The Changing Landscape for Stroke Prevention in AF
Authors: Menno V. Huisman, Kenneth J. Rothman, Miney Paquette, Christine Teutsch, Hans-Christoph Diener, Sergio J. Dubner, Jonathan L. Halperin, Chang Sheng Ma, Kristina Zint, Amelie Elsaesser, Dorothee B. Bartels, Gregory Y.H. Lip, Dzifa Abban, Nasser Abdul, Mark Abelson, Alan Ackermann, Fran Adams, Luthando Adams, Pedro Adragão, Walter Ageno, Rajesh Aggarwal, Sergio Agosti, Javier Aguila Marin, Francisco Aguilar, Julio Alberto Aguilar Linares, Luis Aguinaga, Zia Ahmad, Paul Ainsworth, Kamal Al Ghalayini, Saad Al Ismail, Abdelfatah Alasfar, Abdul Alawwa, Raed Al-Dallow, Lisa Alderson, Dimitrios Alexopoulos, Abdullah Ali, Malik Ali, Pareed Aliyar, Tammam Al-Joundi, Soufian Al Mahameed, Hossein Almassi, Khalid Almuti, Mohamed Al-Obaidi, Mohamed Alshehri, Ute Altmann, Alvaro Rabelo Alves, Ayham Al-Zoebi, Walid Amara, Mathieu Amelot, Nima Amjadi, Fabrizio Ammirati, Nabil Andrawis, Denis Angoulvant, Giorgio Annoni, Gerardo Ansalone, Sorin Alexandru Antonescu, Mehrdad Ariani, Juan Carlos Arias, Sébastien Armero, Rohit Arora, Chander Arora, William Ashcraft, M. Shakil Aslam, Alfredo Astesiano, Philippe Audouin, Charles Augenbraun, S. Aydin, Rabih Azar, Abul Azim, Shahid Aziz, Luciano Marcelo Backes, Mirza Baig, Suchdeep Bains, Asaad Bakbak, Seth Baker, Karim Bakhtiar, Richard Bala, Jonathan Banayan, Stellan Bandh, Shigenobu Bando, Subhash Banerjee, Alan Bank, Olga Barbarash, Gonzalo Barón, Craig Barr, Carlos Barrera, John Barton, Vanja Basic Kes, Giovanni Baula, Hamid Bayeh, Nooshin Bazargani, Steffen Behrens, Alan Bell, Juan Benezet-Mazuecos, Bouziane Benhalima, Philippe Berdagué, B.J. Berg van den, P.F.M.M. Bergen van, Edvard Berngard, Richard Bernstein, Percy Berrospi, Sergio Berti, Vicente Bertomeu, Andrea Berz, Paulo Bettencourt, Robert Betzu, Jan Beyer-Westendorf, Ravi Bhagwat, Toby Black, Jorge Hugo Blanco Ibaceta, Stephen Bloom, Edwin Blumberg, Mario Bo, Valerie Bockisch, Ellen Bøhmer, Maria Grazia Bongiorni, Giuseppe Boriani, Ralph Bosch, D.J. Boswijk, Jochen Bott, Edo Bottacchi, Marica Bracic Kalan, Axel Brandes, Bjørn Bratland, Donald Brautigam, Nicolas Breton, P.J.A.M. Brouwers, Kevin Browne, Jordi Bruguera, Myriam Brunehaut, Claude Brunschwig, Hervé Buathier, Aurélie Buhl, John Bullinga, Kenneth Butcher, Jose Walter Cabrera Honorio, Alberto Caccavo, Didier Cadinot, Shanglang Cai, Valeria Calvi, John Camm, Rui Candeias, James Capo, Alessandro Capucci, Juliano Novaes Cardoso, Yan Carlos Duarte Vera, Brian Carlson, Paula Carvalho, Susanna Cary, Rene Casanova, Gavino Casu, Simon Cattan, Claudio Cavallini, Guillaume Cayla, Tae Joon Cha, Kwang Soo Cha, Said Chaaban, Jei Keon Chae, Krishnan Challappa, Sunil Chand, Harinath Chandrashekar, Mark Chang, Paul Charbel, Ludovic Chartier, Kausik Chatterjee, Aamir Cheema, Shih-Ann Chen, Pierre Chevallereau, Fu-Tien Chiang, Francesco Chiarella, Lin Chih-Chan, Yong Keun Cho, Dong Ju Choi, Guy Chouinard, None Danny, Hoi Fan Chow, Dimitrios Chrysos, Galina Chumakova, Eduardo Julián José Roberto Chuquiure Valenzuela, Tomas Cieza-Lara, Violeta