Patterns of oral anticoagulant use and outcomes in Asian patients with atrial fibrillation: a post-hoc analysis from the GLORIA-AF Registry
Previous studies suggested potential ethnic differences in the management and outcomes of atrial fibrillation (AF). We aim to analyse oral anticoagulant (OAC) prescription, discontinuation, and risk of adverse outcomes in Asian patients with AF, using data from a global prospective cohort study. Fro...
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creator | Manterola, Fernando Alfonso Amara, Walid Armero, Sébastien Arora, Chander Bando, Shigenobu Berneau, Jean-Baptiste Biscione, Francesco Brautigam, Donald Breton, Nicolas Cabrera, Jose Walter Chartier, Ludovic Cheema, Amjad Chen, Lin Cohen, Andrew Cohen, Serge Compton, Steve Buenostro, Gabriel Contreras Dascotte, Olivier Davis, Gershan de Groot, J.R. Brkljacic, Diana Delic Dupljakov, Dmitry Dutta, Dipankar Duvilla, Nathalie Hernandes, Mauro Esteves Fang, Quan Fera, Steven R. Fruntelata, Ana Gabriela Ganeshkumar, Priya Georgeson, Steven Gillespie, Eve Glotzer, Taya V. Gmehling, Joachim Goldbarg, Seth Guevara, Carolina Ha, Andrew Hahalis, Georgios Hayek, Emil Hendriks, I. Huang, Chi-Hung Ikpoh, Margaret Jeanfreau, Robert J. Jenkins, Ronald D. Joen-Jakobsen, Tomas Kneller, G. Larsen Kraft, Peter Krantz, Mori Küppers, Achim Leschke, Matthias Ma, Changsheng Maurer, Tillmann McIntyre, Hugh Mercader, Marco Chreih, Rami Mihail Mirault, Tristan Miyamoto, Naomasa Mondillo, Sergio Montagud, Vicente Monti, Cristina Mori, Kiyoo Moriarty, Andrew Muriago, Michela Musial, Wlodzimierz Neiman, James Neuenschwander, Fernando Carvalho Nossan, Janko Novikova, Tatiana Nurgalieva, Svetlana Park, Hyung Wook Parthenakis, Fragkiskos Perlman, Richard Pflücke, Christian Phlaum, Stephen Pieters, Denis Précoma, Dalton Bertolim Prodafikas, John Pye, Maurice Ramos, Ricardo Rieker, Werner Briones, Ignacio Rodriguez Ronner, E. Saltzman, Marco A. Shaw, Louise Shin, Eun-Seok Singh, Narendra Siostrzonek, Peter Spinar, Jindrich Swart, H. Singh Takhar, Amrit Pal Tang, Sherman Tayebjee, Muzahir Touze, Emmanuel Valadão, C. Victory, Jason Warner, Alberta L. Williams, David Xu, Xiangdong Yamanoue, Hiroki Yamashita, Takeshi Zahn, Ralf |
description | Previous studies suggested potential ethnic differences in the management and outcomes of atrial fibrillation (AF). We aim to analyse oral anticoagulant (OAC) prescription, discontinuation, and risk of adverse outcomes in Asian patients with AF, using data from a global prospective cohort study.
From the GLORIA-AF Registry Phase II–III (November 2011–December 2014 for Phase II, and January 2014–December 2016 for Phase III), we analysed patients according to their self-reported ethnicity (Asian vs. non-Asian), as well as according to Asian subgroups (Chinese, Japanese, Korean and other Asian). Logistic regression was used to analyse OAC prescription, while the risk of OAC discontinuation and adverse outcomes were analysed through Cox-regression model. Our primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACE). The original studies were registered with ClinicalTrials.gov, NCT01468701, NCT01671007, and NCT01937377.
