Author + information
- Freek W.A.A. Verheugt,
- Wael Al Mahmeed,
- Giuseppe Ambrosio,
- Pantep Angchaisuksiri,
- Dan Atar,
- Jean-Pierre Bassand,
- A. John Camm,
- Frank Cools,
- John W. Eikelboom,
- Haiyan Gao,
- Gloria Kayani,
- Toon Wei Lim,
- Frank Misselwitz,
- Martin van Eickels and
- Ajay Kakkar
Background: Antiplatelet (AP) therapy is widely prescribed in patients with atrial fibrillation (AF), though it is not recommended for primary stroke prevention in Europe, and in the US only considered for those at low stroke risk.
Methods: Using contemporary data from GARFIELD-AF, temporal changes in AP only and factors associated with prescription of AP only vs anticoagulant (AC) therapy only were assessed.
Results: From Mar 2010-Jul 2016, a total of 51,270 patients with newly diagnosed nonvalvular AF and ≥1 stroke risk factor were enrolled prospectively in 5 cohorts (C1 2010-1; C2 2011-3; C3 2013-4; C4 2014-5; C5 2015-6) from 35 countries. With each successive cohort use of AP only declined (p<0.0001, Fig), with a substantial drop in nonindicated use, while use of AP+AC or no antithrombotic therapy did not change. However, even in 2015-6 ∼50% of AP-treated patients had no indication except AF and of these, 69% had a CHA2DS2-VASc of ≥2. AP prescribing in low-risk patients (CHA2DS2-VASc 1) was greater in middle/low than high income countries (34.9% vs 20.9%, p<0.0001). Overall, the odds of receiving AP vs AC were significantly higher for patients of Chinese ethnicity and those with history of vascular disease, bleeding, ACS or dementia and significantly lower for those with history of SE, stroke/TIA, any alcohol use, age 55-75 y, paroxysmal or permanent AF.
Conclusions: Prescribing of AP only in newly diagnosed AF has declined, but even in 2015-6 a substantial proportion of patients have no indication for AP except AF.
Moderated Poster Contributions
Arrhythmias and Clinical EP Moderated Poster Theater, Poster Hall, Hall C
Saturday, March 18, 2017, 12:45 p.m.-12:55 p.m.
Session Title: Stroke and AF: Thinking About the Heart
Abstract Category: 8. Arrhythmias and Clinical EP: Supraventricular/Ventricular Arrhythmias
Presentation Number: 1223M-05
- 2017 American College of Cardiology Foundation