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

The transmission dynamics of a within- and between-hosts malaria model

In this paper, we developed a novel deterministic coupled model tying together the effects of within-host and population level dynamics on malaria transmission dynamics. We develop within-host and within-vector dynamic models, population level between-hosts models, and a nested coupled model combining these levels. The unique feature of this work is the way the coupling and feedback for the model use the various life stages of the malaria parasite both in the human host and the mosquito vector. Analysis of the coupled and the within-human host models indicate the existence of locally asymptotically stable infection- and parasite-free equilibria when the associated reproduction numbers are less than one. The population-level model, on the other hand, exhibits backward bifurcation, where the stable disease-free equilibrium co-exists with a stable endemic equilibrium. A global sensitivity analysis was carried out to measure the effects of the sensitivity and uncertainty in the various model parameters estimates. The results indicate that the most important parameters driving the pathogen level within an infected human are the production rate of the red blood cells from the bone marrow, the infection rate, the immunogenicity of the infected red blood cells, merozoites and gametocytes, and the immunosensitivity of the merozoites and gametocytes. The key parameters identified at the population level are the human recovery rate, the death rate of the mosquitoes, the recruitment rate of susceptible humans into the population, the mosquito biting rate, the transmission probabilities per contact in mosquitoes and in humans, and the parasite production and clearance rates in the mosquitoes. Defining the feedback functions as a linear function of the mosquito biting rate, numerical exploration of the coupled model reveals oscillations in the parasite populations within a human host in the presence of the host immune response. These oscillations dampen as the mosquito biting rate increases. We also observed that the oscillation and damping effect seen in the within-human host dynamics fed back into the population level dynamics; this in turn amplifies the oscillations in the parasite population within the mosquito-host