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

Influence of solution thermal and structural history on the nucleation of m-hydroxybenzoic acid polymorphs

The influence of solution pretreatment on primary nucleation of m-hydroxybenzoic acid has been investigated through 550 cooling crystallization experiments. The metastable zone width has been determined at constant cooling rate, and the time and temperature of the preceding superheating step have been varied. m-Hydroxybenzoic acid has two polymorphs, and the influence of the polymorph used to prepare the solutions has also been investigated. There is an overall tendency in the experiments for the solution to exhibit a larger metastable zone width if it is superheated for a longer time and at a higher temperature, but under the investigated conditions this tendency is not very strong. The results show that the metastable form II preferentially crystallizes in all experiments and in particular when the solution has been more strongly superheated for several hours. However, when the time and/or the temperature of superheating is reduced, there is an increasing tendency to obtain the stable form I. This is most clearly found for solutions prepared by dissolving form I. When the solutions are prepared by dissolution of form II, this tendency is weaker in what appears to be a systematic way. It is hypothesized that, unless the solution is strongly superheated for several hours, it will contain for a significant period of time clusters of solute molecules that can retain some degree of structure from the dissolved crystal. This leads to ";memory" effects in the solution, which may influence subsequent nucleation. The work includes a comprehensive review of previous published work on the influence of thermal history on nucleation in solutions and melts