What question did this study set out to answer?

To investigate evolving patterns in antithrombotic treatment among UK patients with newly diagnosed non-valvular atrial fibrillation.

January 1, 2018BMJ OpenOpen Access

Temporal trends in antithrombotic treatment of real-world UK patients with newly diagnosed atrial fibrillation: findings from the GARFIELD-AF registry

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Why the study?

How have antithrombotic treatment patterns evolved over time in UK patients with newly diagnosed non-valvular atrial fibrillation?

Key Points

To investigate evolving patterns in antithrombotic treatment among UK patients with newly diagnosed non-valvular atrial fibrillation.
Multicenter prospective trial (GARFIELD-AF, NCT01090362) enrolling 3,482 adult participants with newly diagnosed non-valvular atrial fibrillation and stroke risk factors across 186 primary care practices in the UK.
Participants were prospectively tracked across four sequential cohorts between September 2011 and July 2016 (Cohort 2: n=830; Cohort 3: n=902; Cohort 4: n=850; Cohort 5: n=900).
Use of non-vitamin K antagonist oral anticoagulants (NOACs) with or without antiplatelet therapy increased substantially across cohorts: 1.3% in C2, 8.0% in C3, 22.7% in C4, and 43.3% in C5.
Vitamin K antagonist (VKA) use with or without antiplatelet therapy decreased from 53.3% in C2 to 30.6% in C5, while combination VKA plus antiplatelet therapy fell from 13.6% to 5.8%.
Antiplatelet monotherapy decreased steadily from 36.4% in C2 to 25.5% in C3, 11.9% in C4, and 10.5% in C5.

Structured PICO

How have antithrombotic treatment patterns evolved over time in UK patients with newly diagnosed non-valvular atrial fibrillation?

Population

3,482 adults (aged ≥18) with newly diagnosed non-valvular atrial fibrillation and at least one risk factor for stroke, enrolled in 186 primary care practices in the UK across four sequential cohorts (2011-2016).

Intervention

Antithrombotic treatment patterns over time (NOACs, VKAs, antiplatelets)

Comparator

Temporal comparison across four sequential cohorts (Cohort 2: 2011-2013, Cohort 3: 2013-2014, Cohort 4: 2014-2015, Cohort 5: 2015-2016)

Outcome

Patterns of antithrombotic treatment (proportion of patients receiving VKAs, NOACs, or antiplatelets)

There has been a progressive increase in guideline-recommended NOAC therapy for newly diagnosed AF in the UK from 2011 to 2016, with a corresponding decrease in antiplatelet monotherapy.

Implication

Documents shifting UK AF antithrombotic patterns; extends observational trend data but leaves open outcome associations.

Abstract

OBJECTIVE: To investigate evolving patterns in antithrombotic treatment in UK patients with newly diagnosed non-valvular atrial fibrillation (AF). DESIGN: Prospective, multicentre, international registry. SETTING: 186 primary care practices in the UK. PARTICIPANTS: 3482 participants prospectively enrolled in four sequential cohorts (cohort 2 (C2) n=830, diagnosed September 2011 to April 2013; cohort 3 (C3) n=902, diagnosed April 2013 to June 2014; cohort 4 (C4) n=850, diagnosed July 2014 to June 2015; cohort 5 (C5) n=900, diagnosed June 2015 to July 2016). Participants had newly diagnosed non-valvular AF and at least one risk factor for stroke, were aged ≥18, and provided informed consent. MAIN OUTCOME MEASURES: -VASc (cardiac failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)) and bleeding risk using HAS-BLED (hypertension, abnormal renal/liver function (1 point each), stroke, bleeding history or predisposition, elderly (>65), drugs/alcohol concomitantly (1 point each)). RESULTS: -VASc ≥2. The use of vitamin K antagonists (VKAs)±antiplatelet (AP) drugs decreased from C2 to C5 (C2 53.3%, C3 52.1%, C4 50.3%, C5 30.6%), while the use of non-vitamin K antagonist oral anticoagulants (NOACs)±AP increased (C2 1.3%, C3 8.0%, C4 22.7%, C5 43.3%). The use of AP only decreased (C2 36.4%, C3 25.5%, C4 11.9%, C5 10.5%), as did the combination therapy of VKA+AP (C2 13.6%, C3 11.0%, C4 9.6%, C5 5.8%). CONCLUSION: There has been a progressive increase in the proportion of patients newly diagnosed with AF receiving guideline-recommended therapy in the UK, potentially driven by the availability of NOACs. TRIAL REGISTRATION NUMBER: NCT01090362; Pre-results.