In the Journals

More patients with AF receive guideline-recommended anticoagulant therapy

At-risk patients who are newly diagnosed with atrial fibrillation are more likely to receive guideline-recommended therapy since the introduction of the use of non-vitamin K antagonist oral anticoagulants, recent data show.

The researchers also found a decline in the use of antiplatelet and vitamin K antagonist therapies in this population.

A. John Camm, MD, FRCP, FACC, FESC, FAHA, FHRS, from the division of cardiovascular sciences at St George’s, University of London, and colleagues analyzed evolving antithrombotic therapy patterns in patients with newly diagnosed nonvalvular AF. All 39,670 patients in the study had at least one added risk factor for stroke and were evaluated from 2010 to 2015.

The patients were divided into four cohorts in the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) study: Cohort one included 5,500 patients enrolled from 2010 to 2011; cohort two had 11,662 patients enrolled from 2011 to 2013; cohort three comprised 11,462 patients enrolled from 2013 to 2014; and cohort four included 11,046 patients enrolled from 2014 to 2015. All patients had similar baseline characteristics.

Anticoagulant therapy

The proportion of patients prescribed anticoagulant therapy went up by nearly 15 percentage points over time, from 57.4% of patients in cohort one to 71.1% of patients in cohort four, Camm and colleagues found.

From cohort one to cohort four, the use of vitamin K antagonists with or without an antiplatelet declined from 53.2% to 34%. The use of antiplatelet monotherapy also declined from 30.2% of the patients in cohort one to 16.6% of the patients in cohort four. There was an increase in the use of non-vitamin K oral anticoagulants with or without an antiplatelet from cohort one (4.2%) to cohort four (37%).

The researchers calculated that men (OR = 1.08; 95% CI, 1.01-1.15), the elderly (OR = 1.1 for ages 65 to 80; 1.19 for ages 80 to 85; 1.32 for ages 86 and older), patients of Asian ethnicity (OR = 1.28; 95% CI, 1.19-1.37), those with dementia (OR = 1.46; 95% CI, 1.13-1.88), those using nonsteroidal anti-inflammatory drugs (OR = 1.27; 95% CI, 1.06-1.53) and current smokers (OR = 1.16; 95% CI, 1.05-1.29) were more often prescribed non-vitamin K oral anticoagulants than vitamin K antagonists.

In patients with cardiac, vascular or renal comorbidities, vitamin K antagonist therapies were more often prescribed.

High-risk patients

Most patients with a CHA2DS2-VASc score of 2 or higher received anticoagulation therapy, and the percentage increased over time, driven by non-vitamin K oral anticoagulant prescriptions, Camm and colleagues wrote.

GARFIELD-AF provides a unique picture of prescribing at the end of the [vitamin K antagonist]-only era, showing the global increase in [non-vitamin K oral anticoagulant] prescribing. Our findings are strengthened by protocol mandated source data verification of 20% of [electronic case report forms] and central monitoring, ensuring high data quality. A limitation of this study is that only global patterns of antithrombotic therapy were investigated. Regional differences in prescribing trends were not taken into account, nor was the rate of [non-vitamin K oral anticoagulant] approvals across each region. Comorbidities were also likely confounders, which were not fully assessed in this analysis,” Camm and colleagues wrote. by Suzanne Reist

Disclosure: The registry is supported in part by an unrestricted research grant from Bayer. Camm reports advising for Bayer, Boehringer Ingelheim, Daiichi Sankyo and Pfizer/Bristol-Myers Squibb. Please see the full study for a list of the other researchers’ relevant financial disclosures.

At-risk patients who are newly diagnosed with atrial fibrillation are more likely to receive guideline-recommended therapy since the introduction of the use of non-vitamin K antagonist oral anticoagulants, recent data show.

The researchers also found a decline in the use of antiplatelet and vitamin K antagonist therapies in this population.

A. John Camm, MD, FRCP, FACC, FESC, FAHA, FHRS, from the division of cardiovascular sciences at St George’s, University of London, and colleagues analyzed evolving antithrombotic therapy patterns in patients with newly diagnosed nonvalvular AF. All 39,670 patients in the study had at least one added risk factor for stroke and were evaluated from 2010 to 2015.

The patients were divided into four cohorts in the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) study: Cohort one included 5,500 patients enrolled from 2010 to 2011; cohort two had 11,662 patients enrolled from 2011 to 2013; cohort three comprised 11,462 patients enrolled from 2013 to 2014; and cohort four included 11,046 patients enrolled from 2014 to 2015. All patients had similar baseline characteristics.

Anticoagulant therapy

The proportion of patients prescribed anticoagulant therapy went up by nearly 15 percentage points over time, from 57.4% of patients in cohort one to 71.1% of patients in cohort four, Camm and colleagues found.

From cohort one to cohort four, the use of vitamin K antagonists with or without an antiplatelet declined from 53.2% to 34%. The use of antiplatelet monotherapy also declined from 30.2% of the patients in cohort one to 16.6% of the patients in cohort four. There was an increase in the use of non-vitamin K oral anticoagulants with or without an antiplatelet from cohort one (4.2%) to cohort four (37%).

The researchers calculated that men (OR = 1.08; 95% CI, 1.01-1.15), the elderly (OR = 1.1 for ages 65 to 80; 1.19 for ages 80 to 85; 1.32 for ages 86 and older), patients of Asian ethnicity (OR = 1.28; 95% CI, 1.19-1.37), those with dementia (OR = 1.46; 95% CI, 1.13-1.88), those using nonsteroidal anti-inflammatory drugs (OR = 1.27; 95% CI, 1.06-1.53) and current smokers (OR = 1.16; 95% CI, 1.05-1.29) were more often prescribed non-vitamin K oral anticoagulants than vitamin K antagonists.

In patients with cardiac, vascular or renal comorbidities, vitamin K antagonist therapies were more often prescribed.

High-risk patients

Most patients with a CHA2DS2-VASc score of 2 or higher received anticoagulation therapy, and the percentage increased over time, driven by non-vitamin K oral anticoagulant prescriptions, Camm and colleagues wrote.

GARFIELD-AF provides a unique picture of prescribing at the end of the [vitamin K antagonist]-only era, showing the global increase in [non-vitamin K oral anticoagulant] prescribing. Our findings are strengthened by protocol mandated source data verification of 20% of [electronic case report forms] and central monitoring, ensuring high data quality. A limitation of this study is that only global patterns of antithrombotic therapy were investigated. Regional differences in prescribing trends were not taken into account, nor was the rate of [non-vitamin K oral anticoagulant] approvals across each region. Comorbidities were also likely confounders, which were not fully assessed in this analysis,” Camm and colleagues wrote. by Suzanne Reist

Disclosure: The registry is supported in part by an unrestricted research grant from Bayer. Camm reports advising for Bayer, Boehringer Ingelheim, Daiichi Sankyo and Pfizer/Bristol-Myers Squibb. Please see the full study for a list of the other researchers’ relevant financial disclosures.