Patterns of oral anticoagulant use and outcomes in Asian patients with atrial fibrillation: a post-hoc analysis from the GLORIA-AF Registry

Giulio Francesco Romiti; Bernadette Corica; Marco Proietti; Davide Antonio Mei; Juliane Frydenlund; Arnaud Bisson; Giuseppe Boriani; Brian Olshansky; Yi Hsin Chan; Menno V. Huisman; Tze Fan Chao; Gregory Y.H. Lip; Dzifa Wosornu Abban; Nasser Abdul; Atilio Marcelo Abud; Fran Adams; Srinivas Addala; Pedro Adragão; Walter Ageno; Rajesh Aggarwal; Sergio Agosti; Piergiuseppe Agostoni; Francisco Aguilar; Julio Aguilar Linares; Luis Aguinaga; Jameel Ahmed; Allessandro Aiello; Paul Ainsworth; Jorge Roberto Aiub; Raed Al-Dallow; Lisa Alderson; Jorge Antonio Aldrete Velasco; Dimitrios Alexopoulos; Fernando Alfonso Manterola; Pareed Aliyar; David Alonso; Fernando Augusto Alves da Costa; José Amado; Walid Amara; Mathieu Amelot; Nima Amjadi; Fabrizio Ammirati; Marianna Andrade; Nabil Andrawis; Giorgio Annoni; Gerardo Ansalone; M. Kevin Ariani; Juan Carlos Arias; Gershan Davis; David Williams; GLORIA-AF Investigators

doi:10.1016/j.eclinm.2023.102039

Patterns of oral anticoagulant use and outcomes in Asian patients with atrial fibrillation: a post-hoc analysis from the GLORIA-AF Registry

Giulio Francesco Romiti, Bernadette Corica, Marco Proietti, Davide Antonio Mei, Juliane Frydenlund, Arnaud Bisson, Giuseppe Boriani, Brian Olshansky, Yi Hsin Chan, Menno V. Huisman, Tze Fan Chao^*, Gregory Y.H. Lip^*, Dzifa Wosornu Abban, Nasser Abdul, Atilio Marcelo Abud, Fran Adams, Srinivas Addala, Pedro Adragão, Walter Ageno, Rajesh AggarwalSergio Agosti, Piergiuseppe Agostoni, Francisco Aguilar, Julio Aguilar Linares, Luis Aguinaga, Jameel Ahmed, Allessandro Aiello, Paul Ainsworth, Jorge Roberto Aiub, Raed Al-Dallow, Lisa Alderson, Jorge Antonio Aldrete Velasco, Dimitrios Alexopoulos, Fernando Alfonso Manterola, Pareed Aliyar, David Alonso, Fernando Augusto Alves da Costa, José Amado, Walid Amara, Mathieu Amelot, Nima Amjadi, Fabrizio Ammirati, Marianna Andrade, Nabil Andrawis, Giorgio Annoni, Gerardo Ansalone, M. Kevin Ariani, Juan Carlos Arias, Gershan Davis, David Williams, GLORIA-AF Investigators

