Steinberg BA et al. – The objective of this study was to provide detailed data on international patterns of treatment for atrial fibrillation (AF) stroke prevention. Although the use of non–vitamin K antagonist oral anticoagulant (NOAC) has increased and antiplatelet monotherapy has decreased among new–onset AF patients, anticoagulation is used frequently in low–risk patients and inconsistently in those at high risk of stroke. There is a significant geographic variability in anticoagulation, which indicates an opportunity for improvement.

Methods

• Demographics, comorbidities, and stroke risk of the patients in the GARFIELD–AF (N = 51,270), ORBIT–AF I (N = 10,132), and ORBIT–AF II (N = 11,602) registries were compared, along with the assessment of stroke prevention therapies among patients with new–onset AF (≥6 weeks).

Results

• Patients from GARFIELD–AF were less likely to have CAD (19%) compared with patients from ORBIT–AF I (36%) and ORBIT–AF II (27%), but had similar risk of stroke (85% CHA2DS2–VASc ≥ 2, vs 91% and 85%), and lower bleeding risk (11% with HAS–BLED ≥3 vs 24% and 15%).
• The use of oral anticoagulant (OAC) was 46% and 57% for patients with a CHA2DS2–VASc = 0 and 69% and 87% for CHA2DS2–VASc ?2, in GARFIELD–AF and ORBIT–AF II, respectively, but with substantial geographic heterogeneity in use of OAC (30%–93% [GARFIELD–AF] and 52%–100% [ORBIT–AF II]).
• Among patients with new–onset AF, use of NOAC increased over time to 45% and 71% for GARFIELD–AF and ORBIT–AF II, respectively, while use of antiplatelet monotherapy reduced from 35% to 14% (GARFIELD–AF) and 18% to 8% (ORBIT–AF I and II).