Clinical research study
‘Real-World’ Antithrombotic Treatment in Atrial Fibrillation: The EORP-AF Pilot Survey

https://doi.org/10.1016/j.amjmed.2013.12.022Get rights and content

Abstract

Background

Current guidelines strongly recommend that oral anticoagulation should be offered to patients with atrial fibrillation and ≥1 stroke risk factors. The guidelines also recommend that oral anticoagulation still should be used in the presence of stroke risk factors irrespective of rate or rhythm control.

Methods

In an analysis from the dataset of the EURObservational Research Programme on Atrial Fibrillation Pilot Survey (n = 3119), we examined antithrombotic therapy prescribing, with particular focus on the risk factors determining oral anticoagulation or antiplatelet therapy use.

Results

When oral anticoagulation was used among admitted patients in whom no pharmacologic cardioversion, electrical cardioversion, or catheter ablation was performed or planned, vitamin K antagonist therapy was prescribed in the majority (72.2%), whereas novel oral anticoagulants were used in the minority (7.7%). There was no significant difference in bleeding risk factors among the patients treated with the different types of antithrombotic therapies, except for those with chronic kidney disease, in whom oral anticoagulation was less commonly used (P = .0318). Antiplatelet therapy was more commonly used in patients with a high Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly (>65 years), Drugs/alcohol concomitantly score (≥2) (P < .0001). More oral anticoagulation use was associated with female gender (P = .0245). Less novel oral anticoagulant use was associated with valvular heart disease (P < .0001), chronic heart failure (P = .0010), coronary artery disease (P < .0001), and peripheral artery disease (P = .0092). Coronary artery disease was the strongest reason for combination therapy with oral anticoagulation plus antiplatelet drug (odds ratio, 8.54; P < .0001). When the Congestive heart failure, Hypertension, Age ≥75 [Doubled], Diabetes, Stroke [Doubled]-Vascular disease, Age 65-74, and Sex category [female] score was used, 95.6% of patients with a score ≥1 received antithrombotic therapy, with 80.5% of patients with a score ≥1 receiving oral anticoagulation. Of note, 83.7% of those with a score ≥2 received antithrombotic therapy. Of the latter, 70.9% of those with a score ≥2 received oral anticoagulation, vitamin K antagonists were used in 64.1%, and novel oral anticoagulants were used in 6.9%.

Conclusions

The EURObservational Research Programme on Atrial Fibrillation Pilot Survey provides contemporary data on oral anticoagulation prescribing by European cardiologists for atrial fibrillation. Although the uptake of oral anticoagulation (mostly vitamin K antagonist therapy) has improved since the Euro Heart Survey a decade ago, antiplatelet therapy is still commonly prescribed, with or without oral anticoagulation, whereas elderly patients are commonly undertreated with oral anticoagulation.

Section snippets

Materials and Methods

The full baseline features and results from the EORP-AF Pilot Survey have been published.11 In this ancillary analysis, we focused on the clinical features associated with antithrombotic therapy use. In brief, the registry population comprised consecutive inpatients and outpatients with atrial fibrillation presenting to cardiologists in participating ESC countries. Consecutive patients were screened for eligibility at the time of their presentation to a cardiologist (hospital or medical

Results

We enrolled 3119 patients from February 2012 to March 2013. Table 1 shows the characteristics versus antithrombotic drug use of patients admitted to the hospital in whom no pharmacologic or electrical cardioversion and catheter ablation were performed or planned. In the whole cohort, when oral anticoagulation was used, vitamin K antagonist therapy was prescribed in the majority (651/902 = 72.2%), whereas novel oral anticoagulants were used in the minority (69/902 = 7.7%). No antithrombotic

Discussion

In this report from the EORP-AF Pilot Survey, we found that oral anticoagulation often was used for atrial fibrillation, especially when heart failure or other cardiac diseases were present. However, antiplatelet therapy still was prescribed routinely with or without oral anticoagulation when there was coexistent myocardial infarction or coronary artery disease. Oral anticoagulation was prescribed less often in elderly patients, and antiplatelet therapy alone was prescribed more commonly. When

Conclusions

The EORP-AF Pilot Survey provides contemporary data on oral anticoagulation prescribing by European cardiologists for atrial fibrillation. Although the uptake of oral anticoagulation (mostly vitamin K antagonist therapy) has improved since the Euro Heart Survey a decade ago, antiplatelet therapy still is prescribed routinely with or without oral anticoagulation, whereas elderly patients often are undertreated with oral anticoagulation.

Acknowledgments

Executive steering committee, Steering Committee (National Coordinators), and Study Investigators were listed in the primary article describing the baseline data, by Lip et al.11 Data monitor and technical support team: Data collection was conducted by the EURObservational Research Program department from the European Cardiac Society by Viviane Missiamenou. Statistical analyses were performed by Cécile Laroche with the support of Renato Urso. Overall activities were coordinated by Aldo P.

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    Funding: None.

    Conflict of Interest: GYHL is a consultant for Bayer, Medtronic, Sanofi, BMS/Pfizer, Daiichi-Sankyo, and Boehringer Ingelheim, and has been a speaker for Bayer, BMS/Pfizer, Boehringer Ingelheim, Daiichi-Sankyo, and Medtronic. LHR is on the speakers bureaus for Bayer, BMS/Pfizer, Janssen Pharmaceuticals, Takeda, Roche Diagnostics, and Boehringer Ingelheim. GB has received small speaker's fees from Medtronic Inc and Boston Scientific. The remaining authors do not have any conflicts of interest associated with the work presented in this manuscript. EURObservational Research Programme Sponsors: At the time of the registry, the following companies were supporting the EURObservational Research Programme: GOLD: Abbott Vascular, Bayer Pharma, Bristol Myers Squibb (BMS), Pfizer, Boehringer Ingelheim, Daiichi Sankyo Europe, Menarini International Operations, Novartis Pharma, Sanofi-Aventis, Servier International. SILVER: Amgen. BRONZE: Boston Scientific International, Merck & Co (MSD).

    Authorship: All authors had access to the data and played a role in writing this manuscript.

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