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

Development of predator defences in fishes

A variety of development characteristics, morphological, behavioural, and experiential, contribute to the extreme vulnerability of young fishes to predation. The influence of these characteristics is complicated by the fact that the larval period is one of substantial and rapid change. Yet survival is the ultimate goal;-it is only by reaching maturity that individual fish have the opportunity to reproduce. With such high stakes it is not surprising that predator defences are of major importance during all phases of life. Developmental constraints may limit the defensive options for young fishes. Avoidance behaviours, which reduce the likelihood of encountering a predator or of being attacked by it, are particulaly evident in the youngest stages. Here size, coloration and dispersal are used to help elude the predator's attention. As fishes grow and acquire greater morphological and behavioural sophistication, there is more scope for predator evasion when avoidance fails. Older fishes are increasingly able to respond to external stimuli and can detect and react to predators or join conspecifics in common defence (schooling). Behavioural development is not simply a consequence of growth and the concomitant physical alterations of the body; it is also mediated by experience that comes through interaction with the physical and biotic environment. Predispositions to respond to experience may be a product of evolutionary history. Although mortality rates decline markedly with development and maturity, changes in size or behaviour can render fishes vulnerable to new suites of predators. Effective predator avoidance can compromise other activities, such as foraging, and individuals may be forced to reconcile conflicting demands. Developmental niche shifts that occur, for example, when certain size classes take refuge in less profitable feeding habitats, represent one such trade-off. Niche shifts may also be mediated by the influence of the programme for morphological development on sensory or behavioural capabilities. In addition to all of these developmental consderations, natural variations in environmental conditions - such as temperature, photoperiod, predator density and variety, and presence of alternative prey - represent additional challenges to predator defences during the rite of passage from birth to reproduction.</p