Bassand, J-P; Accetta, G; Camm, AJ; Cools, F; Fitzmaurice, DA; Fox, KAA; Goldhaber, SZ; ... GARFIELD-AF Investigators, .; + view all 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; GARFIELD-AF Investigators, .; - view fewer (2016) Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF. European Heart Journal , 37 (38) pp. 2882-2889. 10.1093/eurheartj/ehw233.

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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.

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