Real world data from 13,835 patients with atrial fibrillation (AF) in 6 Asian countries show remarkable differences in patient profiles, risk factors for major cardiovascular events, treatment patterns and economic burden
Yokohama, Japan, 18th September 2017, 08:00am JST – The latest results from one of the largest, ongoing global disease registries in AF, the Global Anticoagulant Registry in the Field – Atrial Fibrillation (GARFIELD-AF), show that there are significant differences in the characteristics of patients with AF in Asia as well as in their risk factors and treatment patterns. The differences were observed between Asian and non-Asian patients, as well as between patients across Asia, and between the direct costs of AF in Asian countries.
These results were among the findings unveiled by the London-based Thrombosis Research Institute (TRI) in three oral presentations and at a Teatime Seminar at the joint meeting of the 10th Asia Pacific Heart Rhythm Society Session (APHRS) and the 64th Annual Meeting of the Japanese Heart Rhythm Society which took place in Yokohama, Japan last week.
A total of 52,081 patients were enrolled prospectively between March 2010 and August 2016 in GARFIELD-AF globally, including 13,835 (26.6%) patients from 419 centres in 6 Asian countries – China, India, Japan, Singapore, South Korea and Thailand. Examining the baseline characteristics and treatment patterns in patients with newly diagnosed AF, the GARFIELD-AF researchers found that1:
With diabetes mellitus (DM) being a common comorbidity in patients with AF, the GARFIELD-AF researchers also looked at risk factor profiles and management of 2,977 Asian patients with DM compared with 10,858 Asian patients without DM and non-Asian patients. They found that:
Analysing data from 774 Asian patients with AF and another comorbidity CKD compared with non-Asian patients, the key findings were that3:
Other data from the GARFIELD-AF registry presented during a Teatime Seminar demonstrated that Asian patients have increased incidence of stroke and bleeding, and that those with comorbidities have more mortality compared to non-Asian populations.
The Seminar also included a look at the economic burden of AF in Asia, using China and Japan as examples, compared with Europe. The cost per patient per year was calculated from a combination of costs for AF-related visits to doctors, admissions, procedures and drugs (not including concomitant conditions). In Japan the unit cost was significantly higher at ¥521,269 compared to ¥14,225 in China – and both were higher than the cost in Europe which was only ¥1,970. The vast majority of the costs were attributable to inpatient costs (70.5% in Japan, 63.6% in China).
Speaking after the Seminar, co-chair Professor Shinya Goto of Tokai University School of Medicine, Tokyo, commented: “GARFIELD-AF offers a unique opportunity to obtain a comprehensive and contemporary description of the spectrum of patients with AF and their management globally, and in regions including Asia, as they evolve over time. By enhancing the breadth and depth of understanding of stroke prevention in AF, we can ultimately inform strategies to improve patient outcomes, safety and utilisation of healthcare resources.”
About the GARFIELD-AF registry
GARFIELD-AF is the largest ongoing prospective registry of patients with AF. 2016 marked the end of the enrolment phase for GARFIELD-AF, with 57,262 patients enrolled of which 52,000 are prospective. The real-world insights that continue to be gathered from the GARFIELD-AF registry are being converted into real-world evidence that helps inform and identify areas where the medical community can continue to improve patient outcomes.
GARFIELD-AF is a pioneering, independent academic research initiative led by an international steering committee under the auspices of the TRI, London, UK.
It is an international, non-interventional study of stroke prevention in patients with newly diagnosed AF. Patients were enrolled from over 1,000 centres in 35 countries worldwide, including from the Americas, Europe, Africa and Asia-Pacific.
Contemporary understanding of AF is based on data gathered in controlled clinical trials. Whilst essential for evaluating the efficacy and safety of new treatments, these trials are not representative of everyday clinical practice and, hence, uncertainty persists about the real-life burden and management of this disease. GARFIELD-AF seeks to provide insights into the impact of anticoagulant therapy on thromboembolic and bleeding complications seen in this patient population. It will provide a better understanding of the potential opportunities for improving care and clinical outcomes amongst a representative and diverse group of patients and across distinctive populations. This should help physicians and healthcare systems to appropriately adopt innovation to ensure the best outcomes for patients and populations.
The registry started in December 2009. Four key design features of the GARFIELD-AF protocol ensure a comprehensive and representative description of AF; these are:
Included patients must have been diagnosed with non-valvular AF within the previous 6 weeks and have at least one risk factor for stroke; as such, they are potential candidates for anticoagulant therapy to prevent blood clots leading to stroke. It is left to the investigator to identify a patient’s stroke risk factor(s), which need not be restricted to those included in established risk scores. Patients are included whether or not they receive anticoagulant therapy, so that the merit of current and future treatment strategies can be properly understood in relation to patients’ individual risk profiles.
The GARFIELD-AF registry is funded by an unrestricted research grant from Bayer AG, Berlin, Germany.
For more information, visit our website: www.garfieldregistry.org
The burden of AF
Up to 2% of the global population has AF,4 including around 8.8 million people in Europe5 and 5–6.1 million in the United States.6 It is estimated that its prevalence will at least double by 2050 as the global population ages.6 AF is associated with a five-fold increase in stroke risk, and one out of five strokes is attributed to this arrhythmia.4 Ischaemic strokes related to AF are often fatal, and those patients who survive are left more frequently and more severely disabled and have a greater risk of recurrence than patients with other causes of stroke.4 Hence, the risk of mortality from AF-associated stroke is doubled and the cost of care is 50% higher.4
AF occurs when parts of the atria emit uncoordinated electrical signals. This causes the chambers to pump too quickly and irregularly, not allowing blood to be pumped out completely.7 As a result, blood may pool, clot and lead to thrombosis, which is the number one cardiovascular killer in the world.8 If a blood clot leaves the left atrium, it could potentially lodge in an artery in other parts of the body, including the brain. A blood clot in an artery in the brain leads to a stroke; 92% of fatal strokes are caused by thrombosis.8 Stroke is a major cause of death and long-term disability worldwide – each year, 6.5 million people die9 and 5 million are left permanently disabled.10 People with AF also are at high risk for heart failure, chronic fatigue and other heart rhythm problems.11
About the TRI
The TRI is dedicated to bringing new solutions to patients for the detection, prevention and treatment of blood clots. The TRI’s goal is to advance the science of real-world enquiry so that the value of real-world data is realised and becomes a critical link in the chain of evidence. Our pioneering research programme, across medical disciplines and across the world, continues to provide breakthrough solutions in thrombosis.
For more information, visit: http://www.tri-london.ac.uk/.
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