Guideline-directed medical therapies for comorbidities among patients with atrial fibrillation: results from GARFIELD-AF

AIMS: This study aimed to identify relationships in recently diagnosed atrial fibrillation (AF) patients with respect to anticoagulation status, use of guideline-directed medical therapy (GDMT) for comorbid cardiovascular conditions (co-GDMT), and clinical outcomes. The Global Anticoagulant Registry...

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Autores principales: Camm, Alan John, Steffel, Jan, Virdone, Saverio, Bassand, Jean-Pierre, Fox, Keith A A, Goldhaber, Samuel Z, Goto, Shinya, Haas, Sylvia, Turpie, Alexander G G, Verheugt, Freek W A, Misselwitz, Frank, Herreros, Ramón Corbalán, Kayani, Gloria, Pieper, Karen S, Kakkar, Ajay K
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10246824/
https://www.ncbi.nlm.nih.gov/pubmed/37293139
http://dx.doi.org/10.1093/ehjopen/oead051
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author Camm, Alan John
Steffel, Jan
Virdone, Saverio
Bassand, Jean-Pierre
Fox, Keith A A
Goldhaber, Samuel Z
Goto, Shinya
Haas, Sylvia
Turpie, Alexander G G
Verheugt, Freek W A
Misselwitz, Frank
Herreros, Ramón Corbalán
Kayani, Gloria
Pieper, Karen S
Kakkar, Ajay K
author_facet Camm, Alan John
Steffel, Jan
Virdone, Saverio
Bassand, Jean-Pierre
Fox, Keith A A
Goldhaber, Samuel Z
Goto, Shinya
Haas, Sylvia
Turpie, Alexander G G
Verheugt, Freek W A
Misselwitz, Frank
Herreros, Ramón Corbalán
Kayani, Gloria
Pieper, Karen S
Kakkar, Ajay K
author_sort Camm, Alan John
collection PubMed
description AIMS: This study aimed to identify relationships in recently diagnosed atrial fibrillation (AF) patients with respect to anticoagulation status, use of guideline-directed medical therapy (GDMT) for comorbid cardiovascular conditions (co-GDMT), and clinical outcomes. The Global Anticoagulant Registry in the FIELD (GARFIELD)-AF is a prospective, international registry of patients with recently diagnosed non-valvular AF at risk of stroke (NCT01090362). METHODS AND RESULTS: Guideline-directed medical therapy was defined according to the European Society of Cardiology guidelines. This study explored co-GDMT use in patients enrolled in GARFIELD-AF (March 2013–August 2016) with CHA(2)DS(2)-VASc ≥ 2 (excluding sex) and ≥1 of five comorbidities—coronary artery disease, diabetes mellitus, heart failure, hypertension, and peripheral vascular disease (n = 23 165). Association between co-GDMT and outcome events was evaluated with Cox proportional hazards models, with stratification by all possible combinations of the five comorbidities. Most patients (73.8%) received oral anticoagulants (OACs) as recommended; 15.0% received no recommended co-GDMT, 40.4% received some, and 44.5% received all co-GDMT. At 2 years, comprehensive co-GDMT was associated with a lower risk of all-cause mortality [hazard ratio (HR) 0.89 (0.81–0.99)] and non-cardiovascular mortality [HR 0.85 (0.73–0.99)] compared with inadequate/no GDMT, but cardiovascular mortality was not significantly reduced. Treatment with OACs was beneficial for all-cause mortality and non-cardiovascular mortality, irrespective of co-GDMT use; only in patients receiving all co-GDMT was OAC associated with a lower risk of non-haemorrhagic stroke/systemic embolism. CONCLUSION: In this large prospective, international registry on AF, comprehensive co-GDMT was associated with a lower risk of mortality in patients with AF and CHA(2)DS(2)-VASc ≥ 2 (excluding sex); OAC therapy was associated with reduced all-cause mortality and non-cardiovascular mortality, irrespective of co-GDMT use. CLINICAL TRIAL REGISTRATION: Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362.
