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

Role of river bed sediments as sources and sinks of phosphorus across two major eutrophic UK river basins: the Hampshire Avon and Herefordshire Wye

The Equilibrium Phosphorus Concentration (EPC0) of river bed sediments has been measured for a wide range of agricultural subcatchments and main river sites across two major eutrophic river basins: the Hampshire Avon and Herefordshire Wye catchments, to examine whether bed sediments are acting as sources or sinks of soluble reactive phosphorus (SRP) under low flows and times of greatest eutrophication risk. A conceptual reach-based model of interactions between bed sediment and river water has been used to estimate relative differences in bed-sediment SRP flux transfers. In this model, processes of SRP uptake and release are assumed to occur within an operationally defined 0.1 m river water ‘boundary layer’ and the uptake and release of SRP is assumed to be driven by a differential between the EPC0 of the sediment and SRP concentration in the boundary layer. Most of the river monitoring sites in the Wye and Avon catchments had elevated SRP and boron (B) concentrations in the water column at low flows, linked to sewage effluent discharges. At these sites, bed sediments consistently acted as net sinks for SRP, demonstrating the role of bed sediments in riverine ‘self-cleansing’ mechanisms. In contrast, bed sediments were found to act as net sources of SRP under three circumstances: (i) where there was minimal sewage influence (in headwater streams of the Avon), (ii) where sewage inputs were subject to large hydrological dilution by water of low SRP concentration (in the main River Wye), (iii) where EPC0 values were relatively high, as a result of deposition of particulates with high exchangeable P concentrations from diffuse sources or from effluents (immediately downstream of sewage treatment works (STWs)). Under baseflow conditions, high SRP concentrations from sewage effluent in the tributaries appear to ‘swamp out’ any potential release of SRP from the bed sediments. For rivers that are subject to effluent P-stripping, reductions in SRP in the overlying water could potentially result in changes to the in-stream P-cycling mechanisms, with bed sediments possibly switching from net sinks to net sources of SRP. This feature is of potential importance in relation to environmental management and phosphorus mitigation operations