Predictors of NOAC versus VKA use for stroke prevention in patients with newly diagnosed atrial fibrillation: Results from GARFIELD-AF

GARFIELD-AF Investigators

doi:10.1016/j.ahj.2019.03.013

Predictors of NOAC versus VKA use for stroke prevention in patients with newly diagnosed atrial fibrillation: Results from GARFIELD-AF

GARFIELD-AF Investigators

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

27 Citations (Scopus)

Abstract

Introduction: A principal aim of the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) was to document changes in treatment practice for patients with newly diagnosed atrial fibrillation during an era when non–vitamin K antagonist oral anticoagulants (NOACs) were becoming more widely adopted. In these analyses, the key factors which determined the choice between NOACs and vitamin K antagonists (VKAs) are explored. Methods: Logistic least absolute shrinkage and selection operator regression determined predictors of NOAC and VKA use. Data were collected from 24,137 patients who were initiated on AC ± antiplatelet (AP) therapy (NOAC [51.4%] or VKA [48.6%]) between April 2013 and August 2016. Results: The most significant predictors of AC therapy were country, enrolment year, care setting at diagnosis, AF type, concomitant AP, and kidney disease. Patients enrolled in emergency care or in the outpatient setting were more likely to receive a NOAC than those enrolled in hospital (OR 1.16 [95% CI: 1.04-1.30], OR: 1.15 [95% CI: 1.05-1.25], respectively). NOAC prescribing seemed to be favored in lower-risk groups, namely, patients with paroxysmal AF, normotensive patients, and those with moderate alcohol consumption, but also the elderly and patients with acute coronary syndrome. By contrast, VKAs were preferentially used in patients with permanent AF, moderate to severe kidney disease, heart failure, vascular disease, and diabetes and with concomitant AP. Conclusion: GARFIELD-AF data highlight marked heterogeneity in stroke prevention strategies globally. Physicians are adopting an individualized approach to stroke prevention where NOACs are favored in patients with a lower stroke risk but also in the elderly and patients with acute coronary syndrome.

Original language	English
Pages (from-to)	35-46
Number of pages	12
Journal	American heart journal
Volume	213
DOIs	https://doi.org/10.1016/j.ahj.2019.03.013
Publication status	Published - 2019 Jul 1

Bibliographical note

Funding Information:
Funding: This work was supported by an unrestricted research grant from Bayer AG (Berlin, Germany) to the Thrombosis Research Institute (London, UK), which sponsors the GARFIELD-AF registry. The funding source had no involvement in the data collection, data analysis, or data interpretation.

Funding Information:
S. Haas: personal fees from Aspen, Bayer, BMS, Daiichi-Sankyo, Portola, Sanofi, outside the submitted work; A. J. Camm: personal fees from Bayer, personal fees from Boehringer Ingelheim, personal fees from Pfizer/BMS, personal fees from Daiichi Sankyo, outside the submitted work; J. P. Bassand: none; P. Angchaisuksiri: none; F. Cools: speaker fees from Boehringer-Ingelheim Pharma, Bayer AG, Pfizer and speaker fees and modest research grant from Daiichi-Sankyo Europe; R. Corbalan: none; H. Gibbs: personal fees from Pfizer, Bayer, Boehringer Ingelheim; B. F.: speakers' fees and advisory board honoraria from Bayer Pharma AG, Boehringer Ingelheim, BMS/Pfizer; B. Jacobson: research grants from Aspen, Bayer, and Sanofi; Y. Koretsune: research grant from Daiichi Sankyo and Boeringer Ingelheim; personal fees from Daiichi Sankyo, Boehringer Ingelheim, Bayer, Bristol Meyers, and Pfizer; L. G. Mantovani: grants and personal fees from Bayer AG during the conduct of the study and grants from Boehringer Ingelheim, grants and personal fees from Pfzer, and personal fees from Daiichi Sankyo outside the submitted work; F. Misselwitz: employee of Bayer AG; E. Panchenko: personal fees from Aspen, Bayer, Pfizer, Boehringer Ingelheim, Sanofi, AstraZeneca, and Daiichi Sankyo, outside the submitted work; H. I. Ragy: none; J. Stepinska: research grants from Bayer; personal fees from Amgen, Astra Zeneca, Bayer, Boehringer Ingelheim, BMS/Pfizer, Novartis, Sanofi, and Servier; expert witness for Boehringer Ingelheim; A. G. G. Turpie: personal fees from Bayer Healthcare, Janssen Pharmaceutical Research & Development LLC, Satilla's, Portola, Takeda; Jitendra P. S. Sawhney: personal fee from Pfizer, Astra Zeneca, Novartis, Sanofi & BMS; J Steffel: consultant and/or speaker fees from Abbott, Amgen, Astra-Zeneca, Atricure, Bayer, Biosense Webster, Biotronik, Boehringer-Ingelheim, Boston Scientific, Bristol-Myers Squibb, Daiichi Sankyo, Medscape, Medtronic, Merck/MSD, Novartis, Pfizer, Sanofi-Aventis, WebMD, and Zoll. He reports ownership of CorXL. Grant support through his institution from Abbott, Bayer Healthcare, Biosense Webster, Biotronik, Boston Scientific, Daiichi Sankyo, and Medtronic. Toon Wei Lim: research support from Bayer, Pfizer, Boerhinger-Ingelheim; personal fees from Bayer, Pfizer; K. Pieper: consultant for Thrombosis Research Institute, AstraZeneca, and Bayer; S.V.: none to declare; F. W. A. Verheugt: grants from Bayer Healthcare; personal fees from Bayer Healthcare, BMS/Pfizer, Daiichi-Sankyo, and Boehringer-Ingelheim; A. K. Kakkar: Bayer AG, during the conduct of the study; grants and personal fees from Bayer AG, Boehringer-Ingelheim Pharma, Daiichi Sankyo Europe, Janssen Pharma Sanofi SA, and Verseon outside the submitted work.

