Evolving antithrombotic treatment patterns for patients with newly diagnosed atrial fibrillation
ObjectiveWe studied evolving antithrombotic therapy patterns in patients with newly diagnosed non-valvular atrial fibrillation (AF) and ≥1 additional stroke risk factor between 2010 and 2015.Methods39 670 patients were prospectively enrolled in four sequential cohorts in the Global Anticoagulant Reg...
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| Veröffentlicht in: | Heart (British Cardiac Society) 2017-02, Vol.103 (4), p.307-314 |
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| creator | Camm, A John Accetta, Gabriele Ambrosio, Giuseppe Atar, Dan Bassand, Jean-Pierre Berge, Eivind Cools, Frank Fitzmaurice, David A Goldhaber, Samuel Z Goto, Shinya Haas, Sylvia Kayani, Gloria Koretsune, Yukihiro Mantovani, Lorenzo G Misselwitz, Frank Oh, Seil Turpie, Alexander G G Verheugt, Freek W A Kakkar, Ajay K |
| description | ObjectiveWe studied evolving antithrombotic therapy patterns in patients with newly diagnosed non-valvular atrial fibrillation (AF) and ≥1 additional stroke risk factor between 2010 and 2015.Methods39 670 patients were prospectively enrolled in four sequential cohorts in the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF): cohort C1 (2010–2011), n=5500; C2 (2011–2013), n=11 662; C3 (2013–2014), n=11 462; C4 (2014–2015), n=11 046. Baseline characteristics and antithrombotic therapy initiated at diagnosis were analysed by cohort.ResultsBaseline characteristics were similar across cohorts. Median CHA2DS2-VASc (cardiac failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65–74 and sex category (female)) score was 3 in all four cohorts. From C1 to C4, the proportion of patients on anticoagulant (AC) therapy increased by almost 15% (C1 57.4%; C4 71.1%). Use of vitamin K antagonist (VKA)±antiplatelet (AP) (C1 53.2%; C4 34.0%) and AP monotherapy (C1 30.2%; C4 16.6%) declined, while use of non-VKA oral ACs (NOACs)±AP increased (C1 4.2%; C4 37.0%). Most CHA2DS2-VASc ≥2 patients received AC, and this proportion increased over time, largely driven by NOAC prescribing. NOACs were more frequently prescribed than VKAs in men, the elderly, patients of Asian ethnicity, those with dementia, or those using non-steroidal anti-inflammatory drugs, and current smokers. VKA use was more common in patients with cardiac, vascular, or renal comorbidities.ConclusionsSince NOACs were introduced, there has been an increase in newly diagnosed patients with AF at risk of stroke receiving guideline-recommended therapy, predominantly driven by increased use of NOACs and reduced use of VKA±AP or AP alone.Trial registration numberNCT01090362; Pre-results. |
| doi_str_mv | 10.1136/heartjnl-2016-309832 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5293840</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>4314269491</sourcerecordid><originalsourceid>FETCH-LOGICAL-b509t-a5da57a60066ff21b858ed5b4d262ffb38f468960fb7faf693604ff4300cdb283</originalsourceid><addsrcrecordid>eNqNkU9PXCEUxUnTplrrN2gakm7cvMp_eJsmjVHbxKSbNukO4T2YYfIeTIEZ47eXcdRUV66Ay--e3HMPAJ8w-ooxFadLZ3JdxakjCIuOol5R8gYcYibUrvT3bbtTzjuBqDwAH0pZIYRYr8R7cECkYBILdQiuz7dp2oa4gCbWUJc5zTbVMMCanamzixWuTa0uxwJ9yrtHaMUCbxoMo7uZbuEYzCKm4kZoag5mgj7YHKapoSl-BO-8mYo7fjiPwJ-L899nP7qrX5c_z75fdZajvnaGj4ZLIxASwnuCreLKjdyykQjivaXKN2O9QN5Kb7zoqUDMe0YRGkZLFD0C3_a6642d3Ti0IbOZ9DqH2eRbnUzQz39iWOpF2mpOeqoYagInDwI5_du4UvUcyuCajejSpmisRNswJ_I1KO8lkZTKhn55ga7SJse2iXtBzoRQuFFsTw05lZKdf5obI71LWz-mrXdp633are3z_56fmh7jbcDpHrDz6nWSd64auho</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1868546681</pqid></control><display><type>article</type><title>Evolving