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

Sexual violence risk assessment: an investigation of the interrater reliability of professional judgments made using the risk for sexual violence protocol

The RSVP is a set of structured professional judgment guidelines for assessing risk of sexual violence. We investigated the interrater reliability (IRR) of judgments made using the RSVP in a multidisciplinary forensic-clinical context. Raters were 28 forensic mental health and intellectual disability professionals with diverse training and experience. They used the RSVP to evaluate six case vignettes that varied with respect to offense characteristics, clinical complexity, and level of risk. The IRR of ratings for individual risk factors was generally fair. There was a good level of interrater reliability on Summary Judgments and Supervision Recommendations. Interrater reliability was highest when used by professionals who were highly trained in forensic risk assessment. On average, professionals with lower levels of specialist training agreed less with their colleagues and experts, and provided higher estimations of sexual violence risk. Lower levels of agreement were found in cases with moderate levels of complexity and risk. The RSVP can be used to make judgments of risk with adequate levels of interrater reliability. However, this is dependent on the training and expertise of professionals who use the tool. Methodological strengths and limitations are considered, followed by a discussion of implications for training, practice, and future research

A small constellation: risk factors informing police perceptions of domestic abuse

Police in the United States (US) and the United Kingdom (UK) now routinely use risk assessment tools to identify common risk factors for re-abuse and lethality when responding to domestic abuse. Nevertheless, little is known about the extent to which officers understand and perceive the importance of factors commonly included on risk assessment tools for predicting future abuse. This study attempts to shed some light into this area of research by exploring the responses of 720 British and American police officers to questions regarding how important and how essential various risk factors are for evaluating the level of risk or harm a victim of domestic abuse may face in the future. Findings indicated that British and American officers were largely in agreement about a small constellation of risk factors that they considered integral to the risk assessment process: using or threatening to use a weapon; strangulation; physical assault resulting in injury and escalation of abuse. The results revealed that officers’ country of employment, rather than their demographic characteristics or experience policing domestic abuse, was a particularly influential predictor of their perceptions, and that both the situational context and the victim’s perception about risk are important in domestic abuse risk assessment