Temporal trends in antithrombotic treatment of real-world UK patients with newly diagnosed atrial fibrillation: findings from the GARFIELD-AF registry

Patricia N Apenteng; Haiyan Gao; Fd Richard Hobbs; David A Fitzmaurice; UK GARFIELD-AF Investigators and GARFIELD-AF Steering Committee

doi:10.1136/bmjopen-2017-018905

Temporal trends in antithrombotic treatment of real-world UK patients with newly diagnosed atrial fibrillation: findings from the GARFIELD-AF registry

Patricia N Apenteng, Haiyan Gao, Fd Richard Hobbs, David A Fitzmaurice, UK GARFIELD-AF Investigators and GARFIELD-AF Steering Committee

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Abstract

OBJECTIVE: To investigate evolving patterns in antithrombotic treatment in UK patients with newly diagnosed non-valvular atrial fibrillation (AF).

DESIGN: Prospective, multicentre, international registry.

SETTING: 186 primary care practices in the UK.

PARTICIPANTS: 3482 participants prospectively enrolled in four sequential cohorts (cohort 2 (C2) n=830, diagnosed September 2011 to April 2013; cohort 3 (C3) n=902, diagnosed April 2013 to June 2014; cohort 4 (C4) n=850, diagnosed July 2014 to June 2015; cohort 5 (C5) n=900, diagnosed June 2015 to July 2016). Participants had newly diagnosed non-valvular AF and at least one risk factor for stroke, were aged ≥18, and provided informed consent.

MAIN OUTCOME MEASURES: Antithrombotic treatment initiated at diagnosis, overall and according to stroke and bleeding risks. Stroke risk was retrospectively calculated using CHA₂DS₂-VASc (cardiac failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)) and bleeding risk using HAS-BLED (hypertension, abnormal renal/liver function (1 point each), stroke, bleeding history or predisposition, elderly (>65), drugs/alcohol concomitantly (1 point each)).

RESULTS: 42.7% were women and the mean age was 74.5 years. The median CHA2DS2-VASc score was 3 in all cohorts and the median HAS-BLED score was 2 in all cohorts. There was a statistically significant increase in the use of anticoagulant therapy from C2 to C5 (C2 54.7%, C3 60.3%, C4 73.1%, C5 73.9%; P value for trend <0.0001). The increase in the use of anticoagulant was mainly in patients with CHA2DS2-VASc ≥2. The use of vitamin K antagonists (VKAs)±antiplatelet (AP) drugs decreased from C2 to C5 (C2 53.3%, C3 52.1%, C4 50.3%, C5 30.6%), while the use of non-vitamin K antagonist oral anticoagulants (NOACs)±AP increased (C2 1.3%, C3 8.0%, C4 22.7%, C5 43.3%). The use of AP only decreased (C2 36.4%, C3 25.5%, C4 11.9%, C5 10.5%), as did the combination therapy of VKA+AP (C2 13.6%, C3 11.0%, C4 9.6%, C5 5.8%).

CONCLUSION: There has been a progressive increase in the proportion of patients newly diagnosed with AF receiving guideline-recommended therapy in the UK, potentially driven by the availability of NOACs.

TRIAL REGISTRATION NUMBER: NCT01090362; Pre-results.

Original language	English
Article number	e018905
Number of pages	11
Journal	BMJ open
Volume	8
Issue number	1
DOIs	https://doi.org/10.1136/bmjopen-2017-018905
Publication status	Published - 13 Jan 2018

Bibliographical note

Keywords

Aged
Aged, 80 and over
Anticoagulants/therapeutic use
Atrial Fibrillation/complications
Clinical Protocols
Female
Fibrinolytic Agents/therapeutic use
Guideline Adherence/trends
Hemorrhage/etiology
Humans
Male
Middle Aged
Platelet Aggregation Inhibitors/therapeutic use
Prospective Studies
Registries
Risk Assessment
Risk Factors
Stroke/etiology
United Kingdom
Vitamin K/antagonists & inhibitors

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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@article{59e7a747a491446d8ff4dee5d62e23f1,

title = "Temporal trends in antithrombotic treatment of real-world UK patients with newly diagnosed atrial fibrillation: findings from the GARFIELD-AF registry",

