Afib: evolving treatment patterns in UK concordant with guideline recommendations

Takeaway

• This study involving participants from UK cohort of GARFIELD-AF registry indicates gradual improvement in clinical management of patients with Afib.
• High-risk patients are more frequently receiving guideline-recommended therapies.
• In recent years, vitamin K antagonists (VKAs) are prescribed less frequently than non-VKA oral anticoagulants (NOACs).

Why this matters

• Evidence indicates increasing concordance between clinical practice and guideline recommendations for patients newly diagnosed with Afib.

Study design

• Based on time of diagnosis, this observational study categorised 3482 patients with newly diagnosed Afib into 4 cohorts (C):
  • C₂ (between September 2011 and April 2013), C₃ (between April 2013 and June 2014, C₄ (between July 2014 and June 2015) and C₅ (between June 2015 and July 2016).
• Funding: None disclosed.

Key results

• Proportion of patients prescribed anticoagulants ± antiplatelet increased significantly between C₂ and C₅ (C₂, 54.7%; C₅, 73.9%; P_trend<.0001).
• Increase was highest in patients with CHA2DS2-VASc ≥2 (C₂, 56.7%; C₄, 75.6%).
• Proportion of patients receiving NOACs ± antiplatelet increased (C₂, 1.3%; C₅, 43.3%), whereas those receiving VKAs ± antiplatelet decreased (C₂, 53.3%; C₅, 30.6%).
• Proportion of patients prescribed antiplatelet only declined, whereas proportion of high-risk patients not receiving any antithrombotic therapy remained similar between C₄ and C₅.
• Patient refusal and physician’s choice were main reasons for decreased use of anticoagulants in patients with CHA2DS2-VASc ≥2.

Limitations

• Small study population for low-risk patients.