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

GARFIELD-AF Investigators; Jean-Pierre Bassand; Gabriele Accetta; Alan John Camm; Frank Cools; David A Fitzmaurice; Keith A A Fox; Samuel Z Goldhaber; Shinya Goto; Sylvia Haas; Werner Hacke; Gloria Kayani; Lorenzo G Mantovani; Frank Misselwitz; Hugo Ten Cate; Alexander G G Turpie; Freek W A Verheugt; Ajay K Kakkar

doi:10.1093/eurheartj/ehw233

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

GARFIELD-AF Investigators, Jean-Pierre Bassand, Gabriele Accetta, Alan John Camm, Frank Cools, David A Fitzmaurice, Keith A A Fox, Samuel Z Goldhaber, Shinya Goto, Sylvia Haas, Werner Hacke, Gloria Kayani, Lorenzo G Mantovani, Frank Misselwitz, Hugo Ten Cate, Alexander G G Turpie, Freek W A Verheugt, Ajay K Kakkar

Research output: Contribution to journal › Article › peer-review

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.

Original language	English
Journal	European Heart Journal
DOIs	https://doi.org/10.1093/eurheartj/ehw233
Publication status	Published - 29 Jun 2016

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Fox K Two year outcomes..
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GARFIELD-AF Investigators, Bassand, J-P., Accetta, G., Camm, A. J., Cools, F., Fitzmaurice, D. A., Fox, K. A. A., Goldhaber, S. Z., Goto, S., Haas, S., Hacke, W., Kayani, G., Mantovani, L. G., Misselwitz, F., Ten Cate, H., Turpie, A. G. G., Verheugt, F. W. A., & Kakkar, A. K. (2016). Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF. European Heart Journal. https://doi.org/10.1093/eurheartj/ehw233

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

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.",

author = "{GARFIELD-AF Investigators} and Jean-Pierre Bassand and Gabriele Accetta and Camm, {Alan John} and Frank Cools and Fitzmaurice, {David A} and Fox, {Keith A A} and Goldhaber, {Samuel Z} and Shinya Goto and Sylvia Haas and Werner Hacke and Gloria Kayani and Mantovani, {Lorenzo G} and Frank Misselwitz and {Ten Cate}, Hugo and Turpie, {Alexander G G} and Verheugt, {Freek W A} and Kakkar, {Ajay K}",

note = "{\textcopyright} The Author 2016. Published by Oxford University Press on behalf of the European Society of Cardiology.",

year = "2016",

month = jun,

day = "29",

doi = "10.1093/eurheartj/ehw233",

language = "English",

journal = "European Heart Journal",

issn = "0195-668X",

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GARFIELD-AF Investigators, Bassand, J-P, Accetta, G, Camm, AJ, Cools, F, Fitzmaurice, DA, Fox, KAA, Goldhaber, SZ, Goto, S, Haas, S, Hacke, W, Kayani, G, Mantovani, LG, Misselwitz, F, Ten Cate, H, Turpie, AGG, Verheugt, FWA & Kakkar, AK 2016, 'Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF', European Heart Journal. https://doi.org/10.1093/eurheartj/ehw233

TY - JOUR

T1 - Two-year outcomes of patients with newly diagnosed atrial fibrillation

T2 - results from GARFIELD-AF

AU - GARFIELD-AF Investigators

AU - Bassand, Jean-Pierre

AU - Accetta, Gabriele

AU - Camm, Alan John

AU - Cools, Frank

AU - Fitzmaurice, David A

AU - Fox, Keith A A

AU - Goldhaber, Samuel Z

AU - Goto, Shinya

AU - Haas, Sylvia

AU - Hacke, Werner

AU - Kayani, Gloria

AU - Mantovani, Lorenzo G

AU - Misselwitz, Frank

AU - Ten Cate, Hugo

AU - Turpie, Alexander G G

AU - Verheugt, Freek W A

AU - Kakkar, Ajay K

PY - 2016/6/29

Y1 - 2016/6/29

N2 - 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.

AB - 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.

U2 - 10.1093/eurheartj/ehw233

DO - 10.1093/eurheartj/ehw233

M3 - Article

C2 - 27357359

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

ER -

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

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