ACC: NVAF patients at high risk for stroke may be undertreated

Many nonvalvular atrial fibrillation (NVAF) patients at high risk for stroke may be undertreated, according to poster presentation sessions at the American College of Cardiology (ACC) 64^th Annual Scientific Session in San Diego, Calif.

Boehringer Ingelheim presented results from 2 analyses of the GLORIA-AF Registry Program examining the use of antithrombotic treatment to reduce the risk of stroke for patients with NVAF. The findings come from the GLORIA-AF study, a 3-phase global registry program designed to characterize the population of newly diagnosed patients with NVAF at risk for stroke, and to study patterns, predictors and outcomes of different treatment regimens for stroke prevention. The new findings are the first reported prescribing patterns data from phase 2 of the GLORIA-AF Registry Program.

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The data presented is based on treatment trends in 3,415 patients who entered the GLORIA-AF registry from November 2011 to February 2014 in North America. All patients had a recent diagnosis of NVAF, and 86.2 percent had a CHA₂DS₂-VASc score of 2 or higher.

Dr Halperin“The two analyses suggest that despite available new treatment options for NVAF, some patients at high risk of stroke are undertreated or receive no treatment,” said Jonathan L. Halperin, MD, the Robert and Harriet Heilbrunn Professor of Medicine at Mount Sinai School of Medicine, and member of the GLORIA-AF steering committee. “Ongoing studies of factors that contribute to prescribing patterns for NVAF patients, like GLORIA-AF, provide valuable information about the use of available treatments in clinical practice.”

While clinical practice guidelines call for patients to receive antithrombotic therapy based on their risk of stroke or thromboembolism and bleeding, rather than the type of atrial fibrillation, 21.9% of patients with new-onset paroxysmal (occasional) NVAF and a CHA₂DS₂-VASc score of 2 or higher were not given an oral anticoagulant medication, compared to 12.4% and 11.2% of those diagnosed with persistent or permanent NVAF, respectively, and a CHA₂DS₂-VASc score of 2 or higher.

Results from the first analysis demonstrated that patients with the paroxysmal (occasional) form of NVAF and at a high risk for stroke (CHA₂DS₂-VASc score of 2 or higher) were given an anticoagulant medication less often than those with persistent or permanent forms of NVAF and a CHA₂DS₂-VASc score of 2 or higher. This pattern runs counter to NVAF guidelines which recommend that patients receive antithrombotic therapy based on their risk of stroke or thromboembolism and bleeding, rather than the type of atrial fibrillation.

In the second analysis, researchers found that despite high stroke risk, a considerable number of patients receive only aspirin or no medication. The analysis showed that a considerable number of new-onset NVAF patients with a CHA₂DS₂-VASc score of 2 or higher received aspirin alone or went untreated (aged 64 years or younger, 20.6%; aged 65 to 74 years, 19.7%d; age 75 to 79 years, 15.6%; aged 80 years or older, 17.6%). Newer drugs known as novel oral anticoagulants, accounted for 52.1% of anticoagulants prescribed (25.0% dabigatran, 20.5% rivaroxaban, and 6.6% apixaban). The most frequently prescribed oral anticoagulants in patients with a CHA₂DS₂-VASc score of 2 or higher were vitamin K antagonists (VKAs, eg, warfarin), especially among elderly and very elderly patients (aged 64 years or younger, 27.9%; aged 65 to 74 years, 24.7%; aged 75 to 79 years, 27.9%; aged 80 years or older, 31.7%).

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