Antithrombotic Treatment Patterns for Atrial Fibrillation

Oct 11, 2016
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Authors:
Camm AJ, Accetta G, Ambrosio G, et al., on behalf of the GARFIELD-AF Investigators.
Citation:
Evolving Antithrombotic Treatment Patterns for Patients With Newly Diagnosed Atrial Fibrillation. Heart 2016;Sep 19:[Epub ahead of print].
Summary By:
Thomas C. Crawford, MD, FACC

Study Questions:

How has the antithrombotic therapy pattern changed in patients with newly diagnosed nonvalvular atrial fibrillation (AF) between 2010 and 2015?

Methods:

A total of 39,670 patients were prospectively enrolled in four sequential cohorts in the GARFIELD-AF (Global Anticoagulant Registry in the FIELD-Atrial Fibrillation): cohort C1 (2010–2011), n = 5,500; C2 (2011–2013), n = 11,662; C3 (2013–2014), n = 11,462; and C4 (2014–2015), n = 11,046.

Results:

Median CHA2DS2-VASc 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%) decreased. The 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 nonsteroidal 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.

Perspective:

Numerous reports indicate that the use of oral anticoagulation therapy in the community is underused, especially in patients at highest risk. The use of anticoagulation increased from 2010 to 2015 by 15% mostly driven by more NOACs, and now exceeds 70% among patients with ≥1 additional stroke risk factor. This is a plus, but much work remains on improving adherence to the guideline-sanctioned use of anticoagulation in patients at low risk of bleeding.

Keywords: Anticoagulants, Anti-Inflammatory Agents, Non-Steroidal, Arrhythmias, Cardiac, Atrial Fibrillation, Fibrinolytic Agents, Dementia, Geriatrics, Heart Failure, Primary Prevention, Risk Factors, Smoking, Stroke, Vitamin K


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