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

E-collaborer pour réduire le risque. L’entre-deux d’une expédition sur l’Everest

National audienc

Weather patterns and hydro-climatological precursors of extreme floods in Switzerland since 1868

The generation of 24 extreme floods in large catchments of the central Alps is analyzed from instrumental and documentary data, newly digitized observations of precipitation (DigiHom) and 20th Century Reanalysis (20CR) data. Extreme floods are determined by the 95th percentile of differences between an annual flood and a defined contemporary flood. For a selection of six events between 1868 and 1910, we describe preconditioning elements such as precipitation, temperature, and snow cover anomalies. Specific weather patterns are assessed through a subjective analysis of three-dimensional atmospheric circulation. A focus is placed on synoptic-scale features including mid-tropospheric ascent, low-level moisture transport, propagation of cyclones, and temperature anomalies. We propose a hydro-meteorological classification of all 24 investigated events according to flood-generating weather conditions. Key elements of the upper-level synoptic-scale flow are summarized by five types: (i) pivoting cut-off lows, (ii) elongated cut-off lows, (iii) elongated troughs, (iv) waves (with a kink), and (v) approximately zonal flow over the Alpine region. We found that the most extreme floods (as above, but ≥ 98th percentile) in Switzerland since 1868 were caused by the interaction of severe hydro-climatologic conditions with a flood-inducing weather situation. The 20CR data provide plausible synoptic-scale meteorological patterns leading to heavy precipitation. The proposed catalogue of weather patterns and hydro-climatologic precursors can give direction when anticipating the possibility of severe floods in the Alpine region