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

Latitudinal Patterns in Tachinid Parasitoid Diversity (Diptera: Tachinidae): A Review of the Evidence

Insect parasitoids may be an exception to the typical biogeographic pattern of increasing species richness at lower latitudes exhibited by most taxa. Evidence for this ‘anomalous’ latitudinal gradient has been derived from observations of hymenopteran parasitoids and it has been argued that other parasitoid groups should show a similar pattern of diversity. Several mechanisms have been proposed to explain this disparity, most notably the nasty host and resource fragmentation hypotheses. We review and evaluate these hypotheses with respect to tachinid flies (Diptera: Tachinidae), and bring to the argument evidence from eight trapping surveys from temperate and tropical regions in the Americas including the United States, Costa Rica, and Ecuador. We find no evidence that tachinid fly diversity is lower in the tropics than in the temperate region. Our results, along with other lines of evidence, rather suggest that New World Tachinidae likely conform to the same negative relationship between latitude and richness as their largely phytophagous host taxa. We discuss geographic patterns of tachinid diversity in relation to ecological and evolutionary processes, and why they may differ from their hymenopteran parasitoid counterparts. Parasitoid taxa appear to vary strongly in their diversity responses to latitude and we concur with previous researchers that more survey data are necessary to reach strong conclusions about parasitoid latitudinal diversity patterns