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ATRIAL FIBRILLATION TREATMENT PARADOX: CHARACTERISTICS OF AND FIRST-YEAR EVENTS IN PATIENTS NOT TREATED WITH VITAMIN-K ANTAGONISTS COMPARED TO TREATED PATIENTS. THE GARFIELD REGISTRY
E379 JACC March 12, 2013 Volume 61, Issue 10
Arrhythmias Atrial Fibrillation Treatment Paradox: Characteristics of and First-Year Events in Patients Not Treated with Vitamin-K antagonists Compared to Treated patients. The GARFIELD Registry Poster Contributions Poster Sessions, Expo North Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Arrhythmias: AF/SVT VIII Abstract Category: 4. Arrhythmias: AF/SVT Presentation Number: 1237-49 Authors: Jean-Pierre L. Bassand, Sophie Rushton-Smith, A John Camm, Samuel Z. Goldhaber, Shinya Goto, Sylvia Haas, Iris Mueller, Alexander G. Turpie, Ajay Kakkar, For the GARFIELD Investigators, University Hospital Jean-Minjoz, Besançon, France, Thrombosis Research Institute, London, United Kingdom Background: A large proportion of atrial fibrillation (AF) patients do not receive guideline-recommended thromboprophylaxis, leaving them at risk for stroke and death. Using data from the 1st cohort of the prospective GARFIELD Registry, we characterized factors associated with non-use of vitamin K antagonists (VKA) for stroke prevention in AF. Methods: Consecutive patients (≥18 y) with newly diagnosed (≤6 weeks) non-valvular AF and ≥1 additional investigator-defined stroke risk factor were enrolled at 543 randomly selected sites in 19 countries (Dec 09-Oct 11). Sites are representative of the distribution of AF care settings in each country. Results: Of the 10,537 patients enrolled, 42.6% did not receive a VKA. Non-VKA-treated patients were younger than VKA-treated patients, with a lower prevalence of cardiovascular risk factors, except coronary artery disease (Table) and lower CHADS2 score (1.7±1.2 vs 2.0±1.2; P<.001), and were more likely to receive antiplatelets (76.0% vs 21.1%; P<.001). They were less likely to have persistent or permanent AF (14.7% vs 20.5%, 19.7% vs 28.8% respectively; P<.001). However, unadjusted death rate during the 1st year of AF diagnosis was higher among no-VKA patients, whereas major bleeding was less frequent. There were numerically more stroke/systemic emboli in the no-VKA group. Conclusions: These observational data suggest a higher risk of death in patients not treated vs treated with VKAs. Table. Patient characteristics and 1st-year outcomes, according to VKA use Characteristics / outcomes Women, % Age, mean (SD), years Age ≥75 years, % Pulse, mean (SD), beats per min Congestive heart failure, % Hypercholesterolemia, % Hypertension, % Coronary artery disease, % Family history of premature cardiac disease, % Diabetes mellitus, % Prior stroke or transient ischemic attack, % Outcomes in 1st year (unadjusted), % Stroke/systemic embolism Major hemorrhage Death
No VKA (n=4,490) 44.3 69±12 36.7 86±25 18.5 34.8 74.6 20.8 16.2 20.8 11.6
VKA (n=6,047) 42.4 71±10 39.7 87±25 22.9 42.4 80.0 18.0 19.8 22.9 16.3
P 0.06 <0.001 0.002 0.001 <0.001 <0.001 <0.001 <0.001 <0.001 0.030 <0.001
1.45 0.36 2.85
1.05 0.75 1.74
0.07 0.014 <0.001
Arrhythmias Atrial Fibrillation Treatment Paradox: Characteristics of and First-Year Events in Patients Not Treated with Vitamin-K antagonists Compared to Treated patients. The GARFIELD Registry Poster Contributions Poster Sessions, Expo North Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Arrhythmias: AF/SVT VIII Abstract Category: 4. Arrhythmias: AF/SVT Presentation Number: 1237-49 Authors: Jean-Pierre L. Bassand, Sophie Rushton-Smith, A John Camm, Samuel Z. Goldhaber, Shinya Goto, Sylvia Haas, Iris Mueller, Alexander G. Turpie, Ajay Kakkar, For the GARFIELD Investigators, University Hospital Jean-Minjoz, Besançon, France, Thrombosis Research Institute, London, United Kingdom Background: A large proportion of atrial fibrillation (AF) patients do not receive guideline-recommended thromboprophylaxis, leaving them at risk for stroke and death. Using data from the 1st cohort of the prospective GARFIELD Registry, we characterized factors associated with non-use of vitamin K antagonists (VKA) for stroke prevention in AF. Methods: Consecutive patients (≥18 y) with newly diagnosed (≤6 weeks) non-valvular AF and ≥1 additional investigator-defined stroke risk factor were enrolled at 543 randomly selected sites in 19 countries (Dec 09-Oct 11). Sites are representative of the distribution of AF care settings in each country. Results: Of the 10,537 patients enrolled, 42.6% did not receive a VKA. Non-VKA-treated patients were younger than VKA-treated patients, with a lower prevalence of cardiovascular risk factors, except coronary artery disease (Table) and lower CHADS2 score (1.7±1.2 vs 2.0±1.2; P<.001), and were more likely to receive antiplatelets (76.0% vs 21.1%; P<.001). They were less likely to have persistent or permanent AF (14.7% vs 20.5%, 19.7% vs 28.8% respectively; P<.001). However, unadjusted death rate during the 1st year of AF diagnosis was higher among no-VKA patients, whereas major bleeding was less frequent. There were numerically more stroke/systemic emboli in the no-VKA group. Conclusions: These observational data suggest a higher risk of death in patients not treated vs treated with VKAs. Table. Patient characteristics and 1st-year outcomes, according to VKA use Characteristics / outcomes Women, % Age, mean (SD), years Age ≥75 years, % Pulse, mean (SD), beats per min Congestive heart failure, % Hypercholesterolemia, % Hypertension, % Coronary artery disease, % Family history of premature cardiac disease, % Diabetes mellitus, % Prior stroke or transient ischemic attack, % Outcomes in 1st year (unadjusted), % Stroke/systemic embolism Major hemorrhage Death
No VKA (n=4,490) 44.3 69±12 36.7 86±25 18.5 34.8 74.6 20.8 16.2 20.8 11.6
VKA (n=6,047) 42.4 71±10 39.7 87±25 22.9 42.4 80.0 18.0 19.8 22.9 16.3
P 0.06 <0.001 0.002 0.001 <0.001 <0.001 <0.001 <0.001 <0.001 0.030 <0.001
1.45 0.36 2.85
1.05 0.75 1.74
0.07 0.014 <0.001