Changes in anticoagulant prescription in Dutch patients with recent-onset atrial fibrillation: observations from the GARFIELD-AF registry

J Seelig,On Behalf Of The Garfield-Af Investigators ,A Lucassen,M Pieterse,K Pieper,J P R Herrman,L Illingworth,P Hoogslag,W Hermans,H Ten Cate,L V A Boersma,B E Groenemeijer,F W A Verheugt,H Adriaansen,M E W Hemels,M C M Bongaerts

doi:10.1186/s12959-020-00218-x

Abstract

BackgroundFor the improvement of AF care, it is important to gain insight into current anticoagulation prescription practices and guideline adherence. This report focuses on the largest Dutch subset of AF-patients, derived from the GARFIELD-AF registry.MethodsAcross 35 countries worldwide, patients with newly diagnosed ‘non-valvular’ atrial fibrillation (AF) with at least one additional risk factor for stroke were included. Dutch patients were enrolled in five, independent, consecutive cohorts from 2010 until 2016.ResultsIn the Netherlands, 1189 AF-patients were enrolled. The prescription of non-vitamin K antagonist oral anticoagulants (NOAC) has increased sharply, and as per 2016, more patients were initiated on NOACs instead of vitamin K antagonists (VKA). In patients with a class I recommendation for anticoagulation, only 7.5% compared to 30.0% globally received no anticoagulation. Reasons for withholding anticoagulation in these patients were unfortunately often unclear.ConclusionsThe data from the GARFIELD-AF registry shows the rapidly changing anticoagulation preference of Dutch physicians in newly diagnosed AF. Adherence to European AF guidelines in terms of anticoagulant regimen would appear to be appropriate. In absence of structured follow up of AF patients on NOAC, the impact of these rapid practice changes in anticoagulation prescription in the Netherlands remains to be established.

Highlights

In the Netherlands, atrial fibrillation (AF) patients on vitamin K antagonist (VKA) therapy are routinely managed by specialized anticoagulation clinics
It is important that AF guidelines are adhered to, as non-adherence is associated with increased ischemic stroke and mortality rates [8, 9]
In the Netherlands, 1189 patients were enrolled, making it the largest Dutch AF-cohort available to date. This manuscript provides a unique insight in the rapid changes in anticoagulation management of novel AF, which had not been described since the introduction of the non-vitamin K antagonist oral anticoagulants (NOAC) in the Netherlands

Summary

Introduction

In the Netherlands, AF patients on vitamin K antagonist (VKA) therapy are routinely managed by specialized anticoagulation clinics. It is important to monitor anticoagulation prescription trends for AF in the Netherlands, which are currently unknown This will give insights in how to further improve our AF care. In subjects with AF the ischemic stroke rate will rise, primarily due to ageing and an increase in patients with multiple morbidities [5,6,7]. This increases health-care related costs and reduces quality of life. To minimise these aspects, it is important that AF guidelines are adhered to, as non-adherence is associated with increased ischemic stroke and mortality rates [8, 9]. This report focuses on the largest Dutch subset of AF-patients, derived from the GARFIELD-AF registry

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Discussion

Conclusion