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

Speaking the same language: can the Sustainable Development Goals translate the needs of inland fisheries into irrigation decisions?

Irrigated agriculture and inland fisheries both make important contributions to food security, nutrition, livelihoods and wellbeing. Typically, in modern irrigation systems, these components operate independently. Some practices, commonly associated with water use and intensification of crop production can be in direct conflict with and have adverse effects on fisheries. Food security objectives may be compromised if fish are not considered in the design phases of irrigation systems. The 2030 Agenda for Sustainable Development provides a framework that can serve as a backdrop to help integrate both sectors in policy discussions and optimise their contributions to achieving the Sustainable Development Goals (SDGs). Inland fisheries systems do play an important role in supporting many SDG objectives, but these contributions can sometimes be at odds with irrigated agriculture. Using case studies of two globally important river catchments, namely the Lower Mekong and Murray–Darling basins, we highlight the conflicts and opportunities for improved outcomes between irrigated agriculture and inland fisheries. We explore SDG 2 (Zero Hunger) as a path to advance our irrigation systems as a means to benefit both agriculture and inland fisheries, preserving biodiversity and enhancing the economic, environmental and social benefits they both provide to people