Asian ethnicity was associated with a lower risk of the primary composite outcome of all-cause death and MACE compared to non-Asian ethnicity (HR 0.86; 95% CI 0.76-0.96).
Cohort (n=34,421)
Yes
Does Asian ethnicity affect oral anticoagulant prescription, discontinuation, and adverse outcomes in patients with atrial fibrillation?
Asian patients with atrial fibrillation have lower rates of oral anticoagulant prescription, higher discontinuation rates, and a distinct risk profile including higher risks of thromboembolism and intracranial hemorrhage compared to non-Asian patients.
Effect estimate: HR 0.86 (95% CI 0.76-0.96)
Background: Previous 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. Methods: From 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. Findings: 34,421 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. Interpretation: Our 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. Funding: The GLORIA-AF Registry was funded by Boehringer Ingelheim GmbH.
Romiti et al. (Fri,) conducted a cohort in Atrial fibrillation (n=34,421). Asian ethnicity vs. Non-Asian ethnicity was evaluated on Composite of all-cause death and major adverse cardiovascular events (MACE) (HR 0.86, 95% CI 0.76-0.96). Asian ethnicity was associated with a lower risk of the primary composite outcome of all-cause death and MACE compared to non-Asian ethnicity (HR 0.86; 95% CI 0.76-0.96).