^*Corresponding author for this work

Research output: Contribution to journal › Article (journal) › peer-review

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Abstract

Background: Previous studies suggested potential ethnic differences in the management and outcomes of atrial fibrillation (AF). We aim to analyse oral anticoagulant (OAC) prescription, discontinuation, and risk of adverse outcomes in Asian patients with AF, using data from a global prospective cohort study. Methods: From the GLORIA-AF Registry Phase II–III (November 2011–December 2014 for Phase II, and January 2014–December 2016 for Phase III), we analysed patients according to their self-reported ethnicity (Asian vs. non-Asian), as well as according to Asian subgroups (Chinese, Japanese, Korean and other Asian). Logistic regression was used to analyse OAC prescription, while the risk of OAC discontinuation and adverse outcomes were analysed through Cox-regression model. Our primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACE). The original studies were registered with ClinicalTrials.gov, NCT01468701, NCT01671007, and NCT01937377. Findings: 34,421 patients were included (70.0 ± 10.5 years, 45.1% females, 6900 (20.0%) Asian: 3829 (55.5%) Chinese, 814 (11.8%) Japanese, 1964 (28.5%) Korean and 293 (4.2%) other Asian). Most of the Asian patients were recruited in Asia (n = 6701, 97.1%), while non-Asian patients were mainly recruited in Europe (n = 15,449, 56.1%) and North America (n = 8378, 30.4%). Compared to non-Asian individuals, prescription of OAC and non-vitamin K antagonist oral anticoagulant (NOAC) was lower in Asian patients (Odds Ratio [OR] and 95% Confidence Intervals (CI): 0.23 [0.22–0.25] and 0.66 [0.61–0.71], respectively), but higher in the Japanese subgroup. Asian ethnicity was also associated with higher risk of OAC discontinuation (Hazard Ratio [HR] and [95% CI]: 1.79 [1.67–1.92]), and lower risk of the primary composite outcome (HR [95% CI]: 0.86 [0.76–0.96]). Among the exploratory secondary outcomes, Asian ethnicity was associated with higher risks of thromboembolism and intracranial haemorrhage, and lower risk of major bleeding. Interpretation: Our results showed that Asian patients with AF showed suboptimal thromboembolic risk management and a specific risk profile of adverse outcomes; these differences may also reflect differences in country-specific factors. Ensuring integrated and appropriate treatment of these patients is crucial to improve their prognosis. Funding: The GLORIA-AF Registry was funded by Boehringer Ingelheim GmbH.

Original language	English
Article number	102039
Pages (from-to)	1-11
Journal	eClinicalMedicine
Volume	63
Early online date	25 Aug 2023
DOIs	https://doi.org/10.1016/j.eclinm.2023.102039
Publication status	Published - 19 Sept 2023

Keywords

Asia
Atrial fibrillation
Ethnic differences
Oral anticoagulant
Outcomes

Research Centres

Cardio-Respiratory Research Centre

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1-s2.0-S258953702300216X-mainFinal published version, 420 KBLicence: CC BY

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Romiti, G. F., Corica, B., Proietti, M., Mei, D. A., Frydenlund, J., Bisson, A., Boriani, G., Olshansky, B., Chan, Y. H., Huisman, M. V., Chao, T. F., Lip, G. Y. H., Abban, D. W., Abdul, N., Abud, A. M., Adams, F., Addala, S., Adragão, P., Ageno, W., ... GLORIA-AF Investigators (2023). Patterns of oral anticoagulant use and outcomes in Asian patients with atrial fibrillation: a post-hoc analysis from the GLORIA-AF Registry. eClinicalMedicine, 63, 1-11. Article 102039. https://doi.org/10.1016/j.eclinm.2023.102039

@article{11f5327e40324060897da83fbfa345f0,

title = "Patterns of oral anticoagulant use and outcomes in Asian patients with atrial fibrillation: a post-hoc analysis from the GLORIA-AF Registry",

