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

To speak with the other's voice: reducing asymmetry and social distance in mental health care admission interviews

The aim of this article is to examine the case of adoption of characteristic features of the interlocutor's ‘voice’ in mental health care admission interviews at a public hospital in Buenos Aires, Argentina. We observed ethnographically that ‘speaking with the Other's voice’ is a strategy adopted by psychoanalysts to achieve clinical goals, though they overlook its wider implications and contradictions as it involves both professionals and patients. We will argue that patients adopt bureaucratic and psychiatric terms in order to decrease asymmetry and reorient the activity conducted between the professional and the client. On the other hand, professionals tend to consider social class, age, ethnicity or religion when adopting the patient's voice in an attempt to decrease social distance. These strategies are employed to accomplish different goals during the interview: to the patient, it is a way to show competence in the activity of medical consultation, indexing the highly valued voices of state institutions and psychiatric knowledge; to the professional, it is a strategy to achieve clinical goals by decreasing social distance and enhancing transference. Analysis will show the unequal distribution of voicing options for participants: while patients attempt to reduce asymmetry despite social distance, psychotherapists try to decrease social distance but maintain asymmetry. In conclusion, wider implications will be discussed for intergroup communication between professionals and clients.Fil: Bonnin, Juan Eduardo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Saavedra 15. Centro de Estudios E Investigaciones Laborales; Argentin