34,421 patients were included (70 ± 10.5 years, 45.1% females, 6900 (20.0%) Asian: 3829 (55.5%) Chinese, 814 (11.8%) Japanese, 1964 (28.5%) Korean and 293 (4.2%) other Asian). Most of the Asian patients were recruited in Asia (n = 6701, 97.1%), while non-Asian patients were mainly recruited in Europe (n = 15,449, 56.1%) and North America (n = 8378, 30.4%). Compared to non-Asian individuals, prescription of OAC and non-vitamin K antagonist oral anticoagulant (NOAC) was lower in Asian patients (Odds Ratio [OR] and 95% Confidence Intervals (CI): 0.23 [0.22–0.25] and 0.66 [0.61–0.71], respectively), but higher in the Japanese subgroup. Asian ethnicity was also associated with higher risk of OAC discontinuation (Hazard Ratio [HR] and [95% CI]: 1.79 [1.67–1.92]), and lower risk of the primary composite outcome (HR [95% CI]: 0.86 [0.76–0.96]). Among the exploratory secondary outcomes, Asian ethnicity was associated with higher risks of thromboembolism and intracranial haemorrhage, and lower risk of major bleeding.
Our results showed that Asian patients with AF showed suboptimal thromboembolic risk management and a specific risk profile of adverse outcomes; these differences may also reflect differences in country-specific factors. Ensuring integrated and appropriate treatment of these patients is crucial to improve their prognosis.
The GLORIA-AF Registry was funded by Boehringer Ingelheim GmbH. |
doi_str_mv | 10.1016/j.eclinm.2023.102039 |
format | Article |
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Larsen ; Kraft, Peter ; Krantz, Mori ; Küppers, Achim ; Leschke, Matthias ; Ma, Changsheng ; Maurer, Tillmann ; McIntyre, Hugh ; Mercader, Marco ; Chreih, Rami Mihail ; Mirault, Tristan ; Miyamoto, Naomasa ; Mondillo, Sergio ; Montagud, Vicente ; Monti, Cristina ; Mori, Kiyoo ; Moriarty, Andrew ; Muriago, Michela ; Musial, Wlodzimierz ; Neiman, James ; Neuenschwander, Fernando Carvalho ; Nossan, Janko ; Novikova, Tatiana ; Nurgalieva, Svetlana ; Park, Hyung Wook ; Parthenakis, Fragkiskos ; Perlman, Richard ; Pflücke, Christian ; Phlaum, Stephen ; Pieters, Denis ; Précoma, Dalton Bertolim ; Prodafikas, John ; Pye, Maurice ; Ramos, Ricardo ; Rieker, Werner ; Briones, Ignacio Rodriguez ; Ronner, E. ; Saltzman, Marco A. ; Shaw, Louise ; Shin, Eun-Seok ; Singh, Narendra ; Siostrzonek, Peter ; Spinar, Jindrich ; Swart, H. ; Singh Takhar, Amrit Pal ; Tang, Sherman ; Tayebjee, Muzahir ; Touze, Emmanuel ; Valadão, C. ; Victory, Jason ; Warner, Alberta L. ; Williams, David ; Xu, Xiangdong ; Yamanoue, Hiroki ; Yamashita, Takeshi ; Zahn, Ralf</creator><creatorcontrib>Manterola, Fernando Alfonso ; Amara, Walid ; Armero, Sébastien ; Arora, Chander ; Bando, Shigenobu ; Berneau, Jean-Baptiste ; Biscione, Francesco ; Brautigam, Donald ; Breton, Nicolas ; Cabrera, Jose Walter ; Chartier, Ludovic ; Cheema, Amjad ; Chen, Lin ; Cohen, Andrew ; Cohen, Serge ; Compton, Steve ; Buenostro, Gabriel Contreras ; Dascotte, Olivier ; Davis, Gershan ; de Groot, J.R. ; Brkljacic, Diana Delic ; Dupljakov, Dmitry ; Dutta, Dipankar ; Duvilla, Nathalie ; Hernandes, Mauro Esteves ; Fang, Quan ; Fera, Steven R. ; Fruntelata, Ana Gabriela ; Ganeshkumar, Priya ; Georgeson, Steven ; Gillespie, Eve ; Glotzer, Taya V. ; Gmehling, Joachim ; Goldbarg, Seth ; Guevara, Carolina ; Ha, Andrew ; Hahalis, Georgios ; Hayek, Emil ; Hendriks, I. ; Huang, Chi-Hung ; Ikpoh, Margaret ; Jeanfreau, Robert J. ; Jenkins, Ronald