abstract = "Background: Previous studies suggested potential ethnic differences in the management and outcomes of atrial fibrillation (AF). We aim to analyse oral anticoagulant (OAC) prescription, discontinuation, and risk of adverse outcomes in Asian patients with AF, using data from a global prospective cohort study. Methods: From the GLORIA-AF Registry Phase II–III (November 2011–December 2014 for Phase II, and January 2014–December 2016 for Phase III), we analysed patients according to their self-reported ethnicity (Asian vs. non-Asian), as well as according to Asian subgroups (Chinese, Japanese, Korean and other Asian). Logistic regression was used to analyse OAC prescription, while the risk of OAC discontinuation and adverse outcomes were analysed through Cox-regression model. Our primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACE). The original studies were registered with ClinicalTrials.gov, NCT01468701, NCT01671007, and NCT01937377. Findings: 34,421 patients were included (70.0 ± 10.5 years, 45.1% females, 6900 (20.0%) Asian: 3829 (55.5%) Chinese, 814 (11.8%) Japanese, 1964 (28.5%) Korean and 293 (4.2%) other Asian). Most of the Asian patients were recruited in Asia (n = 6701, 97.1%), while non-Asian patients were mainly recruited in Europe (n = 15,449, 56.1%) and North America (n = 8378, 30.4%). Compared to non-Asian individuals, prescription of OAC and non-vitamin K antagonist oral anticoagulant (NOAC) was lower in Asian patients (Odds Ratio [OR] and 95% Confidence Intervals (CI): 0.23 [0.22–0.25] and 0.66 [0.61–0.71], respectively), but higher in the Japanese subgroup. Asian ethnicity was also associated with higher risk of OAC discontinuation (Hazard Ratio [HR] and [95% CI]: 1.79 [1.67–1.92]), and lower risk of the primary composite outcome (HR [95% CI]: 0.86 [0.76–0.96]). Among the exploratory secondary outcomes, Asian ethnicity was associated with higher risks of thromboembolism and intracranial haemorrhage, and lower risk of major bleeding. Interpretation: Our results showed that Asian patients with AF showed suboptimal thromboembolic risk management and a specific risk profile of adverse outcomes; these differences may also reflect differences in country-specific factors. Ensuring integrated and appropriate treatment of these patients is crucial to improve their prognosis. Funding: The GLORIA-AF Registry was funded by Boehringer Ingelheim GmbH.",

keywords = "Asia, Atrial fibrillation, Ethnic differences, Oral anticoagulant, Outcomes",

author = "Romiti, {Giulio Francesco} and Bernadette Corica and Marco Proietti and Mei, {Davide Antonio} and Juliane Frydenlund and Arnaud Bisson and Giuseppe Boriani and Brian Olshansky and Chan, {Yi Hsin} and Huisman, {Menno V.} and Chao, {Tze Fan} and Lip, {Gregory Y.H.} and Abban, {Dzifa Wosornu} and Nasser Abdul and Abud, {Atilio Marcelo} and Fran Adams and Srinivas Addala and Pedro Adrag{\~a}o and Walter Ageno and Rajesh Aggarwal and Sergio Agosti and Piergiuseppe Agostoni and Francisco Aguilar and Linares, {Julio Aguilar} and Luis Aguinaga and Jameel Ahmed and Allessandro Aiello and Paul Ainsworth and Aiub, {Jorge Roberto} and Raed Al-Dallow and Lisa Alderson and {Aldrete Velasco}, {Jorge Antonio} and Dimitrios Alexopoulos and Manterola, {Fernando Alfonso} and Pareed Aliyar and David Alonso and {Alves da Costa}, {Fernando Augusto} and Jos{\'e} Amado and Walid Amara and Mathieu Amelot and Nima Amjadi and Fabrizio Ammirati and Marianna Andrade and Nabil Andrawis and Giorgio Annoni and Gerardo Ansalone and Ariani, {M. Kevin} and Arias, {Juan Carlos} and Gershan Davis and David Williams and {GLORIA-AF Investigators}",

note = "{\textcopyright} 2023 The Authors.",

year = "2023",

month = sep,

day = "19",

doi = "10.1016/j.eclinm.2023.102039",

language = "English",

volume = "63",

pages = "1--11",

journal = "eClinicalMedicine",

issn = "2589-5370",

publisher = "Lancet Publishing Group",

}

Romiti, GF, Corica, B, Proietti, M, Mei, DA, Frydenlund, J, Bisson, A, Boriani, G, Olshansky, B, Chan, YH, Huisman, MV, Chao, TF, Lip, GYH, Abban, DW, Abdul, N, Abud, AM, Adams, F, Addala, S, Adragão, P, Ageno, W, Aggarwal, R, Agosti, S, Agostoni, P, Aguilar, F, Linares, JA, Aguinaga, L, Ahmed, J, Aiello, A, Ainsworth, P, Aiub, JR, Al-Dallow, R, Alderson, L, Aldrete Velasco, JA, Alexopoulos, D, Manterola, FA, Aliyar, P, Alonso, D, Alves da Costa, FA, Amado, J, Amara, W, Amelot, M, Amjadi, N, Ammirati, F, Andrade, M, Andrawis, N, Annoni, G, Ansalone, G, Ariani, MK, Arias, JC, Davis, G , Williams, D & GLORIA-AF Investigators 2023, 'Patterns of oral anticoagulant use and outcomes in Asian patients with atrial fibrillation: a post-hoc analysis from the GLORIA-AF Registry', eClinicalMedicine, vol. 63, 102039, pp. 1-11. https://doi.org/10.1016/j.eclinm.2023.102039

