title: The Changing Landscape for Stroke Prevention in AF: Findings From the GLORIA-AF Registry Phase 2.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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).
authors.affiliation: Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: M.V.Huisman@lumc.nl.
authors.forename: Menno V
authors.initials: MV
authors.lastname: Huisman
authors.affiliation: RTI Health Solutions, Research Triangle Institute, Research Triangle Park, North Carolina.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Rothman
authors.affiliation: Department of Medicine, Boehringer Ingelheim, Burlington, Canada.
authors.forename: Miney
authors.initials: M
authors.lastname: Paquette
authors.affiliation: Medical Department, Boehringer Ingelheim, Ingelheim, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Teutsch
authors.affiliation: Department of Neurology, University of Duisburg-Essen, Duisburg-Essen, Germany.
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Diener
authors.affiliation: Clínica y Maternidad Suizo Argentina, Buenos Aires, Argentina.
authors.forename: Sergio J
authors.initials: SJ
authors.lastname: Dubner
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Halperin
authors.affiliation: Cardiology Department, Atrial Fibrillation Center, Beijing AnZhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Chang Sheng
authors.initials: CS
authors.lastname: Ma
authors.affiliation: Global Epidemiology Department, Boehringer Ingelheim, Ingelheim, Germany.
authors.forename: Kristina
authors.initials: K
authors.lastname: Zint
authors.affiliation: Biostatistics and Data Sciences Department, Boehringer Ingelheim, Ingelheim, Germany.
authors.forename: Amelie
authors.initials: A
authors.lastname: Elsaesser
authors.affiliation: Global Epidemiology Department, Boehringer Ingelheim, Ingelheim, Germany; Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover, Germany.
authors.forename: Dorothee B
authors.initials: DB
authors.lastname: Bartels
authors.affiliation: University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom.
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
mesh_terms: D000368:Aged; D000991:Antithrombins / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications*; D003430:Cross-Sectional Studies; D000069604:Dabigatran / Q000627:therapeutic use*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000991:Antithrombins; D005343:Fibrinolytic Agents; D000069604:Dabigatran
keywords: atrial fibrillation; oral anticoagulation; registry