Atrial fibrillation (AF) is an important health problem in Tunisia. A significant change in the epidemiological pattern of heart disease has been noticed.

The purpose of the NATURE-AF registry was to determine the incidence of thrombo-embolic (TE) events and cardiovascular (CV) death at 1 year in patients with newly diagnosed AF. Secondary end points were to determine the incidence of hemorrhagic events and to calculate the mean time in therapeutic range (TTR) in patients receiving Vitamin K antagonists (VKA).

NATURE AF is a multicenter, prospective study which enrolled 915 patients with AF between March and June 2017. The mean age was 64.2±13.4 years (sex ratio 1.1). Common co morbidities were hypertension (53.4%), valvular disease (25.5%), diabetes (24.9%) and heart failure (HF)(14.4%). At one year the incidence of TE events was 1.64%. Ischemic stroke represented 53.3% of the total TE events. Heart failure (HF) and obstructive sleep apnea were the significant predictors of the TE events. CV mortality was 5.7%. HF was the only predictor factor of CV mortality. Hemorrhagic events occurred in 5.8% of the population among whom 0.5% had hemorrhagic stroke and 1% digestive hemorrhage. Hypertension, neoplasy and prescription of antiplatelet agents were the main significant predictors of hemorrhagic events. VKA were prescribed in 70.4% of the population (644 patients). The mean TTR was 48.9±28.7%. TTR>65% was noticed in 35% of the population. Patients receiving direct oral anticagulants (DOA) represented 2.2% of the population.

NATURE AF reflects the epidemiological, therapeutic and outcome features of AF in the Tunisian population. The prevalence of valvular AF remains high. Control of the anticoagulation by VKA is poor. The use of DOA is low. These results highlight the need for other therapeutic choices in Tunisia particularly concerning anticoagulation.