Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

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

EUROfusion Integrated Modelling (EU-IM) capabilities and selected physics applications

International audienceRecent developments and achievements of the EUROfusion Code Development for Integrated Modelling project (WPCD), which aim is to provide a validated integrated modelling suite for the simulation and prediction of complete plasma discharges in any tokamak, are presented. WPCD develops generic complex integrated simulations, workflows, for physics applications, using the standardized European Integrated Modelling (EU-IM) framework. Selected physics applications of EU-IM workflows are illustrated in this paper

EUROfusion Integrated Modelling (EU-IM) capabilities and selected physics applications

Recent developments and achievements of the EUROfusion Code Development for Integrated Modelling project (WPCD, follow-up of EFDA-ITM-TF), which aims at providing a validated integrated modelling suite for the simulation and prediction of complete plasma discharges in any tokamak, are presented. WPCD develops generic complex integrated simulations, workflows, for physics applications, using the standardized EU Integrated Modelling (EU-IM) framework. The integration of codes in EU-IM workflows is besides accompanied by a thorough cross-verification and, recently, by the introduction of rigorous release procedures. Among the achievements, the European TransportSimulator(ETS),hasnowreachedacapabilityequivalenttothestate-of-the-artintegrated modeling transport codes, including interchangeable physics modules for equilibrium (both fixed and free boundary), transport (interpretative analytical, neoclassical, anomalous), impurities (all ionization states), NTM, sawteeth, pellets, neutrals, Heating and Current Drive (HCD) sources including all the heating schemes (EC, NBI, IC, nuclear) and synergy effects. The core ETS has been released and deployed at JET, offering a leading tool for both interpretive transport analysis and predictive modelling of complex scenarios. Selected physics applications are presented, in particular ETS simulations of plasma density control in reactor-scale plasmas fueled with multiple pellets. A MHD stability chain was developed for the analysis of equilibria from any tokamak in the EU-IM platform; it includes a pool of interoperable high-resolution equilibrium and linear MHD stability codes. Having passed a benchmark on core and global ideal kink instabilities, the chain has been released and applied to the predictive analysis of DEMO and JT60-SA scenarios and can be straightforwardly used for interpretive runs on present devices as JET and ASDEX Upgrade. A predictive J-alpha MHD pedestal stability analysis workflow has also been developed. Routine application to sensitivity analysis of DEMO1 scenarios is performed. Furthermore, a workflow including a turbulence code and a synthetic probe was developed and applied to investigate the turbulent transport in the edge and Scrape-Off-Layer (SOL) of ASDEX Upgrade. Finally, a prototype edge workflow integrating the interaction with PFC was demonstrated

Turbulence correlation properties measured with ultrafast sweeping reflectometry on Tore Supra

The ultrafast sweep reflectometry technique is used to investigate plasma turbulence on Tore Supra. Thanks to the X-mode polarization, the plasma density and fluctuations over the whole tokamak radius, from the far scrape-off layer (SOL) to the core can be measured. Cross-correlation analysis is applied to all the signal components to estimate the fluctuation correlation length radial profile. The correlation length decreases from the plasma centre to the last closed flux surface and grows again into the far SOL

EUROfusion Integrated Modelling (EU-IM) capabilities and selected physics applications

Recent developments and achievements of the EUROfusion Code Development for Integrated Modelling project (WPCD, follow-up of EFDA-ITM-TF), which aims at providing a validated integrated modelling suite for the simulation and prediction of complete plasma discharges in any tokamak, are presented. WPCD develops generic complex integrated simulations, workflows, for physics applications, using the standardized EU Integrated Modelling (EU-IM) framework. The integration of codes in EU-IM workflows is besides accompanied by a thorough cross-verification and, recently, by the introduction of rigorous release procedures. Among the achievements, the European TransportSimulator(ETS),hasnowreachedacapabilityequivalenttothestate-of-the-artintegrated modeling transport codes, including interchangeable physics modules for equilibrium (both fixed and free boundary), transport (interpretative analytical, neoclassical, anomalous), impurities (all ionization states), NTM, sawteeth, pellets, neutrals, Heating and Current Drive (HCD) sources including all the heating schemes (EC, NBI, IC, nuclear) and synergy effects. The core ETS has been released and deployed at JET, offering a leading tool for both interpretive transport analysis and predictive modelling of complex scenarios. Selected physics applications are presented, in particular ETS simulations of plasma density control in reactor-scale plasmas fueled with multiple pellets. A MHD stability chain was developed for the analysis of equilibria from any tokamak in the EU-IM platform; it includes a pool of interoperable high-resolution equilibrium and linear MHD stability codes. Having passed a benchmark on core and global ideal kink instabilities, the chain has been released and applied to the predictive analysis of DEMO and JT60-SA scenarios and can be straightforwardly used for interpretive runs on present devices as JET and ASDEX Upgrade. A predictive J-alpha MHD pedestal stability analysis workflow has also been developed. Routine application to sensitivity analysis of DEMO1 scenarios is performed. Furthermore, a workflow including a turbulence code and a synthetic probe was developed and applied to investigate the turbulent transport in the edge and Scrape-Off-Layer (SOL) of ASDEX Upgrade. Finally, a prototype edge workflow integrating the interaction with PFC was demonstrated