D. ; Joen-Jakobsen, Tomas ; Kneller, G. Larsen ; Kraft, Peter ; Krantz, Mori ; Küppers, Achim ; Leschke, Matthias ; Ma, Changsheng ; Maurer, Tillmann ; McIntyre, Hugh ; Mercader, Marco ; Chreih, Rami Mihail ; Mirault, Tristan ; Miyamoto, Naomasa ; Mondillo, Sergio ; Montagud, Vicente ; Monti, Cristina ; Mori, Kiyoo ; Moriarty, Andrew ; Muriago, Michela ; Musial, Wlodzimierz ; Neiman, James ; Neuenschwander, Fernando Carvalho ; Nossan, Janko ; Novikova, Tatiana ; Nurgalieva, Svetlana ; Park, Hyung Wook ; Parthenakis, Fragkiskos ; Perlman, Richard ; Pflücke, Christian ; Phlaum, Stephen ; Pieters, Denis ; Précoma, Dalton Bertolim ; Prodafikas, John ; Pye, Maurice ; Ramos, Ricardo ; Rieker, Werner ; Briones, Ignacio Rodriguez ; Ronner, E. ; Saltzman, Marco A. ; Shaw, Louise ; Shin, Eun-Seok ; Singh, Narendra ; Siostrzonek, Peter ; Spinar, Jindrich ; Swart, H. ; Singh Takhar, Amrit Pal ; Tang, Sherman ; Tayebjee, Muzahir ; Touze, Emmanuel ; Valadão, C. ; Victory, Jason ; Warner, Alberta L. ; Williams, David ; Xu, Xiangdong ; Yamanoue, Hiroki ; Yamashita, Takeshi ; Zahn, Ralf ; GLORIA-AF Investigators</creatorcontrib><description>Previous studies suggested potential ethnic differences in the management and outcomes of atrial fibrillation (AF). We aim to analyse oral anticoagulant (OAC) prescription, discontinuation, and risk of adverse outcomes in Asian patients with AF, using data from a global prospective cohort study.
From the GLORIA-AF Registry Phase II–III (November 2011–December 2014 for Phase II, and January 2014–December 2016 for Phase III), we analysed patients according to their self-reported ethnicity (Asian vs. non-Asian), as well as according to Asian subgroups (Chinese, Japanese, Korean and other Asian). Logistic regression was used to analyse OAC prescription, while the risk of OAC discontinuation and adverse outcomes were analysed through Cox-regression model. Our primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACE). The original studies were registered with ClinicalTrials.gov, NCT01468701, NCT01671007, and NCT01937377.
34,421 patients were included (70 ± 10.5 years, 45.1% females, 6900 (20.0%) Asian: 3829 (55.5%) Chinese, 814 (11.8%) Japanese, 1964 (28.5%) Korean and 293 (4.2%) other Asian). Most of the Asian patients were recruited in Asia (n = 6701, 97.1%), while non-Asian patients were mainly recruited in Europe (n = 15,449, 56.1%) and North America (n = 8378, 30.4%). Compared to non-Asian individuals, prescription of OAC and non-vitamin K antagonist oral anticoagulant (NOAC) was lower in Asian patients (Odds Ratio [OR] and 95% Confidence Intervals (CI): 0.23 [0.22–0.25] and 0.66 [0.61–0.71], respectively), but higher in the Japanese subgroup. Asian ethnicity was also associated with higher risk of OAC discontinuation (Hazard Ratio [HR] and [95% CI]: 1.79 [1.67–1.92]), and lower risk of the primary composite outcome (HR [95% CI]: 0.86 [0.76–0.96]). Among the exploratory secondary outcomes, Asian ethnicity was associated with higher risks of thromboembolism and intracranial haemorrhage, and lower risk of major bleeding.
Our results showed that Asian patients with AF showed suboptimal thromboembolic risk management and a specific risk profile of adverse outcomes; these differences may also reflect differences in country-specific factors. Ensuring integrated and appropriate treatment of these patients is crucial to improve their prognosis.
