5 years ago

International trends in clinical characteristics and oral anticoagulation treatment for patients with atrial fibrillation: Results from the GARFIELD, ORBIT-AF I, and ORBIT-AF II Registries

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 (≤6weeks). 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 CAD (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 (OAC) 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 OAC (range: 30%–93% [GARFIELD-AF] and 52% -100% [ORBIT-AF II]). Among patients with new-onset AF, non-Vitamin K antagonist oral anticoagulant (NOAC) use increased over time to 45% in 2016 for GARFIELD-AF and 71% for ORBIT-AF II, while use of antiplatelet monotherapy decreased from 35% to 14% (GARFIELD-AF) and 18% to 8% (ORBIT-AF I and II). Conclusions Among new-onset AF patients, NOAC 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.

Publisher URL: www.sciencedirect.com/science

DOI: S0002870317302417

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