GARFIELD-AF: risk profiles, treatment patterns and 2-year outcomes in patients with atrial fibrillation in Germany, Austria and Switzerland (DACH) compared to 32 countries in other regions worldwide

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doi:10.1007/s00392-022-02079-y

Background The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is a worldwide non-interventional study of stroke prevention in patients with non-valvular AF.Methods and results 52,080 patients with newly diagnosed AF were prospectively enrolled from 2010 to 2016. 4121 (7.9%) of these patients were recruited in DACH [Germany (n= 3567), Austria (n=465) and Switzerland (n=89) combined], and 47,959 patients were from 32 countries in other regions worldwide (ORW). Hypertension was most prevalent in DACH and ORW (85.3% and 75.6%, respectively). Diabetes, hypercholesterolaemia, carotid occlusive disease and vascular disease were more prevalent in DACH patients vs ORW (27.6%, 49.4%, 5.8% and 29.0% vs 21.7%, 40.9%, 2.8% and 24.5%). The use of non-vitamin K antagonist oral anticoagulants (NOACs) increased more in DACH over time. Management of vitamin K antagonists was suboptimal in DACH and ORW (time in therapeutic range of INR >= 65% in 44.6% and 44.4% of patients or >= 70% in 36.9% and 36.0% of patients, respectively). Adjusted rates of cardiovascular mortality and MI/ACS were higher in DACH while non-haemorrhagic stroke/systemic embolism was lower after 2-year follow-up.Conclusions Similarities and dissimilarities in AF management and clinical outcomes are seen in DACH and ORW. The increased use of NOAC was associated with a mismatch of risk-adapted anticoagulation (over-and-undertreatment) in DACH. Suboptimal control of INR requires educational activities in both regional groups. Higher rates of cardiovascular death in DACH may reflect the higher risk profile of these patients and lower rates of non-haemorrhagic stroke could be associated with increased NOAC use.[GRAPHICS].

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GARFIELD-AF: risk profiles, treatment patterns and 2-year outcomes in patients with atrial fibrillation in Germany, Austria and Switzerland (DACH) compared to 32 countries in other regions worldwide

Haas, Sylvia;Camm, John A;Harald, Darius;Steffel, Jan;Virdone, Saverio;Pieper, Karen;Brodmann, Marianne;Schellong, Sebastian;Misselwitz, Frank;Kayani, Gloria;Kakkar, Ajay K;Jean-Pierre Bassand;A. John Camm;David A. Fitzmaurice;Keith A. A. Fox;Bernard J. Gersh;Samuel Z. Goldhaber;Shinya Goto;Sylvia Haas;Werner Hacke;Lorenzo G. Mantovani;Frank Misselwitz;Karen S. Pieper;Alexander G. G. Turpie;Martin van Eickels;Freek W. A. Verheugt;Keith A. A. Fox Bernard;J. Gersh;Hector Lucas;Luciardi Harry Gibbs;Marianne Brodmann;Frank Cools;Antonio Carlos Pereira Barretto;Stuart J. 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Franco;W Michael Kutayli;Annette Quick;Niraj Sharma;Vance Wilson;Stephen Miller;Mark Alberts;Edwin Blumberg;Roddy Canosa;Ted Gutowski;Rodney Ison;Jorge Garcia;Paul Mullen;Howard Noveck;Pamela Rama;Rajneesh Reddy;Marcus Williams;Daniel Nishijima;Keith Ferdinand;Ihsan Haque;Robert Mendelson;Sridevi Pitta;Daniel Theodoro;Charles Treasure;Moustafa Moustafa;Cas Cader;Walter Pharr;Alisha Oropallo;George Platt;Jaspal Gujral;James Welker;Firas Koura

2022

Abstract

Background The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is a worldwide non-interventional study of stroke prevention in patients with non-valvular AF.Methods and results 52,080 patients with newly diagnosed AF were prospectively enrolled from 2010 to 2016. 4121 (7.9%) of these patients were recruited in DACH [Germany (n= 3567), Austria (n=465) and Switzerland (n=89) combined], and 47,959 patients were from 32 countries in other regions worldwide (ORW). Hypertension was most prevalent in DACH and ORW (85.3% and 75.6%, respectively). Diabetes, hypercholesterolaemia, carotid occlusive disease and vascular disease were more prevalent in DACH patients vs ORW (27.6%, 49.4%, 5.8% and 29.0% vs 21.7%, 40.9%, 2.8% and 24.5%). The use of non-vitamin K antagonist oral anticoagulants (NOACs) increased more in DACH over time. Management of vitamin K antagonists was suboptimal in DACH and ORW (time in therapeutic range of INR >= 65% in 44.6% and 44.4% of patients or >= 70% in 36.9% and 36.0% of patients, respectively). Adjusted rates of cardiovascular mortality and MI/ACS were higher in DACH while non-haemorrhagic stroke/systemic embolism was lower after 2-year follow-up.Conclusions Similarities and dissimilarities in AF management and clinical outcomes are seen in DACH and ORW. The increased use of NOAC was associated with a mismatch of risk-adapted anticoagulation (over-and-undertreatment) in DACH. Suboptimal control of INR requires educational activities in both regional groups. Higher rates of cardiovascular death in DACH may reflect the higher risk profile of these patients and lower rates of non-haemorrhagic stroke could be associated with increased NOAC use.[GRAPHICS].

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	Parole chiave
	
				Atrial fibrillation; GARFIELD-AF; Non-vitamin K antagonist oral anticoagulants; Oral anticoagulation; Phenprocoumon; Vitamin K antagonists
			
	Settori scientifico-disciplinari dell'articolo (sola visualizzazione)
	
				Settore MED/11 - Malattie dell'Apparato Cardiovascolare
			
	Data di pubblicazione
	
				12-set-2022
			
	Rivista in ANCE
	
				CLINICAL RESEARCH IN CARDIOLOGY
			
	DOI
	
				https://dx.doi.org/10.1007/s00392-022-02079-y
			
	Tipologia
	
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				01 - Articolo su periodico

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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/964276

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