abstract = "OBJECTIVE: To investigate evolving patterns in antithrombotic treatment in UK patients with newly diagnosed non-valvular atrial fibrillation (AF).DESIGN: Prospective, multicentre, international registry.SETTING: 186 primary care practices in the UK.PARTICIPANTS: 3482 participants prospectively enrolled in four sequential cohorts (cohort 2 (C2) n=830, diagnosed September 2011 to April 2013; cohort 3 (C3) n=902, diagnosed April 2013 to June 2014; cohort 4 (C4) n=850, diagnosed July 2014 to June 2015; cohort 5 (C5) n=900, diagnosed June 2015 to July 2016). Participants had newly diagnosed non-valvular AF and at least one risk factor for stroke, were aged ≥18, and provided informed consent.MAIN OUTCOME MEASURES: Antithrombotic treatment initiated at diagnosis, overall and according to stroke and bleeding risks. Stroke risk was retrospectively calculated using CHA2DS2-VASc (cardiac failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)) and bleeding risk using HAS-BLED (hypertension, abnormal renal/liver function (1 point each), stroke, bleeding history or predisposition, elderly (>65), drugs/alcohol concomitantly (1 point each)).RESULTS: 42.7% were women and the mean age was 74.5 years. The median CHA2DS2-VASc score was 3 in all cohorts and the median HAS-BLED score was 2 in all cohorts. There was a statistically significant increase in the use of anticoagulant therapy from C2 to C5 (C2 54.7%, C3 60.3%, C4 73.1%, C5 73.9%; P value for trend <0.0001). The increase in the use of anticoagulant was mainly in patients with CHA2DS2-VASc ≥2. The use of vitamin K antagonists (VKAs)±antiplatelet (AP) drugs decreased from C2 to C5 (C2 53.3%, C3 52.1%, C4 50.3%, C5 30.6%), while the use of non-vitamin K antagonist oral anticoagulants (NOACs)±AP increased (C2 1.3%, C3 8.0%, C4 22.7%, C5 43.3%). The use of AP only decreased (C2 36.4%, C3 25.5%, C4 11.9%, C5 10.5%), as did the combination therapy of VKA+AP (C2 13.6%, C3 11.0%, C4 9.6%, C5 5.8%).CONCLUSION: There has been a progressive increase in the proportion of patients newly diagnosed with AF receiving guideline-recommended therapy in the UK, potentially driven by the availability of NOACs.TRIAL REGISTRATION NUMBER: NCT01090362; Pre-results.",

keywords = "Aged, Aged, 80 and over, Anticoagulants/therapeutic use, Atrial Fibrillation/complications, Clinical Protocols, Female, Fibrinolytic Agents/therapeutic use, Guideline Adherence/trends, Hemorrhage/etiology, Humans, Male, Middle Aged, Platelet Aggregation Inhibitors/therapeutic use, Prospective Studies, Registries, Risk Assessment, Risk Factors, Stroke/etiology, United Kingdom, Vitamin K/antagonists & inhibitors",

author = "Apenteng, {Patricia N} and Haiyan Gao and Hobbs, {Fd Richard} and Fitzmaurice, {David A} and {UK GARFIELD-AF Investigators and GARFIELD-AF Steering Committee}",

note = "{\textcopyright} Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.",

year = "2018",

month = jan,

day = "13",

doi = "10.1136/bmjopen-2017-018905",

language = "English",

volume = "8",

journal = "BMJ open",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

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TY - JOUR

T1 - Temporal trends in antithrombotic treatment of real-world UK patients with newly diagnosed atrial fibrillation

T2 - findings from the GARFIELD-AF registry

AU - Apenteng, Patricia N

AU - Gao, Haiyan

AU - Hobbs, Fd Richard

AU - Fitzmaurice, David A

AU - UK GARFIELD-AF Investigators and GARFIELD-AF Steering Committee

PY - 2018/1/13

Y1 - 2018/1/13

N2 - OBJECTIVE: To investigate evolving patterns in antithrombotic treatment in UK patients with newly diagnosed non-valvular atrial fibrillation (AF).DESIGN: Prospective, multicentre, international registry.SETTING: 186 primary care practices in the UK.PARTICIPANTS: 3482 participants prospectively enrolled in four sequential cohorts (cohort 2 (C2) n=830, diagnosed September 2011 to April 2013; cohort 3 (C3) n=902, diagnosed April 2013 to June 2014; cohort 4 (C4) n=850, diagnosed July 2014 to June 2015; cohort 5 (C5) n=900, diagnosed June 2015 to July 2016). Participants had newly diagnosed non-valvular AF and at least one risk factor for stroke, were aged ≥18, and provided informed consent.MAIN OUTCOME MEASURES: Antithrombotic treatment initiated at diagnosis, overall and according to stroke and bleeding risks. Stroke risk was retrospectively calculated using CHA2DS2-VASc (cardiac failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)) and bleeding risk using HAS-BLED (hypertension, abnormal renal/liver function (1 point each), stroke, bleeding history or predisposition, elderly (>65), drugs/alcohol concomitantly (1 point each)).RESULTS: 42.7% were women and the mean age was 74.5 years. The median CHA2DS2-VASc score was 3 in all cohorts and the median HAS-BLED score was 2 in all cohorts. There was a statistically significant increase in the use of anticoagulant therapy from C2 to C5 (C2 54.7%, C3 60.3%, C4 73.1%, C5 73.9%; P value for trend <0.0001). The increase in the use of anticoagulant was mainly in patients with CHA2DS2-VASc ≥2. The use of vitamin K antagonists (VKAs)±antiplatelet (AP) drugs decreased from C2 to C5 (C2 53.3%, C3 52.1%, C4 50.3%, C5 30.6%), while the use of non-vitamin K antagonist oral anticoagulants (NOACs)±AP increased (C2 1.3%, C3 8.0%, C4 22.7%, C5 43.3%). The use of AP only decreased (C2 36.4%, C3 25.5%, C4 11.9%, C5 10.5%), as did the combination therapy of VKA+AP (C2 13.6%, C3 11.0%, C4 9.6%, C5 5.8%).CONCLUSION: There has been a progressive increase in the proportion of patients newly diagnosed with AF receiving guideline-recommended therapy in the UK, potentially driven by the availability of NOACs.TRIAL REGISTRATION NUMBER: NCT01090362; Pre-results.

