Treatment patterns in anticoagulant therapy in patients with newly diagnosed atrial fibrillation in Belgium: results from the GARFIELD-AF registry

Abstract

Background: AF, anticoagulation, NOACs, changing patterns of prescription.

Methods: We describe baseline data and treatment patterns of patients recruited in Belgium in the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF). Recruitment began when novel oral anticoagulants (NOACs) were introduced and provides a unique picture of changing treatment patterns over time. 1713 patients with a new (≤6 weeks duration) diagnosis of non-valvular atrial fibrillation (NVAF) and at least one investigator-defined stroke risk factor were recruited between May 2012 and August 2016, and will be prospectively followed for at least 2 years.

Results: Overall, anticoagulant use in Belgium was higher than in the rest of Europe: 80.1% of patients received an anticoagulant ± antiplatelet (AP) therapy (14.5% on vitamin K antagonists; 65.6% on NOAC), 10.7% AP therapy and 9.3% no antithrombotic therapy. Over time, we observed an increase in anticoagulant use and a decrease in AP use for stroke prevention. NOAC use in Belgium was the highest of Europe at the study start, with many countries catching up later. In high stroke risk patients (CHA₂DS₂-VASc ≥2), anticoagulants were used in 84.3%, leaving 15.7% unprotected. In low risk patients (CHA₂DS₂-VASc 0-1) anticoagulants were overused (58.7%). Factor Xa inhibitors were used more frequently than direct thrombin inhibitors.

Conclusion: Guideline adherence on stroke prevention was higher in Belgium than in the rest of Europe, and increased over time. NOAC use in Belgium was the highest of Europe at the study start, with many countries catching up later. Possible reasons are discussed.

Clinical Trial Registration:

http://www.clinicaltrials.gov. Unique identifier: NCT01090362.

Keywords:

• Atrial fibrillation
• GARFIELD-AF
• Belgium
• anticoagulation
• NOAC

Acknowledgments

We thank the physicians, nurses and patients involved in the GARFIELD-AF registry. Editorial support was provided by Rae Hobbs and Surekha Damineni (TRI, London, UK).

Disclosure statement

Frank Cools, corresponding author, reports speaker fees from Boehringer-Ingelheim Pharma, Bayer AG, Pfizer and speaker fees and modest research grant from Daiichi-Sankyo Europe. Wim Anné: speaker fees from Daiichi-Sankyo Europe, Bayer AG, Boehringer-Ingelheim. Georges Mairesse, reports speaker fees from Bayer AG, Hoehringer-Ingelheim, BMS-Pfizer and Daiichi-Sankyo Europe. Jean-Pierre Bassand reports personal fees from Aspen, outside the submitted work. The other authors report no conflicts of interest.

Additional information

Funding

The GARFIELD-AF registry is sponsored by the Thrombosis Research Institute, London, UK, and is supported by an unrestricted research grant from Bayer AG, Berlin, Germany.