Nine-Year Trends in Atrial Fibrillation Prevalence among Romanian Adult Hypertensives: A Post-Hoc Analysis of SEPHAR II-IV Surveys.

Objectives: There are limited epidemiological data regarding atrial fibrillation (AF) in hypertensive (HT) Romanian adults. We sought to evaluate AF prevalence trends in the SEPHAR surveys (Study for Evaluation of Prevalence of Hypertension and Cardiovascular Risk in an Adult Population in Romania) during a nine-year interval (2012−2016−2021). Methods: Three consecutive editions of a national epidemiological survey regarding HT included representative samples of subjects stratified by age, gender and area of residence (SEPHAR II-IV­in total, 5422 subjects, mean age 48.69 ± 16.65 years, 57.5% (n = 3116) females). A post-hoc analysis of AF prevalence and oral anticoagulation (OAC) rates was performed. AF definition was based on a documented medical history of AF and/or AF documentation by study electrocardiogram. Results: General AF prevalence was 5.5% (n = 297). AF prevalence in HT subjects was 8.9% (n = 209) and has risen since SEPHAR II­7.2% (n = 57) and SEPHAR III­8.1% (n = 72) to SEPHAR IV­11.8% (n = 80), respectively (p = 0.001). AF prevalence has increased in HT males (SEPHAR II­5.3% (n = 19), SEPHAR III­7.6% (n = 26) and SEPHAR IV­11.7% (n = 35) (p = 0.010)) and in HT from urban areas (SEPHAR II­7.8% (n = 37), SEPHAR III­7.8% (n = 40), SEPHAR IV­14.7% (n = 50), p < 0.001). In SEPHAR III-IV, only 19.3% (n = 23) of HT AF patients with OAC indication were anticoagulated. Conclusions: AF prevalence has increased by ~64% in hypertensive Romanian adults between 2012 and 2021. However, anticoagulation strategies may be suboptimal in patients with cardioembolic risk.