Dataset Information

Stroke-prevention strategies in North American patients with atrial fibrillation: The GLORIA-AF registry program.

ABSTRACT: BACKGROUND:Antithrombotic prophylaxis with oral anticoagulation (OAC) substantially reduces stroke and mortality in patients with atrial fibrillation (AF). HYPOTHESIS:Analysis of data in the Global Registry on Long-Term Antithrombotic Treatments in Patients With Atrial Fibrillation (GLORIA-AF), an international, observational registry of patients with newly diagnosed AF, can identify factors associated with treatment decisions and outcomes. METHODS:Multivariable regression identified patient, physician, and temporal factors associated with OAC prescription, compared with management with antiplatelet drugs or no antithrombotic drugs in North American patients enrolled between November 2011 and February 2014. RESULTS:Of 3320 eligible patients (mean age, 71?± 11?years; 1879 males with CHA2 DS2 -VASc ?1 and 1441 females with CHA2 DS2 -VASc ?2), 79.3%, 12.5%, and 7.4% received OAC, antiplatelet drugs, or no antithrombotic therapy, respectively. Of those prescribed OAC, 66.4% received non-vitamin K antagonist oral anticoagulation and 24.5% received concomitant therapy with antiplatelet drugs. Independent predictors of OAC therapy were nonparoxysmal AF (odds ratio, 95% confidence interval: 2.02, 1.56-2.63), prior stroke/transient ischemic attack (2.00, 1.37-2.92), specialist care (1.50, 1.04-2.17), more concomitant medications (1.47, 1.13-1.92), commercial insurance (1.41, 1.07-1.85), and heart failure (1.44, 1.07-1.92). Antiplatelet drugs (0.18, 0.14-0.23), prior falls (0.41, 0.27-0.63), and prior bleeding (0.50, 0.35-0.72) were inversely associated with OAC prescription. CONCLUSIONS:In GLORIA-AF, 20% of the population comprising males with CHA2 DS2 -VASc ?1 and females with CHA2 DS2 -VASc ?2 did not receive OAC therapy. Patient characteristics associated with a lower likelihood of OAC prescription were use of antiplatelet drugs, paroxysmal pattern of AF, history of falls, and prior bleeding.

SUBMITTER: McIntyre WF

PROVIDER: S-EPMC6032943 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Stroke-prevention strategies in North American patients with atrial fibrillation: The GLORIA-AF registry program.

McIntyre William F WF Conen David D Olshansky Brian B Halperin Jonathan L JL Hayek Emil E Huisman Menno V MV Lip Gregory Y H GYH Lu Shihai S Healey Jeff S JS

Clinical cardiology 20180510 6

<h4>Background</h4>Antithrombotic prophylaxis with oral anticoagulation (OAC) substantially reduces stroke and mortality in patients with atrial fibrillation (AF).<h4>Hypothesis</h4>Analysis of data in the Global Registry on Long-Term Antithrombotic Treatments in Patients With Atrial Fibrillation (GLORIA-AF), an international, observational registry of patients with newly diagnosed AF, can identify factors associated with treatment decisions and outcomes.<h4>Methods</h4>Multivariable regression ...[more]

PMID: 29546729

Similar Datasets

Project description:BackgroundPrevious studies suggested potential ethnic differences in the management and outcomes of atrial fibrillation (AF). We aim to analyse oral anticoagulant (OAC) prescription, discontinuation, and risk of adverse outcomes in Asian patients with AF, using data from a global prospective cohort study.MethodsFrom the GLORIA-AF Registry Phase II-III (November 2011-December 2014 for Phase II, and January 2014-December 2016 for Phase III), we analysed patients according to their self-reported ethnicity (Asian vs. non-Asian), as well as according to Asian subgroups (Chinese, Japanese, Korean and other Asian). Logistic regression was used to analyse OAC prescription, while the risk of OAC discontinuation and adverse outcomes were analysed through Cox-regression model. Our primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACE). The original studies were registered with ClinicalTrials.gov, NCT01468701, NCT01671007, and NCT01937377.Findings34,421 patients were included (70.0 ± 10.5 years, 45.1% females, 6900 (20.0%) Asian: 3829 (55.5%) Chinese, 814 (11.8%) Japanese, 1964 (28.5%) Korean and 293 (4.2%) other Asian). Most of the Asian patients were recruited in Asia (n = 6701, 97.1%), while non-Asian patients were mainly recruited in Europe (n = 15,449, 56.1%) and North America (n = 8378, 30.4%). Compared to non-Asian individuals, prescription of OAC and non-vitamin K antagonist oral anticoagulant (NOAC) was lower in Asian patients (Odds Ratio [OR] and 95% Confidence Intervals (CI): 0.23 [0.22-0.25] and 0.66 [0.61-0.71], respectively), but higher in the Japanese subgroup. Asian ethnicity was also associated with higher risk of OAC discontinuation (Hazard Ratio [HR] and [95% CI]: 1.79 [1.67-1.92]), and lower risk of the primary composite outcome (HR [95% CI]: 0.86 [0.76-0.96]). Among the exploratory secondary outcomes, Asian ethnicity was associated with higher risks of thromboembolism and intracranial haemorrhage, and lower risk of major bleeding.InterpretationOur results showed that Asian patients with AF showed suboptimal thromboembolic risk management and a specific risk profile of adverse outcomes; these differences may also reflect differences in country-specific factors. Ensuring integrated and appropriate treatment of these patients is crucial to improve their prognosis.FundingThe GLORIA-AF Registry was funded by Boehringer Ingelheim GmbH.

Project description:BackgroundClinical complexity, as the interaction between ageing, frailty, multimorbidity and polypharmacy, is an increasing concern in patients with AF. There remains uncertainty regarding how combinations of comorbidities influence management and prognosis of patients with atrial fibrillation (AF). We aimed to identify phenotypes of AF patients according to comorbidities and to assess associations between comorbidity patterns, drug use and risk of major outcomes.MethodsFrom the prospective GLORIA-AF Registry, we performed a latent class analysis based on 18 diseases, encompassing cardiovascular, metabolic, respiratory and other conditions; we then analysed the association between phenotypes of patients and (i) treatments received and (ii) the risk of major outcomes. Primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACE). Secondary exploratory outcomes were also analysed.Results32,560 AF patients (mean age 70.0 ± 10.5 years, 45.4% females) were included. We identified 6 phenotypes: (i) low complexity (39.2% of patients); (ii) cardiovascular (CV) risk factors (28.2%); (iii) atherosclerotic (10.2%); (iv) thromboembolic (8.1%); (v) cardiometabolic (7.6%) and (vi) high complexity (6.6%). Higher use of oral anticoagulants was found in more complex groups, with highest magnitude observed for the cardiometabolic and high complexity phenotypes (odds ratio and 95% confidence interval CI): 1.76 [1.49-2.09] and 1.57 [1.35-1.81], respectively); similar results were observed for beta-blockers and verapamil or diltiazem. We found higher risk of the primary outcome in all phenotypes, except the CV risk factor one, with highest risk observed for the cardiometabolic and high complexity groups (hazard ratio and 95%CI: 1.37 [1.13-1.67] and 1.47 [1.24-1.75], respectively).ConclusionsComorbidities influence management and long-term prognosis of patients with AF. Patients with complex phenotypes may require comprehensive and holistic approaches to improve their prognosis.

Dataset Information

Stroke-prevention strategies in North American patients with atrial fibrillation: The GLORIA-AF registry program.

Publications

Stroke-prevention strategies in North American patients with atrial fibrillation: The GLORIA-AF registry program.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets