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Middle East Treatment Strategies and Clinical Outcomes in Patients with Atrial Fibrillation: One-Year Follow-up Data from Garfield-AF Study

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Abstract

Introduction

The Global Anticoagulant Registry in the FIELD–Atrial Fibrillation (GARFIELD-AF) aims to determine real-life treatment patterns and clinical outcomes of patients with newly diagnosed non-valvular atrial fibrillation (AF) and at least one investigator-determined risk factor for stroke. The registry includes a wide array of baseline characteristics and has a particular focus on: (1) bleeding and thromboembolic events; (2) international normalized ratio fluctuations; and (3) therapy compliance and persistence patterns.

Methods

Evolution in baseline treatment for patients enrolled in sequential cohorts showed an increase in prescribing of novel oral anticoagulants over time. Variability in novel oral anticoagulant prescription is primarily due to differences in availability of treatment and prescribing habits between countries and care settings. The GARFIELD-AF registry also provides insights into clinical management and related outcomes of AF in Middle East populations.

Results

A total of 1660 patients with non-valvular AF (median age 64.0 years, interquartile range 56.0–72.0), mostly diagnosed in cardiology settings from Egypt, the United Arab Emirates and Turkey, were recruited in cohorts 3–5. Data from patient populations in the Middle East related to the rates of stroke/systemic embolism, major bleeding and all-cause mortality 1 year after diagnosis of AF and treatment strategies, based on the stroke and bleeding risk, have been analysed and compared with the rest of the world. The use of antithrombotic treatment in the Middle East was generally higher than the non-Middle East, with increased prescription of antiplatelet therapy (AP) therapy. Appropriate use of Factor Xa inhibitors/direct thrombin inhibitors (DTIs) were 74.4% and Factor Xa/DTI + APs were 70.4% in the overall population, whereas they were 57.1% and 63.6%, respectively, in the Middle East.

Conclusion

We have found that rates of stroke and bleeding were lower, although mortality was higher, in the Middle East population. This paper describes the baseline characteristics, patterns of antithrombotic treatment and 1-year outcomes in Middle East AF patients.

Trial Registration

http://www.clinicaltrials.gov. Identifier, NCT01090362.

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References

  1. Lloyd-Jones DM, Wang TJ, Leip EP, et al. Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation. 2004;110(9):1042–6.

    Article  Google Scholar 

  2. Hindricks G, Potpara T, Dagres N, et al. ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2020. https://doi.org/10.1093/eurheartj/ehaa612.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham study. Stroke. 1991;22(8):983–8.

    Article  CAS  Google Scholar 

  4. Vidaillet H, Granada JF, Chyou P, et al. A population-based study of mortality among patients with atrial fibrillation or flutter. Am J Med. 2002;113(5):365–70.

    Article  Google Scholar 

  5. Jorgensen HS, Nakayama H, Reith J, Raaschou HO, Olsen TS. Acute stroke with atrial fibrillation. The Copenhagen Stroke Study. Stroke. 1996;27(10):1765–9.

    Article  CAS  Google Scholar 

  6. Kannel WB, Wolf PA, Benjamin EJ, Levy D. Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol. 1998;82(8a):2n–9n.

    Article  CAS  Google Scholar 

  7. Camm AJ, Lip GY, De Caterina R, et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J. 2012;33(21):2719–47.

    Article  Google Scholar 

  8. Hart RG, Benavente O, McBride R, Pearce LA. Antithrombotic therapy to prevent stroke in patients with atrial fibrillation: a meta-analysis. Ann Intern Med. 1999;131(7):492–501.

    Article  CAS  Google Scholar 

  9. Coppens M, Eikelboom JW, Hart RG, et al. The CHA2DS2-VASc score identifies those patients with atrial fibrillation and a CHADS2 score of 1 who are unlikely to benefit from oral anticoagulant therapy. Eur Heart J. 2013;34(3):170–6.

    Article  CAS  Google Scholar 

  10. Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010;138(5):1093–100.

    Article  Google Scholar 

  11. Fox KAA, Lucas JE, Pieper KS, et al. Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation. BMJ Open. 2017;7(12):e017157.

    Article  Google Scholar 

  12. Mazurek M, Huisman MV, Rothman KJ, et al. Regional differences in antithrombotic treatment for atrial fibrillation: insights from the GLORIA-AF phase II Registry. Thromb Haemost. 2017;117(12):2376–88.

    Article  Google Scholar 

  13. Lip G, Freedman B, De Caterina R, Potpara TS. Stroke prevention in atrial fibrillation: past, present and future. Comparing the guidelines and practical decision-making. Thromb Haemost. 2017;117(7):1230–9.

    Article  Google Scholar 

  14. Lip GYH, Brechin CM, Lane DA. The global burden of atrial fibrillation and stroke: a systematic review of the epidemiology of atrial fibrillation in regions outside North America and Europe. Chest. 2012;142(6):1489–98.

    Article  Google Scholar 

  15. Lip GYH, Skjoth F, Nielsen PB, Kjaeldgaard JN, Larsen TB. Effectiveness and safety of standard-dose nonvitamin K antagonist oral anticoagulants and warfarin among patients with atrial fibrillation with a single stroke risk factor: a nationwide cohort study. JAMA Cardiol. 2017;2(8):872–81.

    Article  Google Scholar 

  16. Alshamkhani W, Ayetey H, Lip YHG. Atrial fibrillation in the Middle East: unmapped, underdiagnosed, undertreated. Expert Rev Cardiovasc Ther. 2018;16:341–84.

