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

Debris-flood reconstruction in a pre-alpine catchment in Switzerland based on tree-ring analysis of conifers and broadleaved trees

Past debris‐flood activity on the forested fan of Torrent de la Greffe located in the Swiss Prealps was assessed from growth disturbances in coniferous and broadleaved tree species. The study of 186 tree‐ring sequences sampled from 44 Norway spruce (Picea abies (L.) Karst.) and 55 broadleaved trees from various species affected by past activity and the sampling of an additional 49 trees for the reference chronology allowed the reconstruction of 17 debris‐flood events since AD 1900. The spatial analysis of trees affected during particular events on the geomorphic map helped the identification of five breakout locations in the torrent and affected sectors on the fan. The coupling of tree‐ring analysis of coniferous and broadleaved tree species proved to be a valuable tool for the reconstruction of past events. Debris‐flood frequency in the investigated torrent (0.16 event yr‐1) is considerably lower than the frequencies reconstructed in most other catchments in the Swiss Alps. As material for the entrainment of debris floods is not always readily available, the torrent has to be seen as supply‐limited