International trends in clinical characteristics and oral anticoagulation treatment for patients with atrial fibrillation: Results from the GARFIELD-AF, ORBIT-AF I, and ORBIT-AF II registries
Benjamin A Steinberg, Haiyan Gao, Peter Shrader, Karen Pieper, Laine Thomas, A John Camm, Michael D Ezekowitz, Gregg C Fonarow, Bernard J Gersh, Samuel Goldhaber, Sylvia Haas, Werner Hacke, Peter R Kowey, Jack Ansell, Kenneth W Mahaffey, Gerald Naccarelli, James A Reiffel, Alexander Turpie, Freek Verheugt, Jonathan P Piccini, Ajay Kakkar, Eric D Peterson, Keith A A Fox, GARFIELD-AF, ORBIT-AF Investigators, Benjamin A Steinberg, Haiyan Gao, Peter Shrader, Karen Pieper, Laine Thomas, A John Camm, Michael D Ezekowitz, Gregg C Fonarow, Bernard J Gersh, Samuel Goldhaber, Sylvia Haas, Werner Hacke, Peter R Kowey, Jack Ansell, Kenneth W Mahaffey, Gerald Naccarelli, James A Reiffel, Alexander Turpie, Freek Verheugt, Jonathan P Piccini, Ajay Kakkar, Eric D Peterson, Keith A A Fox, GARFIELD-AF, ORBIT-AF Investigators
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia in the world. We aimed to provide comprehensive data on international patterns of AF stroke prevention treatment.
Methods: Demographics, comorbidities, and stroke risk of the patients in the GARFIELD-AF (n=51,270), ORBIT-AF I (n=10,132), and ORBIT-AF II (n=11,602) registries were compared (overall N=73,004 from 35 countries). Stroke prevention therapies were assessed among patients with new-onset AF (≤6 weeks).
Results: Patients from GARFIELD-AF were less likely to be white (63% vs 89% for ORBIT-AF I and 86% for ORBIT-AF II) or have coronary artery disease (19% vs 36% and 27%), but had similar stroke risk (85% CHA2DS2-VASc ≥2 vs 91% and 85%) and lower bleeding risk (11% with HAS-BLED ≥3 vs 24% and 15%). Oral anticoagulant use was 46% and 57% for patients with a CHA2DS2-VASc=0 and 69% and 87% for CHA2DS2-VASc ≥2 in GARFIELD-AF and ORBIT-AF II, respectively, but with substantial geographic heterogeneity in use of oral anticoagulant (range: 31%-93% [GARFIELD-AF] and 66%-100% [ORBIT-AF II]). Among patients with new-onset AF, non-vitamin K antagonist oral anticoagulant use increased over time to 43% in 2016 for GARFIELD-AF and 71% for ORBIT-AF II, whereas use of antiplatelet monotherapy decreased from 36% to 17% (GARFIELD-AF) and 18% to 8% (ORBIT-AF I and II).
Conclusions: Among new-onset AF patients, non-vitamin K antagonist oral anticoagulant use has increased and antiplatelet monotherapy has decreased. However, anticoagulation is used frequently in low-risk patients and inconsistently in those at high risk of stroke. Significant geographic variability in anticoagulation persists and represents an opportunity for improvement.
Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.
Source: PubMed