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International trends in clinical characteristics and oral anticoagulation treatment for patients with atrial fibrillation: Results from the GARFIELD-AF, ORBIT-AF I, and ORBIT-AF II registries.

Publication ,  Journal Article
Steinberg, BA; Gao, H; Shrader, P; Pieper, K; Thomas, L; Camm, AJ; Ezekowitz, MD; Fonarow, GC; Gersh, BJ; Goldhaber, S; Haas, S; Hacke, W ...
Published in: Am Heart J
December 2017

UNLABELLED: Atrial fibrillation (AF) is the most common cardiac arrhythmia in the world. We aimed to provide comprehensive data on international patterns of AF stroke prevention treatment. METHODS: Demographics, comorbidities, and stroke risk of the patients in the GARFIELD-AF (n=51,270), ORBIT-AF I (n=10,132), and ORBIT-AF II (n=11,602) registries were compared (overall N=73,004 from 35 countries). Stroke prevention therapies were assessed among patients with new-onset AF (≤6 weeks). RESULTS: Patients from GARFIELD-AF were less likely to be white (63% vs 89% for ORBIT-AF I and 86% for ORBIT-AF II) or have coronary artery disease (19% vs 36% and 27%), but had similar stroke risk (85% CHA2DS2-VASc ≥2 vs 91% and 85%) and lower bleeding risk (11% with HAS-BLED ≥3 vs 24% and 15%). Oral anticoagulant use was 46% and 57% for patients with a CHA2DS2-VASc=0 and 69% and 87% for CHA2DS2-VASc ≥2 in GARFIELD-AF and ORBIT-AF II, respectively, but with substantial geographic heterogeneity in use of oral anticoagulant (range: 31%-93% [GARFIELD-AF] and 66%-100% [ORBIT-AF II]). Among patients with new-onset AF, non-vitamin K antagonist oral anticoagulant use increased over time to 43% in 2016 for GARFIELD-AF and 71% for ORBIT-AF II, whereas use of antiplatelet monotherapy decreased from 36% to 17% (GARFIELD-AF) and 18% to 8% (ORBIT-AF I and II). CONCLUSIONS: Among new-onset AF patients, non-vitamin K antagonist oral anticoagulant use has increased and antiplatelet monotherapy has decreased. However, anticoagulation is used frequently in low-risk patients and inconsistently in those at high risk of stroke. Significant geographic variability in anticoagulation persists and represents an opportunity for improvement.

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

December 2017

Volume

194

Start / End Page

132 / 140

Location

United States

Related Subject Headings

  • Stroke
  • Risk Factors
  • Risk Assessment
  • Registries
  • Prospective Studies
  • Prevalence
  • Middle Aged
  • Male
  • Humans
  • Global Health
 

Citation

APA
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ICMJE
MLA
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Steinberg, B. A., Gao, H., Shrader, P., Pieper, K., Thomas, L., Camm, A. J., … ORBIT-AF Investigators, . (2017). International trends in clinical characteristics and oral anticoagulation treatment for patients with atrial fibrillation: Results from the GARFIELD-AF, ORBIT-AF I, and ORBIT-AF II registries. Am Heart J, 194, 132–140. https://doi.org/10.1016/j.ahj.2017.08.011
Steinberg, Benjamin A., Haiyan Gao, Peter Shrader, Karen Pieper, Laine Thomas, A John Camm, Michael D. Ezekowitz, et al. “International trends in clinical characteristics and oral anticoagulation treatment for patients with atrial fibrillation: Results from the GARFIELD-AF, ORBIT-AF I, and ORBIT-AF II registries.Am Heart J 194 (December 2017): 132–40. https://doi.org/10.1016/j.ahj.2017.08.011.
Steinberg BA, Gao H, Shrader P, Pieper K, Thomas L, Camm AJ, Ezekowitz MD, Fonarow GC, Gersh BJ, Goldhaber S, Haas S, Hacke W, Kowey PR, Ansell J, Mahaffey KW, Naccarelli G, Reiffel JA, Turpie A, Verheugt F, Piccini JP, Kakkar A, Peterson ED, Fox KAA, GARFIELD-AF, ORBIT-AF Investigators. International trends in clinical characteristics and oral anticoagulation treatment for patients with atrial fibrillation: Results from the GARFIELD-AF, ORBIT-AF I, and ORBIT-AF II registries. Am Heart J. 2017 Dec;194:132–140.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

December 2017

Volume

194

Start / End Page

132 / 140

Location

United States

Related Subject Headings

  • Stroke
  • Risk Factors
  • Risk Assessment
  • Registries
  • Prospective Studies
  • Prevalence
  • Middle Aged
  • Male
  • Humans
  • Global Health