Baseline data from the first cohort of the GARFIELD registry (Global anticoagulant registry in the field) shows that established, evidence-based guidelines for preventing stroke in patients with atrial fibrillation (AF) are not being followed in many patients and across diverse populations.
Data from the GARFIELD registry described AF management in everyday clinical practice, highlighting unmet needs and challenges in the use of anticoagulation. The data presented at the European Society of Cardiology (ESC) Congress (Munich, Germany, 25–29 August) assessed practice patterns based on region, gender, age, renal function, AF type and the presence of acute coronary syndrome (ACS). The findings showed that anticoagulant therapy, particularly vitamin K antagonists (VKA), are under-prescribed for AF patients at high risk for stroke, while overused in patients with a very low risk for stroke.
GARFIELD is led by an international steering committee under the auspices of the Thrombosis Research Institute (TRI). It is an international, observational, multicentre, prospective study of men and women designed to understand the global burden of AF.
AF-related stroke remains a major and increasing clinical and societal burden despite the availability of effective preventive treatment. GARFIELD provides holistic new insights into unmet needs and challenges in AF management, identifying potential opportunities to improve patient care.
“Anticoagulant therapy is known to significantly lower the high risk for stroke associated with AF, yet GARFIELD data suggest that global treatment practices are not reflecting clinical trial evidence and current treatment guidelines,” said Ajay Kakkar, director of the TRI, and professor of Surgery, University College London, UK. “GARFIELD is the largest global disease registry that will provide the most complete view of how stroke risk is managed in AF. By understanding current treatment patterns in everyday clinical practice, we can improve disease management and highlight opportunities for appropriate adoption of innovative strategies for stroke prevention.”
The first of five GARFIELD cohorts included 10,537 patients from 19 countries with non-valvular AF with at least one additional risk factor for stroke. ESC treatment guidelines recommend that all patients at high-risk of stroke be prescribed anticoagulation therapy with VKAs, unless contraindicated with complications. High stroke risk is defined as a score >/=2 on the CHADS2 or CHA2DS2-VASc risk score. In Cohort 1, 57.1% of patients had CHADS2 score >/=2 and 82.6% of patients had CHA2DS2-VASc >/=2.
Of the 6,008 cohort 1 patients with CHADS2>/=2, only 62.2% received anticoagulant therapy, whilst only 53.1% of the 3,669 patients with CHADS2=1 were treated with anticoagulants.
“The first cohort of GARFIELD shows that more than one in three patients with atrial fibrillation who are at high risk for stroke is not prescribed the anticoagulant therapies known to prevent a stroke,” said Sylvia Haas, emeritus professor of medicine, former director of the Haemostasis and Thrombosis Research Group at the Institute for Experimental Oncology and Therapy Research, Technical University of Munich. “This year’s baseline data at ESC are showing a similar, concerning treatment pattern across a wide range of at-risk subpopulations. As we continue this prospective study, we will have a clearer picture of the patient outcomes associated with these real-world treatment practices.”
TRI will present the first 12-month follow-up outcomes data from the GARFIELD registry at the upcoming American Heart Association’s Scientific Sessions 2012 in Los Angeles, USA. Recruitment for the second cohort of the GARFIELD registry began on 5 October 2011. Baseline data from this cohort also will be available later this year.
The GARFIELD registry is an observational, multicenter study of men and women with newly diagnosed AF and one or more additional risk factors for stroke. It will prospectively follow 50,000 newly-diagnosed AF patients from at least 1,000 centres in 50 countries in the Americas, Eastern and Western Europe, Asia, Africa and Australia.
GARFIELD is the largest prospective registry of patients with AF at risk of stroke. It seeks to describe the real-life burden of this disease, providing insights into the impact of thromboembolic and bleeding complications, antithrombotic treatment patterns and potential opportunities for improving clinical outcomes amongst a representative and diverse group of patients. This should help physicians and healthcare systems appropriately adopt innovation to ensure the best outcomes for patients and populations.