antithrombotic treatment patterns for patients with newly diagnosed atrial fibrillation</title><source>MEDLINE</source><source>PubMed Central</source><creator>Camm, A John ; Accetta, Gabriele ; Ambrosio, Giuseppe ; Atar, Dan ; Bassand, Jean-Pierre ; Berge, Eivind ; Cools, Frank ; Fitzmaurice, David A ; Goldhaber, Samuel Z ; Goto, Shinya ; Haas, Sylvia ; Kayani, Gloria ; Koretsune, Yukihiro ; Mantovani, Lorenzo G ; Misselwitz, Frank ; Oh, Seil ; Turpie, Alexander G G ; Verheugt, Freek W A ; Kakkar, Ajay K</creator><creatorcontrib>Camm, A John ; Accetta, Gabriele ; Ambrosio, Giuseppe ; Atar, Dan ; Bassand, Jean-Pierre ; Berge, Eivind ; Cools, Frank ; Fitzmaurice, David A ; Goldhaber, Samuel Z ; Goto, Shinya ; Haas, Sylvia ; Kayani, Gloria ; Koretsune, Yukihiro ; Mantovani, Lorenzo G ; Misselwitz, Frank ; Oh, Seil ; Turpie, Alexander G G ; Verheugt, Freek W A ; Kakkar, Ajay K ; GARFIELD-AF Investigators</creatorcontrib><description>ObjectiveWe studied evolving antithrombotic therapy patterns in patients with newly diagnosed non-valvular atrial fibrillation (AF) and ≥1 additional stroke risk factor between 2010 and 2015.Methods39 670 patients were prospectively enrolled in four sequential cohorts in the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF): cohort C1 (2010–2011), n=5500; C2 (2011–2013), n=11 662; C3 (2013–2014), n=11 462; C4 (2014–2015), n=11 046. Baseline characteristics and antithrombotic therapy initiated at diagnosis were analysed by cohort.ResultsBaseline characteristics were similar across cohorts. Median CHA2DS2-VASc (cardiac failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65–74 and sex category (female)) score was 3 in all four cohorts. From C1 to C4, the proportion of patients on anticoagulant (AC) therapy increased by almost 15% (C1 57.4%; C4 71.1%). Use of vitamin K antagonist (VKA)±antiplatelet (AP) (C1 53.2%; C4 34.0%) and AP monotherapy (C1 30.2%; C4 16.6%) declined, while use of non-VKA oral ACs (NOACs)±AP increased (C1 4.2%; C4 37.0%). Most CHA2DS2-VASc ≥2 patients received AC, and this proportion increased over time, largely driven by NOAC prescribing. NOACs were more frequently prescribed than VKAs in men, the elderly, patients of Asian ethnicity, those with dementia, or those using non-steroidal anti-inflammatory drugs, and current smokers. VKA use was more common in patients with cardiac, vascular, or renal comorbidities.ConclusionsSince NOACs were introduced, there has been an increase in newly diagnosed patients with AF at risk of stroke receiving guideline-recommended therapy, predominantly driven by increased use of NOACs and reduced use of VKA±AP or AP alone.Trial registration numberNCT01090362; Pre-results.</description><identifier>ISSN: 1355-6037</identifier><identifier>EISSN: 1468-201X</identifier><identifier>DOI: 10.1136/heartjnl-2016-309832</identifier><identifier>PMID: 27647168</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Administration, Oral ; Age Factors ; Aged ; Aged, 80 and over ; Anticoagulants ; Arrhythmias and Sudden Death ; Atrial Fibrillation - diagnosis ; Atrial Fibrillation - drug therapy ; Atrial Fibrillation - epidemiology ; Cardiac arrhythmia ; Cardiovascular disease ; Comorbidity ; Diabetes ; Female ; Fibrinolytic Agents - administration & dosage ; Fibrinolytic Agents - adverse effects ; Guideline Adherence ; Humans ; Hypertension ; Kidney diseases ; Male ; Middle Aged ; Practice Guidelines as Topic ; Practice Patterns, Physicians' - trends ; Prospective Studies ; Ratios ; Registries ; Risk Assessment ; Risk Factors ; Sex Factors ; Stroke ; Stroke - diagnosis ; Stroke - epidemiology ; Stroke - prevention & control ; Thrombosis ; Time Factors ; Transient ischemic attack ; Treatment Outcome ; Variables ; Vein & artery diseases</subject><ispartof>Heart (British Cardiac Society), 2017-02, Vol.103 (4), p.307-314</ispartof><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.