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GLORIA-AF Registry: non-valvular atrial fibrillation patients at high risk of stroke may be undertreated

The results from two analyses of the GLORIA-AF Registry Program examining the use of antithrombotic treatment to reduce the risk of stroke for patients with non-valvular atrial fibrillation ( NVAF ) were presented.
The new findings are the first reported prescribing patterns data from phase II of the GLORIA-AF Registry Program.

Results from one analysis demonstrated 21.9% of patients with paroxysmal non-valvular atrial fibrillation 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 non-valvular atrial fibrillation, respectively, and a CHA2DS2-VASc score of 2 or higher.
Current non-valvular atrial fibrillation guidelines call for a choice of antithrombotic therapy based on patients' risk of stroke or thromboembolism and bleeding, rather than the type of non-valvular atrial fibrillation.

A second analysis showed that a considerable number of new-onset non-valvular atrial fibrillation patients with a CHA2DS2-VASc score of 2 or higher received Aspirin alone or went untreated ( age 64 or younger, 20.6%; age 65-74, 19.7%; age 75-79, 15.6%; age 80 or older, 17.6% ).
Newer drugs known as novel oral anticoagulants ( NOACs ) accounted for 52.1% of anticoagulants prescribed ( 25.0% Dabigatran [ Pradaxa ], 20.5% Rivaroxaban [ Xarelto ], and 6.6% Apixaban [ Eliquis ] ).
The most frequently prescribed oral anticoagulants in patients with a CHA2DS2-VASc score of 2 or higher were vitamin K antagonists ( VKAs, e.g., Warfarin [ Coumadin ] ), especially among elderly and very elderly patients ( age 64 or younger, 27.9%; age 65-74, 24.7%; age 75-79, 27.9%; age 80 or older, 31.7% ).

The data are 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 non-valvular atrial fibrillation, and 86.2% had a CHA2DS2-VASc score of 2 or higher.
Non-valvular atrial fibrillation accounts for up to 95% of atrial fibrillation cases in the U.S.

GLORIA-AF is a global Registry Program run in different phases and designed to characterize the population of newly diagnosed patients with non-valvular atrial fibrillation at risk for stroke, and to study patterns, predictors and outcomes of different treatment regimens for stroke prevention.
Patient characteristics, clinical usage patterns and patient outcomes of anticoagulation therapy will be documented in up to 56,000 patients in 2,200 sites and more than 50 countries throughout the world.
The current analyses are based on a pre-specified interim analysis which includes the baseline data from the first 10,000 patients enrolled in GLORIA-AF phase II from five defined geographical regions. ( Xagena )

Source: American College of Cardiology 64th Annual Scientific Session, 2015