Publisher Copyright:
© 2019 The Authors

All Science Journal Classification (ASJC) codes

Cardiology and Cardiovascular Medicine

UN SDGs

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

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10.1016/j.ahj.2019.03.013

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@article{2aa5f5a8dbc54a59aa00333cfd00fc08,

title = "Predictors of NOAC versus VKA use for stroke prevention in patients with newly diagnosed atrial fibrillation: Results from GARFIELD-AF",

abstract = "Introduction: A principal aim of the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) was to document changes in treatment practice for patients with newly diagnosed atrial fibrillation during an era when non–vitamin K antagonist oral anticoagulants (NOACs) were becoming more widely adopted. In these analyses, the key factors which determined the choice between NOACs and vitamin K antagonists (VKAs) are explored. Methods: Logistic least absolute shrinkage and selection operator regression determined predictors of NOAC and VKA use. Data were collected from 24,137 patients who were initiated on AC ± antiplatelet (AP) therapy (NOAC [51.4%] or VKA [48.6%]) between April 2013 and August 2016. Results: The most significant predictors of AC therapy were country, enrolment year, care setting at diagnosis, AF type, concomitant AP, and kidney disease. Patients enrolled in emergency care or in the outpatient setting were more likely to receive a NOAC than those enrolled in hospital (OR 1.16 [95% CI: 1.04-1.30], OR: 1.15 [95% CI: 1.05-1.25], respectively). NOAC prescribing seemed to be favored in lower-risk groups, namely, patients with paroxysmal AF, normotensive patients, and those with moderate alcohol consumption, but also the elderly and patients with acute coronary syndrome. By contrast, VKAs were preferentially used in patients with permanent AF, moderate to severe kidney disease, heart failure, vascular disease, and diabetes and with concomitant AP. Conclusion: GARFIELD-AF data highlight marked heterogeneity in stroke prevention strategies globally. Physicians are adopting an individualized approach to stroke prevention where NOACs are favored in patients with a lower stroke risk but also in the elderly and patients with acute coronary syndrome.",

author = "{GARFIELD-AF Investigators} and Sylvia Haas and Camm, {A. John} and Bassand, {Jean Pierre} and Pantep Angchaisuksiri and Frank Cools and Ramon Corbalan and Harry Gibbs and Barry Jacobson and Yukihiro Koretsune and Mantovani, {Lorenzo G.} and Frank Misselwitz and Elizaveta Panchenko and Ragy, {Hany Ibrahim} and Janina Stepinska and Turpie, {Alexander GG} and Sawhney, {Jitendra PS} and Jan Steffel and Lim, {Toon Wei} and Pieper, {Karen S.} and Saverio Virdone and Verheugt, {Freek WA} and Kakkar, {Ajay K.} and Fitzmaurice, {David A.} and Shinya Goto and Werner Hacke and Gersh, {Bernard J.} and Luciardi, {Hector Lucas} and Marianne Brodmann and Barretto, {Antonio Carlos Pereira} and Connolly, {Stuart J.} and Alex Spyropoulos and John Eikelboom and Dayi Hu and Petr Jansky and Nielsen, {J{\o}rn Dalsgaard} and Pekka Raatikainen and {Le Heuzey}, {Jean Yves} and Harald Darius and Matyas Keltai and Sanjay Kakkar and Giancarlo Agnelli and Giuseppe Ambrosio and D{\'i}az, {Carlos Jerjes S{\'a}nchez} and {ten Cate}, Hugo and Dan Atar and Seil Oh and Xavier Vi{\~n}olas and Marten Rosenqvist and Alex Parkhomenko and Pak, {H. N.}",