</rights><rights>Copyright: 2017 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b509t-a5da57a60066ff21b858ed5b4d262ffb38f468960fb7faf693604ff4300cdb283</citedby><cites>FETCH-LOGICAL-b509t-a5da57a60066ff21b858ed5b4d262ffb38f468960fb7faf693604ff4300cdb283</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/PMC5293840/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5293840/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27647168$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Camm, A John</creatorcontrib><creatorcontrib>Accetta, Gabriele</creatorcontrib><creatorcontrib>Ambrosio, Giuseppe</creatorcontrib><creatorcontrib>Atar, Dan</creatorcontrib><creatorcontrib>Bassand, Jean-Pierre</creatorcontrib><creatorcontrib>Berge, Eivind</creatorcontrib><creatorcontrib>Cools, Frank</creatorcontrib><creatorcontrib>Fitzmaurice, David A</creatorcontrib><creatorcontrib>Goldhaber, Samuel Z</creatorcontrib><creatorcontrib>Goto, Shinya</creatorcontrib><creatorcontrib>Haas, Sylvia</creatorcontrib><creatorcontrib>Kayani, Gloria</creatorcontrib><creatorcontrib>Koretsune, Yukihiro</creatorcontrib><creatorcontrib>Mantovani, Lorenzo G</creatorcontrib><creatorcontrib>Misselwitz, Frank</creatorcontrib><creatorcontrib>Oh, Seil</creatorcontrib><creatorcontrib>Turpie, Alexander G G</creatorcontrib><creatorcontrib>Verheugt, Freek W A</creatorcontrib><creatorcontrib>Kakkar, Ajay K</creatorcontrib><creatorcontrib>GARFIELD-AF Investigators</creatorcontrib><title>Evolving antithrombotic treatment patterns for patients with newly diagnosed atrial fibrillation</title><title>Heart (British Cardiac Society)</title><addtitle>Heart</addtitle><description>ObjectiveWe studied evolving antithrombotic therapy patterns in patients with newly diagnosed non-valvular atrial fibrillation (AF) and ≥1 additional stroke risk factor between 2010 and 2015.Methods39 670 patients were prospectively enrolled in four sequential cohorts in the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF): cohort C1 (2010–2011), n=5500; C2 (2011–2013), n=11 662; C3 (2013–2014), n=11 462; C4 (2014–2015), n=11 046. Baseline characteristics and antithrombotic therapy initiated at diagnosis were analysed by cohort.ResultsBaseline characteristics were similar across cohorts. Median CHA2DS2-VASc (cardiac failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65–74 and sex category (female)) score was 3 in all four cohorts. From C1 to C4, the proportion of patients on anticoagulant (AC) therapy increased by almost 15% (C1 57.4%; C4 71.1%). Use of vitamin K antagonist (VKA)±antiplatelet (AP) (C1 53.2%; C4 34.0%) and AP monotherapy (C1 30.2%; C4 16.6%) declined, while use of non-VKA oral ACs (NOACs)±AP increased (C1 4.2%; C4 37.0%). Most CHA2DS2-VASc ≥2 patients received AC, and this proportion increased over time, largely driven by NOAC prescribing. NOACs were more frequently prescribed than VKAs in men, the elderly, patients of Asian ethnicity, those with dementia, or those using non-steroidal anti-inflammatory drugs, and current smokers. VKA use was more common in patients with cardiac, vascular, or renal comorbidities.ConclusionsSince NOACs were introduced, there has been an increase in newly diagnosed patients with AF at risk of stroke receiving guideline-recommended therapy, predominantly driven by increased use of NOACs and reduced use of VKA±AP or AP alone.Trial registration numberNCT01090362; Pre-results.