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

Recovery of Forest Structure Following Large-Scale Windthrows in the Northwestern Amazon

The dynamics of forest recovery after windthrows (i.e., broken or uprooted trees by wind) are poorly understood in tropical forests. The Northwestern Amazon (NWA) is characterized by a higher occurrence of windthrows, greater rainfall, and higher annual tree mortality rates (~2%) than the Central Amazon (CA). We combined forest inventory data from three sites in the Iquitos region of Peru, with recovery periods spanning 2, 12, and 22 years following windthrow events. Study sites and sampling areas were selected by assessing the windthrow severity using remote sensing. At each site, we recorded all trees with a diameter at breast height (DBH) ≥ 10 cm along transects, capturing the range of windthrow severity from old-growth to highly disturbed (mortality &gt; 60%) forest. Across all damage classes, tree density and basal area recovered to &gt;90% of the old-growth values after 20 years. Aboveground biomass (AGB) in old-growth forest was 380 (±156) Mg ha−1. In extremely disturbed areas, AGB was still reduced to 163 (±68) Mg ha−1 after 2 years and 323 (± 139) Mg ha−1 after 12 years. This recovery rate is ~50% faster than that reported for Central Amazon forests. The faster recovery of forest structure in our study region may be a function of its higher productivity and adaptability to more frequent and severe windthrows. These varying rates of recovery highlight the importance of extreme wind and rainfall on shaping gradients of forest structure in the Amazon, and the different vulnerabilities of these forests to natural disturbances whose severity and frequency are being altered by climate change

Windthrow characteristics and their regional association with rainfall, soil, and surface elevation in the Amazon

Windthrows (trees uprooted and broken by winds) are common across the Amazon. They range in size from single trees to large gaps that lead to changes in forest dynamics, composition, structure, and carbon balance. Yet, the current understanding of the spatial variability of windthrows is limited. By integrating remote sensing data and geospatial analysis, we present the first study to examine the occurrence, area, and direction of windthrows and the control that environmental variables exert on them across the whole Amazon. Windthrows are more frequent and larger in the northwestern Amazon (Peru and Colombia), with the central Amazon (Brazil) being another hot spot of windthrows. The predominant direction of windthrows is westward. Rainfall, surface elevation, and soil characteristics explain the variability (20%-50%) of windthrows but their effects vary regionally. A better understanding of the spatial dynamics of windthrows will improve understanding of the functioning of Amazon forests

Windthrow characteristics and their regional association with rainfall, soil, and surface elevation in the Amazon

Windthrows (trees uprooted and broken by winds) are common across the Amazon. They range in size from single trees to large gaps that lead to changes in forest dynamics, composition, structure, and carbon balance. Yet, the current understanding of the spatial variability of windthrows is limited. By integrating remote sensing data and geospatial analysis, we present the first study to examine the occurrence, area, and direction of windthrows and the control that environmental variables exert on them across the whole Amazon. Windthrows are more frequent and larger in the northwestern Amazon (Peru and Colombia), with the central Amazon (Brazil) being another hot spot of windthrows. The predominant direction of windthrows is westward. Rainfall, surface elevation, and soil characteristics explain the variability (20%–50%) of windthrows but their effects vary regionally. A better understanding of the spatial dynamics of windthrows will improve understanding of the functioning of Amazon forests

Windthrows Inventory Data Base (WInD) v1

&lt;p&gt;In total 1403 windthrow swere identified, of which 1343 were processed, identified, and Classify.&lt;/p&gt

Recovery of forest structure following large-scale windthrows in the northwestern amazon