Cindea Nica, Vlad Ciobotaru, David Cislowski, Olivier Citerne, Matthias Claus, Anthony Clay, Piers Clifford, Serge Cohen, Andrew Cohen, Furio Colivicchi, Rónán Collins, Steve Compton, Sean Connors, Alberto Conti, Gabriel Contreras Buenostro, Gregg Coodley, Martin Cooper, Lynn Corbett, Oran Corey, Julián Coronel, John Corrigan, Rosa Ysabel Cotrina Pereyra, Yves Cottin, Benoit Coutu, Aurel Cracan, Peter Crean, James Crenshaw, H.J.G.M. Crijns, Charles Crump, Fred Cucher, David Cudmore, Lianqun Cui, John Culp, Harald Darius, Patrick Dary, Olivier Dascotte, Ira Dauber, Thomas Davee, Ruth Davies, Gershan Davis, Jean-Marc Davy, Mark Dayer, Axel De La Briolle, Manuel de Mora, Eduardo De Teresa, Luc De Wolf, Eric Decoulx, Sasalu Deepak, Pascal Defaye, Freddy Del-Carpio Munoz, Diana Delic Brkljacic, Laurent Deluche, Sylvain Destrac, N.Joseph Deumite, Silvia Di Legge, Olivier Dibon, Igor Diemberger, Jean Dillinger, Pedro Dionísio, Stefan Naydenov, Imran Dotani, Elena Dotcheva, Anthony D'Souza, Simon Dubrey, Xavier Ducrocq, Dmitry Dupljakov, Vuong DuThinh, Oscar Pereira Dutra, Dipankar Dutta, Nathalie Duvilla, Johnny Dy, Rainer Dziewas, Charles Eaton, William Eaves, Matthew Ebinger, J.W.M. Eck van, Tim Edwards, Isabel Egocheaga, Clifford Ehrlich, Steven Eisenberg, Abdel El Hallak, Adnan El Jabali, Rami El Mahmoud, Mahfouz El Shahawy, Zayd Eldadah, Fouad Elghelbazouri, Omar Elhag, Mehiar El-Hamdani, Darlene Elias, Adam Ellery, Hassan El-Sayed, A. Elvan, Bernard Erickson, Eric Espaliat, Louis Essandoh, Tamara Everington, Rudolph Evonich, Andrey Ezhov, Lorenzo Fácila, Ramin Farsad, Maxime Fayard, Francesco Fedele, Luis Gustavo Gomes Ferreira, Daniel Ferreira, José Ferreira Santos, Anna Ferrier, Alexandra Finsen, Brian First, Raymond Fisher, John Floyd, Thomas Folk, Catarina Fonseca, Luisa Fonseca, Steven Forman, Magnus Forsgren, Malcolm Foster, Nathan Foster, Michael Frais, Brad Frandsen, Thierry Frappé, Ramon Freixa, William French, Marina Freydlin, Siegfried Frickel, Ana Gabriela Fruntelata, Shigeru Fujii, Yusuke Fujino, Hiroshi Fukunaga, Yutaka Furukawa, Matthias Gabelmann, Michael Gabris, Niels Gadsbøll, Pavel Galin, Michel Galinier, Ricky Ganim, Ronnie Garcia, Antonio Garcia Quintana, Olivier Gartenlaub, Conrad Genz, Frédéric Georger, Jean-Louis Georges, Steven Georgeson, Ali Ghanbasha, Evaldas Giedrimas, Mariusz Gierba, Eve Gillespie, Alberto Giniger, Alexandros Gkotsis, Joachim Gmehling, Jacek Gniot, Peter Goethals, Ronald Goldberg, Britta Goldmann, David Goldscher, Sergey Golitsyn, Efrain Alonso Gomez Lopez, Juan Esteban Gomez Mesa, Efrain Gonzalez, Emilio Gonzalez Cocina, Carlos Gonzalez Juanatey, Vladimir Gorbunov, Brian Gordon, Hervé Gorka, Charles Gornick, Diana Gorog, Franz Goss, Andreas Götte, Pascal Goube, Ioannis Goudevenos, Dudley Goulden, Brett Graham, Angel Grande, Cesare Greco, Martin Green, Gerald Greer, Uwe Gremmler, Paul Grena, Yuriy Grinshstein, Martin Grond, Edoardo Gronda, Francois Grondin, Gerian Grönefeld, J.R. Groot de, Gabriele Guardigli, Thomas Guarnieri, Carolina Guevara Caiedo, Alexandre Guignier, Michele