</description><subject>Administration, Oral</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anticoagulants</subject><subject>Arrhythmias and Sudden Death</subject><subject>Atrial Fibrillation - diagnosis</subject><subject>Atrial Fibrillation - drug therapy</subject><subject>Atrial Fibrillation - epidemiology</subject><subject>Cardiac arrhythmia</subject><subject>Cardiovascular disease</subject><subject>Comorbidity</subject><subject>Diabetes</subject><subject>Female</subject><subject>Fibrinolytic Agents - administration & dosage</subject><subject>Fibrinolytic Agents - adverse effects</subject><subject>Guideline Adherence</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Kidney diseases</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Practice Guidelines as Topic</subject><subject>Practice Patterns, Physicians' - trends</subject><subject>Prospective Studies</subject><subject>Ratios</subject><subject>Registries</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Sex Factors</subject><subject>Stroke</subject><subject>Stroke - diagnosis</subject><subject>Stroke - epidemiology</subject><subject>Stroke - prevention & control</subject><subject>Thrombosis</subject><subject>Time Factors</subject><subject>Transient ischemic attack</subject><subject>Treatment Outcome</subject><subject>Variables</subject><subject>Vein & artery diseases</subject><issn>1355-6037</issn><issn>1468-201X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>ACMMV</sourceid><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqNkU9PXCEUxUnTplrrN2gakm7cvMp_eJsmjVHbxKSbNukO4T2YYfIeTIEZ47eXcdRUV66Ay--e3HMPAJ8w-ooxFadLZ3JdxakjCIuOol5R8gYcYibUrvT3bbtTzjuBqDwAH0pZIYRYr8R7cECkYBILdQiuz7dp2oa4gCbWUJc5zTbVMMCanamzixWuTa0uxwJ9yrtHaMUCbxoMo7uZbuEYzCKm4kZoag5mgj7YHKapoSl-BO-8mYo7fjiPwJ-L899nP7qrX5c_z75fdZajvnaGj4ZLIxASwnuCreLKjdyykQjivaXKN2O9QN5Kb7zoqUDMe0YRGkZLFD0C3_a6642d3Ti0IbOZ9DqH2eRbnUzQz39iWOpF2mpOeqoYagInDwI5_du4UvUcyuCajejSpmisRNswJ_I1KO8lkZTKhn55ga7SJse2iXtBzoRQuFFsTw05lZKdf5obI71LWz-mrXdp633are3z_56fmh7jbcDpHrDz6nWSd64auho</recordid><startdate>20170215</startdate><enddate>20170215</enddate><creator>Camm, A John</creator><creator>Accetta, Gabriele</creator><creator>Ambrosio, Giuseppe</creator><creator>Atar, Dan</creator><creator>Bassand, Jean-Pierre</creator><creator>Berge, Eivind</creator><creator>Cools, Frank</creator><creator>Fitzmaurice, David A</creator><creator>Goldhaber, Samuel Z</creator><creator>Goto, Shinya</creator><creator>Haas, Sylvia</creator><creator>Kayani, Gloria</creator><creator>Koretsune, Yukihiro</creator><creator>Mantovani, Lorenzo G</creator><creator>Misselwitz, Frank</creator><creator>Oh, Seil</creator><creator>Turpie, Alexander G G</creator><creator>Verheugt, Freek W A</creator><creator>Kakkar, Ajay K</creator><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>9YT</scope><scope>ACMMV</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>P64</scope><scope>5PM</scope></search><sort><creationdate>20170215</creationdate><title>Evolving antithrombotic treatment patterns for patients with newly diagnosed atrial fibrillation</title><author>Camm, A John ; Accetta, Gabriele ; Ambrosio, Giuseppe ; Atar, Dan ; Bassand, Jean-Pierre ; Berge, Eivind ; Cools, Frank ; Fitzmaurice, David A ; Goldhaber, Samuel Z ; Goto, Shinya ; Haas, Sylvia ; Kayani, Gloria ; Koretsune, Yukihiro ; Mantovani, Lorenzo G ; Misselwitz, Frank ; Oh, Seil ; Turpie, Alexander