note = "Funding Information: Funding: This work was supported by an unrestricted research grant from Bayer AG (Berlin, Germany) to the Thrombosis Research Institute (London, UK), which sponsors the GARFIELD-AF registry. The funding source had no involvement in the data collection, data analysis, or data interpretation. Funding Information: S. Haas: personal fees from Aspen, Bayer, BMS, Daiichi-Sankyo, Portola, Sanofi, outside the submitted work; A. J. Camm: personal fees from Bayer, personal fees from Boehringer Ingelheim, personal fees from Pfizer/BMS, personal fees from Daiichi Sankyo, outside the submitted work; J. P. Bassand: none; P. Angchaisuksiri: none; F. Cools: speaker fees from Boehringer-Ingelheim Pharma, Bayer AG, Pfizer and speaker fees and modest research grant from Daiichi-Sankyo Europe; R. Corbalan: none; H. Gibbs: personal fees from Pfizer, Bayer, Boehringer Ingelheim; B. F.: speakers' fees and advisory board honoraria from Bayer Pharma AG, Boehringer Ingelheim, BMS/Pfizer; B. Jacobson: research grants from Aspen, Bayer, and Sanofi; Y. Koretsune: research grant from Daiichi Sankyo and Boeringer Ingelheim; personal fees from Daiichi Sankyo, Boehringer Ingelheim, Bayer, Bristol Meyers, and Pfizer; L. G. Mantovani: grants and personal fees from Bayer AG during the conduct of the study and grants from Boehringer Ingelheim, grants and personal fees from Pfzer, and personal fees from Daiichi Sankyo outside the submitted work; F. Misselwitz: employee of Bayer AG; E. Panchenko: personal fees from Aspen, Bayer, Pfizer, Boehringer Ingelheim, Sanofi, AstraZeneca, and Daiichi Sankyo, outside the submitted work; H. I. Ragy: none; J. Stepinska: research grants from Bayer; personal fees from Amgen, Astra Zeneca, Bayer, Boehringer Ingelheim, BMS/Pfizer, Novartis, Sanofi, and Servier; expert witness for Boehringer Ingelheim; A. G. G. Turpie: personal fees from Bayer Healthcare, Janssen Pharmaceutical Research & Development LLC, Satilla's, Portola, Takeda; Jitendra P. S. Sawhney: personal fee from Pfizer, Astra Zeneca, Novartis, Sanofi & BMS; J Steffel: consultant and/or speaker fees from Abbott, Amgen, Astra-Zeneca, Atricure, Bayer, Biosense Webster, Biotronik, Boehringer-Ingelheim, Boston Scientific, Bristol-Myers Squibb, Daiichi Sankyo, Medscape, Medtronic, Merck/MSD, Novartis, Pfizer, Sanofi-Aventis, WebMD, and Zoll. He reports ownership of CorXL. Grant support through his institution from Abbott, Bayer Healthcare, Biosense Webster, Biotronik, Boston Scientific, Daiichi Sankyo, and Medtronic. Toon Wei Lim: research support from Bayer, Pfizer, Boerhinger-Ingelheim; personal fees from Bayer, Pfizer; K. Pieper: consultant for Thrombosis Research Institute, AstraZeneca, and Bayer; S.V.: none to declare; F. W. A. Verheugt: grants from Bayer Healthcare; personal fees from Bayer Healthcare, BMS/Pfizer, Daiichi-Sankyo, and Boehringer-Ingelheim; A. K. Kakkar: Bayer AG, during the conduct of the study; grants and personal fees from Bayer AG, Boehringer-Ingelheim Pharma, Daiichi Sankyo Europe, Janssen Pharma Sanofi SA, and Verseon outside the submitted work. Publisher Copyright: {\textcopyright} 2019 The Authors",

year = "2019",

month = jul,

day = "1",

doi = "10.1016/j.ahj.2019.03.013",

language = "English",

volume = "213",

pages = "35--46",

journal = "American Heart Journal",

issn = "0002-8703",

publisher = "Mosby Inc.",

}

TY - JOUR

T1 - Predictors of NOAC versus VKA use for stroke prevention in patients with newly diagnosed atrial fibrillation

T2 - Results from GARFIELD-AF

AU - GARFIELD-AF Investigators

AU - Haas, Sylvia

AU - Camm, A. John

AU - Bassand, Jean Pierre

AU - Angchaisuksiri, Pantep

AU - Cools, Frank

AU - Corbalan, Ramon

AU - Gibbs, Harry

AU - Jacobson, Barry

AU - Koretsune, Yukihiro

AU - Mantovani, Lorenzo G.

