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

Caracterización de los pacientes con hemorragia de vías digestivas altas no varicosa en un hospital de tercer nivel de Cundinamarca, Colombia

Upper gastrointestinal tract bleeding is a common emergency whose most common etiology is a peptic ulcer. Restoration of intravascular volume and blood pressure management are priorities before identifying the cause of bleeding. After initial resuscitation and after hemodynamic stabilization has been achieved, an esophagogastroduodenoscopy (EGD) should be performed to identify the cause of bleeding and determine the treatment needed. This is a study performed at a third level referral hospital in Cundinamarca, Colombia. Materials and Methods: This is a retrospective study of data from electronic medical records of adult patients admitted to the emergency room of the Hospital Universitario de la Samaritana (HUS) because of upper gastrointestinal tract bleeding which ahd been diagnosed because of hematemesis, melena, rectal bleeding and/or anemia. Patients all underwent EGD between April 2010 and April 2011. Results: 385 patients with upper gastrointestinal tract bleeding were seen during the study period, but 100 were excluded because of bleeding secondary esophageal varices, incomplete clinical histories and lower gastrointestinal bleeding. A total of 285 patients were included. 69.1 % were older than 60 years, 73.3 % had hypertension, 55.1 % reported use of inflammatory drugs (NSAIDs) and aspirin (ASA), 19.6 % reported previous bleeding episodes, and 17.9 % had hemodynamic instability. 63 patients (22.1 %) required endoscopic hemostasis, and 32 (11.2 %) experienced rebleeding. Overall mortality reported was 13.1 % of which 55.3 % were men. Mortality attributable to gastrointestinal bleeding was 3.1 %. Conclusions: The majority of patients served by the HUS with upper GI bleeding are adults over 60 years. Peptic ulcers remain the most common diagnosis associated with the use of NSAIDs and ASA. The mortality rate is comparable to international standards. © 2013 Asociaciones Colombianas de Gastroenterología

Caracterización de los pacientes con hemorragia de vías digestivas altas no varicosa en un hospital de tercer nivel de Cundinamarca, Colombia

Upper gastrointestinal tract bleeding is a common emergency whose most common etiology is a peptic ulcer. Restoration of intravascular volume and blood pressure management are priorities before identifying the cause of bleeding. After initial resuscitation and after hemodynamic stabilization has been achieved, an esophagogastroduodenoscopy (EGD) should be performed to identify the cause of bleeding and determine the treatment needed. This is a study performed at a third level referral hospital in Cundinamarca, Colombia. Materials and Methods: This is a retrospective study of data from electronic medical records of adult patients admitted to the emergency room of the Hospital Universitario de la Samaritana (HUS) because of upper gastrointestinal tract bleeding which ahd been diagnosed because of hematemesis, melena, rectal bleeding and/or anemia. Patients all underwent EGD between April 2010 and April 2011. Results: 385 patients with upper gastrointestinal tract bleeding were seen during the study period, but 100 were excluded because of bleeding secondary esophageal varices, incomplete clinical histories and lower gastrointestinal bleeding. A total of 285 patients were included. 69.1 % were older than 60 years, 73.3 % had hypertension, 55.1 % reported use of inflammatory drugs (NSAIDs) and aspirin (ASA), 19.6 % reported previous bleeding episodes, and 17.9 % had hemodynamic instability. 63 patients (22.1 %) required endoscopic hemostasis, and 32 (11.2 %) experienced rebleeding. Overall mortality reported was 13.1 % of which 55.3 % were men. Mortality attributable to gastrointestinal bleeding was 3.1 %. Conclusions: The majority of patients served by the HUS with upper GI bleeding are adults over 60 years. Peptic ulcers remain the most common diagnosis associated with the use of NSAIDs and ASA. The mortality rate is comparable to international standards. © 2013 Asociaciones Colombianas de Gastroenterología