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spelling pubmed-102468242023-06-08 Guideline-directed medical therapies for comorbidities among patients with atrial fibrillation: results from GARFIELD-AF Camm, Alan John Steffel, Jan Virdone, Saverio Bassand, Jean-Pierre Fox, Keith A A Goldhaber, Samuel Z Goto, Shinya Haas, Sylvia Turpie, Alexander G G Verheugt, Freek W A Misselwitz, Frank Herreros, Ramón Corbalán Kayani, Gloria Pieper, Karen S Kakkar, Ajay K Eur Heart J Open Original Article AIMS: This study aimed to identify relationships in recently diagnosed atrial fibrillation (AF) patients with respect to anticoagulation status, use of guideline-directed medical therapy (GDMT) for comorbid cardiovascular conditions (co-GDMT), and clinical outcomes. The Global Anticoagulant Registry in the FIELD (GARFIELD)-AF is a prospective, international registry of patients with recently diagnosed non-valvular AF at risk of stroke (NCT01090362). METHODS AND RESULTS: Guideline-directed medical therapy was defined according to the European Society of Cardiology guidelines. This study explored co-GDMT use in patients enrolled in GARFIELD-AF (March 2013–August 2016) with CHA(2)DS(2)-VASc ≥ 2 (excluding sex) and ≥1 of five comorbidities—coronary artery disease, diabetes mellitus, heart failure, hypertension, and peripheral vascular disease (n = 23 165). Association between co-GDMT and outcome events was evaluated with Cox proportional hazards models, with stratification by all possible combinations of the five comorbidities. Most patients (73.8%) received oral anticoagulants (OACs) as recommended; 15.0% received no recommended co-GDMT, 40.4% received some, and 44.5% received all co-GDMT. At 2 years, comprehensive co-GDMT was associated with a lower risk of all-cause mortality [hazard ratio (HR) 0.89 (0.81–0.99)] and non-cardiovascular mortality [HR 0.85 (0.73–0.99)] compared with inadequate/no GDMT, but cardiovascular mortality was not significantly reduced. Treatment with OACs was beneficial for all-cause mortality and non-cardiovascular mortality, irrespective of co-GDMT use; only in patients receiving all co-GDMT was OAC associated with a lower risk of non-haemorrhagic stroke/systemic embolism. CONCLUSION: In this large prospective, international registry on AF, comprehensive co-GDMT was associated with a lower risk of mortality in patients with AF and CHA(2)DS(2)-VASc ≥ 2 (excluding sex); OAC therapy was associated with reduced all-cause mortality and non-cardiovascular mortality, irrespective of co-GDMT use. CLINICAL TRIAL REGISTRATION: Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362. Oxford University Press 2023-05-19 /pmc/articles/PMC10246824/ /pubmed/37293139 http://dx.doi.org/10.1093/ehjopen/oead051 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Original Article
Camm, Alan John
Steffel, Jan
Virdone, Saverio
Bassand, Jean-Pierre
Fox, Keith A A
Goldhaber, Samuel Z
Goto, Shinya
Haas, Sylvia
Turpie, Alexander G G
Verheugt, Freek W A
Misselwitz, Frank
Herreros, Ramón Corbalán
Kayani, Gloria
Pieper, Karen S
Kakkar, Ajay K
Guideline-directed medical therapies for comorbidities among patients with atrial fibrillation: results from GARFIELD-AF
title Guideline-directed medical therapies for comorbidities among patients with atrial fibrillation: results from GARFIELD-AF
title_full Guideline-directed medical therapies for comorbidities among patients with atrial fibrillation: results from GARFIELD-AF
title_fullStr Guideline-directed medical therapies for comorbidities among patients with atrial fibrillation: results from GARFIELD-AF
title_full_unstemmed Guideline-directed medical therapies for comorbidities among patients with atrial fibrillation: results from GARFIELD-AF
title_short Guideline-directed medical therapies for comorbidities among patients with atrial fibrillation: results from GARFIELD-AF
title_sort guideline-directed medical therapies for comorbidities among patients with atrial fibrillation: results from garfield-af
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10246824/
https://www.ncbi.nlm.nih.gov/pubmed/37293139
http://dx.doi.org/10.1093/ehjopen/oead051
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