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Kamis, 04 Juli 2013

New European Survey Highlights Ischaemic Stroke Protection as Treatment Priority for Patients with Atrial Fibrillation

  • Over two thirds of physicians point out preventing ischaemic stroke as the most important treatment goal for patients with atrial fibrillation (AF)1
  • Physicians highlight the vital need for awareness of the true incidence of ischaemic stroke1
  • 92% of all strokes in patients with AF are ischaemic strokes2, making ischaemic stroke prevention a key treatment priority

Ingelheim, Germany, 28th May, 2013 – New findings from a pan-European online survey of 1,000 physicians have demonstrated that for over two thirds of physicians, preventing ischaemic stroke is the most important treatment goal for patients with atrial fibrillation (AF).1 Ischaemic stroke is the most common type of stroke suffered by patients with AF2, and as such   physicians across Europe have highlighted the vital need for increased awareness of the true incidence and impact in this patient population. The survey findings were announced in parallel with the European Stroke Conference in London (28th-31st May) and highlight the need for additional information and education about the risk and impact of ischaemic stroke on the lives of AF patients.
Every year, up to three million patients with AF have a stroke.3,4 92% of strokes in AF patients are ischaemic.2 They occur when a blood vessel supplying the brain with blood is blocked e.g. by a blood clot. This reduction or complete prevention of blood flow to the brain may result in severe and burdensome physical impairment, paralysis or even death.5 Atrial fibrillation is the most common sustained heart rhythm condition6 affecting approximately 2% of the total population.7 The condition leads to a five-fold increase in the risk of stroke.7

Professor Hans-Christoph Diener, Professor of Neurology and Chairman of the Department of Neurology, University of Essen, Germany

“Every physician who treats patients with atrial fibrillation needs to recognise the risk of ischaemic stroke in these patients,” commented Professor Hans-Christoph Diener, Professor of Neurology and Chairman of the Department of Neurology, University of Essen, Germany. “Today, we have great and new possibilities at hand to prevent many of these devastating events. It is our responsibility as treating physicians to identify the patients in need for stroke prevention through screening, diagnosis and risk assessment and then protect them as best as we can from the possible consequences of an ischaemic stroke or an intracranial haemorrhage.”
Cardiologists and general practitioners (GPs) in seven European countries were surveyed via a MedLIVETM PULSE online survey to ascertain their perspectives on treatment priorities in AF. The survey explored factors affecting prescribing behaviours, such as the importance of stroke prevention in AF, the comparative need for treatment experience and convenience, and the perceived awareness of the incidence of ischaemic stroke. Key findings demonstrated:1
  • 67% of physicians state that preventing ischaemic stroke is the most important treatment goal for patients with AF
  • 84% of physicians highlight the vital need for awareness of the impact of ischaemic strokes for patients with AF, stating that the true  incidence may be underestimated*
  • When questioned on important factors that affect prescribing decisions, 56% of physicians responded that protecting patients against ischaemic stroke is the single most important factor affecting their prescribing decisions, followed by general treatment efficacy (protection against all strokes) and treatment safety (minimising the risk of bleeding in  patients)
When asked which attributes were most important when choosing treatments for patients with AF, 50% of physicians stated that the availability of clinical data was the most important attribute to consider and 39% selected experience in clinical practice over the treatment’s convenience for daily management

Trudie Lobban, MBE, Founder & CEO of Atrial Fibrillation Association (AFA)

“Ischaemic stroke is a real concern; not only because the risk is so high, but also because of the potential life-changing impact that it may have on patients with atrial fibrillation. Ischaemic strokes can be devastating for both patients and their families, and have a significant impact on their daily lives. They also increase health-care utilisation and the need for long-term care,” stated Trudie Lobban, MBE, Founder & CEO of Atrial Fibrillation Association (AFA). “It is essential that more work is undertaken to raise awareness of the risk of ischaemic stroke and to ensure that patients with AF receive    treatments that provide the most comprehensive protection.”
Appropriate anticoagulation therapy can help to prevent strokes experienced by patients with AF and improve overall outcomes.8 Major treatment guidelines in Europe, the US and worldwide recognise the benefits of anticoagulant treatments for stroke prevention in atrial fibrillation.9 Pradaxa® (dabigatran etexilate) 150mg bid is the only novel oral anticoagulant, for which its trial (RE-LY®**, comparing Pradaxa® vs. warfarin) has shown a relevant reduction of ischaemic stroke: In patients with non-valvular AF, Pradaxa® 150mg reduced the risk for ischaemic stroke by 25% compared to warfarin.10,11 In addition, patients taking Pradaxa® 150mg had a 59% lower risk of  intracranial bleeding, the most feared side-effect of anticoagulation.10,11
Overall in the RE-LY® trial, Pradaxa® 150mg bid provided a 35% reduction in the overall risk of stroke and systemic embolism versus warfarin.10,11Pradaxa® 110mg bid was shown to be non-inferior compared to warfarin for the prevention of stroke and systemic embolism.10,11 Pradaxa® 150mg showed a similar risk of major bleeds versus warfarin and Pradaxa® 110mg bid demonstrated significantly lower major bleeding.10,11 Both doses of Pradaxa® were associated with significantly lower total, intracranial and life-threatening bleeding compared to warfarin.10,11
Clinical experience of Pradaxa® exceeds that of all other novel oral anticoagulants: It equates to over 1.6 million patient-years in all licensed indications and spans over 100 countries worldwide.12


