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Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.

Bassand, J-P; Accetta, G; Camm, AJ; Cools, F; Fitzmaurice, DA; Fox, KAA; Goldhaber, SZ; Goto, S; Haas, S; Hacke, W; et al. Bassand, J-P; Accetta, G; Camm, AJ; Cools, F; Fitzmaurice, DA; Fox, KAA; Goldhaber, SZ; Goto, S; Haas, S; Hacke, W; Kayani, G; Mantovani, LG; Misselwitz, F; Ten Cate, H; Turpie, AGG; Verheugt, FWA; Kakkar, AK; GARFIELD-AF Investigators (2016) Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF. European Heart Journal, 37 (38). pp. 2882-2889. ISSN 1522-9645 https://doi.org/10.1093/eurheartj/ehw233
SGUL Authors: Camm, Alan John

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Abstract

AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy. The mean (standard deviation) age was 69.8 (11.4) years, 43.8% were women, and the mean CHA2DS2-VASc score was 3.3 (1.6); 60.8% of patients were prescribed anticoagulant therapy with/without antiplatelet (AP) therapy, 27.4% AP monotherapy, and 11.8% no antithrombotic therapy. At 2-year follow-up, all-cause mortality, stroke/SE, and major bleeding had occurred at a rate (95% confidence interval) of 3.83 (3.62; 4.05), 1.25 (1.13; 1.38), and 0.70 (0.62; 0.81) per 100 person-years, respectively. Rates for all three major events were highest during the first 4 months. Congestive heart failure, acute coronary syndromes, sudden/unwitnessed death, malignancy, respiratory failure, and infection/sepsis accounted for 65% of all known causes of death and strokes for <10%. Anticoagulant treatment was associated with a 35% lower risk of death. CONCLUSION: The most frequent of the three major outcome measures was death, whose most common causes are not known to be significantly influenced by anticoagulation. This suggests that a more comprehensive approach to the management of NVAF may be needed to improve outcome. This could include, in addition to anticoagulation, interventions targeting modifiable, cause-specific risk factors for death. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01090362.

Item Type: Article
Additional Information: © The Author 2016. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
Keywords: Anticoagulation, Atrial fibrillation, Bleeding, Stroke, Stroke prevention, GARFIELD-AF Investigators, Anticoagulation, Atrial fibrillation, Bleeding, Stroke, Stroke prevention, Cardiovascular System & Hematology, 1102 Cardiovascular Medicine And Haematology
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) > Cardiac (INCCCA)
Journal or Publication Title: European Heart Journal
ISSN: 1522-9645
Language: ENG
Dates:
DateEvent
7 October 2016Published
29 June 2016Published Online
29 April 2016Accepted
Publisher License: Creative Commons: Attribution-Noncommercial 4.0
PubMed ID: 27357359
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/108172
Publisher's version: https://doi.org/10.1093/eurheartj/ehw233

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