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

Sleep quality and duration – Potentially modifiable risk factors for Coronary Artery Disease?

Purpose: Previous studies have shown that lack of sleep exerts deleterious effects on a variety of systems with detectable changes in metabolic, endocrine and immune pathways. Both short and long sleep durations are related to increased likelihood of diabetes and hypertension. However, the relation between sleep duration, sleep quality and Coronary Artery Disease (CAD) is not clear in the Indian population. We examined the hypothesis that sleep duration (compared with  5) are risk factors for CAD. Methods: A retrospective & controlled study was conducted on 352 adult (>18 yrs) subjects (176 controls and 176 cases, 60% men, age M = 51 ± 9.38). Sleep quality and duration was measured with Pittsburg Sleep Quality Index (PSQI). Poor sleep quality and short sleep duration was defined as PSQI >5 and total sleep time <6.0 h, respectively. OSA patients were excluded from the study. The main outcome of interest was the presence of any CAD (n = 176), including MI, angina, and stroke. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated using Multivariate Logistic Regression analysis. Results: We found both poor quality of sleep and short sleep duration to be independently associated with CAD. Compared with a total sleep time of 6.0 h, the multivariate odds ratio (95% confidence interval) of CAD was 3.81 (1.69–8.58) whereas for poor sleep quality (PSQI > 5) it came out to be 16.62 (9.13–30.28). Conclusion: There was a positive association between both short sleep duration and poor sleep quality with CAD in a selected sample of Indian adults. These results suggest that poor sleep quality and short sleep duration may be important modifiable CAD risk factors in the Indian population

Ambulatory blood pressure monitoring in clinical practice

Being one of the most widely prevalent diseases throughout the world, hypertension has emerged as one of the leading causes of global premature morbidity and mortality. Hence, blood pressure (BP) measurements are essential for physicians in the diagnosis and management of hypertension. Current American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend initiating antihypertensive medications on the basis of office BP readings. However, office BP readings provide a snapshot evaluation of the patient's BP, which might not reflect patient's true BP, with the possibility of being falsely elevated or falsely low. Recently, there is ample evidence to show that ambulatory blood pressure monitoring (ABPM) is a better predictor of major cardiovascular events than BP measurements at clinic settings. ABPM helps in reducing the number of possible false readings, along with the added benefit of understanding the dynamic variability of BP. This article will focus on the significance of ambulatory BP, its advantages and limitations compared with the standard office BP measurement and a brief outlook on its use and interpretation to diagnose and treat hypertension. Keywords: Ambulatory blood pressure, White coat hypertension, Masked hypertension, Nocturnal hypertension, Dippin

Anemia profile in patients with congestive heart failure a hospital based observational study

Objectives: Iron deficiency (ID) is an emerging problem in patients with congestive heart failure (CHF) and can be a potential therapeutic target. As ID is highly prevalent in the society, it is hypothesized that Indian patients with CHF have high prevalence of ID. Methods: CHF patients (n = 275) were selected and underwent laboratory evaluation including hemoglobin concentration, serum iron, transferrin, ferritin, B12 and folate level. Results: Two hundred and seventy-five patients with heart failure (mean age - 62.72, mean Hb- 10.54 g/dl, 188 males [68.36%] and 87 females [31.64%]) were enrolled in the study. 211 out of 275 (76.7%) were found to be anemic. Out of 275 patients. 148 (53.8%) were diagnosed with iron deficiency. 12.7% (n = 35) were B12 deficient and 5.1% (n = 14) were folate deficient. In the anemic group, ID was present in 130 patients (61.61%), B12 deficiency in 32 patients (15.16%) and folate deficiency in 12 patients (5.68%). In the group of patients without anemia, ID was present in 18 patients (28.12%) while B12 and folate deficiency was present in 3 (4.68%) and 2 (3.12%) patients, respectively. Conclusion: Iron deficiency is present in substantial number while B12 and folate account for a few number of cases. Substantial number of patients without anemia were found to be iron deficient. Keywords: Anemia, Iron, B 12, Folate, Heart failur