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

Impact of landscape composition and configuration on forest specialist and generalist bird species in the fragmented Lacandona rainforest, Mexico

With accelerated land-use change throughout the tropics, an increasing proportion of global biodiversity is located in human-modified landscapes. Understanding the relative effects of landscape composition and configuration on biodiversity is needed to design effective conservation strategies. Yet this topic is poorly understood because most studies have been performed at the patch scale, and do not assess the impact of landscape structure on species. Using a multi-model inference approach, we assessed the relative effect of landscape composition (i.e. percentage of forest cover and matrix composition) and landscape configuration (i.e. number of forest patches and forest edge density) on α- and β-diversity of birds in 17 forest fragments and three areas of continuous forest within the Lacandona rainforest, Mexico. We tested these impacts at two spatial scales (100 and 500. ha) for forest specialist and generalist birds. In general, forest specialist birds showed stronger responses to landscape characteristics than generalist species, particularly to variations in landscape composition at the 100-ha scale. The loss of forest cover represented the main threat to forest specialist birds, with a negative impact on α-diversity that was consistent across the two spatial scales. In contrast, at the two spatial scales generalist birds seemed to be favored