The GLORIA-AF Registry was funded by Boehringer Ingelheim GmbH.</description><identifier>ISSN: 2589-5370</identifier><identifier>EISSN: 2589-5370</identifier><identifier>DOI: 10.1016/j.eclinm.2023.102039</identifier><language>eng</language><publisher>Elsevier Ltd</publisher><subject>Asia ; Atrial fibrillation ; Ethnic differences ; Oral anticoagulant ; Outcomes</subject><ispartof>EClinicalMedicine, 2023-09, Vol.63, p.102039-102039, Article 102039</ispartof><rights>2023 The Authors</rights><rights>2023 The Authors 2023</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c441t-5bc5aeae8ce8071a59ee05b057af246e8f503c848c3911eb470ad6309539fcbb3</citedby><cites>FETCH-LOGICAL-c441t-5bc5aeae8ce8071a59ee05b057af246e8f503c848c3911eb470ad6309539fcbb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10518516/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10518516/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,27924,27925,53791,53793</link.rule.ids></links><search><creatorcontrib>Manterola, Fernando Alfonso</creatorcontrib><creatorcontrib>Amara, Walid</creatorcontrib><creatorcontrib>Armero, Sébastien</creatorcontrib><creatorcontrib>Arora, Chander</creatorcontrib><creatorcontrib>Bando, Shigenobu</creatorcontrib><creatorcontrib>Berneau, Jean-Baptiste</creatorcontrib><creatorcontrib>Biscione, Francesco</creatorcontrib><creatorcontrib>Brautigam, Donald</creatorcontrib><creatorcontrib>Breton, Nicolas</creatorcontrib><creatorcontrib>Cabrera, Jose Walter</creatorcontrib><creatorcontrib>Chartier, Ludovic</creatorcontrib><creatorcontrib>Cheema, Amjad</creatorcontrib><creatorcontrib>Chen, Lin</creatorcontrib><creatorcontrib>Cohen, Andrew</creatorcontrib><creatorcontrib>Cohen, Serge</creatorcontrib><creatorcontrib>Compton, Steve</creatorcontrib><creatorcontrib>Buenostro, Gabriel Contreras</creatorcontrib><creatorcontrib>Dascotte, Olivier</creatorcontrib><creatorcontrib>Davis, Gershan</creatorcontrib><creatorcontrib>de Groot, J.R.</creatorcontrib><creatorcontrib>Brkljacic, Diana Delic</creatorcontrib><creatorcontrib>Dupljakov, Dmitry</creatorcontrib><creatorcontrib>Dutta, Dipankar</creatorcontrib><creatorcontrib>Duvilla, Nathalie</creatorcontrib><creatorcontrib>Hernandes, Mauro Esteves</creatorcontrib><creatorcontrib>Fang, Quan</creatorcontrib><creatorcontrib>Fera, Steven R.</creatorcontrib><creatorcontrib>Fruntelata, Ana Gabriela</creatorcontrib><creatorcontrib>Ganeshkumar, Priya</creatorcontrib><creatorcontrib>Georgeson, Steven</creatorcontrib><creatorcontrib>Gillespie, Eve</creatorcontrib><creatorcontrib>Glotzer, Taya V.</creatorcontrib><creatorcontrib>Gmehling, Joachim</creatorcontrib><creatorcontrib>Goldbarg, Seth</creatorcontrib><creatorcontrib>Guevara, Carolina</creatorcontrib><creatorcontrib>Ha, Andrew</creatorcontrib><creatorcontrib>Hahalis, Georgios</creatorcontrib><creatorcontrib>Hayek, Emil</creatorcontrib><creatorcontrib>Hendriks, I.</creatorcontrib><creatorcontrib>Huang, Chi-Hung</creatorcontrib><creatorcontrib>Ikpoh, Margaret</creatorcontrib><creatorcontrib>Jeanfreau, Robert J.</creatorcontrib><creatorcontrib>Jenkins, Ronald D.</creatorcontrib><creatorcontrib>Joen-Jakobsen, Tomas</creatorcontrib><creatorcontrib>Kneller, G. 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We aim to analyse oral anticoagulant (OAC) prescription, discontinuation, and risk of adverse outcomes in Asian patients with AF, using data from a global prospective cohort study.
