Stroke prevention in patients from Latin American countries with non‐valvular atrial fibrillation: Insights from the GARFIELD‐AF registry

Abstract

Background Atrial fibrillation (AF) is an important preventable cause of stroke. Anticoagulation (AC) therapy can reduce this risk. However, prescribing patterns and outcomes in patients with non‐valvular AF (NVAF) from Latin American countries are poorly described. Methods Using data from the Global Anticoagulant Registry in the FIELD‐AF (GARFIELD‐AF), we examined the stroke prevention strategies and the 1‐year outcomes in patients from four Latin American countries: Argentina, Brazil, Chile, and Mexico. Results A total of 4162 patients (2010‐2014) were included in this analysis. At the time of AF diagnosis, 39.9% of patients were prescribed vitamin K antagonists (VKA) ± antiplatelet (AP) therapy, 21.8% non‐VKA oral anticoagulant (NOAC) ± AP, 24.1% AP only and 14.1% no antithrombotic treatment. The proportion of moderate‐high risk patients receiving no AC therapy at participating centers was highest in Mexico (46.4%) and lowest in Chile (14.3%). During 1‐year follow‐up, the rates of all‐cause mortality, stroke/SE and major bleeding were: 5.77 (95% CI) (5.06‐6.56), 1.58 (1.23‐2.02), and 0.99 (0.72‐1.36) and per 100 person‐years, respectively, which are higher than the global rates across all countries in GARFIELD‐AF. Unadjusted rates of all‐cause mortality were highest in Argentina, 6.95 (5.43‐8.90), and lowest in Chile, 4.01 (2.92‐5.52). Conclusions GARFIELD‐AF results describes the marked variation in the baseline characteristics and patterns of antithrombotic treatments in patients with NVAF in four Latin American countries. Over one‐third of patients with a moderate‐to‐high risk of stroke received no AC therapy, highlighting the need for improved management of patients according to national guideline. Clinical Trial Registration—URL http://www.clinicaltrials.gov. Unique identifier: NCT01090362.

Meta-analysis of the efficacy and safety of non-vitamin K antagonist oral anticoagulants with warfarin in Latin American patients with atrial fibrillation

“…The variations in the baseline characteristics and antithrombotic treatment patterns for AF are remarkable in different LatAm countries. [ 22 ] Several major guidelines in Latin America including the Brazilian Society of Cardiology 2009, [ 23 ] the Brazilian Cardiogeriatrics Society, [ 24 ] and the Latin-American Society of Cerebrovascular Diseases [ 25 ] recommend the use of vitamin K antagonists for AF stroke prevention. However, there is a significant proportion of high-risk patients receiving no anticoagulation.…”

“…[ 11 ] Aspirin is no longer recommended for stroke prevention in current AF guidelines mainly because of an increased risk of bleeding. Moreover, many AF patients with a moderate-to-high risk of stroke in Latin America receive no anticoagulation therapy regardless of sex, [ 12 , 13 ] suggesting the need for improved management of AF in this region. In contrast, NOACs have a predictable pharmacokinetic profile, which may overcome many limitations associated with warfarin and aspirin use.…”

Atrial fibrillation in low- and middle-income countries: a narrative review

“…Most samples are from hospitals, 55 , 57 , 59 , 63–65 outpatient departments, 66 , 67 or anticoagulation clinics, 68 , 69 which often reflect more selective samples. Designs also vary widely, including cross-sectional or registry studies, 52 , 54 , 57 cohort studies, 58 , 70 and systematic reviews, 71 limiting comparability.…”

“… 12 , 31 , 51–59 , 61–67 , 70 , 72–77 We excluded multicentric studies including both LMICs and high-income countries, from which it was not possible to retrieve the LMIC results separately. Of the studies in Supplementary material online, Table S2 , 20 have information about a single country; 2 have information describing several LMIC countries but presenting consolidated results 54 , 70 and 2 have information about more than one country, with results stratified by location. 62 , 72 The Realize AF Survey 51 presented two arms, one with African countries and Lebanon and the other with Latin American countries.…”

“…In Table 1 , we summarize the main findings from published studies set in LMICs in the last decade that evaluated fatal (all-cause, cardiovascular, non-cardiovascular causes of death) and non-fatal outcomes (stroke, major bleeding and dementia) related to AF in clinical and non-clinical settings. 15 , 54 , 84–88 Systemic embolism is an additional AF-related outcome. However, it is relatively rare, and usually described with stroke as a combined endpoint.…”