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

090 Extracellular Matrix Regulation and Dermal Repair in Burn Wound

To better understand the mechanisms of dermal restoration in burn wound we examined the mRNA expressions, using a porcine secondary‐degree burn wound model, of major dermal matrices including type I, III collagens and elastin, basement membrane components of collagen IV and laminins, regulatory Matrix Metalloproteinase MMP 1 and MMP 9, as well as growth factors of bFGF, CTGF, TGFβ, and VEGF. Fresh skin burn wound samples from six pigs were collected at days 0, 1, 4, 7, 10, 14, and 21. Semiquantitative Reverse Transcription and Polymerase Chain Reactions (RT‐PCR) were used with gene‐specific primers. RT‐PCR products were run on ethidium bromide gel and analyzed under UV light with Bio‐Rad Gel Document 2000 system. One‐way analysis of variance was used for statistical analysis. The results showed:'1) There were increases of all dermal extracellular matrices and growth factors tested; 2) A significant increase of type IV collagen occurred the earliest, while expressions of type I collagen and elastin increased at the latest; 3) A dramatic induction of MMP 1 and MMP 9 was observed shortly after wounding, which lasted through entire experiment; 4) The increased expression of VEGF, which is critical to angiogenesis, occurred early with peak at days 1 and 4, respectively. The expression pattern of bFGF, which has strong promoting effects on both endothelial cells and fibroblasts, is similar to that of VEGF; 5) For growth factors important for matrix deposition, both TGF beta 1 and 3 expressions increased gradually with sustained high level during entire experiment. The expression of CTGF, which is important in matrix production and remodeling, increased in later stage. This study showed the correlation between growth factor expression and dermal matrix deposition, which may have implications in developing strategies to improve burn wound healing.This study was supported by grants from DOD/DARPA and the Dermatology Foundation of South Florida