Geographic differences in outcomes in outpatients with established atherothrombotic disease: results from the REACH Registry

Ducrocq, Grégory; Bhatt, DL; Labreuche, Julien; Corbalán, Ramón; Porath, Avi; Gao, Runlin; Panchenko, E. P.; Cs, Liau; Ikeda, Yasuo; Goto, Shinya; Amarenco, Pierre; Steg, Philippe Gabriel

doi:10.1177/2047487313501278

Cited by 27 publications

(19 citation statements)

References 34 publications

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“…Asian populations have consistently been shown to be at a higher overall risk of stroke than white populations. [27][28][29] The REACH registry 30,31 showed that, although Eastern Europe was the region in which patients were at highest risk of composite cardio vascular and cerebrovascular outcomes, individuals in Japan had the highest risk of haemorrhagic stroke. The relative burden of stroke compared with ischaemic heart disease is significantly greater in Asian countries, particularly China, compared with the West, as is the cost in d isability-adjusted life years.…”

Section: Af and Stroke Epidemiology In Asiansmentioning

confidence: 99%

Oral anticoagulants for Asian patients with atrial fibrillation

et al. 2014

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Anticoagulation is the most-important intervention to prevent stroke in patients with atrial fibrillation (AF). Despite a lower point prevalence of AF in Asian communities and Asian countries than in other populations, individuals of Asian ethnicity are at a disproportionately high risk of stroke and have greater consequent mortality. Warfarin and other vitamin K antagonists are conventionally used for anticoagulation, and demonstrably reduce the risk of stroke and all-cause mortality in patients with AF. The use of warfarin in Asian countries is suboptimal, primarily owing to the universal challenge of achieving controlled anticoagulation with an unpredictable drug as well as concerns about the particularly high-risk of haemorrhage in Asian patients. Instead, antiplatelet therapy has been favoured in Asian communities, this strategy is neither safe nor effective for stroke prevention in these individuals. The non-vitamin K antagonist, oral anticoagulant drugs offer a solution to this challenge. The direct thrombin inhibitor dabigatran, and the direct factor Xa inhibitors apixaban, edoxaban, and rivaroxaban, have demonstrated noninferiority to warfarin in the prevention of stroke and systemic embolism in international, randomized, controlled trials. Importantly, some of these drugs are also associated with a significantly lower incidence of major haemorrhage, and all result in lower rates of intracranial haemorrhage and haemorrhagic stroke than warfarin. In this article, we review the use of the non-vitamin K antagonist anticoagulants in the management of AF in Asian populations.

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Section: Af and Stroke Epidemiology In Asiansmentioning

confidence: 99%

Oral anticoagulants for Asian patients with atrial fibrillation

et al. 2014

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“…Residual ischemic risk was uniformly distributed over the different geographic areas, except for Japan, where patients experienced lower event rates. The explanations for such differences have been described previously . Briefly, differences in disease management and medication use have been reported (in particular, the use of clopidogrel is substantially higher in Japan than in other regions of the world), which may have contributed to some extent in the improved outcomes in Japan, supported by evidence that clopidogrel use may be superior to aspirin in reducing major CV events in PAD patients .…”

Section: Discussionmentioning

confidence: 88%

“…In addition, gaps in country‐based payer policies and healthcare systems might explain differences in risk factor prevalence and management. Moreover, genetic susceptibilities and lifestyle differences may also play a role in risk variation . Nevertheless, residual risk remains high, and events accrued progressively over time across all geographic areas.…”

Section: Discussionmentioning

confidence: 99%

“…The explanations for such differences have been described previously. 29 Briefly, differences in disease management and medication use have been reported (in particular, the use of clopidogrel is substantially higher in Japan than in other regions of the world), which may have contributed to some extent in the improved outcomes in Japan, supported by evidence that clopidogrel use may be superior to aspirin in reducing major CV events in PAD FIGURE 1 Cumulative incidence rates of primary outcome of CV death, MI, or stroke for post-MI patients with no history of TIA/stroke. Abbreviations: CV, cardiovascular; MI, myocardial infarction; TIA, transient ischemic attack FIGURE 2 Cumulative incidence rates of cardiovascular outcomes in PAD patients with no history of stroke or TIA by year of follow-up.…”

Section: Discussionmentioning

confidence: 99%

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Geographic variation and risk factors for systemic and limb ischemic events in patients with symptomatic peripheral artery disease: Insights from the REACH Registry

