September 1, 2015 — The first-ever two-year outcomes from the Global Anticoagulant Registry in the Field - Atrial Fibrillation (GARFIELD-AF) were showcased at the European Society of Cardiology (ESC) Congress 2015 in London. The results expose that all-cause death was the most frequent major event in more than 17,000 newly diagnosed AF patients, far exceeding the rate of stroke or major bleeding. These two-year prospective outcomes from cohorts 1 and 2 show a mortality rate of 3.83 percent per person year compared to stroke rates of 1.25 percent per person year and major bleeding rates of 0.70 percent per person year.
Additional one-year outcomes from more than 28,000 AF patients in cohorts 1-3 demonstrate a likely impact of comorbidities on increasing mortality, stroke and major bleeding. Patients with moderate-to-severe chronic kidney disease and those with a history of myocardial infarction had a markedly higher mortality rate than the overall population (9.4 percent and 6.9 percent respectively, compared to 4 percent).
"These data from the GARFIELD-AF registry indicate the importance of comorbidities in predicting patient outcomes and can offer physicians guidance in managing AF," said Prof. Sam Goldhaber of Harvard Medical School and the Brigham and Women's Hospital. "The results suggest physicians should consider increasing the prescription of anticoagulants in AF patients with these comorbidities."
Insights from nearly 40,000 patients with AF across the four sequential GARFIELD-AF cohorts from 2010 to 2015 show a shift in how AF is being managed across the globe. Overall, patients initiated on anticoagulant treatment for stroke prevention increased from 57.4 percent to 71.1 percent. Use of vitamin K antagonists (VKAs) and antiplatelets (combined or alone) fell from 83.4 percent to 50.6 percent, whilst use of non-vitamin K antagonist oral anticoagulants (NOACs) with or without an antiplatelet increased from 4.1 percent to 37 percent.
"This evolution in treatment patterns is consistent with the adoption of innovative therapies for stroke prevention," said Prof. Ajay Kakkar, professor of surgery at University College London and director of the Thrombosis Research Institute. "The remaining challenge, however, is to ensure that the correct patient receives the appropriate therapy."
Prof. John Camm of St George's University, London expanded on the treatment patterns revealed in GARFIELD-AF: "While we are seeing an overall increase in the use of appropriate anticoagulation therapy, GARFIELD-AF reveals a substantial variation in NOAC uptake between countries. Analysis in over 20,000 newly diagnosed AF patients across Europe from cohorts 1-3 showed these variations ranged from 2.6 percent to 58 percent. The ongoing insights being gathered across countries and different care settings will help clinicians better understand how to improve care and outcomes for AF patients."
GARFIELD-AF is the largest ongoing prospective registry of patients with newly diagnosed AF and at least one additional stroke risk factor. The ongoing real-world insights continuing to be gathered from the registry are being converted into real-world evidence that help inform and identify areas where the medical community can continue to improve patient outcomes.
For more information: www.escardio.org