TY - JOUR

T1 - Patterns of oral anticoagulant use and outcomes in Asian patients with atrial fibrillation

T2 - a post-hoc analysis from the GLORIA-AF Registry

AU - Romiti, Giulio Francesco

AU - Corica, Bernadette

AU - Proietti, Marco

AU - Mei, Davide Antonio

AU - Frydenlund, Juliane

AU - Bisson, Arnaud

AU - Boriani, Giuseppe

AU - Olshansky, Brian

AU - Chan, Yi Hsin

AU - Huisman, Menno V.

AU - Chao, Tze Fan

AU - Lip, Gregory Y.H.

AU - Abban, Dzifa Wosornu

AU - Abdul, Nasser

AU - Abud, Atilio Marcelo

AU - Adams, Fran

AU - Addala, Srinivas

AU - Adragão, Pedro

AU - Ageno, Walter

AU - Aggarwal, Rajesh

AU - Agosti, Sergio

AU - Agostoni, Piergiuseppe

AU - Aguilar, Francisco

AU - Linares, Julio Aguilar

AU - Aguinaga, Luis

AU - Ahmed, Jameel

AU - Aiello, Allessandro

AU - Ainsworth, Paul

AU - Aiub, Jorge Roberto

AU - Al-Dallow, Raed

AU - Alderson, Lisa

AU - Aldrete Velasco, Jorge Antonio

AU - Alexopoulos, Dimitrios

AU - Manterola, Fernando Alfonso

AU - Aliyar, Pareed

AU - Alonso, David

AU - Alves da Costa, Fernando Augusto

AU - Amado, José

AU - Amara, Walid

AU - Amelot, Mathieu

AU - Amjadi, Nima

AU - Ammirati, Fabrizio

AU - Andrade, Marianna

AU - Andrawis, Nabil

AU - Annoni, Giorgio

AU - Ansalone, Gerardo

AU - Ariani, M. Kevin

AU - Arias, Juan Carlos

AU - Davis, Gershan

AU - Williams, David

AU - GLORIA-AF Investigators

PY - 2023/9/19

Y1 - 2023/9/19

N2 - Background: Previous studies suggested potential ethnic differences in the management and outcomes of atrial fibrillation (AF). We aim to analyse oral anticoagulant (OAC) prescription, discontinuation, and risk of adverse outcomes in Asian patients with AF, using data from a global prospective cohort study. Methods: From the GLORIA-AF Registry Phase II–III (November 2011–December 2014 for Phase II, and January 2014–December 2016 for Phase III), we analysed patients according to their self-reported ethnicity (Asian vs. non-Asian), as well as according to Asian subgroups (Chinese, Japanese, Korean and other Asian). Logistic regression was used to analyse OAC prescription, while the risk of OAC discontinuation and adverse outcomes were analysed through Cox-regression model. Our primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACE). The original studies were registered with ClinicalTrials.gov, NCT01468701, NCT01671007, and NCT01937377. Findings: 34,421 patients were included (70.0 ± 10.5 years, 45.1% females, 6900 (20.0%) Asian: 3829 (55.5%) Chinese, 814 (11.8%) Japanese, 1964 (28.5%) Korean and 293 (4.2%) other Asian). Most of the Asian patients were recruited in Asia (n = 6701, 97.1%), while non-Asian patients were mainly recruited in Europe (n = 15,449, 56.1%) and North America (n = 8378, 30.4%). Compared to non-Asian individuals, prescription of OAC and non-vitamin K antagonist oral anticoagulant (NOAC) was lower in Asian patients (Odds Ratio [OR] and 95% Confidence Intervals (CI): 0.23 [0.22–0.25] and 0.66 [0.61–0.71], respectively), but higher in the Japanese subgroup. Asian ethnicity was also associated with higher risk of OAC discontinuation (Hazard Ratio [HR] and [95% CI]: 1.79 [1.67–1.92]), and lower risk of the primary composite outcome (HR [95% CI]: 0.86 [0.76–0.96]). Among the exploratory secondary outcomes, Asian ethnicity was associated with higher risks of thromboembolism and intracranial haemorrhage, and lower risk of major bleeding. Interpretation: Our results showed that Asian patients with AF showed suboptimal thromboembolic risk management and a specific risk profile of adverse outcomes; these differences may also reflect differences in country-specific factors. Ensuring integrated and appropriate treatment of these patients is crucial to improve their prognosis. Funding: The GLORIA-AF Registry was funded by Boehringer Ingelheim GmbH.

