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Clinical Outcomes in Asymptomatic and Symptomatic Atrial Fibrillation Presentations in GARFIELD-AF: Implications for AF Screening.

Gibbs, H; Freedman, B; Rosenqvist, M; Virdone, S; Mahmeed, WA; Ambrosio, G; Camm, AJ; Jacobson, B; Jerjes-Sanchez, C; Kayani, G; et al. Gibbs, H; Freedman, B; Rosenqvist, M; Virdone, S; Mahmeed, WA; Ambrosio, G; Camm, AJ; Jacobson, B; Jerjes-Sanchez, C; Kayani, G; Oto, A; Panchenko, E; Ragy, H; Kakkar, AK; GARFIELD-AF Investigators (2021) Clinical Outcomes in Asymptomatic and Symptomatic Atrial Fibrillation Presentations in GARFIELD-AF: Implications for AF Screening. Am J Med, 134 (7). 893-901.e11. ISSN 1555-7162 https://doi.org/10.1016/j.amjmed.2021.01.017
SGUL Authors: Camm, Alan John

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Abstract

BACKGROUND: Asymptomatic atrial fibrillation is often detected incidentally. Prognosis and optimal therapy for asymptomatic compared with symptomatic atrial fibrillation is uncertain. This study compares clinical characteristics, treatment, and 2-year outcomes of asymptomatic and symptomatic atrial fibrillation presentations. METHODS: Global Anticoagulant Registry in the Field-Atrial Fibrillation (GARFIELD-AF) is a global, prospective, observational study of newly diagnosed atrial fibrillation with ≥1 stroke risk factors (http://www.clinicaltrials.gov, unique identifier: NCT01090362). Patients were characterized by atrial fibrillation-related symptoms at presentation and the (CHA2DS2-VASc) score. Two-year follow-up recorded anticoagulation patterns (vitamin K antagonist, direct oral anticoagulants, parenteral therapy) and outcomes (stroke/systemic embolism, all-cause mortality, and bleeding). RESULTS: At presentation, of 52,032 eligible patients, 25.4% were asymptomatic and 74.6% symptomatic. Asymptomatic patients were slightly older (72 vs 70 years), more often male (64.2% vs 52.9%), and more frequently initiated on anticoagulation ± antiplatelets (69.4% vs 66.0%). No difference in events (adjusted hazard ratios, 95% confidence interval) for nonhemorrhagic stroke/systemic embolism (1.19, 0.97-1.45), all-cause mortality (1.06, 0.94-1.20), or bleeding (1.02, 0.87-1.19) was observed. Anticoagulation was associated with comparable reduction in nonhemorrhagic stroke/systemic embolism (0.59, 0.43-0.82 vs 0.78, 0.65-0.93) and all-cause mortality (0.69, 0.59-0.81 vs 0.77, 0.71-0.85) in asymptomatic versus symptomatic, respectively. CONCLUSIONS: Major outcomes do not differ between asymptomatic and symptomatic atrial fibrillation presentations and are comparably reduced by anticoagulation. Opportunistic screening-detected asymptomatic atrial fibrillation likely has the same prognosis as asymptomatic atrial fibrillation at presentation and likely responds similarly to anticoagulation thromboprophylaxis.

Item Type: Article
Additional Information: © 2021 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license(http://creativecommons.org/licenses/by-nc-nd/4.0/)
Keywords: Anticoagulation, Asymptomatic, Atrial fibrillation, Symptomatic, GARFIELD-AF Investigators, Atrial fibrillation, anticoagulation, asymptomatic, symptomatic, General & Internal Medicine, 11 Medical and Health Sciences
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Am J Med
ISSN: 1555-7162
Language: eng
Dates:
DateEvent
July 2021Published
16 February 2021Published Online
14 January 2021Accepted
Publisher License: Creative Commons: Attribution-Noncommercial-No Derivative Works 4.0
PubMed ID: 33607088
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/113018
Publisher's version: https://doi.org/10.1016/j.amjmed.2021.01.017

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