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Observational Study
. 2025 Feb 15:421:132866.
doi: 10.1016/j.ijcard.2024.132866. Epub 2024 Dec 2.

Association of care specialty with anticoagulant prescription and clinical outcomes in newly diagnosed atrial fibrillation: Results from the GARFIELD-AF registry

C Fielder Camm  1 , Saverio Virdone  2 , Carlos Jerjes-Sánchez  3 , Seil Oh  4 , John W Eikelboom  5 , Ali Oto  6 , Keith A A Fox  7 , A John Camm  8 , Karen S Pieper  2 , Shinya Goto  9 , Hany Ragy  10 , Ajay K Kakkar  2 ; GARFIELD-AF registry
Affiliations
Free article
Observational Study

Association of care specialty with anticoagulant prescription and clinical outcomes in newly diagnosed atrial fibrillation: Results from the GARFIELD-AF registry

C Fielder Camm et al. Int J Cardiol. .
Free article

Abstract

Objective: To determine whether stroke prevention strategy, comorbidity management, and clinical outcome risks differ across atrial fibrillation (AF) care specialties.

Methods: Newly diagnosed non-valvular AF patients enrolled in the international, prospective GARFIELD-AF registry (enrolment: 2010-2016) were analysed. Prescription of oral anticoagulation (OAC) therapy and select comorbidities was assessed by baseline care specialty: cardiology, primary care, or other specialties (internist/neurologist/geriatrician). Associations between care specialty and 2-year clinical outcomes were evaluated using multivariable Cox frailty models to account for within-country homogeneity.

Results: In 52,011 patients, 34,172 (65.7 %) were diagnosed and initially managed in cardiology care, 7396 (14.2 %) in primary care, and 10,443 (20.1 %) in other specialties. The inter-country care specialty distribution varied considerably. Non-vitamin K OAC (NOAC) therapy among CHA2DS2-VASc ≥2 patients was more common in cardiology care (31.0 %) than primary care (19.8 %) and other specialty care (24.9 %), but comorbidity management was similar across specialties. Compared to cardiology care, primary care was associated with greater non-cardiovascular mortality (1.21 [1.01-1.45]), major bleeding (1.31 [1.05-1.62]), and new/worsening heart failure risk (2.09 [1.69-2.59]). Care in other specialties was associated with greater all-cause (adjusted hazard ratio, 1.19 [95 % CI, 1.09-1.29]), cardiovascular (1.15 [1.01-1.31]), and non-cardiovascular mortality (1.29 [1.13-1.47]), as well as non-haemorrhagic stroke/systemic embolism (1.48 [1.26-1.73]), major bleeding (1.21 [1.02-1.43]), and new/worsening heart failure risk (1.45 [1.21-1.75]) than cardiology care.

Conclusion: Comorbidity management was similar across AF care specialties, but patients outside of cardiology care had fewer NOAC prescriptions and greater risk for most clinical endpoints. Cardiology expertise may have important implications for AF prognosis.

Clinical trial registration: URL: http://www.

Clinicaltrials: gov. Unique identifier for GARFIELD-AF: NCT01090362.

Keywords: Atrial fibrillation; Care setting; Care specialty; Non-vitamin K oral anticoagulant; Outcomes; Vitamin K anticoagulant.

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Conflict of interest statement

Declaration of competing interest C Fielder Camm reports honoraria from Bayer. John W Eikelboom reports grant or in-kind support from AstraZeneca, Bayer, Boehringer-Ingelheim, Bristol Myers Squibb, GlaxoSmithKline, Pfizer, Janssen, Sanofi-Aventis and honoraria from Astra-Zeneca, Bayer, Boehringer-Ingelheim, Bristol-Myer-Squibb, Daiichi-Sankyo, Eli-Lilly, Glaxo-Smith-Kline, Merck, Pfizer, Janssen, Sanofi-Aventis, Servier. Ali Oto reports grants from Pfizer and personal fees from Medtronic, Boston Scientific, Daiichi, A. Menarini Research and Business Service GmbH, and Bayer Healthcare Pharmaceuticals. Keith AA Fox reports grants and personal fees from Bayer/Janssen, and Astra Zeneca. AJ Camm reports institutional grants and personal fees from Bayer, Boehringer Ingelheim, Pfizer/BMS and Daiichi Sankyo, and personal fees from Portola. Karen S Pieper has consultancies with Johnson & Johnson, Element Science, Artivion, and Novartis. Shinya Goto was a recipient of personal fees from Jansen, Merck & Co., Inc., Amgen Inc., and Anthos, as well as fees from the American Heart Association as an Associate Editor for Circulation, and Steering Committee fees from TIMI Study group. Ajay K Kakkar received personal fees and grants from Bayer AG, Sanofi S.A. and Anthos Therapeutics Inc. All other authors report no conflict of interest.

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