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

Sunda to Sahul dispersals inTrichosanthes(Cucurbitaceae): a dated phylogeny reveals five independent dispersal events to Australasia

Aim: The Cucurbitaceae genus Trichosanthes is widespread in Asia and Australia, and previous studies have shown that the genus originated in Asia, and that three independent lineages dispersed through the Sunda archipelago to Australasia. The timing and routes of these three dispersals, as well as the dispersal of two widespread species found in Australia and New Guinea, were investigated.\ud \ud Location: Sunda–Sahul dispersals with a focus on New Guinea and Australia.\ud \ud Methods: A combined dataset of nuclear ribosomal (ITS1–5.8S–ITS2) and plastid DNA (matK, ndhF, rpl20–rps12, rps16) was used for maximum likelihood and Bayesian phylogenetic analysis to infer the relationships of the studied taxa. A fossil-calibrated molecular dating was used to time the dispersal events, and a biogeographical analysis was used to study the origin and dispersal of the genus.\ud \ud Results: The two widespread species, T. pilosa and T. cucumerina, form monophyletic groups in Australia, suggesting single dispersals. Molecular dating analysis dates four of the dispersal events to the Miocene, and two to the Oligo-Miocene boundary and the initial Sahul shelf collision with the Philippine plate. Most known Sahul–Philippine dispersals concern species that migrated from the Sahul shelf, whereas dispersals south are fewer. Southward Miocene dispersals include species that were present on the Sunda shelf before the tectonic formation of the Makassar Straits. All lineages that dispersed to Australasia have undergone extensive diversification following dispersal. Lineages adapted to wet tropical climates have speciated mostly in New Guinea, and lineages adapted to monsoon tropical climates have speciated mostly in northern Australia.\ud \ud Main conclusions: Dispersals in Trichosanthes pre-date human colonization of Australasia, suggesting natural long-distance dispersal and establishment of all lineages. Diversification within lineages found in both Australia and New Guinea is limited, corroborating frequent land connections between these areas during the Pleistocene. Sunda–Sahul dispersals are likely to have been more common through time than previously suggested, especially in genera with floating fruit such as Trichosanthes