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

Mortality trends for primary liver cancer in Puglia, Italy

In the region of Puglia, Italy, the mortality rates from primary liver cancer (PLC) show a considerable geographical variability. In an area including the city of Bari and the northern province [high-risk (HR) area] the mortality rates are significantly higher than elsewhere in the region [low-risk (LR) area]. The aim of this study is to analyze mortality because of PLC from 1980 to 2002 in the HR and LR areas using an age-period-cohort model to identify their respective trend characteristics and the differences that emerge from their comparison. Attention was focused on the identifiable effects, which are on the drift and on the deviations from this regular trend (curvature), specifically attributable to the cohort and the period effects by applying the method recently proposed by Carstensen. The HR area is characterized by a more marked increase in the mortality trend compared with that observed in the LR area, as indicated in the model by a greater drift effect. In both areas the cohort (curvature) effect shows a decreasing trend starting from the early 1930s whereas the period effect shows a peak in the first half of the 1990s. Despite the correspondence of the trends, the rate ratio of death from PLC between the two areas is not constant and tends to rise uniformly by age, birth cohort, and period of time: in 2002, the rate ratio of death was 1.40 [confidence interval (CI): 1.15-1.70] at 40 years old, 1.73 (CI: 1.55-1.93) at 60 years old, and 2.14 (CI: 1.92-2.38) at 80 years old

An outbreak of measles including nosocomial transmission in Apulia, south-east Italy, January-March 2008--a preliminary report

Between 7 January and 16 March 2008, 16 cases of measles were reported in the region of Apulia in south-eastern Italy (about four millions inhabitants). This outbreak is currently ongoing: we present here a preliminary report