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Global Oral Anticoagulation Use Varies by Region in Patients With Recent Diagnosis of Atrial Fibrillation: The

Valentina Bayer1, Agnieszka Kotalczyk2, Bory Kea3

  • 1Biostatistics and Data Sciences Boehringer Ingelheim Pharmaceuticals Inc. Ridgefield CT.

Journal of the American Heart Association
|March 4, 2022
PubMed

Insights

Oral anticoagulant (OAC) use for atrial fibrillation (AF) varies significantly by region and healthcare site. Earlier OAC initiation in Europe contrasts with slower uptake in Asia and Latin America, impacting patient outcomes.

Area of Science:

  • Cardiology
  • Pharmacology
  • Public Health

Background:

  • Oral anticoagulants (OACs) are crucial for stroke prevention in atrial fibrillation (AF) patients.
  • Global variations in OAC prescribing patterns require investigation to ensure guideline adherence.

Purpose of the Study:

  • To analyze geographical and site-specific differences in OAC utilization among recent-onset AF patients.
  • To assess time-to-treatment initiation for direct OACs (DOACs), vitamin K antagonists, and antiplatelet drugs.

Main Methods:

  • Prospective observational cohort study (GLORIA-AF) including 21,237 patients from North America, Europe, Asia, and Latin America (2014-2016).
  • Cumulative incidence functions and Fine-Gray subdistribution hazard models were used to analyze treatment initiation.
  • Stratification by geographical region and type of healthcare site.

Main Results:

  • Within 30 days of AF diagnosis, 40% received DOACs, 16% vitamin K antagonists, and 8.6% antiplatelet drugs.
  • Europe showed earlier DOAC initiation compared to Asia and Latin America (HR 0.66 and 0.79, respectively).
  • DOACs were most initiated in community hospitals, vitamin K antagonists in clinics, and antiplatelets in primary care.

Conclusions:

  • Significant geographic variability exists in OAC use for AF patients.
  • Disparities in time-to-treatment initiation by site suggest suboptimal guideline implementation, potentially increasing harm.
  • Optimizing OAC use can improve AF patient outcomes and reduce healthcare costs.

Keywords:
atrial fibrillationdirect‐acting oral anticoagulantsoral anticoagulationstroke preventionvitamin K antagonists

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