Analysis of Outcomes in Ischemic vs Nonischemic Cardiomyopathy in Patients With Atrial Fibrillation A Report From the GARFIELD-AF Registry

Ramon Corbalan, Jean-Pierre Bassand, Laura Illingworth, Giuseppe Ambrosio, A. John Camm, David A. Fitzmaurice, Keith A. A. Fox, Samuel Z. Goldhaber, Shinya Goto, Sylvia Haas, Gloria Kayani, Lorenzo G. Mantovani, Frank Misselwitz, Karen S. Pieper, Alexander G. G. Turpie, Freek W. A. Verheugt, Ajay K. Kakkar,
JAMA Cardiol. 2019-06-01; 4(6): 526
DOI: 10.1001/JAMACARDIO.2018.4729

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1. JAMA Cardiol. 2019 Jun 1;4(6):526-548. doi: 10.1001/jamacardio.2018.4729.

Analysis of Outcomes in Ischemic vs Nonischemic Cardiomyopathy in Patients With
Atrial Fibrillation: A Report From the GARFIELD-AF Registry.

Corbalan R(1), Bassand JP(2)(3), Illingworth L(3), Ambrosio G(4), Camm AJ(5),
Fitzmaurice DA(6), Fox KAA(7), Goldhaber SZ(8), Goto S(9), Haas S(10), Kayani
G(3), Mantovani LG(11), Misselwitz F(12), Pieper KS(3)(13), Turpie AGG(14),
Verheugt FWA(15), Kakkar AK(16); GARFIELD-AF Investigators.

Author information:
(1)Division of Cardiovascular Diseases, Catholic University School of Medicine,
Santiago, Chile.
(2)University of Besançon, Besançon, France.
(3)Thrombosis Research Institute, London, England.
(4)University of Perugia School of Medicine, Perugia, Italy.
(5)St George’s University of London, London, England.
(6)Warwick Medical School, University of Warwick, Coventry, England.
(7)Edinburgh University, Edinburgh, Scotland.
(8)Brigham and Women’s Hospital and Harvard Medical School, Boston,
Massachusetts.
(9)Tokai University School of Medicine, Kanagawa, Japan.
(10)Formerly at Klinikum rechts der Isar, Technical University of Munich, Munich,
Germany.
(11)Center for Public Health Research, University of Milan Bicocca, Monza, Italy.
(12)Bayer AG Pharmaceuticals, Berlin, Germany.
(13)Duke Clinical Research Institute, Durham, North Carolina.
(14)McMaster University, Hamilton, Ontario, Canada.
(15)Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
(16)University College London, London, United Kingdom.

Importance: Congestive heart failure (CHF) is commonly associated with
nonvalvular atrial fibrillation (AF), and their combination may affect treatment
strategies and outcomes.
Objective: To assess the treatment strategies and 1-year clinical outcomes of
antithrombotic and CHF therapies for patients with newly diagnosed AF with
concomitant CHF stratified by etiology (ischemic cardiomyopathy [ICM] vs
nonischemic cardiomyopathy [NICM]).
Design, Setting, and Participants: The GARFIELD-AF registry is a prospective,
noninterventional registry. A total of 52 014 patients with AF were enrolled
between March 2010 and August 2016. A total of 11 738 patients 18 years and older
with newly diagnosed AF (≤6 weeks’ duration) and at least 1
investigator-determined stroke risk factor were included. Data were analyzed from
December 2017 to September 2018.
Exposures: One-year follow-up rates of death, stroke/systemic embolism, and major
bleeding were assessed.
Main Outcomes and Measures: Event rates per 100 person-years were estimated from
the Poisson model and Cox hazard ratios (HRs) and 95% confidence intervals.
Results: The median age of the population was 71.0 years, 22 987 of 52 013 were
women (44.2%) and 31 958 of 52 014 were white (61.4%). Of 11 738 patients with
CHF, 4717 (40.2%) had ICM and 7021 (59.8%) had NICM. Prescription of oral
anticoagulant and antiplatelet drugs was not balanced between groups. Oral
anticoagulants with or without antiplatelet drugs were used in 2753 patients with
ICM (60.1%) and 5082 patients with NICM (73.7%). Antiplatelets were prescribed
alone in 1576 patients with ICM (34.4%) and 1071 patients with NICM (15.5%).
Compared with patients with NICM, use of angiotensin-converting enzyme
inhibitors/angiotensin receptor blockers (72.6% [3439] vs 60.3% [4236]) and of β
blockers (63.3% [2988] vs 53.2% [3737]) was higher in patients with ICM. Rates of
all-cause and cardiovascular death per 100 patient-years were significantly
higher in the ICM group (all-cause death: ICM, 10.2; 95% CI, 9.2-11.1; NICM, 7.0;
95% CI, 6.4-7.6; cardiovascular death: ICM, 5.1; 95% CI, 4.5-5.9; NICM, 2.9; 95%
CI, 2.5-3.4). Stroke/systemic embolism rates tended to be higher in ICM groups
compared with NICM groups (ICM, 2.0; 95% CI, 1.6-2.5; NICM, 1.5; 95% CI,
1.3-1.9). Major bleeding rates were significantly higher in the ICM group (1.1;
95% CI, 0.8-1.4) compared with the NICM group (0.7; 95% CI, 0.5-0.9).
Conclusions and Relevance: Patients with ICM received oral anticoagulants with or
without antiplatelet drugs less frequently and antiplatelets alone more
frequently than patients with NICM, but they received angiotensin-converting
enzyme inhibitors/angiotensin receptor blockers more often than patients with
NICM. All-cause and cardiovascular death rates were higher in patients with ICM
than patients with NICM.
Trial Registration: ClinicalTrials.gov Identifier: NCT01090362.

DOI: 10.1001/jamacardio.2018.4729
PMCID: PMC6506904
PMID: 31066873 [Indexed for MEDLINE]

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