Epidemiology and impact of frailty in patients with atrial fibrillation in Europe
Proietti M. Romiti G.F. Vitolo M. Harrison S.L. Lane D.A. Fauchier L. Marin F. Näbauer M. Potpara T.S. Dan G.-A. Maggioni A.P. Cesari M. Boriani G. Lip G.Y.H. Zëra E. Ekmekçiu U. Paparisto V. Tase M. Gjergo H. Dragoti J. Goda A. Ciutea M. Ahadi N. El Husseini Z. Raepers M. Leroy J. Haushan P. Jourdan A. Lepiece C. Desteghe L. Vijgen J. Koopman P. Van Genechten G. Heidbuchel H. Boussy T. De Coninck M. Van Eeckhoutte H. Bouckaert N. Friart A. Boreux J. Arend C. Evrard P. Stefan L. Hoffer E. Herzet J. Massoz M. Celentano C. Sprynger M. Pierard L. Melon P. Van Hauwaert B. Kuppens C. Faes D. Van Lier D. Van Dorpe A. Gerardy A. Deceuninck O. Xhaet O. Dormal F. Ballant E. Blommaert D. Yakova D. Hristov M. Yncheva T. Stancheva N. Tisheva S. Tokmakova M. Nikolov F. Gencheva D. Shalganov T. Kunev B. Stoyanov M. Marchov D. Gelev V. Traykov V. Kisheva A. Tsvyatkov H. Shtereva R. Bakalska-Georgieva S. Slavcheva S. Yotov Y. Kubíčková M. Marni Joensen A. Gammelmark A. Hvilsted Rasmussen L. Dinesen P. Riahi S. Krogh Venø S. Sorensen B. Korsgaard A. Andersen K. Fragtrup Hellum C. Svenningsen A. Nyvad O. Wiggers P. May O. Aarup A. Graversen B. Jensen L. Andersen M. Svejgaard M. Vester S. Hansen S. Lynggaard V. Ciudad M. Vettus R. Muda P. Maestre A. Castaño S. Cheggour S. Poulard J. Mouquet V. Leparrée S. Bouet J. Taieb J. Doucy A. Duquenne H. Furber A. Dupuis J. Rautureau J. Font M. Damiano P. Lacrimini M. Abalea J. Boismal S. Menez T. Mansourati J. Range G. Gorka H. Laure C. Vassalière C. Elbaz N. Lellouche N. Djouadi K. Roubille F. Dietz D. Davy J. Granier M. Winum P. Leperchois-Jacquey C. Kassim H. Marijon E. Le Heuzey J. Fedida J. Maupain C. Himbert C. Gandjbakhch E. Hidden-Lucet F. Duthoit G. Badenco N. Chastre T. Waintraub X. Oudihat M. Lacoste J. Stephan C. Bader H. Delarche N. Giry L. Arnaud D. Lopez C. Boury F. Brunello I. Lefèvre M. Mingam R. Haissaguerre M. Le Bidan M. Pavin D. Le Moal V. Leclercq C. Piot O. Beitar T. Martel I. Schmid A. Sadki N. Romeyer-Bouchard C. Da Costa A. Arnault I. Boyer M. Piat C. Lozance N. Nastevska S. Doneva A. Fortomaroska Milevska B. Sheshoski B. Petroska K. Taneska N. Bakrecheski N. Lazarovska K. Jovevska S. Ristovski V. Antovski A. Lazarova E. Kotlar I. Taleski J. Poposka L. Kedev S. Zlatanovik N. Jordanova S. Bajraktarova Proseva T. Doncovska S. Maisuradze D. Esakia A. Sagirashvili E. Lartsuliani K. Natelashvili N. Gumberidze N. Gvenetadze R. Etsadashvili K. Gotonelia N. Kuridze N. Papiashvili G. Menabde I. Glöggler S. Napp A. Lebherz C. Romero H. Schmitz K. Berger M. Zink M. Köster S. Sachse J. Vonderhagen E. Soiron G. Mischke K. Reith R. Schneider M. Rieker W. Boscher D. Taschareck A. Beer A. Oster D. Ritter O. Adamczewski J. Walter S. Frommhold A. Luckner E. Richter J. Schellner M. Landgraf S. Bartholome S. Naumann R. Schoeler J. Westermeier D. William F. Wilhelm K. Maerkl M. Oekinghaus R. Denart M. Kriete M. Tebbe U. Scheibner T. Gruber M. Gerlach A. Beckendorf C. Anneken L. Arnold M. Lengerer S. Bal Z. Uecker C. Förtsch H. Fechner S. Mages V. Martens E. Methe H. Schmidt T. Schaeffer B. Hoffmann B. Moser J. Heitmann K. Willems S. Klaus C. Lange I. Durak M. Esen E. Mibach F. Mibach H. Utech A. Gabelmann M. Stumm R. Ländle V. Gartner C. Goerg C. Kaul N. Messer S. Burkhardt D. Sander C. Orthen R. Kaes S. Baumer A. Dodos F. Barth A. Schaeffer G. Gaertner J. Winkler J. Fahrig A. Aring J. Wenzel I. Steiner S. Kliesch A. Kratz E. Winter K. Schneider P. Haag A. Mutscher I. Bosch R. Taggeselle J. Meixner S. Schnabel A. Shamalla A. Hötz H. Korinth A. Rheinert C. Mehltretter G. Schön B. Schön N. Starflinger A. Englmann E. Baytok G. Laschinger T. Ritscher G. Gerth A. Dechering D. Eckardt L. Kuhlmann M. Proskynitopoulos N. Brunn J. Foth K. Axthelm C. Hohensee H. Eberhard K. Turbanisch S. Hassler N. Koestler A. Stenzel G. Kschiwan D. Schwefer M. Neiner S. Hettwer S. Haeussler-Schuchardt M. Degenhardt R. Sennhenn S. Brendel M. Stoehr A. Widjaja W. Loehndorf S. Logemann A. Hoskamp J. Grundt J. Block M. Ulrych R. Reithmeier A. Panagopoulos V. Martignani C. Bernucci D. Fantecchi E. Diemberger I. Ziacchi M. Biffi M. Cimaglia P. Frisoni J. Giannini I. Boni S. Fumagalli S. Pupo S. Di Chiara A. Mirone P. Pesce F. Zoccali C. Malavasi V.L. Mussagaliyeva A. Ahyt B. Salihova Z. Koshum-Bayeva K. Kerimkulova A. Bairamukova A. Mirrakhimov E. Lurina B. Zuzans R. Jegere S. Mintale I. Kupics K. Jubele K. Erglis A. Kalejs O. Vanhear K. Burg M. Cachia M. Abela E. Warwicker S. Tabone T. Xuereb R. Asanovic D. Drakalovic D. Vukmirovic M. Pavlovic N. Music L. Bulatovic N. Boskovic A. Uiterwaal H. Bijsterveld N. De Groot J. Neefs J. van den Berg N. Piersma F. Wilde A. Hagens V. Van Es J. Van Opstal J. Van Rennes B. Verheij H. Breukers W. Tjeerdsma G. Nijmeijer R. Wegink D. Binnema R. Said S. Erküner Ö. Philippens S. van Doorn W. Crijns H. Szili-Torok T. Bhagwandien R. Janse P. Muskens A. van Eck M. Gevers R. van der Ven N. Duygun A. Rahel B. Meeder J. Vold A. Holst Hansen C. Engset I. Atar D. Dyduch-Fejklowicz B. Koba E. Cichocka M. Sokal A. Kubicius A. Pruchniewicz E. Kowalik-Sztylc A. Czapla W. Mróz I. Kozlowski M. Pawlowski T. Tendera M. Winiarska-Filipek A. Fidyk A. Slowikowski A. Haberka M. Lachor-Broda M. Biedron M. Gasior Z. Kołodziej M. Janion M. Gorczyca-Michta I. Wozakowska-Kaplon B. Stasiak M. Jakubowski P. Ciurus T. Drozdz J. Simiera M. Zajac P. Wcislo T. Zycinski P. Kasprzak J. Olejnik A. Harc-Dyl E. Miarka J. Pasieka M. Zieminska-Łuć M. Bujak W. Sliwinski A. Grech A. Morka J. Petrykowska K. Prasał M. Hordynski G. Feusette P. Lipski P. Wester A. Streb W. Romanek J. Wozniak P. Chlebus M. Szafarz P. Stanik W. Zakrzewski M. Kazmierczak J. Przybylska A. Skorek E. Błaszczyk H. Stepien M. Szabowski S. Krysiak W. Szymanska M. Karasinski J. Blicharz