    Article  CAS  Google Scholar 

  17. Kakkar A, Mueller I, Bassand JP, Fitzmaurice DA, Goldhaber SZ, Goto S, Haas S, Hacke W, Lip GY, Mantovani LG, Verheugt FW, Jamal W, Misselwitz F, Rushton-Smith S, Turpie AG. International longitudinal registry of patients with atrial fibrillation at risk of stroke: Global Anticoagulant Registry in the FIELD (GARFIELD). Am Heart J. 2012;163:13-19.e11.

    Article  Google Scholar 

  18. Fox KAA, Gersh BJ, Traore S, et al. Evolving quality standards for large-scale registries: the GARFIELD-AF experience. Eur Heart J Qual Care Clin Outcomes. 2017;3(2):114–22.

    PubMed  Google Scholar 

  19. Zubaid M, Rashed WA, Alsheikh-Ali AA, et al. Gulf Survey of Atrial Fibrillation Events (Gulf SAFE): design and baseline characteristics of patients with atrial fibrillation in the Arab Middle East. Circ Cardiovasc Qual Outcomes. 2011;4(4):477–82.

    Article  Google Scholar 

  20. Yavuz B, Ata N, Oto E, et al. Demographics, treatment and outcomes of atrial fibrillation in a developing country: the population-based TuRkish Atrial Fibrillation (TRAF) cohort. Europace. 2017;19(5):734–40.

    Article  Google Scholar 

  21. Li YG, Miyazawa K, Wolff A, et al. One-year risks of stroke and mortality in patients with atrial fibrillation from different clinical settings: the Gulf SAFE registry and Darlington AF registry. Int J Cardiol. 2019;274:158–62.

    Article  Google Scholar 

  22. Apostolakis S, Zubaid M, Rashed WA, et al. Assessment of stroke risk in Middle Eastern patients with atrial fibrillation: the Gulf SAFE Registry. Int J Cardiol. 2013;168(2):1644–6.

    Article  CAS  Google Scholar 

  23. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace. 2016;18(11):1609–78.

    Article  Google Scholar 

  24. Miyazawa K, Li YG, Rashed WA, et al. Secondary stroke prevention and guideline adherent antithrombotic treatment in patients with atrial fibrillation: insights from the Gulf Survey of atrial fibrillation events (Gulf SAFE). Int J Cardiol. 2019;274:126–31.

    Article  Google Scholar 

  25. Al-Shamkhani W, Ayetey H, Lip GYH. Atrial fibrillation in the Middle East: unmapped, underdiagnosed, undertreated. Expert Rev Cardiovasc Ther. 2018;16(5):341–8.

    Article  CAS  Google Scholar 

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Acknowledgements

This study also carried out on behalf of GARFIELD-AF investigators*. We thank the physicians, nurses, and patients involved in GARFIELD-AF. Editorial support was provided by Saverio Virdone (TRI, London, UK).

Funding

This work was supported by an unrestricted research grant from Bayer AG (Berlin, Germany) to the Thrombosis Research Institute (London, UK). The funding source had no involvement in the data collection, data analysis, or data interpretation.

No funding or sponsorship was received for this study or publication of this article. The Rapid Service Fee was funded by the authors.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Authorship Contributions

Begum Yetis Sayin , Wael Al Mahmeed , Hany Ibrahim Ragy, Atef Elbahry, Saverio Virdone, Ajay K. Kakkar, Murat Ersanlı and Ali Oto contributed to the study design. Begum Yetis Sayin , Wael Al Mahmeed , Hany Ibrahim Ragy, Atef Elbahry, Saverio Virdone, Ajay K. Kakkar, Murat Ersanlı and Ali Oto contributed to data acquisition. Saverio Virdone analysed the data. All authors contributed to data interpretation. All authors critically reviewed the report and approved the final manuscript.

Disclosures

Begum Yetis Sayin , Wael Al Mahmeed , Hany Ibrahim Ragy, Atef Elbahry, Murat Ersanlı and Ali Oto have nothing to disclose. Saverio Virdone has no direct competing interests but has received sponsorship or consulted for companies with an interest in anticoagulation including Bayer, BI and Pfizer.

Compliance with Ethics Guidelines

All patients provided written informed consent to participate. Independent ethics committee and hospital-based institutional review board approvals were obtained, as necessary, for the registry protocol (protocol number: TRI08888, project code: IPAA4663). The registry is conducted in accordance with the Declaration of Helsinki and guidelines from the International Conference on Harmonisation on Good Clinical Practice and Good Pharmaco-epidemiological Practice, and adheres to all applicable national laws and regulations.

Data Availability

All relevant data are within the paper/as supplementary information files. The datasets generated during the current study are not expected to be made publicly available as participant consent forms and ethics approval did not include permission for secondary use, with access to data only approved for researchers involved in the analysis.

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Authors and Affiliations

  1. Department of Cardiology, Memorial Ankara Hospital, Ankara, Turkey

    Begum Yetis Sayin & Ali Oto

  2. Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, UAE

    Wael Al Mahmeed

  3. National Heart Institute, Ministry of Health, Giza, Egypt

    Hany Ibrahim Ragy

  4. Cardiology Unit, Port Fouad Centre, Port Fouad, Egypt

    Atef Elbahry

  5. Thrombosis Research Institute, London, UK

    Saverio Virdone

  6. Department of Clinical Research, Thrombosis Research Institute (TRI), London, UK

    Ajay K. Kakkar

  7. Department of Cardiology, Institute of Cardiology, Istanbul University, Istanbul, Turkey

    Murat Ersanlı

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  1. Begum Yetis Sayin
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Corresponding author

Correspondence to Begum Yetis Sayin.

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Sayin, B.Y., Al Mahmeed, W., Ragy, H.I. et al. Middle East Treatment Strategies and Clinical Outcomes in Patients with Atrial Fibrillation: One-Year Follow-up Data from Garfield-AF Study. Adv Ther 38, 2391–2405 (2021). https://doi.org/10.1007/s12325-021-01670-5

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