From the GLORIA-AF Registry Phase II–III (November 2011–December 2014 for Phase II, and January 2014–December 2016 for Phase III), we analysed patients according to their self-reported ethnicity (Asian vs. non-Asian), as well as according to Asian subgroups (Chinese, Japanese, Korean and other Asian). Logistic regression was used to analyse OAC prescription, while the risk of OAC discontinuation and adverse outcomes were analysed through Cox-regression model. Our primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACE). The original studies were registered with ClinicalTrials.gov, NCT01468701, NCT01671007, and NCT01937377.
34,421 patients were included (70 ± 10.5 years, 45.1% females, 6900 (20.0%) Asian: 3829 (55.5%) Chinese, 814 (11.8%) Japanese, 1964 (28.5%) Korean and 293 (4.2%) other Asian). Most of the Asian patients were recruited in Asia (n = 6701, 97.1%), while non-Asian patients were mainly recruited in Europe (n = 15,449, 56.1%) and North America (n = 8378, 30.4%). Compared to non-Asian individuals, prescription of OAC and non-vitamin K antagonist oral anticoagulant (NOAC) was lower in Asian patients (Odds Ratio [OR] and 95% Confidence Intervals (CI): 0.23 [0.22–0.25] and 0.66 [0.61–0.71], respectively), but higher in the Japanese subgroup. Asian ethnicity was also associated with higher risk of OAC discontinuation (Hazard Ratio [HR] and [95% CI]: 1.79 [1.67–1.92]), and lower risk of the primary composite outcome (HR [95% CI]: 0.86 [0.76–0.96]). Among the exploratory secondary outcomes, Asian ethnicity was associated with higher risks of thromboembolism and intracranial haemorrhage, and lower risk of major bleeding.
Our results showed that Asian patients with AF showed suboptimal thromboembolic risk management and a specific risk profile of adverse outcomes; these differences may also reflect differences in country-specific factors. Ensuring integrated and appropriate treatment of these patients is crucial to improve their prognosis.
The GLORIA-AF Registry was funded by Boehringer Ingelheim GmbH.</description><subject>Asia</subject><subject>Atrial fibrillation</subject><subject>Ethnic differences</subject><subject>Oral anticoagulant</subject><subject>Outcomes</subject><issn>2589-5370</issn><issn>2589-5370</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp9UU1r3DAQNaGFhjT_oAcdc_FWsiyv3EPLEpoPWEgJ7VnI8nh3FlvaauSU_Q3901FwKO2lpxlm3nvDm1cUHwRfCS6aj4cVuBH9tKp4JfOo4rI9K84rpdtSyTV_81f_rrgkOnCeQbVuG35e_P5mU4LoiYWBhWhHZn1CF-xuHnPHZoI86VmYkwsTEEPPNoTWs6NNCD4R-4Vpz2yKmMkDdhHHMa-C_8QsOwZK5T64rGHHEyGxIYaJpT2w2-3D4_2m3NywR9ghpXh6X7wd7Ehw-Vovih83X79f35Xbh9v76822dHUtUqk6pyxY0A40XwurWgCuOq7WdqjqBvSguHS61k62QkBXr7ntG8lbJdvBdZ28KL4suse5m6B32UU2bo4RJxtPJlg0_2487s0uPBnBldBKNFnh6lUhhp8zUDITkoNs3EOYyVS6aRshleYZWi9QFwNRhOHPHcHNS4DmYJYAzUuAZgkw0z4vNMiPeEKIhlx-t4MeI7hk-oD_F3gGLGmo7A</recordid><startdate>20230901</startdate><enddate>20230901</enddate><creator>Manterola, Fernando Alfonso</creator><creator>Amara, Walid</creator><creator>Armero, Sébastien</creator><creator>Arora, Chander</creator><creator>Bando, Shigenobu</creator><creator>Berneau, Jean-Baptiste</creator><creator>Biscione, Francesco</creator><creator>Brautigam, Donald</creator><creator>Breton, Nicolas</creator><creator>Cabrera, Jose Walter</creator><creator>Chartier, Ludovic</creator><creator>Cheema, Amjad</creator><creator>Chen, Lin</creator><creator>Cohen, Andrew</creator><creator>Cohen, Serge</creator><creator>Compton, Steve</creator><creator>Buenostro, Gabriel Contreras</creator><creator>Dascotte, Olivier</creator><creator>Davis, Gershan</creator><creator>de Groot, J.R.