J. Skura M. Hałas K. Michalczyk L. Orski Z. Krzyzanowski K. Skrobowski A. Zielinski L. Tomaszewska-Kiecana M. Dłuzniewski M. Kiliszek M. Peller M. Budnik M. Balsam P. Opolski G. Tyminska A. Ozieranski K. Wancerz A. Borowiec A. Majos E. Dabrowski R. Szwed H. Musialik-Lydka A. Leopold-Jadczyk A. Jedrzejczyk-Patej E. Koziel M. Lenarczyk R. Mazurek M. Kalarus Z. Krzemien-Wolska K. Starosta P. Nowalany-Kozielska E. Orzechowska A. Szpot M. Staszel M. Almeida S. Pereira H. Brandão Alves L. Miranda R. Ribeiro L. Costa F. Morgado F. Carmo P. Galvao Santos P. Bernardo R. Adragão P. Ferreira da Silva G. Peres M. Alves M. Leal M. Cordeiro A. Magalhães P. Fontes P. Leão S. Delgado A. Costa A. Marmelo B. Rodrigues B. Moreira D. Santos J. Santos L. Terchet A. Darabantiu D. Mercea S. Turcin Halka V. Pop Moldovan A. Gabor A. Doka B. Catanescu G. Rus H. Oboroceanu L. Bobescu E. Popescu R. Dan A. Buzea A. Daha I. Neuhoff I. Baluta M. Ploesteanu R. Dumitrache N. Vintila M. Daraban A. Japie C. Badila E. Tewelde H. Hostiuc M. Frunza S. Tintea E. Bartos D. Ciobanu A. Popescu I. Toma N. Gherghinescu C. Cretu D. Patrascu N. Stoicescu C. Udroiu C. Bicescu G. Vintila V. Vinereanu D. Cinteza M. Rimbas R. Grecu M. Cozma A. Boros F. Ille M. Tica O. Tor R. Corina A. Jeewooth A. Maria B. Georgiana C. Natalia C. Alin D. Dinu-Andrei D. Livia M. Daniela R. Larisa R. Umaar S. Tamara T. Ioachim Popescu M. Nistor D. Sus I. Coborosanu O. Alina-Ramona N. Dan R. Petrescu L. Ionescu G. Vacarescu C. Goanta E. Mangea M. Ionac A. Mornos C. Cozma D. Pescariu S. Solodovnicova E. Soldatova I. Shutova J. Tjuleneva L. Zubova T. Uskov V. Obukhov D. Rusanova G. Odinsova S. Arhipova T. Kazakevich E. Serdechnaya E. Zavyalova O. Novikova T. Riabaia I. Zhigalov S. Drozdova E. Luchkina I. Monogarova Y. Hegya D. Rodionova L. Nevzorova V. Lusanova O. Arandjelovic A. Toncev D. Milanov M. Sekularac N. Zdravkovic M. Hinic S. Dimkovic S. Acimovic T. Saric J. Polovina M. Vujisic-Tesic B. Nedeljkovic M. Zlatar M. Asanin M. Vasic V. Popovic Z. Djikic D. Sipic M. Peric V. Dejanovic B. Milosevic N. Stevanovic A. Andric A. Pencic B. Pavlovic-Kleut M. Celic V. Pavlovic M. Petrovic M. Vuleta M. Petrovic N. Simovic S. Savovic Z. Milanov S. Davidovic G. Iric-Cupic V. Simonovic D. Stojanovic M. Stojanovic S. Mitic V. Ilic V. Petrovic D. Deljanin Ilic M. Ilic S. Stoickov V. Markovic S. Kovacevic S. García Fernandez A. Perez Cabeza A. Anguita M. Tercedor Sanchez L. Mau E. Loayssa J. Ayarra M. Carpintero M. Roldán Rabadan I. Gil Ortega M. Tello Montoliu A. Orenes Piñero E. Manzano Fernández S. Marín F. Romero Aniorte A. Veliz Martínez A. Quintana Giner M. Ballesteros G. Palacio M. Alcalde O. García-Bolao I. Bertomeu Gonzalez V. Otero-Raviña F. García Seara J. Gonzalez Juanatey J. Dayal N. Maziarski P. Gentil-Baron P. Shah D. Koç M. Onrat E. Dural I.E. Yilmaz K. Özin B. Tan Kurklu S. Atmaca Y. Canpolat U. Tokgozoglu L. Dolu A.K. Demirtas B. Sahin