Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry

Abstract

Background: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry.

Methods and results: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up.

Conclusion: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362.

Keywords: Anticoagulant therapy; Arrhythmia; Atrial fibrillation; GARFIELD-AF.

Fig. 1

GARFIELD-AF sites in India. GARFIELD-AF, Global Anticoagulant Registry in the FIELD–Atrial Fibrillation.

Fig. 2

Antithrombotic treatment in patients enrolled in five sequential cohorts: C1 (2010–2011), C2 (2011–2012), C3 (2013–2014), C4 (2014–2015), and C5 (2015–2016), comparison of India versus world data from the GARFIELD-AF registry. GARFIELD-AF, Global Anticoagulant Registry in the FIELD–Atrial Fibrillation.

Fig. 3

Treatment of newly diagnosed AF by CHA₂DS₂-VASc score in (A) India and (B) all countries included in the GARFIELD-AF registry. AF, atrial fibrillation; GARFIELD-AF, Global Anticoagulant Registry in the FIELD–Atrial Fibrillation.

Fig. 4

HAS-BLED scores at baseline in patients with newly diagnosed AF: India versus all countries included in the GARFIELD-AF registry. AF, atrial fibrillation; GARFIELD-AF, Global Anticoagulant Registry in the FIELD–Atrial Fibrillation.

Fig. 5

Treatment of newly diagnosed AF by HAS-BLED score in (A) India and (B) all countries included in the GARFIELD-AF registry. AF, atrial fibrillation; GARFIELD-AF, Global Anticoagulant Registry in the FIELD–Atrial Fibrillation.