Naslov
The Changing Landscape for Stroke Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Autori
Huisman, MV ; Rothman, KJ ; Paquette, M ; Teutsch, C ; Diener, HC ; Dubner, SJ ; Halperin, JL ; Ma, CS ; Zint, K ; Elsaesser, A ; Bartels, DB ; Lip, GY

Izvornik
Journal of the american college of cardiology (0735-1097) 69 (2017), 7; 777-785

Vrsta, podvrsta i kategorija rada
Radovi u časopisima, članak, znanstveni

Ključne riječi
Atrial fibrillation ; Oral anticoagulation ; Registry

Sažetak
BACKGROUND:GLORIA-AF (Global Registry on Long- Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non-vitamin K antagonist oral anticoagulant (NOAC), became available. OBJECTIVES:This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. METHODS:During phase 2, 15, 641 consenting patients were enrolled (November 2011 to December 2014) ; 15, 092 were eligible. This pre-specified cross-sectional analysis describes eligible patients' baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. RESULTS:Of the total patients, 45.5% were female ; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score ≥2 ; 86.1%) ; 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA) ; 12.1% received antiplatelet agents ; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1, 063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively) ; 6.0% of patients received antiplatelet treatment ; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively ; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. CONCLUSIONS:The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA