Author + information
- 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
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.
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.
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.
These observational data suggest a higher risk of death in patients not treated vs treated with VKAs.
|Characteristics/outcomes||No VKA (n=4,490)||VKA (n=6,047)||P|
|Age, mean (SD), years||69±12||71±10||<0.001|
|Age ≥75 years, %||36.7||39.7||0.002|
|Pulse, mean (SD), beats per min||86±25||87±25||0.001|
|Congestive heart failure, %||18.5||22.9||<0.001|
|Coronary artery disease, %||20.8||18.0||<0.001|
|Family history of premature cardiac disease, %||16.2||19.8||<0.001|
|Diabetes mellitus, %||20.8||22.9||0.030|
|Prior stroke or transient ischemic attack, %||11.6||16.3||<0.001|
|Outcomes in 1st year (unadjusted), %|
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
- 2013 American College of Cardiology Foundation