TY - JOUR
T1 - Evolving antithrombotic treatment patterns for patients with newly diagnosed atrial fibrillation
AU - Camm, A John
AU - Accetta, Gabriele
AU - Ambrosio, Giuseppe
AU - Atar, Dan
AU - Bassand, Jean-Pierre
AU - Berge, Eivind
AU - Cools, Frank
AU - Fitzmaurice, David A
AU - Goldhaber, Samuel Z
AU - Goto, Shinya
AU - Haas, Sylvia
AU - Kayani, Gloria
AU - Koretsune, Yukihiro
AU - Mantovani, Lorenzo G
AU - Misselwitz, Frank
AU - Oh, Seil
AU - Turpie, Alexander G G
AU - Verheugt, Freek W A
AU - Kakkar, Ajay K
AU - GARFIELD-AF Investigators
A2 - Nielsen, Jørn Dalsgaard
N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
PY - 2017/2/15
Y1 - 2017/2/15
N2 - OBJECTIVE: We studied evolving antithrombotic therapy patterns in patients with newly diagnosed non-valvular atrial fibrillation (AF) and ≥1 additional stroke risk factor between 2010 and 2015.METHODS: 39 670 patients were prospectively enrolled in four sequential cohorts in the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF): cohort C1 (2010-2011), n=5500; C2 (2011-2013), n=11 662; C3 (2013-2014), n=11 462; C4 (2014-2015), n=11 046. Baseline characteristics and antithrombotic therapy initiated at diagnosis were analysed by cohort.RESULTS: Baseline characteristics were similar across cohorts. Median CHA2DS2-VASc (cardiac failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)) score was 3 in all four cohorts. From C1 to C4, the proportion of patients on anticoagulant (AC) therapy increased by almost 15% (C1 57.4%; C4 71.1%). Use of vitamin K antagonist (VKA)±antiplatelet (AP) (C1 53.2%; C4 34.0%) and AP monotherapy (C1 30.2%; C4 16.6%) declined, while use of non-VKA oral ACs (NOACs)±AP increased (C1 4.2%; C4 37.0%). Most CHA2DS2-VASc ≥2 patients received AC, and this proportion increased over time, largely driven by NOAC prescribing. NOACs were more frequently prescribed than VKAs in men, the elderly, patients of Asian ethnicity, those with dementia, or those using non-steroidal anti-inflammatory drugs, and current smokers. VKA use was more common in patients with cardiac, vascular, or renal comorbidities.CONCLUSIONS: Since NOACs were introduced, there has been an increase in newly diagnosed patients with AF at risk of stroke receiving guideline-recommended therapy, predominantly driven by increased use of NOACs and reduced use of VKA±AP or AP alone.TRIAL REGISTRATION NUMBER: NCT01090362; Pre-results.
AB - OBJECTIVE: We studied evolving antithrombotic therapy patterns in patients with newly diagnosed non-valvular atrial fibrillation (AF) and ≥1 additional stroke risk factor between 2010 and 2015.METHODS: 39 670 patients were prospectively enrolled in four sequential cohorts in the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF): cohort C1 (2010-2011), n=5500; C2 (2011-2013), n=11 662; C3 (2013-2014), n=11 462; C4 (2014-2015), n=11 046. Baseline characteristics and antithrombotic therapy initiated at diagnosis were analysed by cohort.RESULTS: Baseline characteristics were similar across cohorts. Median CHA2DS2-VASc (cardiac failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)) score was 3 in all four cohorts. From C1 to C4, the proportion of patients on anticoagulant (AC) therapy increased by almost 15% (C1 57.4%; C4 71.1%). Use of vitamin K antagonist (VKA)±antiplatelet (AP) (C1 53.2%; C4 34.0%) and AP monotherapy (C1 30.2%; C4 16.6%) declined, while use of non-VKA oral ACs (NOACs)±AP increased (C1 4.2%; C4 37.0%). Most CHA2DS2-VASc ≥2 patients received AC, and this proportion increased over time, largely driven by NOAC prescribing. NOACs were more frequently prescribed than VKAs in men, the elderly, patients of Asian ethnicity, those with dementia, or those using non-steroidal anti-inflammatory drugs, and current smokers. VKA use was more common in patients with cardiac, vascular, or renal comorbidities.CONCLUSIONS: Since NOACs were introduced, there has been an increase in newly diagnosed patients with AF at risk of stroke receiving guideline-recommended therapy, predominantly driven by increased use of NOACs and reduced use of VKA±AP or AP alone.TRIAL REGISTRATION NUMBER: NCT01090362; Pre-results.
KW - Administration, Oral
KW - Age Factors
KW - Aged
KW - Aged, 80 and over
KW - Atrial Fibrillation/diagnosis
KW - Comorbidity
KW - Female
KW - Fibrinolytic Agents/administration & dosage
KW - Guideline Adherence
KW - Humans
KW - Male
KW - Middle Aged
KW - Practice Guidelines as Topic
KW - Practice Patterns, Physicians'/trends
KW - Prospective Studies
KW - Registries
KW - Risk Assessment
KW - Risk Factors
KW - Sex Factors
KW - Stroke/diagnosis
KW - Time Factors
KW - Treatment Outcome
U2 - 10.1136/heartjnl-2016-309832
DO - 10.1136/heartjnl-2016-309832
M3 - Journal article
C2 - 27647168
SN - 1355-6037
VL - 103
SP - 307
EP - 314
JO - Heart (British Cardiac Society)
JF - Heart (British Cardiac Society)
IS - 4
ER -