D. Ozcan Celebi O. Diker E. Gagirci G. Turk U.O. Ari H. Polat N. Toprak N. Sucu M. Akin Serdar O. Taha Alper A. Kepez A. Yuksel Y. Uzunselvi A. Yuksel S. Sahin M. Kayapinar O. Ozcan T. Kaya H. Yilmaz M.B. Kutlu M. Demir M. Gibbs C. Kaminskiene S. Bryce M. Skinner A. Belcher G. Hunt J. Stancombe L. Holbrook B. Peters C. Tettersell S. Shantsila A. Lane D. Senoo K. Russell K. Domingos P. Hussain S. Partridge J. Haynes R. Bahadur S. Brown R. McMahon S. McDonald J. Balachandran K. Singh R. Garg S. Desai H. Davies K. Goddard W. Galasko G. Rahman I. Chua Y. Payne O. Preston S. Brennan O. Pedley L. Whiteside C. Dickinson C. Brown J. Jones K. Benham L. Brady R. Buchanan L. Ashton A. Crowther H. Fairlamb H. Thornthwaite S. Relph C. McSkeane A. Poultney U. Kelsall N. Rice P. Wilson T. Wrigley M. Kaba R. Patel T. Young E. Law J. Runnett C. Thomas H. McKie H. Fuller J. Pick S. Sharp A. Hunt A. Thorpe K. Hardman C. Cusack E. Adams L. Hough M. Keenan S. Bowring A. Watts J. Zaman J. Goffin K. Nutt H. Beerachee Y. Featherstone J. Mills C. Pearson J. Stephenson L. Grant S. Wilson A. Hawksworth C. Alam I. Robinson M. Ryan S. Egdell R. Gibson E. Holland M. Leonard D. Mishra B. Ahmad S. Randall H. Hill J. Reid L. George M. McKinley S. Brockway L. Milligan W. Sobolewska J. Muir J. Tuckis L. Winstanley L. Jacob P. Kaye S. Morby L. Jan A. Sewell T. Boos C. Wadams B. Cope C. Jefferey P. Andrews N. Getty A. Suttling A. Turner C. Hudson K. Austin R. Howe S. Iqbal R. Gandhi N. Brophy K. Mirza P. Willard E. Collins S. Ndlovu N. Subkovas E. Karthikeyan V. Waggett L. Wood A. Bolger A. Stockport J. Evans L. Harman E. Starling J. Williams L. Saul V. Sinha M. Bell L. Tudgay S. Kemp S. Frost L. Ingram T. Loughlin A. Adams C. Adams M. Hurford F. Owen C. Miller C. Donaldson D. Tivenan H. Button H. Nasser A. Jhagra O. Stidolph B. Brown C. Livingstone C. Duffy M. Madgwick P. Roberts P. Greenwood E. Fletcher L. Beveridge M. Earles S. McKenzie D. Beacock D. Dayer M. Seddon M. Greenwell D. Luxton F. Venn F. Mills H. Rewbury J. James K. Roberts K. Tonks L. Felmeden D. Taggu W. Summerhayes A. Hughes D. Sutton J. Felmeden L. Khan M. Walker E. Norris L. O’Donohoe L. Mozid A. Dymond H. Lloyd-Jones H. Saunders G. Simmons D. Coles D. Cotterill D. Beech S. Kidd S. Wrigley B. Petkar S. Smallwood A. Jones R. Radford E. Milgate S. Metherell S. Cottam V. Buckley C. Broadley A. Wood D. Allison J. Rennie K. Balian L. Howard L. Pippard L. Board S. Pitt-Kerby T.
1 January 2022Oxford University Press
Age and Ageing
2022#51Issue 8
Background: Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent. Objectives: We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients. Methods: A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined. Results: Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55–0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty. Conclusions: In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.