G G ; Verheugt, Freek W A ; Kakkar, Ajay K</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b509t-a5da57a60066ff21b858ed5b4d262ffb38f468960fb7faf693604ff4300cdb283</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Administration, Oral</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anticoagulants</topic><topic>Arrhythmias and Sudden Death</topic><topic>Atrial Fibrillation - diagnosis</topic><topic>Atrial Fibrillation - drug therapy</topic><topic>Atrial Fibrillation - epidemiology</topic><topic>Cardiac arrhythmia</topic><topic>Cardiovascular disease</topic><topic>Comorbidity</topic><topic>Diabetes</topic><topic>Female</topic><topic>Fibrinolytic Agents - administration & dosage</topic><topic>Fibrinolytic Agents - adverse effects</topic><topic>Guideline Adherence</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Kidney diseases</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Practice Guidelines as Topic</topic><topic>Practice Patterns, Physicians' - trends</topic><topic>Prospective Studies</topic><topic>Ratios</topic><topic>Registries</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Sex Factors</topic><topic>Stroke</topic><topic>Stroke - diagnosis</topic><topic>Stroke - epidemiology</topic><topic>Stroke - prevention & control</topic><topic>Thrombosis</topic><topic>Time Factors</topic><topic>Transient ischemic attack</topic><topic>Treatment Outcome</topic><topic>Variables</topic><topic>Vein & artery diseases</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Camm, A John</creatorcontrib><creatorcontrib>Accetta, Gabriele</creatorcontrib><creatorcontrib>Ambrosio, Giuseppe</creatorcontrib><creatorcontrib>Atar, Dan</creatorcontrib><creatorcontrib>Bassand, Jean-Pierre</creatorcontrib><creatorcontrib>Berge, Eivind</creatorcontrib><creatorcontrib>Cools, Frank</creatorcontrib><creatorcontrib>Fitzmaurice, David A</creatorcontrib><creatorcontrib>Goldhaber, Samuel Z</creatorcontrib><creatorcontrib>Goto, Shinya</creatorcontrib><creatorcontrib>Haas, Sylvia</creatorcontrib><creatorcontrib>Kayani, Gloria</creatorcontrib><creatorcontrib>Koretsune, Yukihiro</creatorcontrib><creatorcontrib>Mantovani, Lorenzo G</creatorcontrib><creatorcontrib>Misselwitz, Frank</creatorcontrib><creatorcontrib>Oh, Seil</creatorcontrib><creatorcontrib>Turpie, Alexander G G</creatorcontrib><creatorcontrib>Verheugt, Freek W A</creatorcontrib><creatorcontrib>Kakkar, Ajay K</creatorcontrib><creatorcontrib>GARFIELD-AF Investigators</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Heart (British Cardiac Society)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Camm, A John</au><au>Accetta, Gabriele</au><au>Ambrosio, Giuseppe</au><au>Atar, Dan</au><au>Bassand, Jean-Pierre</au><au>Berge, Eivind</au><au>Cools, Frank</au><au>Fitzmaurice, David A</au><au>Goldhaber, Samuel Z</au><au>Goto, Shinya</au><au>Haas, Sylvia</au><au>Kayani, Gloria</au><au>Koretsune, Yukihiro</au><au>Mantovani, Lorenzo G</au><au>Misselwitz, Frank</au><au>Oh, Seil</au><au>Turpie, Alexander G G</au><au>Verheugt, Freek W A</au><au>Kakkar, Ajay K</au><aucorp>GARFIELD-AF Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evolving antithrombotic treatment patterns for patients with newly diagnosed atrial fibrillation</atitle><jtitle>Heart (British Cardiac Society)</jtitle><addtitle>Heart</addtitle><date>2017-02-15</date><risdate>2017</risdate><volume>103</volume><issue>4</issue><spage>307</spage><epage>314</epage><pages>307-314</pages><issn>1355-6037</issn><eissn>1468-201X</eissn><abstract>ObjectiveWe studied evolving antithrombotic therapy patterns in patients with newly diagnosed