Association of care specialty with anticoagulant prescription and clinical outcomes in newly diagnosed atrial fibrillation: Results from the GARFIELD-AF registry.

OBJECTIVE

To determine whether stroke prevention strategy, comorbidity management, and clinical outcome risks differ across atrial fibrillation (AF) care specialties.

METHODS

Newly diagnosed non-valvular AF patients enrolled in the international, prospective GARFIELD-AF registry (enrolment: 2010-2016) were analysed. Prescription of oral anticoagulation (OAC) therapy and select comorbidities was assessed by baseline care specialty: cardiology, primary care, or other specialties (internist/neurologist/geriatrician). Associations between care specialty and 2-year clinical outcomes were evaluated using multivariable Cox frailty models to account for within-country homogeneity.

RESULTS

In 52,011 patients, 34,172 (65.7 %) were diagnosed and initially managed in cardiology care, 7396 (14.2 %) in primary care, and 10,443 (20.1 %) in other specialties. The inter-country care specialty distribution varied considerably. Non-vitamin K OAC (NOAC) therapy among CHA2DS2-VASc ≥2 patients was more common in cardiology care (31.0 %) than primary care (19.8 %) and other specialty care (24.9 %), but comorbidity management was similar across specialties. Compared to cardiology care, primary care was associated with greater non-cardiovascular mortality (1.21 [1.01-1.45]), major bleeding (1.31 [1.05-1.62]), and new/worsening heart failure risk (2.09 [1.69-2.59]). Care in other specialties was associated with greater all-cause (adjusted hazard ratio, 1.19 [95 % CI, 1.09-1.29]), cardiovascular (1.15 [1.01-1.31]), and non-cardiovascular mortality (1.29 [1.13-1.47]), as well as non-haemorrhagic stroke/systemic embolism (1.48 [1.26-1.73]), major bleeding (1.21 [1.02-1.43]), and new/worsening heart failure risk (1.45 [1.21-1.75]) than cardiology care.

CONCLUSION

Comorbidity management was similar across AF care specialties, but patients outside of cardiology care had fewer NOAC prescriptions and greater risk for most clinical endpoints. Cardiology expertise may have important implications for AF prognosis.

CLINICAL TRIAL REGISTRATION: URL: http://www.

CLINICALTRIALS: gov. Unique identifier for GARFIELD-AF: NCT01090362.