Many AF patients at high risk of stroke fail to receive guideline-recommended oral anticoagulant treatment

Boehringer Ingelheim have announced two analyses from the GLORIA™-AF Registry Program examining the use of anticoagulant treatments for stroke prevention in patients with atrial fibrillation (AF).^1,2 

These new analyses found that although oral anticoagulant use is increasing in the US, approximately a fifth of North American AF patients in the GLORIA™-AF Registry Program were either inadequately treated with the antiplatelet acetylsalicylic acid (ASA) or did not receive any treatment at all.^1,2 This is despite current US guidelines stating that AF patients with a CHA₂DS₂-VASc score of 2 or above are considered at high risk for stroke and require anticoagulant treatment.³ The new findings were presented during poster sessions at the American College of Cardiology 64th Annual Scientific Session & Expo on 16 March 2015, San Diego, USA.

Oral anticoagulants underutilised in AF Patients

“These real-world analyses highlight that while physicians have a variety of factors to consider when deciding on antithrombotic treatment options for AF patients, the fact remains that oral anticoagulants, the standard of care for significantly reducing the risk of stroke and systemic embolism in these patients, are underutilized,” said Jonathan L. Halperin, M.D., the Robert and Harriet Heilbrunn Professor of Medicine at Mount Sinai School of Medicine, lead author of the study, and member of the GLORIA-AF steering committee. “We need to continue to uncover why that is and what we can do to bridge that treatment gap.”

The new data are the first reported prescribing patterns from Phase II of the GLORIA™-AF Registry Program, which began in November 2011 after the first novel oral anticoagulant (NOAC), Pradaxa® (dabigatran etexilate), was approved in the US. The data is based on treatment trends in 3,415 AF patients who entered the GLORIA™-AF registry from November 2011 to February 2014.^1,2 All patients had a recent diagnosis of AF and 86 per cent had a CHA₂DS₂-VASc score of 2 or higher, placing them at high risk of stroke.1,2 The data show that dabigatran etexilate was the most widely prescribed NOAC for stroke prevention among the patients included in the study.^1,2

“We still face challenges in ensuring that patients with atrial fibrillation receive the most effective anticoagulant treatment to reduce their risk of stroke, which can be debilitating or even fatal,” said Professor Jörg Kreuzer, Vice President Medicine Therapeutic Area Cardiovascular, Boehringer Ingelheim. “These latest data from GLORIA™-AF, as well as further analyses from the registry, will shed light on the strategies needed to eliminate disparities in treatment and ensure that all patients are optimally protected against stroke.”

Poster Presentation Details

March 16, 9:45-10:30 a.m. Pacific Time
Session: 1246 – Risk Assessment, Exercise and Atrial Fibrillation

• Patterns of newly detected atrial fibrillation and antithrombotic treatment in North America (GLORIA™-AF Phase II) Authors: Halperin JL, Huisman M, Diener H-C, et al. [Poster 1246-124]

Results demonstrated that 21.9 per cent of patients with occasional AF and a CHA₂DS₂-VASc score of 2 or higher were either undertreated with acetylsalicylic acid (ASA) or given no anticoagulant treatment at all*, compared to 12.4 per cent and 11.2 per cent of those diagnosed with persistent or permanent AF, respectively.¹ Current AF guidelines call for patients to receive oral anticoagulant therapy based on their risk of stroke, rather than their type of AF.^3,4 Furthermore, given the availability of NOACs, guidelines state that the use of antiplatelet therapies (such as ASA) for stroke prevention in AF should be limited to the few patients who refuse any form of oral anticoagulant as the evidence for effective stroke prevention from ASA is weak, with a potential for harm.^3,4 

* The analysis defined oral anticoagulation as treatment from warfarin or the novel oral anticoagulants (dabigatran etexilate, rivaroxaban or apixaban)

March 16, 9:45-10:30 a.m. Pacific Time
Session: 1246 – Risk Assessment, Exercise and Atrial Fibrillation

• Antithrombotic treatment in relation to age in patients with newly diagnosed atrial fibrillation in North America (GLORIA™-AF Phase II) Authors: Halperin JL, Huisman M, Diener H-C, et al. [Poster 1246-122]

The second study, which grouped patients by their age and CHA₂DS₂-VASc score, found that about 20 per cent of new-onset AF patients below 75 years with a CHA₂DS₂-VASc score of 2 or higher received ASA alone or went untreated (20.6 per cent of patients aged below 65 years and 19.7 per cent of patients aged 65-74 years).² Over half of patients were prescribed NOACs for stroke prevention, (25 per cent dabigatran, 20.5 per cent rivaroxaban, and 6.6 per cent apixaban).² Vitamin K antagonists (VKAs e.g. warfarin) remain widely used, particularly in high-risk, elderly patients (31.7 per cent of patients aged 80 and older with a CHA₂DS₂-VASc score of 2 or higher).²

For more information on the GLORIA™-AF Registry Program, please visit https://www.gloria-af.com.

References

1. Halperin JL, et al. Patterns of newly detected atrial fibrillation and antithrombotic treatment in North America (GLORIA-AF Phase II). Abstract No./Poster No: 1246-124, Presented at: the American College of Cardiology 64th Annual Scientific Session (ACC.15), March 14-16, 2015, San Diego, CA
2. Halperin JL, et al. Antithrombotic Treatment in Relation to Age in Patients with Newly Diagnosed Atrial Fibrillation in North America (GLORIA-AF Phase II). Abstract No./Poster No: 1246-122, Presented at: the American College of Cardiology 64th Annual Scientific Session (ACC.15), March 14-16, 2015, San Diego, CA.
3. January CT, et al. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation. 2014 Dec 2;130(23):2071-104.
4. Camm AJ, et al. Guidelines for the management of atrial fibrillation. The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J. 2010;31(19):2369–2429.