AB - OBJECTIVE: To investigate evolving patterns in antithrombotic treatment in UK patients with newly diagnosed non-valvular atrial fibrillation (AF).DESIGN: Prospective, multicentre, international registry.SETTING: 186 primary care practices in the UK.PARTICIPANTS: 3482 participants prospectively enrolled in four sequential cohorts (cohort 2 (C2) n=830, diagnosed September 2011 to April 2013; cohort 3 (C3) n=902, diagnosed April 2013 to June 2014; cohort 4 (C4) n=850, diagnosed July 2014 to June 2015; cohort 5 (C5) n=900, diagnosed June 2015 to July 2016). Participants had newly diagnosed non-valvular AF and at least one risk factor for stroke, were aged ≥18, and provided informed consent.MAIN OUTCOME MEASURES: Antithrombotic treatment initiated at diagnosis, overall and according to stroke and bleeding risks. Stroke risk was retrospectively calculated using CHA2DS2-VASc (cardiac failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)) and bleeding risk using HAS-BLED (hypertension, abnormal renal/liver function (1 point each), stroke, bleeding history or predisposition, elderly (>65), drugs/alcohol concomitantly (1 point each)).RESULTS: 42.7% were women and the mean age was 74.5 years. The median CHA2DS2-VASc score was 3 in all cohorts and the median HAS-BLED score was 2 in all cohorts. There was a statistically significant increase in the use of anticoagulant therapy from C2 to C5 (C2 54.7%, C3 60.3%, C4 73.1%, C5 73.9%; P value for trend <0.0001). The increase in the use of anticoagulant was mainly in patients with CHA2DS2-VASc ≥2. The use of vitamin K antagonists (VKAs)±antiplatelet (AP) drugs decreased from C2 to C5 (C2 53.3%, C3 52.1%, C4 50.3%, C5 30.6%), while the use of non-vitamin K antagonist oral anticoagulants (NOACs)±AP increased (C2 1.3%, C3 8.0%, C4 22.7%, C5 43.3%). The use of AP only decreased (C2 36.4%, C3 25.5%, C4 11.9%, C5 10.5%), as did the combination therapy of VKA+AP (C2 13.6%, C3 11.0%, C4 9.6%, C5 5.8%).CONCLUSION: There has been a progressive increase in the proportion of patients newly diagnosed with AF receiving guideline-recommended therapy in the UK, potentially driven by the availability of NOACs.TRIAL REGISTRATION NUMBER: NCT01090362; Pre-results.

KW - Aged

KW - Aged, 80 and over

KW - Anticoagulants/therapeutic use

KW - Atrial Fibrillation/complications

KW - Clinical Protocols

KW - Female

KW - Fibrinolytic Agents/therapeutic use

KW - Guideline Adherence/trends

KW - Hemorrhage/etiology

KW - Humans

KW - Male

KW - Middle Aged

KW - Platelet Aggregation Inhibitors/therapeutic use

KW - Prospective Studies

KW - Registries

KW - Risk Assessment

KW - Risk Factors

KW - Stroke/etiology

KW - United Kingdom

KW - Vitamin K/antagonists & inhibitors

U2 - 10.1136/bmjopen-2017-018905

DO - 10.1136/bmjopen-2017-018905

M3 - Article

C2 - 29331969

SN - 2044-6055

VL - 8

JO - BMJ open

JF - BMJ open

IS - 1

M1 - e018905

ER -

Temporal trends in antithrombotic treatment of real-world UK patients with newly diagnosed atrial fibrillation: findings from the GARFIELD-AF registry

Abstract

Bibliographical note

Keywords

UN SDGs

Access to Document

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Cite this