{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T15:43:37Z","timestamp":1782920617714,"version":"3.54.5"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2013Meier analysis assessed outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean CHA\n                      <jats:sub>2<\/jats:sub>\n                      DS\n                      <jats:sub>2<\/jats:sub>\n                      -VASc score was 2.43. Anticoagulation quality was poor under the standard INR target of 2.0\u20133.0, with a mean time in therapeutic range (TTR) of only 30.1%. Patients with an average INR of 1.6\u20132.5 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Warfarin management at the standard INR target of 2.0\u20133.0 was associated with poor anticoagulation quality. Patients with average INR values of 1.6\u20132.5 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1824720","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T14:45:16Z","timestamp":1782917116000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The characteristics and clinical outcomes of atrial fibrillation patient in middle income country of Indonesia"],"prefix":"10.3389","volume":"13","author":[{"given":"Yoga","family":"Yuniadi","sequence":"first","affiliation":[{"name":"Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia","place":["Jakarta, Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Putra S.","family":"Antara","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Udayana","place":["Denpasar, Indonesia"]},{"name":"Ngoerah General Central Hospital","place":["Denpasar, Bali, Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muzakkir","family":"Amir","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Hasanuddin","place":["Makassar, Indonesia"]},{"name":"Wahidin Soerodihoesodo General Central Hospital","place":["Makassar, Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dicky A.","family":"Hanafy","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia","place":["Jakarta, Indonesia"]},{"name":"National Cardiovascular Center Harapan Kita","place":["Jakarta, Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunu B.","family":"Raharjo","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia","place":["Jakarta, Indonesia"]},{"name":"National Cardiovascular Center Harapan Kita","place":["Jakarta, Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dony Y.","family":"Hermanto","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia","place":["Jakarta, Indonesia"]},{"name":"National Cardiovascular Center Harapan Kita","place":["Jakarta, Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Yamin","sequence":"additional","affiliation":[{"name":"Cipto Mangunkusumo General National Hospital","place":["Jakarta, Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hauda","family":"El-Rasyid","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Andalas","place":["Padang, Indonesia"]},{"name":"M Djamil General Central Hospital","place":["Padang, Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benny","family":"Setiadi","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sam Ratulangi","place":["Manado, Indonesia"]},{"name":"Kandau General Central Hospital","place":["Manado, Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Maharani","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Gajah Mada","place":["Yogyakarta, Indonesia"]},{"name":"Sardjito General Central Hospital","place":["Yogyakarta, Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agus","family":"Harsoyo","sequence":"additional","affiliation":[{"name":"Gatot Subroto Army General Hospital","place":["Jakarta, Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anggia C.","family":"Lubis","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sumatra Utara","place":["Medan, Indonesia"]},{"name":"Adam Malik General Central Hospital","place":["Medan, Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pipin","family":"Ardhianto","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Diponegoro","place":["Semarang, Indonesia"]},{"name":"Kariadi General Central Hospital","place":["Semarang, Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aruman Y. A.","family":"Binarso","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Diponegoro","place":["Semarang, Indonesia"]},{"name":"Kariadi General Central Hospital","place":["Semarang, Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ardian","family":"Rizal","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Brawijaya","place":["Malang, Indonesia"]},{"name":"Syaiful Anwar General Central Hospital","place":["Malang, Indonesia"]},{"name":"Wava Husada Hospital","place":["Malang, Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rerdin","family":"Julario","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga","place":["Surabaya, Indonesia"]},{"name":"Soetomo General Central Hospital","place":["Surabaya, 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