The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Arsenic concentrations in dust emissions from wind erosion and off-road vehicles in the Nellis Recreational Area, Nevada, USA

Field and laboratory experiments were performed in the Nellis Dunes Recreational Area near Las Vegas, NV, USA to evaluate arsenic concentrations associated with dust emissions from wind erosion and offroad vehicles. Soil samples were collected from 17 types of desert surfaces and five unpaved parking lot locations for analyses. The surface units are based on surficial characteristics that affect dust emissions. Arsenic concentrations were also measured in dust emitted from each surface unit using a Portable In Situ Wind Erosion Laboratory (PI-SWERL). Emissions were measured from ORV trails and undisturbed terrain. Concentrations of As in the soil and parking lot samples ranged from 3.49 to 83.02 lg µg-1 and from 16.13 to 312 lg ug-1 in the PI-SWERL samples. The lower concentrations in the soil samples are expected because of the larger particle sizes (<2 mm) as compared to the PI-SWERL samples (<10 and 10–60 lm). Soluble As in the PI-SWERL samples was as high as 14.7 lg g1. In the Nellis Dunes area the emission rates for As for wind-induced emissions (wind erosion) are highest for the surfaces with significant amounts of sand. Surfaces rich in silt and clay, on the other hand, produce nearly no arsenic during wind erosion but can emit substantial arsenic concentrations when driven on by off-road vehicles. The elevated arsenic emissions from the Nellis Dunes area are of great concern because the site is located in the immediate vicinity of the city of Las Vegas, and utilized by over 300,000 visitors annually.status: publishe

Dust emission rate <i>versus</i> airborne dust concentration.

<p>The inset shows the same data with linear scales.</p

Average wind speed and wind rose for the four periods tested in this study.

<p>Period 13: 30 May 2008–12 June 2008; Period 17: 29 July 2008–14 August 2008; Period 23: 21 October 2008–4 November 2008; Period 24: 4 November 2008–18 November 2008.</p

Overview and characteristics of the 17 surface units in the Nellis Dunes Recreation Area.

<p>Overview and characteristics of the 17 surface units in the Nellis Dunes Recreation Area.</p

Relationships for experimental period 13.

<p>A: arsenic content in airborne dust <i>versus</i> arsenic content in topsoil; B: dust emission rate <i>versus</i> airborne dust concentration.</p

Airborne arsenic concentration at 128.2 cm above the surface (level of nostrils for an average American child of 10 years old).

<p>(A) Period 13: 30 May 2008–12 June 2008; (B) Period 17: 29 July 2008–14 August 2008; (C) Period 23: 21 October 2008–4 November 2008; (D) Period 24: 4 November 2008–18 November 2008. Open circles locate position of bedrock sampling sites. (Background aerial photograph image: Copyright 2009 DigitalGlobe)</p

Arsenic concentration at the surface.

<p>A total of 570 points were sampled. (Background aerial photograph image: Copyright 2009 DigitalGlobe)</p

Occurrence of the 17 surface units at the Nellis Dunes Recreation Area.

<p>Occurrence of the 17 surface units at the Nellis Dunes Recreation Area.</p