土耳其心房颤动患者的流行病学、合并症概况及口服抗凝模式：基于国家注册研究和多中心观察性研究的荟萃分析。
完整摘要 · 中文译文
背景：心房颤动（AF）是全球主要的公共卫生负担，与卒中和死亡风险增加相关。虽然全球范围内关于心房颤动管理的真实世界数据不断扩展，但来自土耳其等发展中国家的综合系统评价仍然有限。本研究的目的是基于全国性注册研究和多中心观察性研究，系统评估土耳其心房颤动患者的流行病学特征、合并症谱及口服抗凝药（OAC）使用模式。 方法：于2025年11月15日对PubMed、Scopus、Web of Science和Embase进行系统性检索，并于2026年7月8日进行更新，以纳入土耳其心房颤动患者的相关研究。纳入的注册研究开展于2013年至2024年间。提取的数据包括人口统计学特征、临床风险评分（CHA₂DS₂-VASc、HAS-BLED）、合并症、心房颤动类型及口服抗凝药使用模式。采用限制性最大似然（REML）估计和Knapp-Hartung校正的随机效应 meta 分析计算合并估计值。 结果：共纳入6项注册研究，包含18，219例土耳其心房颤动患者。合并平均年龄为69岁（95% CI：66.9-71.2），女性占58%（95% CI：0.56-0.60）。高血压（0.76，95% CI：0.71-0.80）和糖尿病（0.25，95% CI：0.21-0.28）是最常见的合并症。平均CHA₂DS₂-VASc评分和HAS-BLED评分分别为3.67（95% CI：2.99-4.35）和1.72（95% CI：1.36-2.08），反映中高危血栓栓塞风险和中度出血风险。持续性/永久性心房颤动 占病例的0.73（95% CI：0.57-0.89），尽管极高的异质性需谨慎解读。由于三个登记处按设计基于NOAC治疗纳入患者，治疗模式估计按登记处类型分层。在所有患者登记处中，汇总NOAC使用率为0.60（95% CI：0.20-0.90），总体OAC使用率为0.88（95% CI：0.49-0.98），而汇总所有登记处则产生过高估计（NOAC 0.97，OAC 0.99）；VKA使用率在所有患者登记处相应更高（0.24，95% CI：0.10-0.47）。程序性干预如消融（3%）和电复律（9%）仍不常见。 结论：这项基于登记处和多中心观察性研究的荟萃分析显示，土耳其房颤患者的药物性卒中预防有所进展，在较晚及所有患者登记处中NOAC使用率更高。然而，节律控制策略使用率低及登记处间的显著异质性提示房颤管理仍存在差距，需谨慎解读并改进系统层面措施。
完整摘要 · 英文原文
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.