The characteristics and clinical outcomes of atrial fibrillation patient in middle income country of Indonesia

Abstract

Background: Atrial fibrillation (AF) is an increasing health concern in Asia, but data from developing countries remain scarce. Although direct oral anticoagulants (DOACs) are now preferred globally, vitamin K antagonists (VKAs) remain the mainstay of stroke prevention in low- and middle-income countries, including Indonesia. This study evaluates the clinical outcomes of Indonesian AF patients with warfarin-based treatment. Methods: The OPTIMA (Optimal target of INR for Indonesian) study is a multicenter, prospective cohort study involving 1,599 AF patients across 25 centers in Indonesia. Clinical characteristics, INR levels, and time in therapeutic range (TTR) were analyzed. The primary endpoints were stroke/systemic embolism (efficacy) and major bleeding (safety). Cox proportional hazards regression and Kaplan-Meier analysis assessed outcomes. Results: -VASc score was 2.43. Anticoagulation quality was poor under the standard INR target of 2.0-3.0, with a mean time in therapeutic range (TTR) of only 30.1%. Patients with an average INR of 1.6-2.5 experienced lower rates of stroke and major bleeding. The incidence rates per 100 patient-years were 1.32 for stroke, 1.51 for major bleeding, and 3.15 for mortality. Stroke risk was highest in persistent/permanent AF, with younger, working-age individuals disproportionately affected. Conclusions: Warfarin management at the standard INR target of 2.0-3.0 was associated with poor anticoagulation quality. Patients with average INR values of 1.6-2.5 experienced fewer adverse events, although this finding requires confirmation in prospective trials. Socioeconomic burden is substantial, as AF-related stroke disproportionately affects younger, working-age Indonesians.

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