Stroke prevention in patients from Latin American countries with non‐valvular atrial fibrillation: Insights from the GARFIELD‐AF registry

• Published in: Clinical cardiology (Mahwah, N.J.) Vol. 42; no. 5; pp. 553 - 560
• Main Authors: Jerjes‐Sanchez, Carlos, Corbalan, Ramon, Barretto, Antonio C. P., Luciardi, Hector L., Allu, Jagan, Illingworth, Laura, Pieper, Karen S., Kayani, Gloria
• Format: Journal Article
• Language: English
• Published: New York Wiley Periodicals, Inc 01-05-2019; John Wiley & Sons, Inc
• Subjects: Aged; Anticoagulants; Anticoagulants - administration & dosage; Anticoagulants - adverse effects; antithrombotic treatment; atrial fibrillation; Atrial Fibrillation - diagnosis; Atrial Fibrillation - drug therapy; Atrial Fibrillation - mortality; Cardiac arrhythmia; Clinical Investigations; Drug Prescriptions; Drug Utilization; Female; Hemorrhage - chemically induced; Humans; Latin American; Male; Mexico - epidemiology; Middle Aged; outcomes; Practice Patterns, Physicians; Prospective Studies; Registries; Retrospective Studies; Risk Factors; South America - epidemiology; Stroke; Stroke - diagnosis; Stroke - mortality; Stroke - prevention & control; Treatment Outcome; South America; Mexico; Chile; Argentina; atrial fibrillation; outcomes; Latin American; antithrombotic treatment
• ISSN: 0160-9289; 1932-8737
• DOI: 10.1002/clc.23176

Background
Atrial fibrillation (AF) is an important preventable cause of stroke. Anticoagulation (AC) therapy can reduce this risk. However, prescribing patterns and outcomes in patients with non‐valvular AF (NVAF) from Latin American countries are poorly described.
Methods
Using data from the Global Anticoagulant Registry in the FIELD‐AF (GARFIELD‐AF), we examined the stroke prevention strategies and the 1‐year outcomes in patients from four Latin American countries: Argentina, Brazil, Chile, and Mexico.
Results
A total of 4162 patients (2010‐2014) were included in this analysis. At the time of AF diagnosis, 39.9% of patients were prescribed vitamin K antagonists (VKA) ± antiplatelet (AP) therapy, 21.8% non‐VKA oral anticoagulant (NOAC) ± AP, 24.1% AP only and 14.1% no antithrombotic treatment. The proportion of moderate‐high risk patients receiving no AC therapy at participating centers was highest in Mexico (46.4%) and lowest in Chile (14.3%). During 1‐year follow‐up, the rates of all‐cause mortality, stroke/SE and major bleeding were: 5.77 (95% CI) (5.06‐6.56), 1.58 (1.23‐2.02), and 0.99 (0.72‐1.36) and per 100 person‐years, respectively, which are higher than the global rates across all countries in GARFIELD‐AF. Unadjusted rates of all‐cause mortality were highest in Argentina, 6.95 (5.43‐8.90), and lowest in Chile, 4.01 (2.92‐5.52).
Conclusions
GARFIELD‐AF results describes the marked variation in the baseline characteristics and patterns of antithrombotic treatments in patients with NVAF in four Latin American countries. Over one‐third of patients with a moderate‐to‐high risk of stroke received no AC therapy, highlighting the need for improved management of patients according to national guideline.
Clinical Trial Registration—URL
http://www.clinicaltrials.gov. Unique identifier: NCT01090362.