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Two-year outcomes of UK patients newly diagnosed with atrial fibrillation: findings from the prospective observational cohort study GARFIELD-AF.

Apenteng, PN; Virdone, S; Hobbs, FR; Camm, AJ; Fox, KA; Pieper, KS; Kayani, G; Fitzmaurice, D; GARFIELD UK investigators* (2022) Two-year outcomes of UK patients newly diagnosed with atrial fibrillation: findings from the prospective observational cohort study GARFIELD-AF. Br J Gen Pract, 72 (723). e693-e701. ISSN 1478-5242 https://doi.org/10.3399/BJGP.2021.0548
SGUL Authors: Camm, Alan John

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Abstract

BACKGROUND: The outcomes of patients newly diagnosed with atrial fibrillation (AF) following the introduction of direct-acting oral anticoagulants are not well known. AIM: To determine the 2-year outcomes of patients newly diagnosed with AF, and the effectiveness of oral anticoagulants in everyday practice. DESIGN AND SETTING: This was a prospective observational cohort study in UK primary care. METHOD: In total, 3574 patients aged ≥18 years with a new AF diagnosis were enrolled. A propensity score was applied using an overlap weighting scheme to obtain unbiased estimates of the treatment effect of anticoagulation versus no anticoagulation on the occurrence of death, non-haemorrhagic stroke/systemic embolism, and major bleeding within 2 years of diagnosis. RESULTS: Overall, 65.8% received anticoagulant therapy, 20.8% received an antiplatelet only, and 13.4% received neither. During the study period, the overall incidence rates of all-cause mortality, non-haemorrhagic stroke/systemic embolism, and major bleeding were 4.15 (95% confidence interval [CI] = 3.69 to 4.65), 1.45 (95% CI = 1.19 to 1.77), and 1.21 (95% CI = 0.97 to 1.50) per 100 person-years, respectively. Anticoagulation treatment compared with no anticoagulation treatment was associated with significantly lower all-cause mortality adjusted hazard ratio (aHR) 0.70 (95% CI = 0.53 to 0.93), significantly lower risk of non-haemorrhagic stroke/systemic embolism (aHR 0.39, 95% CI = 0.24 to 0.62), and a non-significant higher risk of major bleeding (aHR 1.31, 95% CI = 0.77 to 2.24). CONCLUSION: The data support a benefit of anticoagulation in reducing stroke and death, without an increased risk of a major bleed in patients with new-onset AF. Anticoagulation treatment in patients at high risk of stroke who are not receiving anticoagulation may further improve outcomes.

Item Type: Article
Additional Information: © The Authors http://creativecommons.org/licenses/by/4.0/ This article is Open Access: CC BY 4.0 licence (http://creativecommons.org/licences/by/4.0/).
Keywords: all-cause mortality, anticoagulation, atrial fibrillation, bleeding, stroke, GARFIELD UK investigators*, Public Health, 1117 Public Health and Health Services
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Br J Gen Pract
ISSN: 1478-5242
Language: eng
Dates:
DateEvent
October 2022Published
18 February 2022Published Online
19 January 2022Accepted
Publisher License: Creative Commons: Attribution 4.0
PubMed ID: 35577587
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/114381
Publisher's version: https://doi.org/10.3399/BJGP.2021.0548

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