</creator><creator>Brkljacic, Diana Delic</creator><creator>Dupljakov, Dmitry</creator><creator>Dutta, Dipankar</creator><creator>Duvilla, Nathalie</creator><creator>Hernandes, Mauro Esteves</creator><creator>Fang, Quan</creator><creator>Fera, Steven R.</creator><creator>Fruntelata, Ana Gabriela</creator><creator>Ganeshkumar, Priya</creator><creator>Georgeson, Steven</creator><creator>Gillespie, Eve</creator><creator>Glotzer, Taya V.</creator><creator>Gmehling, Joachim</creator><creator>Goldbarg, Seth</creator><creator>Guevara, Carolina</creator><creator>Ha, Andrew</creator><creator>Hahalis, Georgios</creator><creator>Hayek, Emil</creator><creator>Hendriks, I.</creator><creator>Huang, Chi-Hung</creator><creator>Ikpoh, Margaret</creator><creator>Jeanfreau, Robert J.</creator><creator>Jenkins, Ronald D.</creator><creator>Joen-Jakobsen, Tomas</creator><creator>Kneller, G. 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Larsen ; Kraft, Peter ; Krantz, Mori ; Küppers, Achim ; Leschke, Matthias ; Ma, Changsheng ; Maurer, Tillmann ; McIntyre, Hugh ; Mercader, Marco ; Chreih, Rami Mihail ; Mirault, Tristan ; Miyamoto, Naomasa ; Mondillo, Sergio ; Montagud, Vicente ; Monti, Cristina ; Mori, Kiyoo ; Moriarty, Andrew ; Muriago, Michela ; Musial, Wlodzimierz ; Neiman, James ; Neuenschwander, Fernando Carvalho ; Nossan, Janko ; Novikova, Tatiana ; Nurgalieva, Svetlana ; Park, Hyung Wook ; Parthenakis, Fragkiskos ; Perlman, Richard ; Pflücke, Christian ; Phlaum, Stephen ; Pieters, Denis ; Précoma, Dalton Bertolim ; Prodafikas, John ; Pye, Maurice ; Ramos, Ricardo ; Rieker, Werner ; Briones, Ignacio Rodriguez ; Ronner, E. ; Saltzman, Marco A. ; Shaw, Louise ; Shin, Eun-Seok ; Singh, Narendra ; Siostrzonek, Peter ; Spinar, Jindrich ; Swart, H. ; Singh Takhar, Amrit Pal ; Tang, Sherman ; Tayebjee, Muzahir ; Touze, Emmanuel ; Valadão, C. ; Victory, Jason ; Warner, Alberta L. ; Williams, David ; Xu, Xiangdong ; Yamanoue, Hiroki ; Yamashita, Takeshi ; Zahn, Ralf</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c441t-5bc5aeae8ce8071a59ee05b057af246e8f503c848c3911eb470ad6309539fcbb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Asia</topic><topic>Atrial fibrillation</topic><topic>Ethnic differences</topic><topic>Oral anticoagulant</topic><topic>Outcomes</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Manterola, Fernando Alfonso</creatorcontrib><creatorcontrib>Amara, Walid</creatorcontrib><creatorcontrib>Armero, Sébastien</creatorcontrib><creatorcontrib>Arora, Chander</creatorcontrib><creatorcontrib>Bando, Shigenobu</creatorcontrib><creatorcontrib>Berneau, Jean-Baptiste</creatorcontrib><creatorcontrib>Biscione, Francesco</creatorcontrib><creatorcontrib>Brautigam, Donald</creatorcontrib><creatorcontrib>Breton, Nicolas</creatorcontrib><creatorcontrib>Cabrera, Jose Walter</creatorcontrib><creatorcontrib>Chartier, Ludovic</creatorcontrib><creatorcontrib>Cheema, Amjad</creatorcontrib><creatorcontrib>Chen, Lin</creatorcontrib><creatorcontrib>Cohen, Andrew</creatorcontrib><creatorcontrib>Cohen, Serge</creatorcontrib><creatorcontrib>Compton, Steve</creatorcontrib><creatorcontrib>Buenostro, Gabriel Contreras</creatorcontrib><creatorcontrib>Dascotte, Olivier</creatorcontrib><creatorcontrib>Davis, Gershan</creatorcontrib><creatorcontrib>de Groot, J.R.