Bassand, J-P; Accetta, G; Al Mahmeed, W; Corbalan, R; Eikelboom, J; Fitzmaurice, DA; Fox, KAA; ... GARFIELD-AF Investigators, .; + view all Bassand, J-P; Accetta, G; Al Mahmeed, W; Corbalan, R; Eikelboom, J; Fitzmaurice, DA; Fox, KAA; Gao, H; Goldhaber, SZ; Goto, S; Haas, S; Kayani, G; Pieper, K; Turpie, AGG; van Eickels, M; Verheugt, FWA; Kakkar, AK; GARFIELD-AF Investigators, .; - view fewer (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) , Article e0191592. 10.1371/journal.pone.0191592.

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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. // Trial registration: ClinicalTrials.gov NCT01090362.

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