atrial fibrillation , chronicity , epidemiology , frailty , older people , oral anticoagulant therapy , outcomes
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Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
Department of Translational and Precision Medicine, Sapienza - University of Rome, Italy
Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, CIBER-CV, Murcia, Spain
Department of Cardiology, Ludwig-Maximilians-University, Munich, Germany
School of Medicine, University of Belgrade, Belgrade, Serbia
Clinical Center of Serbia, Belgrade, Serbia
University of Medicine, ‘Carol Davila’, Colentina University Hospital, Bucharest, Romania
ANMCO Research Center, Heart Care Foundation, Florence, Italy
Durrës, Albania
Tirana, Albania
Bastogne, Belgium
Gilly, Belgium
Haine Saint Paul, Belgium
Hasselt, Belgium
Kortrijk, Belgium
La Louviere, Belgium
Liege, Belgium
Overpelt, Belgium
Waremme, Belgium
Yvoir, Belgium
Pleven, Bulgaria
Plovdiv, Bulgaria
Sofia, Bulgaria
Varna, Bulgaria
Ústí nad Labem, Czech Republic
Aalborg, Denmark
Esbjerg, Denmark
Herning, Denmark
Madrid, Spain
Tallinn, Estonia
Tartu, Estonia
Elche, Alicante, Spain
Toledo, Spain
Abbeville, France
Aix-en-Provence, France
Amiens, France
Angers, France
Aurillac, France
Avignon, Cedex, France
Brest, France
Chartres, France
Creteil, France
Montpellier, France
Nimes, France
Paris, France
Pau, France
Pessac, France
Rennes, France
Saint Denis, France
Saint Etienne, France
Tours, France
Bitola, North Macedonia
Ohrid, North Macedonia
Skopje, North Macedonia
Štip, North Macedonia
Tbilisi, Georgia
Aachen, Germany
Bad Reichenhall, Germany
Berlin, Germany
Biberach, Germany
Boppard, Germany
Brandenburg, Germany
Chemnitz, Germany
Dachau, Germany
Detmold, Germany
Ebersbach, Germany
Erlangen, Germany
Friedberg, Germany
Göttingen, Germany
Hamburg, Germany
Hartmannsdorf, Germany
Heidelberg, Germany
Itzehoe, Germany
Kassel, Germany
Kirchzarten, Germany
Koblenz, Germany
Köln, Germany
Königsbrück, Germany
Leisnig, Germany
Leverkusen, Germany
Limburg, Germany
Ludwigsburg, Germany
Markkleeberg, Germany
Meissen, Germany
Meppen, Germany
Merzig, Germany
Moosburg, Germany
Mühldorf, Germany
Munich, Germany
Münster, Germany
Nienburg, Germany
Paderborn, Germany
Pirna, Germany
Plauen, Germany
Riesa, Germany
Rotenburg a.d. Fulda, Germany
Starnberg, Germany
Westerstede, Germany
Zorneding, Germany
Zwiesel, Germany
Bologna, Italy
Firenze, Italy
Modena, Italy
Almaty, Kazakhstan
Bishkek, Kyrgyzstan
Riga, Latvia
Birkirkara, Malta
Podgorica, Montenegro
Almere, Netherlands
Amsterdam, Netherlands
Delfzijl, Netherlands
Enschede, Netherlands
Heerenveen, Netherlands
Hengelo, Netherlands
Maastricht, Netherlands
Rotterdam, Netherlands
s-Hertogenbosch, Netherlands
Venlo, Netherlands
Oslo, Norway
Bytom, Poland
Cieszyn, Poland
Gliwice, Poland
Katowice, Poland
Kielce, Poland
Łódz, Poland
Nysa, Poland
Opoczno, Poland
Opole, Poland
Radlin, Poland
Rzeszów, Poland
Szczecin, Poland
Tarnów, Poland
Warsaw, Poland
Zabrze, Poland
Zakopane, Poland
Almada, Portugal
Carnaxide, Lisboa, Portugal
Santarém, Portugal
Vila Real, Portugal
Viseu, Portugal
Arad, Romania
Brasov, Romania
Bucharest, Romania
Iaşi, Romania
Oradea, Romania
Târgu Mureş, Romania
Timişoara, Romania
Arkhangelsk, Russian Federation
Arkhangelsk, Russian Federation
Saint-Petersburg, Russian Federation
Vladivostok, Russian Federation
Belgrade, Serbia
Kragujevac, Serbia
Niška Banja, Serbia
Pirot, Serbia
Šabac, Serbia
