Predictors of NOAC versus VKA use for stroke prevention in patients with newly diagnosed atrial fibrillation: Results from GARFIELD-AF

Sylvia Haas, A John Camm, Jean-Pierre Bassand, Pantep Angchaisuksiri, Frank Cools, Ramon Corbalan, Harry Gibbs, Barry Jacobson, Yukihiro Koretsune, Lorenzo G Mantovani, Frank Misselwitz, Elizaveta Panchenko, Hany Ibrahim Ragy, Janina Stepinska, Alexander GG Turpie, Jitendra PS Sawhney, Jan Steffel, Toon Wei Lim, Karen S Pieper, Saverio Virdone, Freek WA Verheugt, Ajay K Kakkar
American Heart Journal. 2019-07-01; 213: 35-46
DOI: 10.1016/J.AHJ.2019.03.013

Read on PubMed

1. Am Heart J. 2019 Jul;213:35-46. doi: 10.1016/j.ahj.2019.03.013. Epub 2019 Apr 11.

Predictors of NOAC versus VKA use for stroke prevention in patients with newly
diagnosed atrial fibrillation: Results from GARFIELD-AF.

Haas S(1), Camm AJ(2), Bassand JP(3), Angchaisuksiri P(4), Cools F(5), Corbalan
R(6), Gibbs H(7), Jacobson B(8), Koretsune Y(9), Mantovani LG(10), Misselwitz
F(11), Panchenko E(12), Ragy HI(13), Stepinska J(14), Turpie AG(15), Sawhney
JP(16), Steffel J(17), Lim TW(18), Pieper KS(19), Virdone S(20), Verheugt FW(21),
Kakkar AK(22); GARFIELD-AF Investigators.

Author information:
(1)Formerly Technical University of Munich, Munich, Germany. Electronic address:
(2)Molecular and Clinical Sciences Research Institute, Cardiology Clinical
Academic Group, St George’s University of London, London, United Kingdom.
(3)University of Besançon, Besançon, France; Thrombosis Research Institute,
London, United Kingdom.
(4)Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
(5)AZ Klina, Brasschaat, Belgium.
(6)Catholic University, Santiago, Chile.
(7)The Alfred Hospital, Melbourne, Australia.
(8)NHLS and University of the Witwatersrand, Charlotte Maxeke Hospital,
Johannesburg, South Africa.
(9)National Hospital Organization, Osaka National Hospital, Osaka, Japan.
(10)University of Milano-Bicocca, Milan, Italy.
(11)Bayer AG, Pharmaceuticals, Berlin, Germany.
(12)Russian Cardiology Research and Production Center, Department of
Atherothrombosis, 3-d Cherepkovskaya str., 15 A, Moscow, Russian Federation.
(13)National Heart Institute, Cairo, Egypt.
(14)Institute of Cardiology, Warsaw, Poland.
(15)McMaster University, Hamilton, Canada.
(16)Sir Ganga Ram Hospital, New Delhi, India.
(17)University Hospital Zurich, Zurich, Switzerland.
(18)National University Heart Centre, Singapore (NUHCS), 1E Kent Ridge Road, NUHS
Tower Block, Level 9, Singapore, Republic of Singapore.
(19)Thrombosis Research Institute, London, United Kingdom; Duke Clinical Research
Institute, Durham, NC, USA.
(20)Thrombosis Research Institute, London, United Kingdom.
(21)Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands.
(22)Thrombosis Research Institute, London, United Kingdom; University College
London, London, United Kingdom.

INTRODUCTION: A principal aim of the Global Anticoagulant Registry in the
FIELD-Atrial Fibrillation (GARFIELD-AF) was to document changes in treatment
practice for patients with newly diagnosed atrial fibrillation during an era when
non-vitamin K antagonist oral anticoagulants (NOACs) were becoming more widely
adopted. In these analyses, the key factors which determined the choice between
NOACs and vitamin K antagonists (VKAs) are explored.
METHODS: Logistic least absolute shrinkage and selection operator regression
determined predictors of NOAC and VKA use. Data were collected from 24,137
patients who were initiated on AC ± antiplatelet (AP) therapy (NOAC [51.4%] or
VKA [48.6%]) between April 2013 and August 2016.
RESULTS: The most significant predictors of AC therapy were country, enrolment
year, care setting at diagnosis, AF type, concomitant AP, and kidney disease.
Patients enrolled in emergency care or in the outpatient setting were more likely
to receive a NOAC than those enrolled in hospital (OR 1.16 [95% CI: 1.04-1.30],
OR: 1.15 [95% CI: 1.05-1.25], respectively). NOAC prescribing seemed to be
favored in lower-risk groups, namely, patients with paroxysmal AF, normotensive
patients, and those with moderate alcohol consumption, but also the elderly and
patients with acute coronary syndrome. By contrast, VKAs were preferentially used
in patients with permanent AF, moderate to severe kidney disease, heart failure,
vascular disease, and diabetes and with concomitant AP.
CONCLUSION: GARFIELD-AF data highlight marked heterogeneity in stroke prevention
strategies globally. Physicians are adopting an individualized approach to stroke
prevention where NOACs are favored in patients with a lower stroke risk but also
in the elderly and patients with acute coronary syndrome.

Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.

DOI: 10.1016/j.ahj.2019.03.013
PMID: 31128503 [Indexed for MEDLINE]

Know more about