The Library
Evolving antithrombotic treatment patterns for patients with newly diagnosed atrial fibrillation
Tools
Camm, A. John, Accetta, Gabriele, Ambrosio, Giuseppe, Atar, Dan, Bassand, Jean-Pierre, Berge, Eivind, Cools, Frank, Fitzmaurice, David A., Goldhaber, Samuel Z, Goto, Shinya, Haas, Sylvia, Kayani, Gloria, Koretsune, Yukihiro, Mantovani, Lorenzo G., Misselwitz, Frank, Oh, Seil, Turpie, Alexander G. G., Verheugt, Freek W. A. and Kakkar, Ajay K. (2016) Evolving antithrombotic treatment patterns for patients with newly diagnosed atrial fibrillation. Heart, 103 (4). pp. 307-314. doi:10.1136/heartjnl-2016-309832 ISSN 1355-6037.
Research output not available from this repository.
Request-a-Copy directly from author or use local Library Get it For Me service.
Official URL: 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.
Item Type: | Journal Article | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
||||||||||
Journal or Publication Title: | Heart | ||||||||||
Publisher: | BMJ Group | ||||||||||
ISSN: | 1355-6037 | ||||||||||
Official Date: | 19 September 2016 | ||||||||||
Dates: |
|
||||||||||
Volume: | 103 | ||||||||||
Number: | 4 | ||||||||||
Page Range: | pp. 307-314 | ||||||||||
DOI: | 10.1136/heartjnl-2016-309832 | ||||||||||
Status: | Peer Reviewed | ||||||||||
Publication Status: | Published | ||||||||||
Access rights to Published version: | Open Access (Creative Commons) |
Request changes or add full text files to a record
Repository staff actions (login required)
View Item |