Gulizia, Michael Gumbley, Dhiraj Gupta, Terrence Hack, Winfried Haerer, Joseph Hakas, Christian Hall, James Hampsey, Georgios Hananis, Basel Hanbali, Franklin Handel, Joe Hargrove, David Hargroves, Kenneth Harris, David Hartley, Tetsuya Haruna, Yoshiki Hata, Emil Hayek, Jeff Healey, Steven Hearne, Geir Heggelund, M.E.W. Hemels, Yann Hemery, Sam Henein, Benhur Henz, Sung-Ho Her, Paul Hermany, Mauro Esteves Hernandes, Yorihiko Higashino, Michael Hill, Tetsuo Hisadome, Eiji Hishida, James Hitchcock, Etienne Hoffer, Matthew Hoghton, Clare Holmes, Suk Keun Hong, Marie-Paule Houppe Nousse, Victor Howard, Li Fern Hsu, Chi-Hung Huang, David Huckins, Kier Huehnergarth, A. Huizenga, Richard Huntley, Gamal Hussein, Gyo-Seung Hwang, Oyidie Igbokidi, Ignacio Iglesias, Margaret Ikpoh, Davide Imberti, Hüseyin Ince, Ciro Indolfi, Tatiana Ionova, John Ip, Didier Irles, Harukazu Iseki, Younus Ismail, Noah Israel, Steven Isserman, Bruce Iteld, Galina Ivanchura, Ramakrishnan Iyer, Venkat Iyer, Ruben Omar Iza Villanueva, Ewart Jackson-Voyzey, Naseem Jaffrani, Frank Jäger, Manish Jain, Martin James, Yann Jamon, Sung Won Jang, Cesar Augusto Pereira Jardim, Nabil Jarmukli, Robert Jeanfreau, Ronald Jenkins, Xianyan Jiang, Heng Jiang, Tiemin Jiang, Nan Jiang, Javier Jimenez, Robert Jobe, Ian Joffe, Bengt Johansson, Nick Jones, Jose Carlos Moura Jorge, Bernard Jouve, Mayar Jundi, Werner Jung, Byung Chun Jung, Kyung Tae Jung, Samer Kabbani, Ameer Kabour, Chrystalenia Kafkala, Koji Kajiwara, Larisa Kalinina, Priit Kampus, Junji Kanda, Shaival Kapadia, Amin Karim, Laszlo Karolyi, Hisham Kashou, Andreas Kastrup, Apostolos Katsivas, Elizabeth Kaufman, Kazuya Kawai, Kenji Kawajiri, John Kazmierski, Phil Keeling, Galal Ali Kerfes, José Francisco Kerr Saraiva, Galina Ketova, Ajit Khaira, Muhammad Khalid, Elena Khludeeva, Aleksey Khripun, Doo Il Kim, Dae Kyeong Kim, Nam Ho Kim, Ki Seok Kim, Young-Hoon Kim, Jin bae Kim, June Soo Kim, Jeong Su Kim, Elena Kinova, Alexander Klein, Christoph Kleinschnitz, James Kmetzo, G. Larsen Kneller, Aleksandar Knezevic, Stanley Koch, Kai Koenig, Su Mei Angela Koh, Martin Köhrmann, Jay Koons, Ravikiran Korabathina, Olga Korennova, Martin Koschutnik, Edward Kosinski, Dragan Kovacic, Jacek Kowalczyk, Natalya Koziolova, J.A. Kragten, Lars Udo Krause, Imad Kreidieh, B.J. Krenning, Kannappan Krishnaswamy, Waldemar Krysiak, Karl-Heinz Kuck, Somnath Kumar, Thomas Kümler, Malte Kuniss, Jen-Yuan Kuo, Achim Küppers, Karla Kurrelmeyer, Tak Kwan, Eisho Kyo, Arthur Labovitz, Alain Lacroix, Andy Lam, Fernando Tomas Lanas Zanetti, Charles Landau, Giancarlo Landini, Wilfried Lang, Torben Bjerregaard Larsen, Volker Laske, Karine Lavandier, Nicki Law, Moon Hyoung Lee, Daniel Lee, Ana Leitão, Dominique Lejay, Malgorzata Lelonek, Radoslaw Lenarczyk, Patrick Leprince, Benoit Lequeux, Matthias Leschke, Nicolas Ley, Zicheng Li, Yansheng Li, Xiaodong Li, Zhanquan Li, Weihua Li, Jianqiu Liang, Ira Lieber, Michael Lillestol, Ramon Horacio Limon Rodriguez, Hailong Lin, Gregory Lip, Jennifer Litchfield, Zhitao Liu, Xuebo Liu, Yalin Liu, Feng Liu, Wenhui Liu, Guillermo