Temporal trends in antithrombotic treatment of real-world UK patients with newly diagnosed atrial fibrillation: findings from the GARFIELD-AF registry
<strong>Objective</strong> To investigate evolving patterns in antithrombotic treatment in UK patients with newly diagnosed non-valvular atrial fibrillation (AF). <strong>Design</strong> Prospective, multicentre, international registry. <strong>Setting</strong>...
| Main Authors: | , , , |
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| Format: | Journal article |
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BMJ Publishing Group Ltd
2018
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| _version_ | 1797095270691897344 |
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| author | Apenteng, P Gao, H Hobbs, F Fitzmaurice, D |
| author_facet | Apenteng, P Gao, H Hobbs, F Fitzmaurice, D |
| author_sort | Apenteng, P |
| collection | OXFORD |
| description | <strong>Objective</strong> To investigate evolving patterns in antithrombotic treatment in UK patients with newly diagnosed non-valvular atrial fibrillation (AF). <strong>Design</strong> Prospective, multicentre, international registry. <strong>Setting</strong> 186 primary care practices in the UK. <strong>Participants</strong> 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. <strong>Main outcome measures</strong> 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)). <strong>Results</strong> 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%). <strong>Conclusion</strong> 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. |
| first_indexed | 2024-03-07T04:25:28Z |
| format | Journal article |
| id | oxford-uuid:cc75afb8-110c-4082-9ed0-bb206c1a64ce |
| institution | University of Oxford |
| last_indexed | 2024-03-07T04:25:28Z |
| publishDate | 2018 |
| publisher | BMJ Publishing Group Ltd |
| record_format | dspace |
| spelling | oxford-uuid:cc75afb8-110c-4082-9ed0-bb206c1a64ce2022-03-27T07:22:14ZTemporal trends in antithrombotic treatment of real-world UK patients with newly diagnosed atrial fibrillation: findings from the GARFIELD-AF registryJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:cc75afb8-110c-4082-9ed0-bb206c1a64ceSymplectic Elements at OxfordBMJ Publishing Group Ltd2018Apenteng, PGao, HHobbs, FFitzmaurice, D <strong>Objective</strong> To investigate evolving patterns in antithrombotic treatment in UK patients with newly diagnosed non-valvular atrial fibrillation (AF). <strong>Design</strong> Prospective, multicentre, international registry. <strong>Setting</strong> 186 primary care practices in the UK. <strong>Participants</strong> 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. <strong>Main outcome measures</strong> 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)). <strong>Results</strong> 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%). <strong>Conclusion</strong> 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. |
| spellingShingle | Apenteng, P Gao, H Hobbs, F Fitzmaurice, D Temporal trends in antithrombotic treatment of real-world UK patients with newly diagnosed atrial fibrillation: findings from the GARFIELD-AF registry |
| title | Temporal trends in antithrombotic treatment of real-world UK patients
with newly diagnosed atrial fibrillation: findings from the GARFIELD-AF registry |
| title_full | Temporal trends in antithrombotic treatment of real-world UK patients
with newly diagnosed atrial fibrillation: findings from the GARFIELD-AF registry |
| title_fullStr | Temporal trends in antithrombotic treatment of real-world UK patients
with newly diagnosed atrial fibrillation: findings from the GARFIELD-AF registry |
| title_full_unstemmed | Temporal trends in antithrombotic treatment of real-world UK patients
with newly diagnosed atrial fibrillation: findings from the GARFIELD-AF registry |
| title_short | Temporal trends in antithrombotic treatment of real-world UK patients
with newly diagnosed atrial fibrillation: findings from the GARFIELD-AF registry |
| title_sort | temporal trends in antithrombotic treatment of real world uk patients with newly diagnosed atrial fibrillation findings from the garfield af registry |
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