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 - 08/12/17
, Haiyan Gao, PhD d, Peter Shrader, MA c, Karen Pieper, MS c, Laine Thomas, PhD c, A. John Camm, MD e, Michael D. Ezekowitz, MB, ChB, DPhil f, Gregg C. Fonarow, MD g, Bernard J. Gersh, MB, ChB, DPhil h, Samuel Goldhaber, MD i, Sylvia Haas, MD j, Werner Hacke, MD, PhD k, Peter R. Kowey, MD l, Jack Ansell, MD m, Kenneth W. Mahaffey, MD n, Gerald Naccarelli, MD o, James A. Reiffel, MD p, Alexander Turpie, MD q, Freek Verheugt, MD r, Jonathan P. Piccini, MD, MHS b, c, Ajay Kakkar, MBBS, PhD d, Eric D. Peterson, MD, MPH b, c, Keith A.A. Fox, MB, ChB sFor the GARFIELD-AF
ORBIT-AF Investigators
Background |
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.
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Vol 194
P. 132-140 - décembre 2017 Retour au numéro
Article précédent
- Predicting risk of cardiac events among ST-segment elevation myocardial infarction patients with conservatively managed non–infarct-related artery coronary artery disease: An analysis of the Duke Databank for Cardiovascular Disease
- Sameer A. Hirji, Susanna R. Stevens, Linda K. Shaw, Erin C. Campbell, Christopher B. Granger, Manesh R. Patel, Michael H. Sketch, Tracy Y. Wang, E. Magnus Ohman, Eric D. Peterson, J. Matthew Brennan
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