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Eur Heart J. 2016 Oct 7;37(38):2882-2889. Epub 2016 Jun 29.

Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.

Author information

1
University of Besançon, Besançon, France jpbassand@tri-london.ac.uk jpbassand@orange.fr.
2
Thrombosis Research Institute, Emmanuel Kaye Building, Manresa Road, London SW3 6LR, UK.
3
St George's University of London, London, UK.
4
AZ Klina, Brasschaat, Belgium.
5
University of Birmingham, Edgbaston, Birmingham, UK.
6
University of Edinburgh, Edinburgh, UK.
7
Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
8
Tokai University, Kanagawa, Japan.
9
Formerly Technical University of Munich, Munich, Germany.
10
University of Heidelberg, Heidelberg, Germany.
11
University of Milano-Bicocca, Milan, Italy.
12
Bayer HealthCare Pharmaceuticals, Berlin, Germany.
13
Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
14
McMaster University, Hamilton, Canada.
15
University Hospital, Nijmegen.
16
Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
17
University College London, London, UK.

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.

KEYWORDS:

Anticoagulation; Atrial fibrillation; Bleeding; Stroke; Stroke prevention

PMID:
27357359
PMCID:
PMC5070447
DOI:
10.1093/eurheartj/ehw233
[Indexed for MEDLINE]
Free PMC Article

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