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Two-year outcomes of patients with newly diagnosed atrial fibrillation : results from GARFIELD-AF
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Bassand, Jean-Pierre, Accetta, Gabriele, Camm, Alan John, Cools, Frank, Fitzmaurice, David A., Fox, Keith A. A., Goldhaber, Samuel Z., Goto, Shinya, Haas, Sylvia, Hacke, Werner, Kayani, Gloria, Mantovani, Lorenzo G., Misselwitz, Frank, ten Cate, Hugo, Turpie, Alexander G. G., Verheugt, Freek W. A. and Kakkar, Ajay K. (2016) Two-year outcomes of patients with newly diagnosed atrial fibrillation : results from GARFIELD-AF. European Heart Journal , 37 (38). pp. 2882-2889. doi:10.1093/eurheartj/ehw233 ISSN 1522-9645.
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Official URL: http://dx.doi.org/10.1093/eurheartj/ehw233
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: | Journal Article | ||||||||||
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Journal or Publication Title: | European Heart Journal | ||||||||||
| Publisher: | Oxford University Press | ||||||||||
| ISSN: | 1522-9645 | ||||||||||
| Official Date: | 7 October 2016 | ||||||||||
| Dates: |
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| Volume: | 37 | ||||||||||
| Number: | 38 | ||||||||||
| Page Range: | pp. 2882-2889 | ||||||||||
| DOI: | 10.1093/eurheartj/ehw233 | ||||||||||
| Status: | Peer Reviewed | ||||||||||
| Publication Status: | Published | ||||||||||
| Access rights to Published version: | Open Access (Creative Commons) |
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