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
American Heart Journal. 2017-12-01; 194: 132-140
DOI: 10.1016/J.AHJ.2017.08.011
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1. Am Heart J. 2017 Dec;194:132-140. doi: 10.1016/j.ahj.2017.08.011. Epub 2017 Aug
24.
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.
Steinberg BA(1), Gao H(2), Shrader P(3), Pieper K(3), Thomas L(3), Camm AJ(4),
Ezekowitz MD(5), Fonarow GC(6), Gersh BJ(7), Goldhaber S(8), Haas S(9), Hacke
W(10), Kowey PR(11), Ansell J(12), Mahaffey KW(13), Naccarelli G(14), Reiffel
JA(15), Turpie A(16), Verheugt F(17), Piccini JP(18), Kakkar A(2), Peterson
ED(18), Fox KAA(19); GARFIELD-AF; ORBIT-AF Investigators.
Author information:
(1)Division of Cardiovascular Medicine, University of Utah Health Sciences
Center, Salt Lake City, UT; Duke University Medical Center, Durham, NC; Duke
Clinical Research Institute, Durham, NC. Electronic address:
.
(2)Thrombosis Research Institute, London, United Kingdom.
(3)Duke Clinical Research Institute, Durham, NC.
(4)St George’s University of London, London, United Kingdom.
(5)Thomas Jefferson Medical College, Lankenau Medical Center, Wynnewood, PA.
(6)UCLA Division of Cardiology, Los Angeles, CA.
(7)Mayo Clinic, Rochester, MN.
(8)Harvard Medical School and Brigham and Women’s Hospital, Boston, MA.
(9)Technical University of Munich, Munich, Germany.
(10)University Hospital of Heidelberg, Heidelberg, Germany.
(11)Lankenau Institute for Medical Research, Wynnewood, PA.
(12)Department of Medicine, Hofstra Northwell School of Medicine, New York, NY.
(13)Stanford University School of Medicine, Palo Alto, CA.
(14)Penn State University School of Medicine, Hershey, PA.
(15)Columbia University College of Physicians and Surgeons, New York, NY.
(16)Department of Medicine, McMaster University, Hamilton, Canada.
(17)Department of Cardiology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The
Netherlands.
(18)Duke University Medical Center, Durham, NC; Duke Clinical Research Institute,
Durham, NC.
(19)Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United
Kingdom.
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.
DOI: 10.1016/j.ahj.2017.08.011
PMID: 29223431 [Indexed for MEDLINE]