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Risk factors for death, stroke, and bleeding in 28,628 patients from the GARFIELD-AF registry : rationale for comprehensive management of atrial fibrillation
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Bassand, Jean-Pierre, Accetta, Gabriele, Al Mahmeed, Mahmeed, Corbalan, Ramon, Eikelboom, John, Fitzmaurice, David A., Fox, Keith A. A., Gao, Haiyan, Goldhaber, Samuel Z., Goto, Shinya, Haas, Sylvia, Kayani, Gloria, Pieper, Karen, Turpie, Alexander G. G., Eickels, Martin van, Verheugt, Freek W. A. and Kakkar, Ajay K. (2018) Risk factors for death, stroke, and bleeding in 28,628 patients from the GARFIELD-AF registry : rationale for comprehensive management of atrial fibrillation. PLoS One, 13 (1). e0191592. doi:10.1371/journal.pone.0191592 ISSN 1932-6203.
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Official URL: https://doi.org/10.1371/journal.pone.0191592
Abstract
Background
The factors influencing three major outcomes–death, stroke/systemic embolism (SE), and major bleeding–have not been investigated in a large international cohort of unselected patients with newly diagnosed atrial fibrillation (AF).
Methods and results
In 28,628 patients prospectively enrolled in the GARFIELD-AF registry with 2-year follow-up, we aimed at analysing: (1) the variables influencing outcomes; (2) the extent of implementation of guideline-recommended therapies in comorbidities that strongly affect outcomes. Median (IQR) age was 71.0 (63.0 to 78.0) years, 44.4% of patients were female, median (IQR) CHA2DS2-VASc score was 3.0 (2.0 to 4.0); 63.3% of patients were on anticoagulants (ACs) with or without antiplatelet (AP) therapy, 24.5% AP monotherapy, and 12.2% no antithrombotic therapy. At 2 years, rates (95% CI) of death, stroke/SE, and major bleeding were 3.84 (3.68; 4.02), 1.27 (1.18; 1.38), and 0.71 (0.64; 0.79) per 100 person-years. Age, history of stroke/SE, vascular disease (VascD), and chronic kidney disease (CKD) were associated with the risks of all three outcomes. Congestive heart failure (CHF) was associated with the risks of death and stroke/SE. Smoking, non-paroxysmal forms of AF, and history of bleeding were associated with the risk of death, female sex and heavy drinking with the risk of stroke/SE. Asian race was associated with lower risks of death and major bleeding versus other races. AC treatment was associated with 30% and 28% lower risks of death and stroke/SE, respectively, compared with no AC treatment. Rates of prescription of guideline-recommended drugs were suboptimal in patients with CHF, VascD, or CKD.
Conclusions
Our data show that several variables are associated with the risk of one or more outcomes, in terms of death, stroke/SE, and major bleeding. Comprehensive management of AF should encompass, besides anticoagulation, improved implementation of guideline-recommended therapies for comorbidities strongly associated with outcomes, namely CHF, VascD, and CKD.
| Item Type: | Journal Article | ||||||
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| Subjects: | R Medicine > RC Internal medicine | ||||||
| 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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| Library of Congress Subject Headings (LCSH): | Atrial fibrillation -- Diagnosis -- Standards, Embolism | ||||||
| Journal or Publication Title: | PLoS One | ||||||
| Publisher: | Public Library of Science | ||||||
| ISSN: | 1932-6203 | ||||||
| Official Date: | 25 January 2018 | ||||||
| Dates: |
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| Volume: | 13 | ||||||
| Number: | 1 | ||||||
| Article Number: | e0191592 | ||||||
| DOI: | 10.1371/journal.pone.0191592 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||||
| Date of first compliant deposit: | 24 January 2018 | ||||||
| Date of first compliant Open Access: | 8 May 2018 | ||||||
| RIOXX Funder/Project Grant: |
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