Benjamin A Steinberg1, Haiyan Gao2, Peter Shrader3, Karen Pieper3, Laine Thomas3, A John Camm4, Michael D Ezekowitz5, Gregg C Fonarow6, Bernard J Gersh7, Samuel Goldhaber8, Sylvia Haas9, Werner Hacke10, Peter R Kowey11, Jack Ansell12, Kenneth W Mahaffey13, Gerald Naccarelli14, James A Reiffel15, Alexander Turpie16, Freek Verheugt17, Jonathan P Piccini18, Ajay Kakkar2, Eric D Peterson18, Keith A A Fox19. 1. Division of Cardiovascular Medicine, University of Utah Health Sciences Center, Salt Lake City, UT; Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC. Electronic address: benjamin.steinberg@hsc.utah.edu. 2. Thrombosis Research Institute, London, United Kingdom. 3. Duke Clinical Research Institute, Durham, NC. 4. St George's University of London, London, United Kingdom. 5. Thomas Jefferson Medical College, Lankenau Medical Center, Wynnewood, PA. 6. UCLA Division of Cardiology, Los Angeles, CA. 7. Mayo Clinic, Rochester, MN. 8. Harvard Medical School and Brigham and Women's Hospital, Boston, MA. 9. Technical University of Munich, Munich, Germany. 10. University Hospital of Heidelberg, Heidelberg, Germany. 11. Lankenau Institute for Medical Research, Wynnewood, PA. 12. Department of Medicine, Hofstra Northwell School of Medicine, New York, NY. 13. Stanford University School of Medicine, Palo Alto, CA. 14. Penn State University School of Medicine, Hershey, PA. 15. Columbia University College of Physicians and Surgeons, New York, NY. 16. Department of Medicine, McMaster University, Hamilton, Canada. 17. Department of Cardiology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands. 18. Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC. 19. Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
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.
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 AFpatients, 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.
Authors: Zak Loring; Suchit Mehrotra; Jonathan P Piccini; John Camm; David Carlson; Gregg C Fonarow; Keith A A Fox; Eric D Peterson; Karen Pieper; Ajay K Kakkar Journal: Europace Date: 2020-11-01 Impact factor: 5.214
Authors: Rachel M Kaplan; Celso L Diaz; Theresa Strzelczyk; Cindy You; Basil Saour; Michelle Fine; Amar Trivedi; Mark J Shen; Prasongchai Sattayaprasert; Alexandru B Chicos; Rishi Arora; Susan Kim; Albert Lin; Nishant Verma; Bradley P Knight; Rod S Passman Journal: Am J Cardiol Date: 2018-07-04 Impact factor: 3.133