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.

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.