Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)

Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.

AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy. The mean (standard deviation) age was 69.8 (11.4) years, 43.8% were women, and the mean CHA2DS2-VASc score was 3.3 (1.6); 60.8% of patients were prescribed anticoagulant therapy with/without antiplatelet (AP) therapy, 27.4% AP monotherapy, and 11.8% no antithrombotic therapy. At 2-year follow-up, all-cause mortality, stroke/SE, and major bleeding had occurred at a rate (95% confidence interval) of 3.83 (3.62; 4.05), 1.25 (1.13; 1.38), and 0.70 (0.62; 0.81) per 100 person-years, respectively. Rates for all three major events were highest during the first 4 months. Congestive heart failure, acute coronary syndromes, sudden/unwitnessed death, malignancy, respiratory failure, and infection/sepsis accounted for 65% of all known causes of death and strokes for <10%. Anticoagulant treatment was associated with a 35% lower risk of death. CONCLUSION: The most frequent of the three major outcome measures was death, whose most common causes are not known to be significantly influenced by anticoagulation. This suggests that a more comprehensive approach to the management of NVAF may be needed to improve outcome. This could include, in addition to anticoagulation, interventions targeting modifiable, cause-specific risk factors for death. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

MATRIX-ISOLATION STUDIES AND FORCE-CONSTANT CALCULATIONS ON SPF3 AND NSF3

KONIGER F, Müller A, GLEMSER O. MATRIX-ISOLATION STUDIES AND FORCE-CONSTANT CALCULATIONS ON SPF3 AND NSF3. JOURNAL OF MOLECULAR STRUCTURE. 1978;46(MAY):29-34

INFRARED BAND CONTOUR ANALYSIS AND MOLECULAR-CONSTANTS OF SPF3 AND NSF3

KONIGER F, BLOM CE, Müller A. INFRARED BAND CONTOUR ANALYSIS AND MOLECULAR-CONSTANTS OF SPF3 AND NSF3. JOURNAL OF MOLECULAR SPECTROSCOPY. 1979;77(1):76-84

SEF6 VIBRATIONAL BAND CONTOURS STUDIED BY LOW-TEMPERATURE AND MATRIX-ISOLATION SPECTROSCOPY, USING ISOTOPE SUBSTITUTION - FORCE CONSTANTS OF SEF6

KONIGER F, Müller A, SELIG H. SEF6 VIBRATIONAL BAND CONTOURS STUDIED BY LOW-TEMPERATURE AND MATRIX-ISOLATION SPECTROSCOPY, USING ISOTOPE SUBSTITUTION - FORCE CONSTANTS OF SEF6. MOLECULAR PHYSICS. 1977;34(6):1629-1635

METAL AND CHLORINE ISOTOPIC SHIFTS, COKIOLIS COUPLING CONSTANTS, AND F2F_{2} SPECIES FORCE CONSTANTS FOR SnCl4SnCl_{4}, GeCl4GeCl_{4} AND TiCl4TiCl_{4}

R. O. Carter is indebted to the Alexander von Humbolt-Stiftung for the grant of a Research Fellowship,""Author Institution: Institute of Chemistry, University of DortmundThe interpretation of the gas phase band contours of $XCL_{4}$ (Td) molecules is not straightforward because of the presence of four different chlorine species and the overlapping of “hot” bands. The bands are further complicated in the case where the cen

INFRARED SPECTRA AND FORCE CONSTANTS OF 116SnCl4^{116}SnCl_{4} AND 124SnCl4^{124}SnCl_{4}

Author Institution: Institut fur Chemie der, Universit\""{a}t Dortmund; Department of Chemistry, Marquette UniversityThe infrared spectra of gaseous $^{116}SnCl_{4}$ and $^{124}SnCl_{4}$ have been measured. From the isotope shift of ${\nu}_{3}(F_{2})$ the force constants of $SnCl_{4}$ have been calculated and compared with those obtained by using other data such as vibrational amplitudes and Coriolis coupling constants. It has been shown that the metal isotope substitution can be used for the calculation of force constants with reasonable error limits. From the exact force field of the tetrahedral molecule the vibrational frequencies of $^{116}Sn^{35}Cl_{3}^{37}Cl, ^{116}Sn^{35}Cl_{2}^{37}Cl_{2}$ and $^{116}Sn^{35}Cl^{37}Cl_{3}$ have been calculated. These frequency data allow an interpretation of the band contours of the ${\nu}_{3}(F_{2})$-fundamental of $^{116}SnCl_{4}$ and $^{124}SnCl_{4}$

Soil column experiments to quantify vadose zone water fluxes in arid settings

For the determination of groundwater recharge processes in arid environments, vadose zone water fluxes and water storage should be considered. To better understand and quantify vadose zone processes influencing groundwater recharge, a soil column experimental setup has been developed that mimics arid atmospheric conditions and measures water and temperature fluxes in high temporal and spatial resolution. The focus of the experiment was on the determination of water infiltration, redistribution, evaporation and percolation under non-isothermal conditions. TDR rod sensors and a specific TDR "Taupe" cable sensor were used for water content measurements and allowed the infiltration fronts to be traced over the whole column length. Applying single irrigations of different amount and intensity showed the applicability of the experimental setup for the measurement of water movement in the unsaturated soil column

Reliability, validity and critical appraisal of the cross-cultural adapted German version of the Mayo Elbow Performance Score (MEPS-G)

Background The Mayo Elbow Performance Score (MEPS) is a rating system consisting of four dimensions to evaluate elbow performance. It is a common tool for assessment of elbow impairments worldwide. We determined the validity and reliability of its German version (MEPS-G) after cross-cultural adaptation. Methods Six investigators examined 57 patients with elbow pathologies. The MEPS-G was compared to validated elbow scores such as the German versions of DASH, the Oxford Elbow Score, pain level and subjective elbow performance on a VAS. Inter-rater reliability (IRR) and validity of the score and its dimensions were also reviewed. Verification was performed using the intraclass correlation coefficient (ICC), the prevalence and bias with adjusted Kappa (PABAK) and the Spearman correlation. Results The IRR of the MEPS-G score was moderate (ICC (2.1) = 0.65). The IRR of the four individual dimensions was moderate to high (K-PABAK = 0.55 -0.81). Validity for the sum score (r = 0.52-0.65) and the dimensions pain (r = 0.53-0.62), range of motion (r = 0.7) and stability (r = - 0.61) was verified. The function subscale reached insufficient validity (r = 0.15-0.39). Conclusion The MEPS-G is not sufficiently valid, which is consistent with its English version. The patient-based dimensions were a weakness, demonstrating high risk of bias. There is no general recommendation for the utilization of the MEPS-G as outcome measurement for patients with elbow pathologies