Evolving antithrombotic treatment patterns for patients with newly diagnosed atrial fibrillation

View/ Open
Author
Camm, A John
Accetta, Gabriele
Ambrosio, Giuseppe
Atar, Dan
Bassand, Jean-Pierre
Berge, Eivind
Cools, Frank
Fitzmaurice, David A
Goto, Shinya
Haas, Sylvia
Kayani, Gloria
Koretsune, Yukihiro
Mantovani, Lorenzo G
Misselwitz, Frank
Oh, Seil
Turpie, Alexander G G
Verheugt, Freek W A
Kakkar, Ajay K
Note: Order does not necessarily reflect citation order of authors.
Published Version
https://doi.org/10.1136/heartjnl-2016-309832Metadata
Show full item recordCitation
Camm, A. J., G. Accetta, G. Ambrosio, D. Atar, J. Bassand, E. Berge, F. Cools, et al. 2017. “Evolving antithrombotic treatment patterns for patients with newly diagnosed atrial fibrillation.” Heart 103 (4): 307-314. doi:10.1136/heartjnl-2016-309832. http://dx.doi.org/10.1136/heartjnl-2016-309832.Abstract
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.Other Sources
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5293840/pdf/Terms of Use
This article is made available under the terms and conditions applicable to Other Posted Material, as set forth at http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAACitable link to this page
http://nrs.harvard.edu/urn-3:HUL.InstRepos:31731763
Collections
- HMS Scholarly Articles [17714]
Contact administrator regarding this item (to report mistakes or request changes)