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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; Gao, H; Shrader, P; Pieper, K; Thomas, L; Camm, AJ; Ezekowitz, MD; Fonarow, GC; Gersh, BJ; Goldhaber, S; et al. Steinberg, BA; Gao, H; Shrader, P; Pieper, K; Thomas, L; Camm, AJ; Ezekowitz, MD; Fonarow, GC; Gersh, BJ; Goldhaber, S; Haas, S; Hacke, W; Kowey, PR; Ansell, J; Mahaffey, KW; Naccarelli, G; Reiffel, JA; Turpie, A; Verheugt, F; Piccini, JP; Kakkar, A; Peterson, ED; Fox, KAA; GARFIELD-AF; ORBIT-AF Investigators (2017) 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. Am Heart J, 194. pp. 132-140. ISSN 1097-6744 https://doi.org/10.1016/j.ahj.2017.08.011
SGUL Authors: Camm, Alan John

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Abstract

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.

Item Type: Article
Additional Information: © 2017 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Keywords: Administration, Oral, Aged, Anticoagulants, Atrial Fibrillation, Female, Global Health, Humans, Male, Middle Aged, Prevalence, Prospective Studies, Registries, Risk Assessment, Risk Factors, Stroke, Cardiovascular System & Hematology, 1102 Cardiovascular Medicine And Haematology, 1117 Public Health And Health Services
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) > Cardiac (INCCCA)
Journal or Publication Title: Am Heart J
ISSN: 1097-6744
Language: eng
Dates:
DateEvent
December 2017Published
24 August 2017Published Online
17 August 2017Accepted
Publisher License: Creative Commons: Attribution-Noncommercial-No Derivative Works 4.0
PubMed ID: 29223431
Web of Science ID: WOS:000417602600015
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/109451
Publisher's version: https://doi.org/10.1016/j.ahj.2017.08.011

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