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

Haas, S; Camm, AJ; Bassand, J-P; Angchaisuksiri, P; Cools, F; Corbalan, R; Gibbs, H; Jacobson, B; Koretsune, Y; Mantovani, LG; et al. Haas, S; Camm, AJ; Bassand, J-P; Angchaisuksiri, P; Cools, F; Corbalan, R; Gibbs, H; Jacobson, B; Koretsune, Y; Mantovani, LG; Misselwitz, F; Panchenko, E; Ragy, HI; Stepinska, J; Turpie, AG; Sawhney, JP; Steffel, J; Lim, TW; Pieper, KS; Virdone, S; Verheugt, FW; Kakkar, AK; GARFIELD-AF Investigators (2019) Predictors of NOAC versus VKA use for stroke prevention in patients with newly diagnosed atrial fibrillation: Results from GARFIELD-AF. Am Heart J, 213. pp. 35-46. ISSN 1097-6744 https://doi.org/10.1016/j.ahj.2019.03.013
SGUL Authors: Camm, Alan John

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Abstract

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.

Item Type: Article
Additional Information: © 2019 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: GARFIELD-AF Investigators, 1102 Cardiovascular Medicine And Haematology, 1117 Public Health And Health Services, Cardiovascular System & Hematology
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Am Heart J
ISSN: 1097-6744
Language: eng
Dates:
DateEvent
July 2019Published
11 April 2019Published Online
27 March 2019Accepted
Publisher License: Creative Commons: Attribution-Noncommercial-No Derivative Works 4.0
PubMed ID: 31128503
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/110922
Publisher's version: https://doi.org/10.1016/j.ahj.2019.03.013

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