Dataset Information

Stroke-prevention strategies in North American patients with atrial fibrillation: The GLORIA-AF registry program.

ABSTRACT:

Background

Antithrombotic prophylaxis with oral anticoagulation (OAC) substantially reduces stroke and mortality in patients with atrial fibrillation (AF).

Hypothesis

Analysis of data in the Global Registry on Long-Term Antithrombotic Treatments in Patients With Atrial Fibrillation (GLORIA-AF), an international, observational registry of patients with newly diagnosed AF, can identify factors associated with treatment decisions and outcomes.

Methods

Multivariable regression identified patient, physician, and temporal factors associated with OAC prescription, compared with management with antiplatelet drugs or no antithrombotic drugs in North American patients enrolled between November 2011 and February 2014.

Results

Of 3320 eligible patients (mean age, 71 ± 11 years; 1879 males with CHA₂ DS₂ -VASc ≥1 and 1441 females with CHA₂ DS₂ -VASc ≥2), 79.3%, 12.5%, and 7.4% received OAC, antiplatelet drugs, or no antithrombotic therapy, respectively. Of those prescribed OAC, 66.4% received non-vitamin K antagonist oral anticoagulation and 24.5% received concomitant therapy with antiplatelet drugs. Independent predictors of OAC therapy were nonparoxysmal AF (odds ratio, 95% confidence interval: 2.02, 1.56-2.63), prior stroke/transient ischemic attack (2.00, 1.37-2.92), specialist care (1.50, 1.04-2.17), more concomitant medications (1.47, 1.13-1.92), commercial insurance (1.41, 1.07-1.85), and heart failure (1.44, 1.07-1.92). Antiplatelet drugs (0.18, 0.14-0.23), prior falls (0.41, 0.27-0.63), and prior bleeding (0.50, 0.35-0.72) were inversely associated with OAC prescription.

Conclusions

In GLORIA-AF, 20% of the population comprising males with CHA₂ DS₂ -VASc ≥1 and females with CHA₂ DS₂ -VASc ≥2 did not receive OAC therapy. Patient characteristics associated with a lower likelihood of OAC prescription were use of antiplatelet drugs, paroxysmal pattern of AF, history of falls, and prior bleeding.

SUBMITTER: McIntyre WF

PROVIDER: S-EPMC6032943 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

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Publications

Stroke-prevention strategies in North American patients with atrial fibrillation: The GLORIA-AF registry program.

McIntyre William F WF Conen David D Olshansky Brian B Halperin Jonathan L JL Hayek Emil E Huisman Menno V MV Lip Gregory Y H GYH Lu Shihai S Healey Jeff S JS

Clinical cardiology 20180510 6

<h4>Background</h4>Antithrombotic prophylaxis with oral anticoagulation (OAC) substantially reduces stroke and mortality in patients with atrial fibrillation (AF).<h4>Hypothesis</h4>Analysis of data in the Global Registry on Long-Term Antithrombotic Treatments in Patients With Atrial Fibrillation (GLORIA-AF), an international, observational registry of patients with newly diagnosed AF, can identify factors associated with treatment decisions and outcomes.<h4>Methods</h4>Multivariable regression ...[more]

PMID: 29546729

Similar Datasets

Project description:Background and purposeProspectively collected data comparing the safety and effectiveness of individual non-vitamin K antagonists (NOACs) are lacking. Our objective was to directly compare the effectiveness and safety of NOACs in patients with newly diagnosed atrial fibrillation (AF).MethodsIn GLORIA-AF, a large, prospective, global registry program, consecutive patients with newly diagnosed AF were followed for 3 years. The comparative analyses for (1) dabigatran vs rivaroxaban or apixaban and (2) rivaroxaban vs apixaban were performed on propensity score (PS)-matched patient sets. Proportional hazards regression was used to estimate hazard ratios (HRs) for outcomes of interest.ResultsThe GLORIA-AF Phase III registry enrolled 21,300 patients between January 2014 and December 2016. Of these, 3839 were prescribed dabigatran, 4015 rivaroxaban and 4505 apixaban, with median ages of 71.0, 71.0, and 73.0 years, respectively. In the PS-matched set, the adjusted HRs and 95% confidence intervals (CIs) for dabigatran vs rivaroxaban were, for stroke: 1.27 (0.79-2.03), major bleeding 0.59 (0.40-0.88), myocardial infarction 0.68 (0.40-1.16), and all-cause death 0.86 (0.67-1.10). For the comparison of dabigatran vs apixaban, in the PS-matched set, the adjusted HRs were, for stroke 1.16 (0.76-1.78), myocardial infarction 0.84 (0.48-1.46), major bleeding 0.98 (0.63-1.52) and all-cause death 1.01 (0.79-1.29). For the comparison of rivaroxaban vs apixaban, in the PS-matched set, the adjusted HRs were, for stroke 0.78 (0.52-1.19), myocardial infarction 0.96 (0.63-1.45), major bleeding 1.54 (1.14-2.08), and all-cause death 0.97 (0.80-1.19).ConclusionsPatients treated with dabigatran had a 41% lower risk of major bleeding compared with rivaroxaban, but similar risks of stroke, MI, and death. Relative to apixaban, patients treated with dabigatran had similar risks of stroke, major bleeding, MI, and death. Rivaroxaban relative to apixaban had increased risk for major bleeding, but similar risks for stroke, MI, and death.RegistrationURL: https://www.Clinicaltrialsgov . Unique identifiers: NCT01468701, NCT01671007. Date of registration: September 2013.

Dataset Information

Stroke-prevention strategies in North American patients with atrial fibrillation: The GLORIA-AF registry program.

Background

Hypothesis

Methods

Results

Conclusions

Publications

Stroke-prevention strategies in North American patients with atrial fibrillation: The GLORIA-AF registry program.

Similar Datasets

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