PMID- 29331969
OWN - NLM
STAT- MEDLINE
DCOM- 20180822
LR  - 20210304
IS  - 2044-6055 (Electronic)
IS  - 2044-6055 (Linking)
VI  - 8
IP  - 1
DP  - 2018 Jan 13
TI  - Temporal trends in antithrombotic treatment of real-world UK patients with newly 
      diagnosed atrial fibrillation: findings from the GARFIELD-AF registry.
PG  - e018905
LID - 10.1136/bmjopen-2017-018905 [doi]
LID - e018905
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 CHA(2)DS(2)-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 CHA(2)DS(2)-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 CHA(2)DS(2)-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.
CI  - (c) 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.
FAU - Apenteng, Patricia N
AU  - Apenteng PN
AD  - Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, 
      UK.
FAU - Gao, Haiyan
AU  - Gao H
AD  - Thrombosis Research Institute, London, UK.
FAU - Hobbs, Fd Richard
AU  - Hobbs FR
AD  - Nuffield Department of Primary Care Health Sciences, University of Oxford, 
      Oxford, UK.
FAU - Fitzmaurice, David A
AU  - Fitzmaurice DA
AD  - Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, 
      UK.
CN  - UK GARFIELD-AF Investigators and GARFIELD-AF Steering Committee
LA  - eng
SI  - ClinicalTrials.gov/NCT01090362
SI  - ClinicalTrials.gov/NCT01090362
GR  - G9900264/MRC_/Medical Research Council/United Kingdom
GR  - IS-SPC-0514-10043/DH_/Department of Health/United Kingdom
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20180113
PL  - England
TA  - BMJ Open
JT  - BMJ open
JID - 101552874
RN  - 0 (Anticoagulants)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 12001-79-5 (Vitamin K)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/*therapeutic use
MH  - Atrial Fibrillation/complications/diagnosis/*therapy
MH  - *Clinical Protocols
MH  - Female
MH  - Fibrinolytic Agents/*therapeutic use
MH  - Guideline Adherence/trends
MH  - Hemorrhage/etiology/prevention & control
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Platelet Aggregation Inhibitors/*therapeutic use
MH  - Prospective Studies
MH  - Registries
MH  - Risk Assessment
MH  - Risk Factors
MH  - Stroke/etiology/*prevention & control
MH  - United Kingdom
MH  - Vitamin K/antagonists & inhibitors
PMC - PMC5781154
OTO - NOTNLM
OT  - anticoagulation
OT  - antithrombotic therapy
OT  - atrial fibrillation
OT  - newly diagnosed
OT  - stroke prophylaxis
COIS- Competing interests: FDRH personal fees and other from BMS/Pfizer, personal fees 
      and other from BI, personal fees and other from Bayer, outside the submitted 
      work.
EDAT- 2018/01/15 06:00
MHDA- 2018/08/23 06:00
PMCR- 2018/01/13
CRDT- 2018/01/15 06:00
PHST- 2018/01/15 06:00 [entrez]
PHST- 2018/01/15 06:00 [pubmed]
PHST- 2018/08/23 06:00 [medline]
PHST- 2018/01/13 00:00 [pmc-release]
AID - bmjopen-2017-018905 [pii]
AID - 10.1136/bmjopen-2017-018905 [doi]
PST - epublish
SO  - BMJ Open. 2018 Jan 13;8(1):e018905. doi: 10.1136/bmjopen-2017-018905.