Antonio Llamas Esperon, Jose Luis Llisterri, Ted Lo, Eric Lo, Jose Maria Lobos, Bernhard-Paul Lodde, Philippe Loiselet, José López-Sendón, Adalberto Menezes Lorga Filho, Ido Lori, Ming Luo, Steven Lupovitch, Philippe Lyrer, Hamed M. Zuhairy, Changsheng Ma, Genshan Ma, Hong Ma, Irene Madariaga, Koji Maeno, Dominique Magnin, Shahid Mahmood, Karen Mahood, Gustavo Maid, Sumeet Mainigi, Konstantinos Makaritsis, José Arturo Maldonado Villalon, Rohit Malhotra, Amir Malik, Catherine Mallecourt, Rajiv Mallik, Rickey Manning, Athanasios Manolis, Ioannis Mantas, Fernando Gabriel Manzur Jattin, Niccolo' Marcionni, Francisco Marín, Antonio Martín Santana, Jorge Martinez, Luis Martinez, Petra Maskova, Norberto Matadamas Hernández, Simon Matskeplishvili, Katsuhiro Matsuda, Alenka Mavri, Erik May, Nolan Mayer, Pilar Mazon, John McClure, Terry McCormack, William McGarity, Michael McGuire, Hugh McIntyre, Paul McLaughlin, Brent McLaurin, Feliz Alvaro Medina Palomino, Paresh Mehta, Reza Mehzad, Andreas Meinel, Francesco Melandri, Amparo Mena, Hirosi Meno, Dhananjai Menzies, Kneale Metcalf, Beat Meyer, Jacek Miarka, Frank Mibach, Dominik Michalski, Patrik Michel, Rami Mihail Chreih, Ghiath Mikdadi, Magdy Mikhail, Milan Mikus, Davor Milicic, Constantin Militaru, Gary Miller, Christos Milonas, Bogdan Minescu, Iveta Mintale, Aurélien Miralles, Tristan Mirault, Dinesh Mistry, George Mitchell, Nicoleta Violeta Miu, Naomasa Miyamoto, Tiziano Moccetti, Akber Mohammed, Azlisham Mohd Nor, Dora Ines Molina de Salazar, Giulio Molon, David Molony, Sergio Mondillo, Lluis Mont, Rajendra Moodley, Roger Moore, Dalmo Antonio Ribeiro Moreira, Kiyoo Mori, Andrew Moriarty, Jacek Morka, Nikitas Moschos, Marco Antônio Mota Gomes, Nicolas Mousallem, Angel Moya, Andreas Mügge, Thomas Mulhearn, Jean-Joseph Muller, Carmen Manuela Muresan, Derek Muse, Wlodzimierz Musial, Francesco Musumeci, Venkatesh Nadar, Thuraia Nageh, Priya Nair, Hidemitsu Nakagawa, Yuichiro Nakamura, Toru Nakayama, Ki-Byeong Nam, Dmitry Napalkov, Indira Natarajan, Hemal Nayak, Libor Nechvatal, James Neiman, Pamela Nerheim, Fernando Carvalho Neuenschwander, Kunihiro Nishida, Alexey Nizov, Tatiana Novikova, Salvatore Novo, Ewa Nowalany-Kozielska, Emmanuel Nsah, Juan Carlos Nunez Fragoso, Ole Nyvad, Manuel Odin de Los Rios Ibarra, Martin O'Donnell, Philip O'Donnell, Dong Jin Oh, Yong Seog Oh, Chia Theng Daniel Oh, Gilles O'Hara, Kostas Oikonomou, Juan Jose Olalla, Zoran Olivari, Richard Oliver, Christoforos Olympios, John Osborne, Joaquin Osca, Raed Osman, Abayomi Osunkoya, Benzy Padanilam, Elizaveta Panchenko, A. Shekhar Pandey, Angelo Amato Vicenzo de Paola, Alexander Paraschos, Herbert Pardell, Hyung Wook Park, Jong Sung Park, Ratika Parkash, Ian Parker, Eric Parrens, Robert Parris, Enrico Passamonti, Jaydutt Patel, Rajesh Patel, William H. 