Abtan

Bhatt

Elbez

et al. 2017

Clinical Cardiology

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Background Patients with symptomatic peripheral artery disease ( PAD ) are at high risk of ischemic events. However, data about predictors of this risk are limited. Hypothesis We analyzed baseline characteristics and 4‐year follow‐up of patients enrolled in the international REduction of Atherothrombosis for Continued Health ( REACH ) Registry with symptomatic PAD and no history of stroke/transient ischemic attack to describe annual rates of recurrent ischemic events globally and geographically. Methods The primary outcome was systemic ischemic events (composite of cardiovascular death, myocardial infarction, or stroke) at 4 years. The secondary outcome was limb ischemic events (composite of lower limb amputation, peripheral bypass graft, and percutaneous intervention for PAD ) at 2 years. Multivariate analysis identified risk factors associated with recurrent ischemic events. Results The primary endpoint rate reached 4.7% during the first year and increased continuously (by 4%–5% each year) to 17.6% by year 4, driven mainly by cardiovascular mortality (11.1% at year 4). Japan experienced lower adjusted ischemic rates ( P < 0.01) vs North America. Renal impairment ( P < 0.01), congestive heart failure ( P < 0.01), history of diabetes ( P < 0.01), history of myocardial infarction ( P = 0.01), vascular disease (single or poly, P < 0.01), and older age ( P < 0.01) were associated with increased risk of systemic ischemic events, whereas statin use was associated with lower risk ( P = 0.03). The limb ischemic event rate was 5.7% at 2 years. Conclusions Four‐year systemic ischemic risk in patients with PAD and no history of stroke or transient ischemic attack remains high, and was mainly driven by cardiovascular mortality.

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“…As event rates vary between geographic areas,27, 28 recalibration to the population of interest is often necessary. This resulted in accurate estimates of the REACH‐SMART model in the external validation sets.…”

Section: Discussionmentioning

confidence: 99%

Estimated Life Expectancy Without Recurrent Cardiovascular Events in Patients With Vascular Disease: The SMART‐REACH Model

Kaasenbrood

Bhatt

Dorresteijn

et al. 2018

JAHA

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BackgroundIn patients with vascular disease, risk models may support decision making on novel risk reducing interventions, such as proprotein convertase subtilisin/kexin type 9 inhibitors or anti‐inflammatory agents. We developed and validated an innovative model to estimate life expectancy without recurrent cardiovascular events for individuals with coronary, cerebrovascular, and/or peripheral artery disease that enables estimation of preventive treatment effect in lifetime gained.Methods and ResultsStudy participants originated from prospective cohort studies: the SMART (Secondary Manifestations of Arterial Disease) cohort and REACH (Reduction of Atherothrombosis for Continued Health) cohorts of 14 259 (REACH Western Europe), 19 170 (REACH North America) and 6959 (SMART, The Netherlands) patients with cardiovascular disease. The SMART‐REACH model to estimate life expectancy without recurrent events was developed in REACH Western Europe as a Fine and Gray competing risk model incorporating cardiovascular risk factors. Validation was performed in REACH North America and SMART. Outcomes were (1) cardiovascular events (myocardial infarction, stroke, cardiovascular death) and (2) noncardiovascular death. Predictors were sex, smoking, diabetes mellitus, systolic blood pressure, total cholesterol, creatinine, number of cardiovascular disease locations, atrial fibrillation, and heart failure. Calibration plots showed high agreement between estimated and observed prognosis in SMART and REACH North America. C‐statistics were 0.68 (95% confidence interval, 0.67–0.70) in SMART and 0.67 (95% confidence interval, 0.66–0.68) in REACH North America. Performance of the SMART‐REACH model was better compared with existing risk scores and adds the possibility of estimating lifetime gained by novel therapies.ConclusionsThe externally validated SMART‐REACH model could be used for estimation of anticipated improvements in life expectancy without recurrent cardiovascular events in individual patients with cardiovascular disease in Western Europe and North America.

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Geographic differences in outcomes in outpatients with established atherothrombotic disease: results from the REACH Registry

Abstract: There are important variations in the outcomes of patients with atherothrombotic across geographic regions. These observations have important implications for public health and clinical research.

Cited by 27 publications

References 34 publications

Oral anticoagulants for Asian patients with atrial fibrillation

Oral anticoagulants for Asian patients with atrial fibrillation

Geographic variation and risk factors for systemic and limb ischemic events in patients with symptomatic peripheral artery disease: Insights from the REACH Registry

Estimated Life Expectancy Without Recurrent Cardiovascular Events in Patients With Vascular Disease: The SMART‐REACH Model

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