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Observational Study
. 2022 Mar 15;11(6):e023907.
doi: 10.1161/JAHA.121.023907. Epub 2022 Mar 4.

Global Oral Anticoagulation Use Varies by Region in Patients With Recent Diagnosis of Atrial Fibrillation: The GLORIA-AF Phase III Registry

Valentina Bayer  1 , Agnieszka Kotalczyk  2 , Bory Kea  3 , Christine Teutsch  4 , Peter Larsen  5 , Dana Button  3 , Menno V Huisman  6 , Gregory Y H Lip  2 , Brian Olshansky  7
Affiliations
Observational Study

Global Oral Anticoagulation Use Varies by Region in Patients With Recent Diagnosis of Atrial Fibrillation: The GLORIA-AF Phase III Registry

Valentina Bayer et al. J Am Heart Assoc. .

Abstract

Background Effective stroke prevention with oral anticoagulants (OAC) is recommended for some patients with atrial fibrillation (AF). We aimed to describe OAC use by geographical region and type of site in patients with recent-onset AF enrolled in a large global registry. Methods and Results Eligible participants were recruited into GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation), a prospective observational cohort study from 2014 to 2016 in 4 international regions: North America, Europe, Asia, and Latin America. Cumulative incidence functions were generated for direct OACs (DOAC), vitamin K antagonists, and antiplatelet drugs considering competing risks, stratified by region and type of site. Time-to-treatment initiation after AF diagnosis was analyzed with Fine-Gray subdistribution hazard models. A total of 21 237 patients eligible for analysis were identified. By 30 days after AF diagnosis, 40%, 16%, and 8.6% of patients had DOAC, vitamin K antagonists, and antiplatelet drugs initiated, respectively. Earlier initiation of DOACs was observed in Europe, with Asia and Latin America having lower hazard rates of DOAC time-to-treatment initiation than Europe (hazard ratio [HR], 0.66; 95% CI, 0.62-0.70 and HR, 0.79; 95% CI, 0.73-0.85, respectively). DOAC initiation was highest in community hospitals, vitamin K antagonists in outpatient health care centers/anticoagulation clinics, and antiplatelet drugs in primary care clinics. Conclusions Important geographic variability exists with the use of OACs for patients with AF. Differences in the time-to-treatment initiation of OAC by type of site suggests suboptimal implementation of guideline recommendations and could result in less benefit and more harm. Optimizing OAC use for patients with AF may improve outcomes and reduce health care costs. Registration URL: http://www.clinicaltrials.gov; Unique identifiers: NCT01468701, NCT01671007.

Keywords: atrial fibrillation; direct‐acting oral anticoagulants; oral anticoagulation; stroke prevention; vitamin K antagonists.

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Figures

Figure 1
Figure 1. Cumulative incidence function of time‐to‐initiation by oral anticoagulant type.
AF indicates atrial fibrillation; DOAC, direct‐acting oral anticoagulants; and VKA, vitamin K antagonists.
See this image and copyright information in PMC

References

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