Presentation (CTI)

OBJECTIVES: Oral anticoagulants (OACs) are widely used for stroke prevention in atrial fibrillation (AF); some patients remain untreated for a range of reasons. This study characterised the clinical profile of patients with AF who were not receiving OACs and explored the reasons for non-use.
METHODS: Baseline clinical and demographic data from the multinational GARDENIA registry of patients with AF not treated with OACs (NCT05421533) were descriptively analysed according to clinician-reported primary reason for OAC non-use.
RESULTS: Of 704 patients, 638 had a clinician-reported primary reason for OAC non-use. Of those 59% were male, mean (SD) age was 79.4 (9.3) years, and 58% provided secondary reasons. The most common primary reasons were prior patient bleeding (PB, 19%), patient refusal (PR 18%), bleeding risk from underlying conditions (UC 17%), and falls/frailty (FF 12%). The proportion of males was PB 59%, PR 58%, UC 60%, FF 57%; mean (SD) age was PB 81.4 (8.60), PR 77.6 (7.90), UC (79.5 (10.54), FF 84.1 (8.91). PR patients were more often managed in primary care (29% vs PB 16%, UC 7%, FF 12%), reported more paroxysmal AF (63% vs PB 27%, UC 33%, FF 36%), less permanent AF (28% vs PB 59%, UC 51%, FF 53%), and had the lowest mean CHA₂DS₂VASc (3.8 vs PB 4.8, UC 4.4, FF 4.2). Clinical history differed across groups: prior stroke/TIA (PB 24%, PR 7%, UC 9%, FF 7%) and bleeding history (PB 92%, PR 17%, UC 51%, FF 24%). Prior cardioversion (FF 5%-PR 15%) and ablation (FF 1%-PR 8%) varied modestly. Concomitant medication varied by subgroup - aspirin (PB 24%-PR 41%), clopidogrel/ticagrelor (PR 2%-FF 8%), and investigator-defined chronic NSAID use (PB 12%-FF 22%).
CONCLUSIONS: AF patients not receiving OACs represent heterogeneous clinical subgroups. Better characterisation of untreated patients could support more individualised anti-coagulation decisions or reassessment of anti-coagulation.