AB - Background: Previous studies suggested potential ethnic differences in the management and outcomes of atrial fibrillation (AF). We aim to analyse oral anticoagulant (OAC) prescription, discontinuation, and risk of adverse outcomes in Asian patients with AF, using data from a global prospective cohort study. Methods: From the GLORIA-AF Registry Phase II–III (November 2011–December 2014 for Phase II, and January 2014–December 2016 for Phase III), we analysed patients according to their self-reported ethnicity (Asian vs. non-Asian), as well as according to Asian subgroups (Chinese, Japanese, Korean and other Asian). Logistic regression was used to analyse OAC prescription, while the risk of OAC discontinuation and adverse outcomes were analysed through Cox-regression model. Our primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACE). The original studies were registered with ClinicalTrials.gov, NCT01468701, NCT01671007, and NCT01937377. Findings: 34,421 patients were included (70.0 ± 10.5 years, 45.1% females, 6900 (20.0%) Asian: 3829 (55.5%) Chinese, 814 (11.8%) Japanese, 1964 (28.5%) Korean and 293 (4.2%) other Asian). Most of the Asian patients were recruited in Asia (n = 6701, 97.1%), while non-Asian patients were mainly recruited in Europe (n = 15,449, 56.1%) and North America (n = 8378, 30.4%). Compared to non-Asian individuals, prescription of OAC and non-vitamin K antagonist oral anticoagulant (NOAC) was lower in Asian patients (Odds Ratio [OR] and 95% Confidence Intervals (CI): 0.23 [0.22–0.25] and 0.66 [0.61–0.71], respectively), but higher in the Japanese subgroup. Asian ethnicity was also associated with higher risk of OAC discontinuation (Hazard Ratio [HR] and [95% CI]: 1.79 [1.67–1.92]), and lower risk of the primary composite outcome (HR [95% CI]: 0.86 [0.76–0.96]). Among the exploratory secondary outcomes, Asian ethnicity was associated with higher risks of thromboembolism and intracranial haemorrhage, and lower risk of major bleeding. Interpretation: Our results showed that Asian patients with AF showed suboptimal thromboembolic risk management and a specific risk profile of adverse outcomes; these differences may also reflect differences in country-specific factors. Ensuring integrated and appropriate treatment of these patients is crucial to improve their prognosis. Funding: The GLORIA-AF Registry was funded by Boehringer Ingelheim GmbH.

KW - Asia

KW - Atrial fibrillation

KW - Ethnic differences

KW - Oral anticoagulant

KW - Outcomes

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UR - http://www.scopus.com/inward/citedby.url?scp=85174976602&partnerID=8YFLogxK

U2 - 10.1016/j.eclinm.2023.102039

DO - 10.1016/j.eclinm.2023.102039

M3 - Article (journal)

C2 - 37753446

AN - SCOPUS:85174976602

SN - 2589-5370

VL - 63

SP - 1

EP - 11

JO - eClinicalMedicine

JF - eClinicalMedicine

M1 - 102039

ER -

Patterns of oral anticoagulant use and outcomes in Asian patients with atrial fibrillation: a post-hoc analysis from the GLORIA-AF Registry

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