Risk factors for death, stroke, and bleeding in 28,628 patients from the GARFIELD-AF registry: Rationale for comprehensive management of atrial fibrillation

Jean-Pierre Bassand, Gabriele Accetta, Wael Al Mahmeed, Ramon Corbalan, John Eikelboom, David A. Fitzmaurice, Keith A. A. Fox, Haiyan Gao, Samuel Z. Goldhaber, Shinya Goto, Sylvia Haas, Gloria Kayani, Karen Pieper, Alexander G. G. Turpie, Martin van Eickels, Freek W. A. Verheugt, Ajay K. Kakkar,
PLoS ONE. 2018-01-25; 13(1): e0191592
DOI: 10.1371/JOURNAL.PONE.0191592

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1. PLoS One. 2018 Jan 25;13(1):e0191592. doi: 10.1371/journal.pone.0191592.
eCollection 2018.

Risk factors for death, stroke, and bleeding in 28,628 patients from the
GARFIELD-AF registry: Rationale for comprehensive management of atrial

Bassand JP(1)(2), Accetta G(2), Al Mahmeed W(3), Corbalan R(4), Eikelboom J(5),
Fitzmaurice DA(6), Fox KAA(7), Gao H(2), Goldhaber SZ(8), Goto S(9), Haas S(10),
Kayani G(2), Pieper K(2)(11), Turpie AGG(5), van Eickels M(12), Verheugt FWA(13),
Kakkar AK(2)(14); GARFIELD-AF Investigators.

Author information:
(1)Department of Cardiology-EA 3920, University of Besançon, Besançon, France.
(2)Thrombosis Research Institute, London, United Kingdom.
(3)Cardiology, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu
Dhabi, United Arab Emirates.
(4)Department of Cardiology, Catholic University School of Medicine, Santiago,
(5)Department of Medicine, McMaster University, Hamilton, Canada.
(6)Warwick Medical School, University of Warwick, Coventry, United Kingdom.
(7)Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United
(8)Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard
Medical School, Boston, Massachusetts, United States of America.
(9)Department of Medicine (Cardiology), Tokai University School of Medicine,
Kanagawa, Japan.
(10)Formerly Klinikum rechts der Isar, Technical University of Munich, Munich,
(11)Duke Clinical Research Institute, Durham, North Carolina, United States of
(12)Bayer AG, Berlin, Germany.
(13)Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The
(14)University College London, London, United Kingdom.

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.

DOI: 10.1371/journal.pone.0191592
PMCID: PMC5784935
PMID: 29370229 [Indexed for MEDLINE]

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