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

Recent Observations on Tin Pest Formation in Solder Alloys

The most recent observations of the response of bulk samples of several lead-free solder alloys, exposed to temperatures below the allotropic transition for tin for extended periods, are reported. Tin pest has been observed in Sn-0.5Cu, Sn-3.5Ag, Sn-3.8Ag-0.7Cu, and Sn-3.0Ag-0.5Cu alloys at both -18 degrees C and -40 degrees C. The process is slow and inconsistent, usually requiring several years, but may eventually result in complete disintegration of the sample. No tin pest was detected in Sn-Zn-3Bi or in the traditional Sn-37Pb solder alloy after exposure for up to 4 and 10 years, respectively. It is suggested that nucleation is affected by local composition and that extremely small amounts of either intentional solute or impurity are influential. Growth of tin pest is accompanied by a large volume change, and it is likely that stress relaxation ahead of the expanding grey tin front is a controlling factor. A stronger matrix would be more resistant in this case, and at the temperatures of exposure Sn-37Pb is stronger than either Sn-3.5Ag or Sn-0.5Cu. The absence of tin pest, to date, on actual joints is attributed to their restricted free surface area and the greater strength associated with very small samples