AU - Misselwitz, Frank

AU - Panchenko, Elizaveta

AU - Ragy, Hany Ibrahim

AU - Stepinska, Janina

AU - Turpie, Alexander GG

AU - Sawhney, Jitendra PS

AU - Steffel, Jan

AU - Lim, Toon Wei

AU - Pieper, Karen S.

AU - Virdone, Saverio

AU - Verheugt, Freek WA

AU - Kakkar, Ajay K.

AU - Fitzmaurice, David A.

AU - Goto, Shinya

AU - Hacke, Werner

AU - Gersh, Bernard J.

AU - Luciardi, Hector Lucas

AU - Brodmann, Marianne

AU - Barretto, Antonio Carlos Pereira

AU - Connolly, Stuart J.

AU - Spyropoulos, Alex

AU - Eikelboom, John

AU - Hu, Dayi

AU - Jansky, Petr

AU - Nielsen, Jørn Dalsgaard

AU - Raatikainen, Pekka

AU - Le Heuzey, Jean Yves

AU - Darius, Harald

AU - Keltai, Matyas

AU - Kakkar, Sanjay

AU - Agnelli, Giancarlo

AU - Ambrosio, Giuseppe

AU - Díaz, Carlos Jerjes Sánchez

AU - ten Cate, Hugo

AU - Atar, Dan

AU - Oh, Seil

AU - Viñolas, Xavier

AU - Rosenqvist, Marten

AU - Parkhomenko, Alex

AU - Pak, H. N.

N1 - Funding Information: Funding: This work was supported by an unrestricted research grant from Bayer AG (Berlin, Germany) to the Thrombosis Research Institute (London, UK), which sponsors the GARFIELD-AF registry. The funding source had no involvement in the data collection, data analysis, or data interpretation. Funding Information: S. Haas: personal fees from Aspen, Bayer, BMS, Daiichi-Sankyo, Portola, Sanofi, outside the submitted work; A. J. Camm: personal fees from Bayer, personal fees from Boehringer Ingelheim, personal fees from Pfizer/BMS, personal fees from Daiichi Sankyo, outside the submitted work; J. P. Bassand: none; P. Angchaisuksiri: none; F. Cools: speaker fees from Boehringer-Ingelheim Pharma, Bayer AG, Pfizer and speaker fees and modest research grant from Daiichi-Sankyo Europe; R. Corbalan: none; H. Gibbs: personal fees from Pfizer, Bayer, Boehringer Ingelheim; B. F.: speakers' fees and advisory board honoraria from Bayer Pharma AG, Boehringer Ingelheim, BMS/Pfizer; B. Jacobson: research grants from Aspen, Bayer, and Sanofi; Y. Koretsune: research grant from Daiichi Sankyo and Boeringer Ingelheim; personal fees from Daiichi Sankyo, Boehringer Ingelheim, Bayer, Bristol Meyers, and Pfizer; L. G. Mantovani: grants and personal fees from Bayer AG during the conduct of the study and grants from Boehringer Ingelheim, grants and personal fees from Pfzer, and personal fees from Daiichi Sankyo outside the submitted work; F. Misselwitz: employee of Bayer AG; E. Panchenko: personal fees from Aspen, Bayer, Pfizer, Boehringer Ingelheim, Sanofi, AstraZeneca, and Daiichi Sankyo, outside the submitted work; H. I. Ragy: none; J. Stepinska: research grants from Bayer; personal fees from Amgen, Astra Zeneca, Bayer, Boehringer Ingelheim, BMS/Pfizer, Novartis, Sanofi, and Servier; expert witness for Boehringer Ingelheim; A. G. G. Turpie: personal fees from Bayer Healthcare, Janssen Pharmaceutical Research & Development LLC, Satilla's, Portola, Takeda; Jitendra P. S. Sawhney: personal fee from Pfizer, Astra Zeneca, Novartis, Sanofi & BMS; J Steffel: consultant and/or speaker fees from Abbott, Amgen, Astra-Zeneca, Atricure, Bayer, Biosense Webster, Biotronik, Boehringer-Ingelheim, Boston Scientific, Bristol-Myers Squibb, Daiichi Sankyo, Medscape, Medtronic, Merck/MSD, Novartis, Pfizer, Sanofi-Aventis, WebMD, and Zoll. He reports ownership of CorXL. Grant support through his institution from Abbott, Bayer Healthcare, Biosense Webster, Biotronik, Boston Scientific, Daiichi Sankyo, and Medtronic. Toon Wei Lim: research support from Bayer, Pfizer, Boerhinger-Ingelheim; personal fees from Bayer, Pfizer; K. Pieper: consultant for Thrombosis Research Institute, AstraZeneca, and Bayer; S.V.: none to declare; F. W. A. Verheugt: grants from Bayer Healthcare; personal fees from Bayer Healthcare, BMS/Pfizer, Daiichi-Sankyo, and Boehringer-Ingelheim; A. K. Kakkar: Bayer AG, during the conduct of the study; grants and personal fees from Bayer AG, Boehringer-Ingelheim Pharma, Daiichi Sankyo Europe, Janssen Pharma Sanofi SA, and Verseon outside the submitted work. Publisher Copyright: © 2019 The Authors

