34 research outputs found

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

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    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.

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    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

    Time-sharing measurements of ionospheric electron temperature and electron density with the electric field using double probes: An experiment on the Antarctic sounding rocket S-310JA-7

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    An experiment was carried out of a time-sharing measurement of auroral ionospheric electric field, electron temperature and electron density with double probes on board the Antarctic sounding roket S-310JA-7 on March 27,1978 at Syowa Station. The measurements of each element are compared with each other, and the electron temperature and density are compared with the other independent measurements which were made simultaneously on board the same rocket. The principle of the measurement of electron temperature and density with double probes is described in detail in the Appendix

    市立旭川病院を中心とした急性心筋梗塞症に対する遠隔地ネットワークの試み Prehospital thrombolysisの有用性

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    雑誌掲載版遠隔地発症の急性心筋梗塞症(AMI)患者に対し,低用量mutant-tPA(mt-PA)を投与してから経皮的冠動脈インターベンション(PCI)施設に搬送する,いわゆるprehospital thrombolysis(preCT:入院前血栓溶解療法)の有用性について施行例と非施行例を比較して検討した.PCIバックアップ下でのpreCTは,従来のPrimary PCIに比べ,より早い再灌流が得られ,心不全への進展を抑制し左室機能保持に有効で,生命予後にも好結果をもたらすと考えられた.又,mt-PAを低用量に抑えることにより,重大な出血性合併症を回避でき

    Vasospastic anginaを合併した右冠動脈左室瘻,左冠動脈肺動脈瘻の1例

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    雑誌掲載版症例は50歳の男性。胸部圧迫感を主訴に入院した。発作時の心電図でV1"'V5のST上昇を認めた。心雑音は聴取しなかったが、冠動脈造影上、右冠動脈は拡張し末梢から左室後壁面へ開口しており、左冠動脈は回旋枝より異常血管が起始して右肺動脈に流入していた。肺動脈でのO2 step upは認めなかった。ergonovineの静注にて胸痛が出現し、前下行枝Seg. 7と右冠動脈Seg.4の100%閉塞を認めた。また運動負荷心電図、 201Tl運動負荷心筋シンチグラム、PTCA用バルーンカテーテルによる痩血管閉塞法によってもcoronary steal現象による心筋虚血は証明されなかった。以上よりcoronary steal現象は関与せず、 vasospastic anginaを合併した右冠動脈―左室痩、左冠動脈―右肺動脈痩と診断した。近 年、冠動脈痩はまれな疾患ではなくなってきているが、本症例のように肺動脈と左心室に開口する例の報告は我々が検索し得た限りでは初めてであり、またvasospastic anginaを合併した冠動脈痩の報告もわずかである
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