• Jean-Pierre Bassand, Gabriele Accetta, Wael Al Mahmeed, Ramon Corbalan, John Eikelboom, David A Fitzmaurice, Fox Keith A A KAA Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom., Haiyan Gao, Samuel Z Goldhaber, Shinya Goto, Sylvia Haas, Gloria Kayani, Karen Pieper, Turpie Alexander G G AGG Department of Medicine, McMaster University, Hamilton, Canada., Martin van Eickels, Verheugt Freek W A FWA Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands., Ajay K Kakkar, and GARFIELD-AF Investigators.
• Department of Cardiology-EA 3920, University of Besançon, Besançon, France.
• Plos One. 2018 Jan 1; 13 (1): e0191592.

BackgroundThe 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 ResultsIn 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.ConclusionsOur 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 RegistrationClinicalTrials.gov NCT01090362.

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