Analysis of outcomes in ischemic vs nonischemic cardiomyopathy in patients with atrial fibrillation: a report from the GARFIELD-AF registry
Importance: Congestive heart failure (CHF) is commonly associated with nonvalvular atrial fibrillation (AF), and their combination may affect treatment strategies and outcomes. - Objective: To assess the treatment strategies and 1-year clinical outcomes of antithrombotic and CHF therapies for patien...
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| Main Authors: | , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
May 8, 2019
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| In: |
JAMA cardiology
Year: 2019, Volume: 4, Issue: 6, Pages: 526-548 |
| ISSN: | 2380-6591 |
| DOI: | 10.1001/jamacardio.2018.4729 |
| Online Access: | Verlag, Volltext: https://doi.org/10.1001/jamacardio.2018.4729
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| Author Notes: | Ramon Corbalan, Jean-Pierre Bassand, Laura Illingworth, Giuseppe Ambrosio, A. John Camm, David A. Fitzmaurice, Keith A.A. Fox, Samuel Z. Goldhaber, Shinya Goto, Sylvia Haas, Gloria Kayani, Lorenzo G. Mantovani, Frank Misselwitz, Karen S. Pieper, Alexander G.G. Turpie, Freek W.A. Verheugt, Ajay K. Kakkar, GARFIELD-AF Investigators |
| Summary: | Importance: Congestive heart failure (CHF) is commonly associated with nonvalvular atrial fibrillation (AF), and their combination may affect treatment strategies and outcomes. - Objective: To assess the treatment strategies and 1-year clinical outcomes of antithrombotic and CHF therapies for patients with newly diagnosed AF with concomitant CHF stratified by etiology (ischemic cardiomyopathy [ICM] vs nonischemic cardiomyopathy [NICM]). - Design, Setting, and Participants: The GARFIELD-AF registry is a prospective, noninterventional registry. A total of 52014 patients with AF were enrolled between March 2010 and August 2016. A total of 11738 patients 18 years and older with newly diagnosed AF (≤6 weeks' duration) and at least 1 investigator-determined stroke risk factor were included. Data were analyzed from December 2017 to September 2018. - Exposures: One-year follow-up rates of death, stroke/systemic embolism, and major bleeding were assessed. - Main Outcomes and Measures: Event rates per 100 person-years were estimated from the Poisson model and Cox hazard ratios (HRs) and 95% confidence intervals. - Results: The median age of the population was 71.0 years, 22987 of 52013 were women (44.2%) and 31958 of 52014 were white (61.4%). Of 11738 patients with CHF, 4717 (40.2%) had ICM and 7021 (59.8%) had NICM. Prescription of oral anticoagulant and antiplatelet drugs was not balanced between groups. Oral anticoagulants with or without antiplatelet drugs were used in 2753 patients with ICM (60.1%) and 5082 patients with NICM (73.7%). Antiplatelets were prescribed alone in 1576 patients with ICM (34.4%) and 1071 patients with NICM (15.5%). Compared with patients with NICM, use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (72.6% [3439] vs 60.3% [4236]) and of β blockers (63.3% [2988] vs 53.2% [3737]) was higher in patients with ICM. Rates of all-cause and cardiovascular death per 100 patient-years were significantly higher in the ICM group (all-cause death: ICM, 10.2; 95% CI, 9.2-11.1; NICM, 7.0; 95% CI, 6.4-7.6; cardiovascular death: ICM, 5.1; 95% CI, 4.5-5.9; NICM, 2.9; 95% CI, 2.5-3.4). Stroke/systemic embolism rates tended to be higher in ICM groups compared with NICM groups (ICM, 2.0; 95% CI, 1.6-2.5; NICM, 1.5; 95% CI, 1.3-1.9). Major bleeding rates were significantly higher in the ICM group (1.1; 95% CI, 0.8-1.4) compared with the NICM group (0.7; 95% CI, 0.5-0.9). - Conclusions and Relevance: Patients with ICM received oral anticoagulants with or without antiplatelet drugs less frequently and antiplatelets alone more frequently than patients with NICM, but they received angiotensin-converting enzyme inhibitors/angiotensin receptor blockers more often than patients with NICM. All-cause and cardiovascular death rates were higher in patients with ICM than patients with NICM. - Trial Registration: ClinicalTrials.gov Identifier: NCT01090362. |
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| Item Description: | GARFIELD-AF Investigators: Ramon Corbalan, Werner Hacke [und 2110 weitere] Gesehen am 16.08.2019 |
| Physical Description: | Online Resource |
| ISSN: | 2380-6591 |
| DOI: | 10.1001/jamacardio.2018.4729 |