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. 2023 Aug 25:63:102039.
doi: 10.1016/j.eclinm.2023.102039. eCollection 2023 Sep.

Patterns of oral anticoagulant use and outcomes in Asian patients with atrial fibrillation: a post-hoc analysis from the GLORIA-AF Registry

Giulio Francesco Romiti  1   2 , Bernadette Corica  1   2 , Marco Proietti  1   3   4 , Davide Antonio Mei  1   5 , Juliane Frydenlund  6 , Arnaud Bisson  1   7 , Giuseppe Boriani  5 , Brian Olshansky  8 , Yi-Hsin Chan  9   10   11 , Menno V Huisman  12 , Tze-Fan Chao  13   14 , Gregory Y H Lip  1   6   14 ; GLORIA-AF Investigators
Collaborators, Affiliations

Patterns of oral anticoagulant use and outcomes in Asian patients with atrial fibrillation: a post-hoc analysis from the GLORIA-AF Registry

Giulio Francesco Romiti et al. EClinicalMedicine. .

Abstract

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.

Keywords: Asia; Atrial fibrillation; Ethnic differences; Oral anticoagulant; Outcomes.

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Conflict of interest statement

GFR reports consultancy for Boehringer Ingelheim and an educational grant from Anthos, outside the submitted work. No fees are directly received personally. AB has been a consultant or speaker for Astra-Zeneca, Bayer, BMS/Pfizer, Medtronic, Vitorpharma and Alnylam. TFC reported honoraria for lectures from Boehringer Ingelheim, Bayer, Pfizer, and Daiichi Sankyo, outside the submitted work. GB reports small speaker fees from Bayer, Boehringer Ingelheim, Boston, BMS, Daiichi, Sanofi, Janssen outside the submitted work. MVH has been receiving research grants from the Dutch Healthcare Fund, Dutch Heart Foundation, BMS-Pfizer, Bayer Healthcare and Boehringer Ingelheim and consulting fees from BMS-Pfizer, Bayer Healthcare and Boehringer Ingelheim to the institution. All other authors have nothing to declare. GYHL has been consultant and speaker for BMS/Pfizer, Boehringer Ingelheim, Anthos and Daiichi-Sankyo. No fees are directly received personally. All the disclosures happened outside the submitted work. GYHL is co-principal investigator of the AFFIRMO project on multimorbidity in AF, which has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 899871.

Figures

Fig. 1
Fig. 1
Rates of antithrombotics prescribed according to Asian ethnicity. Legend: NOAC = Non vitamin-K antagonist oral anticoagulant; VKA = vitamin K antagonist.
Fig. 2
Fig. 2
Survival curves for the primary composite outcome of all-cause death and MACE according to Asian ethnicity. Legend: Panel A: Asian vs. non-Asian; Panel B: Asian Ethnicity subgroups vs. non-Asian. Log-Rank p < 0.001 for both.
See this image and copyright information in PMC

References

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