Author + information
- A. John Camm,
- Gabriele Accetta,
- Giancarlo Agnelli,
- Jean-Pierre Bassand,
- Samuel Goldhaber,
- Gloria Kayani,
- Frank Misselwitz,
- Seil Oh,
- Pekka Raatikainen,
- Alexander Turpie,
- Martin van Eickels and
- Ajay Kakkar
Background: Atrial fibrillation (AF) increases the risk of death and stroke. We evaluated patients who met guideline-defined thresholds for anticoagulant (AC) therapy in the GARFIELD-AF registry for guideline adherence and 1-yr outcomes.
Methods: Data from 39,898 patients with newly diagnosed nonvalvular AF enrolled in Mar 2010-Sep 2015 were analyzed.
Results: The majority of patients (85.2% and 79.8%) met the criteria for AC as per ESC 2012/AHA 2014 guidelines combined (men CHA2DS2-VASc ≥2, women CHA2DS2-VASc ≥2) and ESC 2016 guidelines (men CHA2DS2-VASc ≥2, women CHA2DS2-VASc ≥3). Both groups had high rates of stroke/systemic embolism (SE) (1.62, 1.66/100 person-yrs) and death (4.77, 5.01/100 person-yrs) and were similarly treated with AC ± antiplatelet (AP) (67.2%, 68.1%; AP only 22.2%, 21.6%; no antithrombotic 11.1%, 10.3%). In these groups, AC was associated with lower rates of stroke/SE, death and the composite endpoint of any of death, stroke/SE, major bleed, MI/ACS (Fig). By contrast, patients who met ESC 2016 guideline criteria for “consider AC” (men CHA2DS2-VASc 1, women CHA2DS2-VASc 2) and “consider/not recommend AC” (women CHA2DS2-VASc 2) had a lower risk of stroke/SE that was not clearly reduced by AC, and AC was associated with 3-4× higher risk of major bleeds (Fig).
Conclusions: In guideline-defined moderate/high stroke risk patients, AC therapy was associated with a net clinical benefit. Better risk stratification not yet considered in guidelines is needed for lower risk patients.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Fibrillatory Arrhythmias: Outcomes With Contemporary Practice
Abstract Category: 8. Arrhythmias and Clinical EP: Supraventricular/Ventricular Arrhythmias
Presentation Number: 1110-098
- 2017 American College of Cardiology Foundation