About the Survey1
The survey was conducted via a MedLIVETM PULSE to 1,000 GPs and Cardiologists in France, Germany, Spain, Italy, Belgium, The Netherlands and Ireland on behalf of Boehringer Ingelheim GmbH. The survey consisted of five key questions in English language, with responses received from 556 GPs and 444 Cardiologists. The survey explored factors affecting prescribing behaviours in atrial fibrillation, including the respective importance of treatment attributes and the perceived overall incidence of ischaemic stroke, and provided consensus on the need for ischaemic stroke prevention to become a treatment priority.

Stroke Prevention in Atrial Fibrillation
AF is the most common sustained heart rhythm condition6, with one in four adults over the age of 406 developing the condition in their lifetime. People with AF are more likely to experience blood clots, which increases the risk of stroke by five-fold.7 Up to three million people worldwide suffer strokes related to AF each year.3,4 Strokes due to AF tend to be severe, with an increased likelihood of death (20%), and disability (60%).5
Ischaemic strokes are the most common type of AF-related stroke, accounting for 92% of strokes experienced by AF patients and frequently leading to severe debilitation.2 Appropriate anticoagulation therapy can help to prevent many types of AF-related strokes and improve overall patient outcomes.8 Pradaxa® 150mg bid is the only novel oral anticoagulant, for which the pivotal trial vs. warfarin has shown a statistically significant and clinically relevant reduction of both ischaemic and haemorrhagic strokes.10,11 Additionally, treatment with Pradaxa® is associated with >2-fold lower rates of both fatal and non-fatal intracranial haemorrhage, one of the most devastating complications of anticoagulation therapy.13,14
Worldwide, AF is an extremely costly public health problem, with treatment costs equating to $6.65 billion in the US and over €6.2 billion across Europe each year.15,16 Given AF-related strokes tend to be more severe, this results in higher direct medical patient costs annually.17 The total societal burden of AF-related stroke reaches €13.5 billion per year in the European Union alone.9

1MedLIVE PULSE online survey, data on file with Boehringer Ingelheim.
2Andersen KK, et al. Hemorrhagic and ischemic strokes compared: stroke severity, mortality, and risk factors. Stroke. 2009;40:2068−72.
3Atlas of Heart Disease and Stroke, World Health Organization, September 2004. Viewed Nov 2012 at http://www.who.int/cardiovascular_diseases/en/cvd_atlas_15_burden_stroke.pdf
4Camm JA, et al. Guidelines for the management of atrial fibrillation. Eur Heart J. 2010;31:2369–429.
5Gladstone DJ, et al. Potentially Preventable Strokes in High-Risk Patients With Atrial Fibrillation Who Are Not Adequately Anticoagulated. Stroke. 2009;40:235-240.
6Lloyd-Jones DM, et al. Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation. 2004;110:1042-6.
7Camm JA, et al. 2012 focussed update of the ESC Guidelines for the management of atrial fibrillation. Eur Heart J. 2012;33:2719-41.
8Aguilar MI, Hart R. Oral anticoagulants for preventing stroke in patients with non-valvular atrial fibrillation and no previous history of stroke or transient ischemic attacks. Cochrane Database of Systematic Reviews. 2005, Issue 3. Art. No.: CD001927.
9Fuster V, et al. ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation – executive summary. Circulation. 2006;114:700-52.
10Connolly SJ, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361:1139-51.
11Connolly SJ, et al. Newly identified events in the RE-LY® trial. N Engl J Med. 2010;363(19):1875-76.
12Boehringer Ingelheim data on file.
13Hart RG, et al. Intracranial hemorrhage in atrial fibrillation patients during anticoagulation with Warfarin or Dabigatran: The RE-LY® Trial. Stroke. 2012; 43(6):1511-1517.
14Fang MC, et al. Death and disability from warfarin-associated intracranial and extracranial hemorrhages. Am J Med. 2007; 120:700 –705.
15Coyne KS, et al. Assessing the direct costs of treating nonvalvular atrial fibrillation in the United States. Value Health 2006; 9:348-56.
16Ringborg A, et al. Costs of atrial fibrillation in five European countries: results from the Euro Heart Survey on atrial fibrillation. Europace 2008; 10:403-11.
17Brüggenjürgen B, et al. The impact of atrial fibrillation on the cost of stroke: the Berlin acute stroke study. Value Health 2007;10:137-43.

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