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

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

The ecology of Triatoma sordida in natural environments in two different regions of the state of Minas Gerais, Brazil Ecologia do Triatoma sordida no ambiente silvestre de duas diferentes regiões do estado de Minas Gerais, Brasil

A study was undertaken about T. sordida in the natural environment in two different regions of the state of Minas Gerais: Itapagipe (Triângulo), an area of cerrado modified by the formation of fields of pasture and agriculture, and Mato Verde (north) an area of transition between caatinga and cerrado with profound deforestation in the last years due to the expansion of cotton cultivation. In both regions the principal ecotopes identified were hollow trees and the bark of live or dead trees, where the occurrence of a food source is not frequent. In this environment, the triatomines utilize various food sources; opposums appear to represent an important source of infection. In the north of Minas, a greater concentration of reservoirs and vectors was observed than in the Triángulo which could explain the higher level of infection of the triatomines in the north. Close attention to the process of domiciliation of T. sordida in the north of Minas is recommended where an extensive intervention by man in the natural environment has occurred and where a rise in the population of triatomines in the peridomestic environment has been observed in recent years.<br>Foi realizado um estudo sobre o T. sordida em ambiente silvestre em duas diferentes regiões do estado de Minas Gerais: Itapagipe (Triângulo), área de cerrado modificado para formação de campos de pastagem e agricultura, e Mato Verde (norte) uma área de transição entre a caatinga e o cerrado, profundamente desmatada nos últimos anos com a finalidade de expansão do cultivo de algodão. Em ambas as regiões, os principais ecotopos identificados corresponderam a buracos e cascas de árvores vivas ou mortas, onde a ocorrência de fontes de alimentação não é frequente. Neste ambiente, os triatomíneos utilizam-se de variadas fontes de alimentação; gambás parecem representar urna importante fonte de infecção. No norte de Minas, observou-se urna maior concentração de reservatórios e vetores em comparação com o Triângulo, o que pode explicar a maior taxa de infecção dos triatomíneos no norte. Maior atenção ao processo de domiciliação do T. sordida no norte de Minas Gerais é recomendada, onde, nos últimos anos, tem-se observado urna profunda intervenção do homem sobre o ambiente natural, paralelamente ao aumento da população deste triatomíneo nos peridomicílios