TY - JOUR
T1 - Predictors of NOAC versus VKA use for stroke prevention in patients with newly diagnosed atrial fibrillation
T2 - Results from GARFIELD-AF
AU - GARFIELD-AF Investigators
AU - Haas, Sylvia
AU - Camm, A. John
AU - Bassand, Jean Pierre
AU - Angchaisuksiri, Pantep
AU - Cools, Frank
AU - Corbalan, Ramon
AU - Gibbs, Harry
AU - Jacobson, Barry
AU - Koretsune, Yukihiro
AU - Mantovani, Lorenzo G.
AU - Misselwitz, Frank
AU - Panchenko, Elizaveta
AU - Ragy, Hany Ibrahim
AU - Stepinska, Janina
AU - Turpie, Alexander GG
AU - Sawhney, Jitendra PS
AU - Steffel, Jan
AU - Lim, Toon Wei
AU - Pieper, Karen S.
AU - Virdone, Saverio
AU - Verheugt, Freek WA
AU - Kakkar, Ajay K.
N1 - Publisher Copyright:
© 2019 The Authors
PY - 2019/7/1
Y1 - 2019/7/1
N2 - Introduction: A principal aim of the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) was to document changes in treatment practice for patients with newly diagnosed atrial fibrillation during an era when non–vitamin K antagonist oral anticoagulants (NOACs) were becoming more widely adopted. In these analyses, the key factors which determined the choice between NOACs and vitamin K antagonists (VKAs) are explored. Methods: Logistic least absolute shrinkage and selection operator regression determined predictors of NOAC and VKA use. Data were collected from 24,137 patients who were initiated on AC ± antiplatelet (AP) therapy (NOAC [51.4%] or VKA [48.6%]) between April 2013 and August 2016. Results: The most significant predictors of AC therapy were country, enrolment year, care setting at diagnosis, AF type, concomitant AP, and kidney disease. Patients enrolled in emergency care or in the outpatient setting were more likely to receive a NOAC than those enrolled in hospital (OR 1.16 [95% CI: 1.04-1.30], OR: 1.15 [95% CI: 1.05-1.25], respectively). NOAC prescribing seemed to be favored in lower-risk groups, namely, patients with paroxysmal AF, normotensive patients, and those with moderate alcohol consumption, but also the elderly and patients with acute coronary syndrome. By contrast, VKAs were preferentially used in patients with permanent AF, moderate to severe kidney disease, heart failure, vascular disease, and diabetes and with concomitant AP. Conclusion: GARFIELD-AF data highlight marked heterogeneity in stroke prevention strategies globally. Physicians are adopting an individualized approach to stroke prevention where NOACs are favored in patients with a lower stroke risk but also in the elderly and patients with acute coronary syndrome.
AB - Introduction: A principal aim of the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) was to document changes in treatment practice for patients with newly diagnosed atrial fibrillation during an era when non–vitamin K antagonist oral anticoagulants (NOACs) were becoming more widely adopted. In these analyses, the key factors which determined the choice between NOACs and vitamin K antagonists (VKAs) are explored. Methods: Logistic least absolute shrinkage and selection operator regression determined predictors of NOAC and VKA use. Data were collected from 24,137 patients who were initiated on AC ± antiplatelet (AP) therapy (NOAC [51.4%] or VKA [48.6%]) between April 2013 and August 2016. Results: The most significant predictors of AC therapy were country, enrolment year, care setting at diagnosis, AF type, concomitant AP, and kidney disease. Patients enrolled in emergency care or in the outpatient setting were more likely to receive a NOAC than those enrolled in hospital (OR 1.16 [95% CI: 1.04-1.30], OR: 1.15 [95% CI: 1.05-1.25], respectively). NOAC prescribing seemed to be favored in lower-risk groups, namely, patients with paroxysmal AF, normotensive patients, and those with moderate alcohol consumption, but also the elderly and patients with acute coronary syndrome. By contrast, VKAs were preferentially used in patients with permanent AF, moderate to severe kidney disease, heart failure, vascular disease, and diabetes and with concomitant AP. Conclusion: GARFIELD-AF data highlight marked heterogeneity in stroke prevention strategies globally. Physicians are adopting an individualized approach to stroke prevention where NOACs are favored in patients with a lower stroke risk but also in the elderly and patients with acute coronary syndrome.
UR - http://www.scopus.com/inward/record.url?scp=85065872762&partnerID=8YFLogxK
U2 - 10.1016/j.ahj.2019.03.013
DO - 10.1016/j.ahj.2019.03.013
M3 - Article
C2 - 31128503
AN - SCOPUS:85065872762
SN - 0002-8703
VL - 213
SP - 35
EP - 46
JO - American Heart Journal
JF - American Heart Journal
ER -