PMID- 27647168 OWN - NLM STAT- MEDLINE DCOM- 20170724 LR - 20220409 IS - 1468-201X (Electronic) IS - 1355-6037 (Print) IS - 1355-6037 (Linking) VI - 103 IP - 4 DP - 2017 Feb 15 TI - Evolving antithrombotic treatment patterns for patients with newly diagnosed atrial fibrillation. PG - 307-314 LID - 10.1136/heartjnl-2016-309832 [doi] AB - OBJECTIVE: We 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. METHODS: 39 670 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. RESULTS: Baseline characteristics were similar across cohorts. Median CHA(2)DS(2)-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 CHA(2)DS(2)-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. CONCLUSIONS: Since 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 NUMBER: NCT01090362; Pre-results. CI - 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/. FAU - Camm, A John AU - Camm AJ AD - Division of Cardiovascular Sciences, St George's University of London, London, UK. FAU - Accetta, Gabriele AU - Accetta G AD - Thrombosis Research Institute, London, UK. FAU - Ambrosio, Giuseppe AU - Ambrosio G AD - Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy. FAU - Atar, Dan AU - Atar D AD - Department of Cardiology, Oslo University Hospital Ulleval, Oslo, Norway. AD - Faculty of Medicine, University of Oslo, Oslo, Norway. FAU - Bassand, Jean-Pierre AU - Bassand JP AD - Department of Cardiology, EA 3920, University of Besancon, Besancon, France. FAU - Berge, Eivind AU - Berge E AD - Department of Internal Medicine, Oslo University Hospital, Oslo, Norway. FAU - Cools, Frank AU - Cools F AD - AZ Klina, Brasschaat, Belgium. FAU - Fitzmaurice, David A AU - Fitzmaurice DA AD - Department of Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK. FAU - Goldhaber, Samuel Z AU - Goldhaber SZ AD - Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA. FAU - Goto, Shinya AU - Goto S AD - Department of Medicine (Cardiology), Tokai University School of Medicine, Isehara, Japan. FAU - Haas, Sylvia AU - Haas S AD - Formerly Haemostasis and Thrombosis Research Group, Institute for Experimental Oncology and Therapy Research, Technical University Munich, Munich, Germany. FAU - Kayani, Gloria AU - Kayani G AD - Thrombosis Research Institute, London, UK. FAU - Koretsune, Yukihiro AU - Koretsune Y AD - Institute for Clinical Research, National Hospital Organization, Osaka National Hospital, Osaka, Japan. FAU - Mantovani, Lorenzo G AU - Mantovani LG AD - Center for Public Health Research (CESP), University of Milano-Bicocca, Milan, Italy. FAU - Misselwitz, Frank AU - Misselwitz F AD - Bayer HealthCare Pharmaceuticals, Berlin, Germany. FAU - Oh, Seil AU - Oh S AD - Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea. FAU - Turpie, Alexander G G AU - Turpie AG AD - Department of Medicine, McMaster University, Hamilton, Canada. FAU - Verheugt, Freek W A AU - Verheugt FW AD - Department of Cardiology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands. FAU - Kakkar, Ajay K AU - Kakkar AK AD - Thrombosis Research Institute, London, UK. AD - Department of Surgery, University College London, London, UK. CN - GARFIELD-AF Investigators LA - eng SI - ClinicalTrials.gov/NCT01090362 PT - Journal Article PT - Multicenter Study PT - Observational Study PT - Research Support, Non-U.S. Gov't DEP - 20160919 PL - England TA - Heart JT - Heart (British Cardiac Society) JID - 9602087 RN - 0 (Fibrinolytic Agents) SB - IM MH - Administration, Oral MH - Age Factors MH - Aged MH - Aged, 80 and over MH - Atrial Fibrillation/diagnosis/*drug therapy/epidemiology MH - Comorbidity MH - Female MH - Fibrinolytic Agents/*administration & dosage/adverse effects MH - Guideline Adherence MH - Humans MH - Male MH - Middle Aged MH - Practice Guidelines as Topic MH - Practice Patterns, Physicians'/*trends MH - Prospective Studies MH - Registries MH - Risk Assessment MH - Risk Factors MH - Sex Factors MH - Stroke/diagnosis/epidemiology/*prevention & control MH - Time Factors MH - Treatment Outcome PMC - PMC5293840 OTO - NOTNLM OT - Stroke COIS- AJC: advisor to Bayer, Boehringer Ingelheim, Pfizer/BMS, and Daiichi Sankyo. GAm: advisor to Merck, Menarini, and Angelini. DA: personal fees from Bayer Healthcare, BMS/Pfizer, Boehringer-Ingelheim, and MSD. J-PB: personal fees from Aspen. FC: personal fees from Bayer, BMS, and Boehringer-Ingelheim. DAF: personal fees from BMS/Pfizer, Boehringer-Ingelheim, Daiichi Sankyo, and Bayer. SZG: grants from BiO2 Medical, Boehringer-Ingelheim, Bristol Meyers Squibb, BTG EKOS, Daiichi Sankyo, National Heart Lung and Blood Institute of the National Institutes of Health, Janssen, and Thrombosis Research Group; personal fees from Bayer, Boehringer-Ingelheim, Bristol Meyers Squibb, Daiichi Sankyo, Janssen, and Portola. SG: personal fees from the TRI, Bayer, and AstraZeneca; grants from Sanofi and Pfizer. SH: personal fees from Aspen, Bayer Healthcare, BMS/Pfizer, Daiichi-Sankyo, and Sanofi. YK: grants and personal fees from Daiichi Sankyo and Boehringer-Ingelheim; personal fees from Bayer, Bristol-Meyers Squibb, and Pfizer. LGM: grants and personal fees from Bayer Healthcare and Pfizer; grants from Boehringer Ingelheim; personal fees from Daiichi Sankyo. FM: employee of Bayer Pharma AG. SO: consultant/advisory board payments from Bayer Pharma AG, Bristol-Myers Squibb Korea, Boehringer-Ingelheim Korea, Pfizer Korea, Sanofi-Aventis, and St Jude Medical. AGGT: personal fees from Bayer Healthcare, Janssen Pharmaceutical Research & Development LLC, Astellas, Portola, and Takeda. FWAV: personal fees from Bayer Healthcare, Daiichi-Sankyo, BMS/Pfizer, and Boehringer-Ingelheim. AKK: grants and personal fees from Bayer Healthcare; personal fees from Boehringer-Ingelheim Pharma, Daiichi Sankyo Europe, Sanofi SA, Janssen. EDAT- 2016/09/21 06:00 MHDA- 2017/07/25 06:00 PMCR- 2017/02/07 CRDT- 2016/09/21 06:00 PHST- 2016/04/18 00:00 [received] PHST- 2016/08/01 00:00 [accepted] PHST- 2016/09/21 06:00 [pubmed] PHST- 2017/07/25 06:00 [medline] PHST- 2016/09/21 06:00 [entrez] PHST- 2017/02/07 00:00 [pmc-release] AID - heartjnl-2016-309832 [pii] AID - 10.1136/heartjnl-2016-309832 [doi] PST - ppublish SO - Heart. 2017 Feb 15;103(4):307-314. doi: 10.1136/heartjnl-2016-309832. Epub 2016 Sep 19.