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Introduction: A principal aim of the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) was to document changes in treatment practice for patients with newly diagnosed atrial fibrillation during an era when non–vitamin K antagonist oral anticoagulants (NOACs) were becoming more widely adopted. In these analyses, the key factors which determined the choice between NOACs and vitamin K antagonists (VKAs) are explored. Methods: Logistic least absolute shrinkage and selection operator regression determined predictors of NOAC and VKA use. Data were collected from 24,137 patients who were initiated on AC ± antiplatelet (AP) therapy (NOAC [51.4%] or VKA [48.6%]) between April 2013 and August 2016. Results: The most significant predictors of AC therapy were country, enrolment year, care setting at diagnosis, AF type, concomitant AP, and kidney disease. Patients enrolled in emergency care or in the outpatient setting were more likely to receive a NOAC than those enrolled in hospital (OR 1.16 [95% CI: 1.04-1.30], OR: 1.15 [95% CI: 1.05-1.25], respectively). NOAC prescribing seemed to be favored in lower-risk groups, namely, patients with paroxysmal AF, normotensive patients, and those with moderate alcohol consumption, but also the elderly and patients with acute coronary syndrome. By contrast, VKAs were preferentially used in patients with permanent AF, moderate to severe kidney disease, heart failure, vascular disease, and diabetes and with concomitant AP. Conclusion: GARFIELD-AF data highlight marked heterogeneity in stroke prevention strategies globally. Physicians are adopting an individualized approach to stroke prevention where NOACs are favored in patients with a lower stroke risk but also in the elderly and patients with acute coronary syndrome.

AB - Introduction: A principal aim of the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) was to document changes in treatment practice for patients with newly diagnosed atrial fibrillation during an era when non–vitamin K antagonist oral anticoagulants (NOACs) were becoming more widely adopted. In these analyses, the key factors which determined the choice between NOACs and vitamin K antagonists (VKAs) are explored. Methods: Logistic least absolute shrinkage and selection operator regression determined predictors of NOAC and VKA use. Data were collected from 24,137 patients who were initiated on AC ± antiplatelet (AP) therapy (NOAC [51.4%] or VKA [48.6%]) between April 2013 and August 2016. Results: The most significant predictors of AC therapy were country, enrolment year, care setting at diagnosis, AF type, concomitant AP, and kidney disease. Patients enrolled in emergency care or in the outpatient setting were more likely to receive a NOAC than those enrolled in hospital (OR 1.16 [95% CI: 1.04-1.30], OR: 1.15 [95% CI: 1.05-1.25], respectively). NOAC prescribing seemed to be favored in lower-risk groups, namely, patients with paroxysmal AF, normotensive patients, and those with moderate alcohol consumption, but also the elderly and patients with acute coronary syndrome. By contrast, VKAs were preferentially used in patients with permanent AF, moderate to severe kidney disease, heart failure, vascular disease, and diabetes and with concomitant AP. Conclusion: GARFIELD-AF data highlight marked heterogeneity in stroke prevention strategies globally. Physicians are adopting an individualized approach to stroke prevention where NOACs are favored in patients with a lower stroke risk but also in the elderly and patients with acute coronary syndrome.

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UR - http://www.scopus.com/inward/citedby.url?scp=85065872762&partnerID=8YFLogxK

U2 - 10.1016/j.ahj.2019.03.013

DO - 10.1016/j.ahj.2019.03.013

M3 - Article

C2 - 31128503

AN - SCOPUS:85065872762

SN - 0002-8703

VL - 213

SP - 35

EP - 46

JO - American Heart Journal

JF - American Heart Journal

ER -

Predictors of NOAC versus VKA use for stroke prevention in patients with newly diagnosed atrial fibrillation: Results from GARFIELD-AF

Abstract

Bibliographical note

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UN SDGs

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