Original Investigation
The Changing Landscape for Stroke Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

https://doi.org/10.1016/j.jacc.2016.11.061Get rights and content
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Abstract

Background

GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non–vitamin K antagonist oral anticoagulant (NOAC), became available.

Objectives

This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1.

Methods

During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients’ baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics.

Results

Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score ≥2; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment.

Conclusions

The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701)

Key Words

atrial fibrillation
oral anticoagulation
registry

Abbreviations and Acronyms

AF
atrial fibrillation
ASA
acetylsalicylic acid
IQR
interquartile range
NOAC
non–vitamin K antagonist oral anticoagulant(s)
NVAF
nonvalvular atrial fibrillation
OAC
oral anticoagulant(s)
VKA
vitamin K antagonist(s)

Cited by (0)

This study was funded by Boehringer Ingelheim. Dr. Huisman has received honoraria for presentations as well as research grants from Boehringer Ingelheim, Bayer HealthCare, Pfizer–Bristol-Myers Squibb, GlaxoSmithKline, Aspen, and Actelion Pharmaceuticals. Dr. Rothman is an employee of RTI Health Solutions, an independent nonprofit research organization that does work for government agencies and pharmaceutical companies. M. Paquette and Drs. Zint, Teutsch, Elsaesser, and Bartels are employees of Boehringer Ingelheim. Dr. Diener has received honoraria for participation in clinical trials, contribution to advisory boards, or oral presentations from Abbott, Allergan, AstraZeneca, Bayer Vital, Bristol-Myers Squibb, Boehringer Ingelheim, CoAxia, Corimmun, Covidien, Daiichi-Sankyo, D-Pharm, Fresenius, GlaxoSmithKline, Janssen-Cilag, Johnson and Johnson, Knoll, Lilly, MSD, Medtronic, MindFrame, Neurobiological Technologies, Novartis, Novo-Nordisk, Paion, Parke-Davis, Pfizer, Sanofi, Schering-Plough, Servier, Solvay, St. Jude Medical, Syngis, Talecris, Thrombogenics, WebMD Global, Wyeth, and Yamanouchi; received financial support for research projects from AstraZeneca, GlaxoSmithKline, Boehringer Ingelheim, Lundbeck, Novartis, Janssen-Cilag, Sanofi, Syngis, and Talecris; received research grants awarded to the Department of Neurology at the University Duisburg-Essen from the German Research Council, the German Ministry of Education and Research, the European Union, the National Institutes of Health, the Bertelsmann Foundation, and the Heinz-Nixdorf Foundation; within the past year, has served as the editor of Aktuelle Neurologie, Arzneimitteltherapie, Kopfschmerznews, Stroke News, as the coeditor of Cephalalgia, and was on the editorial board of Lancet Neurology, Stroke, European Neurology and Cerebrovascular Disorders; chairs the Treatment Guidelines Committee of the German Society of Neurology; has contributed to the European Heart Rhythm Association and the European Society of Cardiology guidelines for the treatment of atrial fibrillation; and serves on the Steering Committee of GLORIA-AF. Dr. Dubner has received consultancy fees for serving as a Steering Committee member for Boehringer Ingelheim; and has received research grants from St. Jude Medical. Dr. Halperin is currently conducting research sponsored by Boehringer Ingelheim as a member of the Executive Steering Committee for the GLORIA-AF Registry, and has received consulting fees from Bayer HealthCare, Janssen-Ortho-McNeil, and Pfizer for advisory activities involving the development of anticoagulant drugs. Dr. Ma has received honoraria for presentations as well as research grants from BMS, Boehringer Ingelheim, Bayer HealthCare, Pfizer, AstraZeneca, and Johnson and Johnson. Dr. Lip has been a consultant for Bayer/Janssen, Astellas, Merck, Sanofi, BMS/Pfizer, Biotronik, Medtronic, Portola, Boehringer Ingelheim, Microlife, and Daiichi-Sankyo; and has received speaking fees from Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, Microlife, Roche, and Daiichi-Sankyo. Prakash C. Deedwania, MD, served as Guest Editor for this paper.

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