Global Oral Anticoagulation Use Varies by Region in Patients With Recent Diagnosis of Atrial Fibrillation: The GLORIA‐AF Phase III Registry

Abstract

Background Effective stroke prevention with oral anticoagulants (OAC) is recommended for some patients with atrial fibrillation (AF). We aimed to describe OAC use by geographical region and type of site in patients with recent‐onset AF enrolled in a large global registry. Methods and Results Eligible participants were recruited into GLORIA‐AF (Global Registry on Long‐Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation), a prospective observational cohort study from 2014 to 2016 in 4 international regions: North America, Europe, Asia, and Latin America. Cumulative incidence functions were generated for direct OACs (DOAC), vitamin K antagonists, and antiplatelet drugs considering competing risks, stratified by region and type of site. Time‐to‐treatment initiation after AF diagnosis was analyzed with Fine‐Gray subdistribution hazard models. A total of 21 237 patients eligible for analysis were identified. By 30 days after AF diagnosis, 40%, 16%, and 8.6% of patients had DOAC, vitamin K antagonists, and antiplatelet drugs initiated, respectively. Earlier initiation of DOACs was observed in Europe, with Asia and Latin America having lower hazard rates of DOAC time‐to‐treatment initiation than Europe (hazard ratio [HR], 0.66; 95% CI, 0.62–0.70 and HR, 0.79; 95% CI, 0.73–0.85, respectively). DOAC initiation was highest in community hospitals, vitamin K antagonists in outpatient health care centers/anticoagulation clinics, and antiplatelet drugs in primary care clinics. Conclusions Important geographic variability exists with the use of OACs for patients with AF. Differences in the time‐to‐treatment initiation of OAC by type of site suggests suboptimal implementation of guideline recommendations and could result in less benefit and more harm. Optimizing OAC use for patients with AF may improve outcomes and reduce health care costs. Registration URL: http://www.clinicaltrials.gov ; Unique identifiers: NCT01468701, NCT01671007.

Geographical Variation in the Use of Oral Anticoagulation and Clinical Outcomes among Patients with Atrial Fibrillation in Denmark, Sweden, and Finland

“…Variations in OAC use among four international regions, North America, Europe, Asia, and Latin America, has recently been reported. 18 Reasons for geographical variations in the use of OACs have been suggested to stem from variations in local AF guidelines, variations in health care systems, or socioeconomic factors. 18 In Denmark, there was no regulatory preference for DOACs over vitamin K antagonist (VKA) during the first few years after the introduction of DOACs, but since 2016, DOACs have been preferred over VKA by regulatory authorities in Denmark.…”

“…18 Reasons for geographical variations in the use of OACs have been suggested to stem from variations in local AF guidelines, variations in health care systems, or socioeconomic factors. 18 In Denmark, there was no regulatory preference for DOACs over vitamin K antagonist (VKA) during the first few years after the introduction of DOACs, but since 2016, DOACs have been preferred over VKA by regulatory authorities in Denmark. In Finland, a slower transition from VKA to DOACs can be explained by a lower reimbursement rate for DOACs from 2013 to 2015.…”

Evolution of antithrombotic therapy for patients with atrial fibrillation: The prospective global GLORIA-AF registry program

“…The stable proportion of patients on AP treatment alone or no OAC treatment remained at more than 11% and 6% of patients in phase III, respectively, despite the increased evidence on the superiority of NOACs and VKA in reducing the stroke risk compared to no OAC with no differences in the bleeding risk with VKA, NOAC, or AP therapy [ 6 ], emphasizes that there is still a high unmet medical need for a remarkable number of patients. As treatment initiation varies broadly between region and site, clear and consistent guidelines with AF treatment pathways, along with further education and awareness, would improve patient outcomes and reduce health care costs [ 26 ].…”

Global disparities in arrhythmia care: Mind the gap

“…This registry data also revealed geographic disparities in time to treatment. 27 Regional disparities in the delivery of OAC therapy are particularly concerning given the higher risk of stroke and cardiovascular mortality among patients not receiving optimal anticoagulation reported in Global Anticoagulant Registry in the Field-Atrial Fibrillation (GARFIELD-AF). 28 …”