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Ronner, Thomas Ronziere, F.A. Rooyer, David Rosenbaum, Sherryn Roth, Nadezda Rozkova, Miroslav Rubacek, Frank Rubalcava, Olesya Rubanenko, Andrew Rubin, Mariano Ruiz Borret, Karin Rybak, Hani Sabbour, Oscar Saenz Morales, Tetsuo Sakai, Abraham Salacata, Ilsbe Salecker, Adrien Salem, Marwan Salfity, Rafael Salguero, Alessandro Salvioni, Mercedes Samson, Gregorio Sanchez, Chirag Sandesara, Wladmir Faustino Saporito, Taishi Sasaoka, Payman Sattar, Daniel Savard, Pierre-Jean Scala, Jacques Scemama, Thierry Schaupp, Peter Schellinger, Carlos Scherr, Karl-Heinz Schmitz, Bettina Schmitz, Lisa Schmitz, Robert Schnitzler, Steffen Schnupp, Peter Schoeniger, Norbert Schön, Stefan Schuster, Peter Schwimmbeck, Clare Seamark, Ruediger Seebass, Karl-Heinz Seidl, Barry Seidman, Jaroslaw Sek, Lakshmanan Sekaran, Yoshinori Seko, Pablo Andres Sepulveda Varela, Begoña Sevilla, Vinay Shah, Anil Shah, Neerav Shah, Aman Shah, Jeffrey Shanes, Ali Sharareh, Vijay Kumar Sharma, Louise Shaw, Yutaka Shimizu, Hideki Shimomura, Dong Gu Shin, Eun-Seok Shin, Junya Shite, Mohammad Shoukfeh, Charles Shoultz, Frank Silver, Iveta Sime, T.A. Simmers, Dinesh Singal, Narendra Singh, Peter Siostrzonek, Mohiburrahman Sirajuddin, Mika Skeppholm, Didier Smadja, Richard Smith, David Smith, Hassan Soda, C. Wilson Sofley, Adam Sokal, Rodolfo Sotolongo, Olga Ferreira de Souza, Jon Arne Sparby, Jindrich Spinar, David Sprigings, Alex Spyropoulos, Dimitrios Stakos, Alon Steinberg, Clemens Steinwender, Georgios Stergiou, H. William Stites, Anastas Stoikov, Ruth Strasser, Witold Streb, Ioannis Styliadis, Guohai Su, Xi Su, Rafael Martin Suarez, Wanda Sudnik, Atsushi Sueyoshi, Kai Sukles, Li Sun, Randeep Suneja, Peter Svensson, Antonius Ziekenhuis, Janko Szavits-Nossan, Jens Taggeselle, Yuichiro Takagi, Amrit Takhar, Julio Tallet, Angelika Tamm, Shozo Tanaka, Katsumi Tanaka, Aylmer Tang, Sherman Tang, Tiziana Tassinari, Shinji Tayama, Muzahir Tayebjee, Ulrich Tebbe, Jose Teixeira, Dan Nicolae Tesloianu, Pascal Tessier, S.H.K. The, Jérome Thevenin, Harold Thomas, Serge Timsit, Robert Topkis, Mikhail Torosoff, Emmanuel Touze, Thalie Traissac, Elina Trendafilova, Barry Troyan, Wenchi Kevin Tsai, Hung Fat Tse, Hiroshi Tsutsui, Takashi Tsutsui, Y.S. 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Wong, Ka Sing Lawrence Wong, Brian Wong, Beata Wozakowska-Kaplon, Zhaohui Wu, Shulin Wu, Nell Wyatt, Yong Xu, Xiangdong Xu, Akira Yamada, Kazuya Yamamoto, Hiroki Yamanoue, Takeshi Yamashita, Ping Yen Bryan Yan, Yanmin Yang, Tianlun Yang, Jing Yao, Chakri Yarlagadda, Kuo-Ho Yeh, Yoto Yotov, Serge Yvorra, Ralf Zahn, José Zamorano, Roberto Zanini, Stuart Zarich, James Zebrack, Sergei Zenin, Elisabeth Louise Zeuthen, Xingwei Zhang, Quansan Zhang, Dadong Zhang, Donghui Zhang, Huanyi Zhang, Shuiping Zhao, Xinwen Zhao, Yang Zheng, Qiangsun Zheng, Jing Zhou, Jian Zhou, Sergio Luiz Zimmermann, Rainer Zimmermann, L. Steven Zukerman, C. Zwaan van der
Journal: Journal of the American College of Cardiology (2017)

GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non–vitamin K antagonist oral anticoagulant (NOAC), became available. This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients' baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score ≥2; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701)