GARFIELD UK (Including: Apenteng, Patricia N., Virdone, Saverio, Hobbs, F. D. Richard, Camm, A. John, Fox, Keith A. A., Pieper, Karen S., Kayani, Gloria and Fitzmaurice, David). (2022) Two-year outcomes of UK patients newly diagnosed with atrial fibrillation : findings from the prospective observational cohort study GARFIELD-AF. British Journal of General Practice, 72 (723). e693-e701. doi:10.3399/BJGP.2021.0548 ISSN 0960-1643.

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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:	Journal Article
Subjects:	R Medicine > RC Internal medicine R Medicine > RM Therapeutics. Pharmacology
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Atrial fibrillation , Atrial fibrillation -- Treatment, Anticoagulants (Medicine), Anticoagulants (Medicine) -- Administration , Oral medication
Journal or Publication Title:	British Journal of General Practice
Publisher:	Royal College of General Practitioners
ISSN:	0960-1643
Official Date:	17 May 2022
Dates:	Date Event 17 May 2022 Published 19 January 2022 Accepted 21 September 2021 Submitted
Volume:	72
Number:	723
Page Range:	e693-e701
DOI:	10.3399/BJGP.2021.0548
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	18 July 2022
Date of first compliant Open Access:	19 July 2022
RIOXX Funder/Project Grant:	Project/Grant ID RIOXX Funder Name Funder ID UNSPECIFIED [NIHR] National Institute for Health Research http://dx.doi.org/10.13039/501100000272

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