</creatorcontrib><creatorcontrib>Brkljacic, Diana Delic</creatorcontrib><creatorcontrib>Dupljakov, Dmitry</creatorcontrib><creatorcontrib>Dutta, Dipankar</creatorcontrib><creatorcontrib>Duvilla, Nathalie</creatorcontrib><creatorcontrib>Hernandes, Mauro Esteves</creatorcontrib><creatorcontrib>Fang, Quan</creatorcontrib><creatorcontrib>Fera, Steven R.</creatorcontrib><creatorcontrib>Fruntelata, Ana Gabriela</creatorcontrib><creatorcontrib>Ganeshkumar, Priya</creatorcontrib><creatorcontrib>Georgeson, Steven</creatorcontrib><creatorcontrib>Gillespie, Eve</creatorcontrib><creatorcontrib>Glotzer, Taya V.</creatorcontrib><creatorcontrib>Gmehling, Joachim</creatorcontrib><creatorcontrib>Goldbarg, Seth</creatorcontrib><creatorcontrib>Guevara, Carolina</creatorcontrib><creatorcontrib>Ha, Andrew</creatorcontrib><creatorcontrib>Hahalis, Georgios</creatorcontrib><creatorcontrib>Hayek, Emil</creatorcontrib><creatorcontrib>Hendriks, I.</creatorcontrib><creatorcontrib>Huang, Chi-Hung</creatorcontrib><creatorcontrib>Ikpoh, Margaret</creatorcontrib><creatorcontrib>Jeanfreau, Robert J.</creatorcontrib><creatorcontrib>Jenkins, Ronald D.</creatorcontrib><creatorcontrib>Joen-Jakobsen, Tomas</creatorcontrib><creatorcontrib>Kneller, G. 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Larsen</au><au>Kraft, Peter</au><au>Krantz, Mori</au><au>Küppers, Achim</au><au>Leschke, Matthias</au><au>Ma, Changsheng</au><au>Maurer, Tillmann</au><au>McIntyre, Hugh</au><au>Mercader, Marco</au><au>Chreih, Rami Mihail</au><au>Mirault, Tristan</au><au>Miyamoto, Naomasa</au><au>Mondillo, Sergio</au><au>Montagud, Vicente</au><au>Monti, Cristina</au><au>Mori, Kiyoo</au><au>Moriarty, Andrew</au><au>Muriago, Michela</au><au>Musial, Wlodzimierz</au><au>Neiman, James</au><au>Neuenschwander, Fernando Carvalho</au><au>Nossan, Janko</au><au>Novikova, Tatiana</au><au>Nurgalieva, Svetlana</au><au>Park, Hyung Wook</au><au>Parthenakis, Fragkiskos</au><au>Perlman, Richard</au><au>Pflücke, Christian</au><au>Phlaum, Stephen</au><au>Pieters, Denis</au><au>Précoma, Dalton Bertolim</au><au>Prodafikas, John</au><au>Pye, Maurice</au><au>Ramos, Ricardo</au><au>Rieker, Werner</au><au>Briones, Ignacio Rodriguez</au><au>Ronner, E.</au><au>Saltzman, Marco A.</au><au>Shaw, Louise</au><au>Shin, Eun-Seok</au><au>Singh, Narendra</au><au>Siostrzonek, Peter</au><au>Spinar, Jindrich</au><au>Swart, H.</au><au>Singh Takhar, Amrit Pal</au><au>Tang, Sherman</au><au>Tayebjee, Muzahir</au><au>Touze, Emmanuel</au><au>Valadão, C.</au><au>Victory, Jason</au><au>Warner, Alberta L.</au><au>Williams, David</au><au>Xu, Xiangdong</au><au>Yamanoue, Hiroki</au><au>Yamashita, Takeshi</au><au>Zahn, Ralf</au><aucorp>GLORIA-AF Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Patterns of oral anticoagulant use and outcomes in Asian patients with atrial fibrillation: a post-hoc analysis from the GLORIA-AF Registry</atitle><jtitle>EClinicalMedicine</jtitle><date>2023-09-01</date><risdate>2023</risdate><volume>63</volume><spage>102039</spage><epage>102039</epage><pages>102039-102039</pages><artnum>102039</artnum><issn>2589-5370</issn><eissn>2589-5370</eissn><abstract>Previous studies suggested potential ethnic differences in the management and outcomes of atrial fibrillation (AF). We aim to analyse oral anticoagulant (OAC) prescription, discontinuation, and risk of adverse outcomes in Asian patients with AF, using data from a global prospective cohort study.
