Evolving antithrombotic treatment patterns for patients with newly diagnosed atrial fibrillation

A. John Camm, Gabriele Accetta, Giuseppe Ambrosio, Dan Atar, Jean Pierre Bassand, Eivind Berge, Frank Cools, David A. Fitzmaurice, Samuel Z. Goldhaber, Shinya Goto, Sylvia Haas, Gloria Kayani, Yukihiro Koretsune, Lorenzo G. Mantovani, Frank Misselwitz, Seil Oh, Alexander G.G. Turpie, Freek W.A. Verheugt, Ajay K. Kakkar

Research output: Contribution to journalArticle

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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 (20112013), 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 antiinflammatory 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.

Original languageEnglish
Pages (from-to)307-314
Number of pages8
JournalHeart
Volume103
Issue number4
DOIs
StatePublished - 15 Feb 2017

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Atrial Fibrillation
Anticoagulants
Vitamin K
Stroke
Therapeutics
Vascular Diseases
Blood Vessels
Dementia
Registries
Comorbidity
Anti-Inflammatory Agents
Heart Failure
Guidelines
Hypertension
Kidney
Pharmaceutical Preparations

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Camm, A. J., Accetta, G., Ambrosio, G., Atar, D., Bassand, J. P., Berge, E., ... Kakkar, A. K. (2017). Evolving antithrombotic treatment patterns for patients with newly diagnosed atrial fibrillation. Heart, 103(4), 307-314. https://doi.org/10.1136/heartjnl-2016-309832
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. ; Kakkar, Ajay K. / Evolving antithrombotic treatment patterns for patients with newly diagnosed atrial fibrillation. In: Heart. 2017 ; Vol. 103, No. 4. pp. 307-314.
@article{faf5eebbe4cb43b2b4381d806b1a76a9,
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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 (20112013), 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 antiinflammatory 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.",
author = "Camm, {A. John} and Gabriele Accetta and Giuseppe Ambrosio and Dan Atar and Bassand, {Jean Pierre} and Eivind Berge and Frank Cools and Fitzmaurice, {David A.} and Goldhaber, {Samuel Z.} and Shinya Goto and Sylvia Haas and Gloria Kayani and Yukihiro Koretsune and Mantovani, {Lorenzo G.} and Frank Misselwitz and Seil Oh and Turpie, {Alexander G.G.} and Verheugt, {Freek W.A.} and Kakkar, {Ajay K.}",
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Camm, AJ, Accetta, G, Ambrosio, G, Atar, D, Bassand, JP, Berge, E, Cools, F, Fitzmaurice, DA, Goldhaber, SZ, Goto, S, Haas, S, Kayani, G, Koretsune, Y, Mantovani, LG, Misselwitz, F, Oh, S, Turpie, AGG, Verheugt, FWA & Kakkar, AK 2017, 'Evolving antithrombotic treatment patterns for patients with newly diagnosed atrial fibrillation', Heart, vol. 103, no. 4, pp. 307-314. https://doi.org/10.1136/heartjnl-2016-309832

Evolving antithrombotic treatment patterns for patients with newly diagnosed atrial fibrillation. / 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.; Kakkar, Ajay K.

In: Heart, Vol. 103, No. 4, 15.02.2017, p. 307-314.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Evolving antithrombotic treatment patterns for patients with newly diagnosed atrial fibrillation

AU - Camm, A. John

AU - Accetta, Gabriele

AU - Ambrosio, Giuseppe

AU - Atar, Dan

AU - Bassand, Jean Pierre

AU - Berge, Eivind

AU - Cools, Frank

AU - Fitzmaurice, David A.

AU - Goldhaber, Samuel Z.

AU - Goto, Shinya

AU - Haas, Sylvia

AU - Kayani, Gloria

AU - Koretsune, Yukihiro

AU - Mantovani, Lorenzo G.

AU - Misselwitz, Frank

AU - Oh, Seil

AU - Turpie, Alexander G.G.

AU - Verheugt, Freek W.A.

AU - Kakkar, Ajay K.

PY - 2017/2/15

Y1 - 2017/2/15

N2 - 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 (20112013), 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 antiinflammatory 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.

AB - 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 (20112013), 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 antiinflammatory 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.

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DO - 10.1136/heartjnl-2016-309832

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Camm AJ, Accetta G, Ambrosio G, Atar D, Bassand JP, Berge E et al. Evolving antithrombotic treatment patterns for patients with newly diagnosed atrial fibrillation. Heart. 2017 Feb 15;103(4):307-314. https://doi.org/10.1136/heartjnl-2016-309832