Predictors of NOAC versus VKA use for stroke prevention in patients with newly diagnosed atrial fibrillation: Results from GARFIELD-AF.

Abstract

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.

• Authors: Sylvia Haas, A John Camm, Jean-Pierre Bassand, Pantep Angchaisuksiri, Frank Cools, Ramon Corbalan, Harry Gibbs, Barry Jacobson, Yukihiro Koretsune, Lorenzo G Mantovani, Frank Misselwitz, Elizaveta Panchenko, Hany Ibrahim Ragy, Janina Stepinska, Alexander Gg Turpie, Jitendra Ps Sawhney, Jan Steffel, Toon Wei Lim, Karen S Pieper, Saverio Virdone, Freek Wa Verheugt, Ajay K Kakkar, GARFIELD-AF Investigators
• Journal: American heart journal (Am Heart J) Vol. 213 Pg. 35-46 (07 2019) ISSN: 1097-6744 [Electronic] United States
• PMID: 31128503 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.

Chemical References

• Anticoagulants
• Platelet Aggregation Inhibitors
• Vitamin K

Topics

• Administration, Oral
• Aged
• Anticoagulants (therapeutic use)
• Atrial Fibrillation (complications, ethnology)
• Female
• Humans
• Male
• Platelet Aggregation Inhibitors (therapeutic use)
• Prospective Studies
• Registries
• Stroke (ethnology, prevention & control)
• Vitamin K (antagonists & inhibitors)