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

GLORIA-AF Investigators

Research output: Contribution to journalArticle

109 Citations (Scopus)

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)

Original languageEnglish
Pages (from-to)777-785
Number of pages9
JournalJournal of the American College of Cardiology
Volume69
Issue number7
DOIs
Publication statusPublished - 2017 Feb 21
Externally publishedYes

Fingerprint

Registries
Anticoagulants
Vitamin K
North America
Atrial Fibrillation
Platelet Aggregation Inhibitors
Therapeutics
Stroke
Furylfuramide
Eastern Africa
Middle East
Latin America
Vascular Diseases
Aspirin
Diabetes Mellitus
Heart Failure
Cross-Sectional Studies
Hypertension

Keywords

  • atrial fibrillation
  • oral anticoagulation
  • registry

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

The Changing Landscape for Stroke Prevention in AF : Findings From the GLORIA-AF Registry Phase 2. / GLORIA-AF Investigators.

In: Journal of the American College of Cardiology, Vol. 69, No. 7, 21.02.2017, p. 777-785.

Research output: Contribution to journalArticle

@article{242dab8f5c0a4244af7228ce3c4681eb,
title = "The Changing Landscape for Stroke Prevention in AF: Findings From the GLORIA-AF Registry Phase 2",
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)",
keywords = "atrial fibrillation, oral anticoagulation, registry",
author = "{GLORIA-AF Investigators} and Huisman, {Menno V.} and Rothman, {Kenneth J.} and Miney Paquette and Christine Teutsch and Diener, {Hans Christoph} and Dubner, {Sergio J.} and Halperin, {Jonathan L.} and Ma, {Chang Sheng} and Kristina Zint and Amelie Elsaesser and Bartels, {Dorothee B.} and Lip, {Gregory Y.H.} and Dzifa Abban and Nasser Abdul and Mark Abelson and Alan Ackermann and Fran Adams and Luthando Adams and Pedro Adrag{\~a}o and Walter Ageno and Rajesh Aggarwal and Sergio Agosti and Marin, {Javier Aguila} and Francisco Aguilar and {Aguilar Linares}, {Julio Alberto} and Luis Aguinaga and Zia Ahmad and Paul Ainsworth and {Al Ghalayini}, Kamal and {Al Ismail}, Saad and Abdelfatah Alasfar and Abdul Alawwa and Raed Al-Dallow and Lisa Alderson and Dimitrios Alexopoulos and Abdullah Ali and Malik Ali and Pareed Aliyar and Tammam Al-Joundi and {Al Mahameed}, Soufian and Hossein Almassi and Khalid Almuti and Mohamed Al-Obaidi and Mohamed Alshehri and Ute Altmann and Alves, {Alvaro Rabelo} and Ayham Al-Zoebi and Walid Amara and Mathieu Amelot and Kim, {Young Hoon}",
year = "2017",
month = "2",
day = "21",
doi = "10.1016/j.jacc.2016.11.061",
language = "English",
volume = "69",
pages = "777--785",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "7",

}

TY - JOUR

T1 - The Changing Landscape for Stroke Prevention in AF

T2 - Findings From the GLORIA-AF Registry Phase 2

AU - GLORIA-AF Investigators

AU - Huisman, Menno V.

AU - Rothman, Kenneth J.

AU - Paquette, Miney

AU - Teutsch, Christine

AU - Diener, Hans Christoph

AU - Dubner, Sergio J.

AU - Halperin, Jonathan L.

AU - Ma, Chang Sheng

AU - Zint, Kristina

AU - Elsaesser, Amelie

AU - Bartels, Dorothee B.

AU - Lip, Gregory Y.H.

AU - Abban, Dzifa

AU - Abdul, Nasser

AU - Abelson, Mark

AU - Ackermann, Alan

AU - Adams, Fran

AU - Adams, Luthando

AU - Adragão, Pedro

AU - Ageno, Walter

AU - Aggarwal, Rajesh

AU - Agosti, Sergio

AU - Marin, Javier Aguila

AU - Aguilar, Francisco

AU - Aguilar Linares, Julio Alberto

AU - Aguinaga, Luis

AU - Ahmad, Zia

AU - Ainsworth, Paul

AU - Al Ghalayini, Kamal

AU - Al Ismail, Saad

AU - Alasfar, Abdelfatah

AU - Alawwa, Abdul

AU - Al-Dallow, Raed

AU - Alderson, Lisa

AU - Alexopoulos, Dimitrios

AU - Ali, Abdullah

AU - Ali, Malik

AU - Aliyar, Pareed

AU - Al-Joundi, Tammam

AU - Al Mahameed, Soufian

AU - Almassi, Hossein

AU - Almuti, Khalid

AU - Al-Obaidi, Mohamed

AU - Alshehri, Mohamed

AU - Altmann, Ute

AU - Alves, Alvaro Rabelo

AU - Al-Zoebi, Ayham

AU - Amara, Walid

AU - Amelot, Mathieu

AU - Kim, Young Hoon

PY - 2017/2/21

Y1 - 2017/2/21

N2 - 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)

AB - 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)

KW - atrial fibrillation

KW - oral anticoagulation

KW - registry

UR - http://www.scopus.com/inward/record.url?scp=85012974187&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85012974187&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2016.11.061

DO - 10.1016/j.jacc.2016.11.061

M3 - Article

C2 - 28209218

AN - SCOPUS:85012974187

VL - 69

SP - 777

EP - 785

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 7

ER -