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

• Type of Material: Article
• Authors: Jean-Pierre Bassand, University of Besançon; Gabriele Accetta, Thrombosis Research Institute; Alan John Camm, St George's University of London; Frank Cools, AZ Klina; David A. Fitzmaurice, University of Birmingham; Keith A. A. Fox, University of Edinburgh; Samuel Z. Goldhaber, Brigham and Women's Hospital; Shinya Goto, Tokai University; Sylvia Haas, Technical University of Munich; Werner Hacke, University of Heidelberg; Gloria Kayani, Thrombosis Research Institute; Lorenzo G. Mantovani, University of Milano-Bicocca; Frank Misselwitz, Bayer HealthCare Pharmaceuticals; Hugo ten Cate, Cardiovascular Research Institute Maastricht; Alexander G. G. Turpie, McMaster University; Freek W. A. Verheigt, University Hospital Nijmegen; Ajay K. Kakkar, Thrombosis Research Institute; Peter Wilson, Emory University
• Language: English
• Date: 2016-10-07
• Publisher: Oxford University Press (OUP)
• Publication Version: Final Published Version
• Copyright Statement: © The Author 2016. Published by Oxford University Press on behalf of the European Society of Cardiology.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/eurheartj/ehw233
• Title of Journal or Parent Work: EUROPEAN HEART JOURNAL
• Volume: 37
• Issue: 38
• Start Page: 2882
• End Page: 2889
• Grant/Funding Information: This work was supported by an unrestricted research grant from Bayer Pharma AG, Berlin, Germany, to TRI, London, UK, which sponsors the GARFIELD-AF registry.
• Keywords: Stroke; Stroke prevention; Anticoagulation; Bleeding; Atrial fibrillation
• Research Categories: Health Sciences, Medicine and Surgery

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.