Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF

Abstract

Aims: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year.

Methods and results: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy. The mean (standard deviation) age was 69.8 (11.4) years, 43.8% were women, and the mean CHA₂DS₂-VASc score was 3.3 (1.6); 60.8% of patients were prescribed anticoagulant therapy with/without antiplatelet (AP) therapy, 27.4% AP monotherapy, and 11.8% no antithrombotic therapy. At 2-year follow-up, all-cause mortality, stroke/SE, and major bleeding had occurred at a rate (95% confidence interval) of 3.83 (3.62; 4.05), 1.25 (1.13; 1.38), and 0.70 (0.62; 0.81) per 100 person-years, respectively. Rates for all three major events were highest during the first 4 months. Congestive heart failure, acute coronary syndromes, sudden/unwitnessed death, malignancy, respiratory failure, and infection/sepsis accounted for 65% of all known causes of death and strokes for <10%. Anticoagulant treatment was associated with a 35% lower risk of death.

Conclusion: The most frequent of the three major outcome measures was death, whose most common causes are not known to be significantly influenced by anticoagulation. This suggests that a more comprehensive approach to the management of NVAF may be needed to improve outcome. This could include, in addition to anticoagulation, interventions targeting modifiable, cause-specific risk factors for death.

Clinical trial registration: http://www.clinicaltrials.gov. Unique identifier: NCT01090362.

Keywords: Anticoagulation; Atrial fibrillation; Bleeding; Stroke; Stroke prevention.

Figure 1

Antithrombotic treatment at baseline stratified by CHA₂DS₂-VASc score (A) and by HAS-BLED score (B).

Figure 2

Four-monthly rate ratios* for all-cause mortality (A), stroke/systemic embolism (B), and major bleeding (C). *The ratio between the observed number of events in the period and the expected number of events obtained by applying the overall rate to the period. Only the first occurrence of each event was taken into account.

Figure 3

Adjusted hazard ratios for 2-year all-cause mortality according to baseline characteristics and anticoagulant treatment. Anticoagulant treatment includes both vitamin K antagonists and non-vitamin K antagonist oral anticoagulants. Hazard ratios were adjusted for all variables in the model. Reference groups, from top: <65 years, men, Caucasian/Hispanic/Latino, never smoker, no history of disease (for diabetes, hypertension, stroke/TIA/systemic embolism, history of bleeding, cardiovascular failure, vascular disease, and renal disease), no anticoagulant treatment, and paroxysmal AF. TIA, transient ischaemic attack.

Figure 4

Adjusted hazard ratios for 2-year all-cause mortality (A), stroke/systemic embolism (B), and major bleeding (C) according to CHA₂DS₂-VASc and HAS-BLED scores. Hazard ratios were adjusted for components of CHA₂DS₂-VASc and HAS-BLED scores. Reference groups, from top: CHA₂DS₂-VASc score of 0–1, HAS-BLED score of 0–1.