non-valvular atrial fibrillation (AF) and ≥1 additional stroke risk factor between 2010 and 2015.Methods39 670 patients were prospectively enrolled in four sequential cohorts in the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF): cohort C1 (2010–2011), n=5500; C2 (2011–2013), n=11 662; C3 (2013–2014), n=11 462; C4 (2014–2015), n=11 046. Baseline characteristics and antithrombotic therapy initiated at diagnosis were analysed by cohort.ResultsBaseline characteristics were similar across cohorts. Median CHA2DS2-VASc (cardiac failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65–74 and sex category (female)) score was 3 in all four cohorts. From C1 to C4, the proportion of patients on anticoagulant (AC) therapy increased by almost 15% (C1 57.4%; C4 71.1%). Use of vitamin K antagonist (VKA)±antiplatelet (AP) (C1 53.2%; C4 34.0%) and AP monotherapy (C1 30.2%; C4 16.6%) declined, while use of non-VKA oral ACs (NOACs)±AP increased (C1 4.2%; C4 37.0%). Most CHA2DS2-VASc ≥2 patients received AC, and this proportion increased over time, largely driven by NOAC prescribing. NOACs were more frequently prescribed than VKAs in men, the elderly, patients of Asian ethnicity, those with dementia, or those using non-steroidal anti-inflammatory drugs, and current smokers. VKA use was more common in patients with cardiac, vascular, or renal comorbidities.ConclusionsSince NOACs were introduced, there has been an increase in newly diagnosed patients with AF at risk of stroke receiving guideline-recommended therapy, predominantly driven by increased use of NOACs and reduced use of VKA±AP or AP alone.Trial registration numberNCT01090362; Pre-results.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>27647168</pmid><doi>10.1136/heartjnl-2016-309832</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1355-6037 |
| ispartof | Heart (British Cardiac Society), 2017-02, Vol.103 (4), p.307-314 |
| issn | 1355-6037 1468-201X |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5293840 |
| source | MEDLINE; PubMed Central |
| subjects | Administration, Oral Age Factors Aged Aged, 80 and over Anticoagulants Arrhythmias and Sudden Death Atrial Fibrillation - diagnosis Atrial Fibrillation - drug therapy Atrial Fibrillation - epidemiology Cardiac arrhythmia Cardiovascular disease Comorbidity Diabetes Female Fibrinolytic Agents - administration & dosage Fibrinolytic Agents - adverse effects Guideline Adherence Humans Hypertension Kidney diseases Male Middle Aged Practice Guidelines as Topic Practice Patterns, Physicians' - trends Prospective Studies Ratios Registries Risk Assessment Risk Factors Sex Factors Stroke Stroke - diagnosis Stroke - epidemiology Stroke - prevention & control Thrombosis Time Factors Transient ischemic attack Treatment Outcome Variables Vein & artery diseases |
| title | Evolving antithrombotic treatment patterns for patients with newly diagnosed atrial fibrillation |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-31T23%3A02%3A19IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Evolving%20antithrombotic%20treatment%20patterns%20for%20patients%20with%20newly%20diagnosed%20atrial%20fibrillation&rft.jtitle=Heart%20(British%20Cardiac%20Society)&rft.au=Camm,%20A%20John&rft.aucorp=GARFIELD-AF%20Investigators&rft.date=2017-02-15&rft.volume=103&rft.issue=4&rft.spage=307&rft.epage=314&rft.pages=307-314&rft.issn=1355-6037&rft.eissn=1468-201X&rft_id=info:doi/10.1136/heartjnl-2016-309832&rft_dat=%3Cproquest_pubme%3E4314269491%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1868546681&rft_id=info:pmid/27647168&rfr_iscdi=true |