From the GLORIA-AF Registry Phase II–III (November 2011–December 2014 for Phase II, and January 2014–December 2016 for Phase III), we analysed patients according to their self-reported ethnicity (Asian vs. non-Asian), as well as according to Asian subgroups (Chinese, Japanese, Korean and other Asian). Logistic regression was used to analyse OAC prescription, while the risk of OAC discontinuation and adverse outcomes were analysed through Cox-regression model. Our primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACE). The original studies were registered with ClinicalTrials.gov, NCT01468701, NCT01671007, and NCT01937377.
34,421 patients were included (70 ± 10.5 years, 45.1% females, 6900 (20.0%) Asian: 3829 (55.5%) Chinese, 814 (11.8%) Japanese, 1964 (28.5%) Korean and 293 (4.2%) other Asian). Most of the Asian patients were recruited in Asia (n = 6701, 97.1%), while non-Asian patients were mainly recruited in Europe (n = 15,449, 56.1%) and North America (n = 8378, 30.4%). Compared to non-Asian individuals, prescription of OAC and non-vitamin K antagonist oral anticoagulant (NOAC) was lower in Asian patients (Odds Ratio [OR] and 95% Confidence Intervals (CI): 0.23 [0.22–0.25] and 0.66 [0.61–0.71], respectively), but higher in the Japanese subgroup. Asian ethnicity was also associated with higher risk of OAC discontinuation (Hazard Ratio [HR] and [95% CI]: 1.79 [1.67–1.92]), and lower risk of the primary composite outcome (HR [95% CI]: 0.86 [0.76–0.96]). Among the exploratory secondary outcomes, Asian ethnicity was associated with higher risks of thromboembolism and intracranial haemorrhage, and lower risk of major bleeding.
Our results showed that Asian patients with AF showed suboptimal thromboembolic risk management and a specific risk profile of adverse outcomes; these differences may also reflect differences in country-specific factors. Ensuring integrated and appropriate treatment of these patients is crucial to improve their prognosis.
The GLORIA-AF Registry was funded by Boehringer Ingelheim GmbH.</abstract><pub>Elsevier Ltd</pub><doi>10.1016/j.eclinm.2023.102039</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
fulltext | fulltext |
identifier | ISSN: 2589-5370 |
ispartof | EClinicalMedicine, 2023-09, Vol.63, p.102039-102039, Article 102039 |
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language | eng |
recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10518516 |
source | DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; Alma/SFX Local Collection |
subjects | Asia Atrial fibrillation Ethnic differences Oral anticoagulant Outcomes |
title | Patterns of oral anticoagulant use and outcomes in Asian patients with atrial fibrillation: a post-hoc analysis from the GLORIA-AF Registry |
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