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 impact of year-to-year changes in the weather on the dynamics of Daphnia in a thermally stratified lake

The factors influencing the seasonal dynamics of Daphnia in a thermally stratified lake (Esthwaite Water) are described and related to long-term changes in the weather. The Daphnia produced three cohorts in the year and the strength of the cohorts was determined by year-to-year variations in the physical characteristics of the lake and the abundance of edible algae. Food was most abundant in early summer when small, fast-growing flagellates were particularly common. In late summer, the phytoplankton community was dominated by large, inedible species but edible forms re-appeared when nutrients were entrained by wind mixing. Examples are presented to demonstrate the effect that year-to-year variations in the weather have on the growth of the phytoplankton and the dynamics of the Daphnia. In ‘good’ years, when the lake stratifies early and there are periods of episodic mixing in summer, there are two ‘pulses’ of edible algae and two strong cohorts of Daphnia. In ‘bad’ years when stratification is delayed and there is little episodic mixing, the growth of the edible algae is suppressed and the Daphnia produce two weak cohorts. The results are discussed in relation to the impact of intermediate disturbances on growth of phytoplankton and current theories of population regulation in Daphnia. The evidence suggests that the dynamics of the Daphnia in the lake are strongly influenced by seasonal variations in the mixing regime, the recycling of nutrients and the episodic growth of edible alga