The dynamics of forest recovery after windthrows (i.e., broken or uprooted trees by wind) are poorly understood in tropical forests. The Northwestern Amazon (NWA) is characterized by a higher occurrence of windthrows, greater rainfall, and higher annual tree mortality rates (~2%) than the Central Amazon (CA). We combined forest inventory data from three sites in the Iquitos region of Peru, with recovery periods spanning 2, 12, and 22 years following windthrow events. Study sites and sampling areas were selected by assessing the windthrow severity using remote sensing. At each site, we recorded all trees with a diameter at breast height (DBH) ≥ 10 cm along transects, capturing the range of windthrow severity from old-growth to highly disturbed (mortality &gt; 60%) forest. Across all damage classes, tree density and basal area recovered to &gt;90% of the old-growth values after 20 years. Aboveground biomass (AGB) in old-growth forest was 380 (±156) Mg ha−1 . In extremely disturbed areas, AGB was still reduced to 163 (±68) Mg ha−1 after 2 years and 323 (± 139) Mg ha−1 after 12 years. This recovery rate is ~50% faster than that reported for Central Amazon forests. The faster recovery of forest structure in our study region may be a function of its higher productivity and adaptability to more frequent and severe windthrows. These varying rates of recovery highlight the importance of extreme wind and rainfall on shaping gradients of forest structure in the Amazon, and the different vulnerabilities of these forests to natural disturbances whose severity and frequency are being altered by climate change

Recovery of forest structure following large-scale windthrows in the northwestern amazon

The dynamics of forest recovery after windthrows (i.e., broken or uprooted trees by wind) are poorly understood in tropical forests. The Northwestern Amazon (NWA) is characterized by a higher occurrence of windthrows, greater rainfall, and higher annual tree mortality rates (~2%) than the Central Amazon (CA). We combined forest inventory data from three sites in the Iquitos region of Peru, with recovery periods spanning 2, 12, and 22 years following windthrow events. Study sites and sampling areas were selected by assessing the windthrow severity using remote sensing. At each site, we recorded all trees with a diameter at breast height (DBH) ≥ 10 cm along transects, capturing the range of windthrow severity from old-growth to highly disturbed (mortality &gt; 60%) forest. Across all damage classes, tree density and basal area recovered to &gt;90% of the old-growth values after 20 years. Aboveground biomass (AGB) in old-growth forest was 380 (±156) Mg ha−1 . In extremely disturbed areas, AGB was still reduced to 163 (±68) Mg ha−1 after 2 years and 323 (± 139) Mg ha−1 after 12 years. This recovery rate is ~50% faster than that reported for Central Amazon forests. The faster recovery of forest structure in our study region may be a function of its higher productivity and adaptability to more frequent and severe windthrows. These varying rates of recovery highlight the importance of extreme wind and rainfall on shaping gradients of forest structure in the Amazon, and the different vulnerabilities of these forests to natural disturbances whose severity and frequency are being altered by climate change

Comparison of international normalized ratio audit parameters in patients enrolled in GARFIELD-AF and treated with vitamin K antagonists

Vitamin K antagonist (VKA) therapy for stroke prevention in atrial fibrillation (AF) requires monitoring of the international normalized ratio (INR). We evaluated the agreement between two INR audit parameters, frequency in range (FIR) and proportion of time in the therapeutic range (TTR), using data from a global population of patients with newly diagnosed non-valvular AF, the Global Anticoagulant Registry in the FIELD\u2013Atrial Fibrillation (GARFIELD-AF). Among 17\ua0168 patients with 1-year follow-up data available at the time of the analysis, 8445 received VKA therapy (\ub1antiplatelet therapy) at enrolment, and of these patients, 5066 with 653 INR readings and for whom both FIR and TTR could be calculated were included in the analysis. In total, 70\ua0905 INRs were analysed. At the patient level, TTR showed higher values than FIR (mean, 56\ub70% vs 49\ub78%; median, 59\ub77% vs 50\ub70%). Although patient-level FIR and TTR values were highly correlated (Pearson correlation coefficient [95% confidence interval; CI], 0\ub7860 [0\ub7852\u20130\ub7867]), estimates from individuals showed widespread disagreement and variability (Lin's concordance coefficient [95% CI], 0\ub7829 [0\ub7821\u20130\ub7837]). The difference between FIR and TTR explained 17\ub74% of the total variability of measurements. These results suggest that FIR and TTR are not equivalent and cannot be used interchangeably