Risk Profiles and Antithrombotic Treatment of Patients Newly Diagnosed with Atrial Fibrillation at Risk of Stroke: Perspectives from the International, Observational, Prospective GARFIELD Registry

Abstract

BackgroundLimited data are available on the characteristics, clinical management, and outcomes of patients with atrial fibrillation at risk of stroke, from a worldwide perspective. The aim of this study was to describe the baseline characteristics and initial therapeutic management of patients with non-valvular atrial fibrillation across the spectrum of sites at which these patients are treated.Methods and FindingsThe Global Anticoagulant Registry in the FIELD (GARFIELD) is an observational study of patients newly diagnosed with non-valvular atrial fibrillation. Enrollment into Cohort 1 (of 5) took place between December 2009 and October 2011 at 540 sites in 19 countries in Europe, Asia-Pacific, Central/South America, and Canada. Investigator sites are representative of the distribution of atrial fibrillation care settings in each country. Cohort 1 comprised 10,614 adults (≥18 years) diagnosed with non-valvular atrial fibrillation within the previous 6 weeks, with ≥1 investigator-defined stroke risk factor (not limited to those in existing risk-stratification schemes), and regardless of therapy. Data collected at baseline included demographics, medical history, care setting, nature of atrial fibrillation, and treatments initiated at diagnosis. The mean (SD) age of the population was 70.2 (11.2) years; 43.2% were women. Mean±SD CHADS2 score was 1.9±1.2, and 57.2% had a score ≥2. Mean CHA2DS2-VASc score was 3.2±1.6, and 8,957 (84.4%) had a score ≥2. Overall, 38.0% of patients with a CHADS2 score ≥2 did not receive anticoagulant therapy, whereas 42.5% of those at low risk (score 0) received anticoagulant therapy.ConclusionsThese contemporary observational worldwide data on non-valvular atrial fibrillation, collected at the end of the vitamin K antagonist-only era, indicate that these drugs are frequently not being used according to stroke risk scores and guidelines, with overuse in patients at low risk and underuse in those at high risk of stroke.Trial RegistrationClinicalTrials.gov TRI08888

Prevalence, Characteristics, and Outcomes of Valvular Heart Disease in Patients With Atrial Fibrillation: Insights From the ORBIT‐AF (Outcomes Registry for Better Informed Treatment for Atrial Fibrillation)

“…Anticoagulation use was highest among those with MS/MV. Anticoagulation use was comparable in our cohort of patients to other contemporary registries in which anticoagulation use has ranged from 70% to 80% 20, 21, 22, 23. Notably, there were 6 patients in which DOAC use was reported in the setting of MS/MV.…”

Effectiveness and Safety of Apixaban, Dabigatran, and Rivaroxaban Versus Warfarin in Frail Patients With Nonvalvular Atrial Fibrillation

“…Similarly, the Frailty, Stroke Risk and Bleeding Risk on Anticoagulation in the Elderly With Atrial Fibrillation (FRAIL‐AF) study showed that patients classified as non‐to‐moderately frail using the Clinical Frailty Scale (CFS) were 3.4‐fold ( P <0.0001) more likely to receive anticoagulation therapy than patients classified as severely frail (CFS ≥7) 6. Studies have shown cognitive dysfunction or dementia, perceived fall risk and advancing age, each of which are included in the Johns Hopkins Claims‐based Frailty Indicator, to be associated with a significant reduction in the odds of anticoagulation use in NVAF patients 20, 21. Furthermore, some clinicians have supported utilizing certain OACs, or reduced doses of OACs in various clinical scenarios often associated with a frail state (eg, >75 years old, renal impairment) 7.…”

The Appropriateness of Antithrombotic Therapy in Patients With Non-Valvular Atrial Fibrillation in Real Clinical Practice

“…В зарубежных регистрах GARFIELD [7], PREFER [8] и международном наблюдательном исследовании XANTUS [9] также наблюдались пациенты с высоким риском тромбо-эмболических осложнений. В сравнении с нашими дан-ными и результатами РЕКВАЗА, несколько реже встреча-лись такие факторы риска, как АГ, застойная ХСН и пере-несенный инфаркт миокарда.…”

“…), что близко к данным наблюдательного проекта XANTUS (44%) [9]. По материа-лам зарубежных регистров GARFIELD [7] Средний балл по CHADS 2 Примечание. ТКЦ -Тюменский кардиологический центр (собственные данные); «-» -нет данных.…”