Risk profile, antithrombotic treatment and clinical outcomes of patients in Nordic countries with atrial fibrillation: results from the GARFIELD-AF registry

Marita Knudsen Pope, Dan Atar*, Arne Svilaas, Torstein Hole, Jørn Dalsgaard Nielsen, Ulrik Hintze, Milita Crisby, Pekka Raatikainen, K. E. Juhani Airaksinen, Saverio Virdone, Karen Pieper, Gloria Kayani, Jean Yves Le Heuzey, Jan Steffel, Janina Stepinska, Jean Pierre Bassand, A. John Camm, for the GARFIELD-AF Investigators

*Corresponding author for this work

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Abstract

Aims: The objective was to evaluate the clinical characteristics, management and two-year outcomes of patients with newly diagnosed non-valvular atrial fibrillation at risk for stroke in Nordic countries. Methods: We examined the baseline characteristics, antithrombotic treatment, and two-year clinical outcomes of patients from four Nordic countries. Results: A total of 52,080 patients were enrolled in the GARFIELD-AF. Out of 29,908 European patients, 2,396 were recruited from Nordic countries. The use of oral anticoagulants, alone or in combination with antiplatelet (AP), was higher in Nordic patients in all CHA2DS2-VASc categories: 0–1 (72.8% vs 60.3%), 2–3 (78.7% vs 72.9%) and ≥4 (79.2% vs 74.1%). In Nordic patients, NOAC ± AP was more frequently prescribed (32.0% vs 27.7%) and AP monotherapy was less often prescribed (10.4% vs 18.2%) when compared with Non-Nordic European patients. The rates (per 100 patient years) of all-cause mortality and non-haemorrhagic stroke/systemic embolism (SE) were similar in Nordic and Non-Nordic European patients [3.63 (3.11–4.23) vs 4.08 (3.91–4.26), p value =.147] and [0.98 (0.73–1.32) vs 1.02 (0.93–1.11), p value =.819], while major bleeding was significantly higher [1.66 (1.32–2.09) vs 1.01 (0.93–1.10), p value <.001]. Conclusion: Nordic patients had significantly higher major bleeding than Non-Nordic-European patients. In contrast, rates of all-cause mortality and non-haemorrhagic stroke/SE were comparable. Clinical Trial Registration: Unique identifier: NCT01090362. URL: http://www.clinicaltrials.gov. Key Message: Nordic countries had significantly higher major bleeding than Non-Nordic-European countries. Rates of mortality and non-haemorrhagic stroke/SE were similar.

Original languageEnglish
JournalAnnals of Medicine
Volume53
Issue number1
Pages (from-to)485-494
ISSN0785-3890
DOIs
Publication statusPublished - Apr 2021
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Keywords

  • antithrombotic treatment
  • Atrial fibrillation
  • Nordic countries
  • stroke prevention
  • Prospective Studies
  • Platelet Aggregation Inhibitors/therapeutic use
  • Humans
  • Middle Aged
  • Fibrinolytic Agents/therapeutic use
  • Male
  • Embolism/epidemiology
  • Cause of Death
  • Scandinavian and Nordic Countries/epidemiology
  • Drug Prescriptions/statistics & numerical data
  • Europe/epidemiology
  • Aged, 80 and over
  • Female
  • Registries
  • Drug Therapy, Combination
  • Risk Factors
  • Treatment Outcome
  • Anticoagulants/therapeutic use
  • Stroke/epidemiology
  • Aged
  • Atrial Fibrillation/complications

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