Alicante, Spain
Benalmadena, Spain
Córdoba, Spain
Granada, Spain
Huarte, Spain
Murcia, Spain
Pamplona, Spain
San Juan de Alicante, Spain
Santiago de Compostela, Spain
Geneva, Switzerland
Adana, Turkey
Afyon, Turkey
Ankara, Turkey
Antalya, Turkey
Bayraklı, Izmir, Turkey
Bursa, Turkey
Diyarbakır, Turkey
Gaziantep, Turkey
Görükle, Bursa, Turkey
Istanbul, Turkey
Kurupelit, Samsun, Turkey
Merkez, Düzce, Turkey
Mersin, Turkey
Sivas, Turkey
Trabzon, Turkey
Yüreǧir, Adana, Turkey
Barnstaple, United Kingdom
Birmingham, United Kingdom
Blackburn, United Kingdom
Blackpool, United Kingdom
Carlisle, United Kingdom
Chertsey, United Kingdom
Cramlington, United Kingdom
Exeter, United Kingdom
Great Yarmouth, United Kingdom
Harrogate, United Kingdom
Huddersfield, United Kingdom
Macclesfield, United Kingdom
Maidstone, United Kingdom
Manchester, United Kingdom
Nottingham, United Kingdom
Poole, United Kingdom
Portsmouth, United Kingdom
Redhill, United Kingdom
Rhyl, United Kingdom
Salisbury, United Kingdom
Shrewsbury, United Kingdom
South Shields, United Kingdom
Southampton, United Kingdom
Taunton, United Kingdom
Torquay, United Kingdom
Watford, United Kingdom
Weston-super-Mare, United Kingdom
Wolverhampton, United Kingdom
Yeovil, United Kingdom
Liverpool Centre for Cardiovascular Science
Department of Clinical Sciences and Community Health
Geriatric Unit
Department of Translational and Precision Medicine
Cardiology Division
Clinical and Experimental Medicine PhD Program
Department of Clinical Medicine
Service de Cardiologie
Department of Cardiology
Department of Cardiology
School of Medicine
Clinical Center of Serbia
University of Medicine
ANMCO Research Center
Durrës
Tirana
Bastogne
Gilly
Haine Saint Paul
Hasselt
Kortrijk
La Louviere
Liege
Overpelt
Waremme
Yvoir
Pleven
Plovdiv
Sofia
Varna
Ústí nad Labem
Aalborg
Esbjerg
Herning
Madrid
Tallinn
Tartu
Elche
Toledo
Abbeville
Aix-en-Provence
Amiens
Angers
Aurillac
Avignon
Brest
Chartres
Creteil
Montpellier
Nimes
Paris
Pau
Pessac
Rennes
Saint Denis
Saint Etienne
Tours
Bitola
Ohrid
Skopje
Štip
Tbilisi
Aachen
Bad Reichenhall
Berlin
Biberach
Boppard
Brandenburg
Chemnitz
Dachau
Detmold
Ebersbach
Erlangen
Friedberg
Göttingen
Hamburg
Hartmannsdorf
Heidelberg
Itzehoe
Kassel
Kirchzarten
Koblenz
Köln
Königsbrück
Leisnig
Leverkusen
Limburg
Ludwigsburg
Markkleeberg
Meissen
Meppen
Merzig
Moosburg
Mühldorf
Munich
Münster
Nienburg
Paderborn
Pirna
Plauen
Riesa
Rotenburg a.d. Fulda
Starnberg
Westerstede
Zorneding
Zwiesel
Bologna
Firenze
Modena
Almaty
Bishkek
Riga
Birkirkara
Podgorica
Almere
Amsterdam
Delfzijl
Enschede
Heerenveen
Hengelo
Maastricht
Rotterdam
s-Hertogenbosch
Venlo
Oslo
Bytom
Cieszyn
Gliwice
Katowice
Kielce
Łódz
Nysa
Opoczno
Opole
Radlin
Rzeszów
Szczecin
Tarnów
Warsaw
Zabrze
Zakopane
Almada
Carnaxide
Santarém
Vila Real
Viseu
Arad
Brasov
Bucharest
Iaşi
Oradea
Târgu Mureş
Timişoara
Arkhangelsk
Arkhangelsk
Saint-Petersburg
Vladivostok
Belgrade
Kragujevac
Niška Banja
Pirot
Šabac
Alicante
Benalmadena
Córdoba
Granada
Huarte
Murcia
Pamplona
San Juan de Alicante
Santiago de Compostela
Geneva
Adana
Afyon
Ankara
Antalya
Bayraklı
Bursa
Diyarbakır
Gaziantep
Görükle
Istanbul
Kurupelit
Merkez
Mersin
Sivas
Trabzon
Yüreǧir
Barnstaple
Birmingham
Blackburn
Blackpool
Carlisle
Chertsey
Cramlington
Exeter
Great Yarmouth
Harrogate
Huddersfield
Macclesfield
Maidstone
Manchester
Nottingham
Poole
Portsmouth
Redhill
Rhyl
Salisbury
Shrewsbury
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