-cause mortality. Predictors of mortality were evaluated using adjusted Cox regression, and associations of risk scores were explored using univariate Cox models with restricted cubic splines. Results: Median age was 70 years, 48% female, with intermediate CHA2DS2-VASc (most 2-5) and low-to-intermediate HAS-BLED scores (most 0-2). Permanent AF wasthe most common subtype (48%). Antithrombotic therapy largely reflected risk profiles, with NOACs being the dominant treatment (65%). Over 2 years, all-cause mortality was 8.9%, ischemic stroke/SE 2.4%, and major bleeding 1.3%. In adjusted analysis, age, congestive heart failure, and diabetes mellitus were independent predictors of mortality. Both CHA2DS2-VASc and HAS-BLED scores showed threshold effects for mortality and thromboembolic risk but notfor bleeding. Conclusion: TRAFFIC provides contemporary Turkish NVAF data, showing lower event rates than historical cohorts. Outcomes are comparable with international registries; persistent mortality burden highlights the needforAF care beyond anticoagulation.