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

• Published in: The American heart journal 2017-12, Vol.194, p.132-140
• Main Authors: Steinberg, Benjamin A., Gao, Haiyan, Shrader, Peter, Pieper, Karen, Thomas, Laine, Camm, A. John, Ezekowitz, Michael D., Fonarow, Gregg C., Gersh, Bernard J., Goldhaber, Samuel, Haas, Sylvia, Hacke, Werner, Kowey, Peter R., Ansell, Jack, Mahaffey, Kenneth W., Naccarelli, Gerald, Reiffel, James A., Turpie, Alexander, Verheugt, Freek, Piccini, Jonathan P., Kakkar, Ajay, Peterson, Eric D., Fox, Keith A.A.
• Format: Article
• Language: English
• Subjects: Administration, Oral; Aged; Anticoagulants; Anticoagulants - administration & dosage; Arrhythmia; Atrial Fibrillation - complications; Atrial Fibrillation - drug therapy; Bleeding; Cardiac arrhythmia; Cardiology; Collaboration; Coronary artery; Coronary artery disease; Demographics; Demography; Enrollments; Family medical history; Female; Fibrillation; Global Health; Health risks; Heart; Heart diseases; Humans; International; Laboratories; Male; Middle Aged; Patients; Prevalence; Prevention; Primary care; Prospective Studies; Registries; Regulatory approval; Risk Assessment; Risk Factors; Stroke; Stroke - epidemiology; Stroke - etiology; Stroke - prevention & control; Vitamin K
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2017.08.011

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. 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). 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). 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.