Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

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

Assessment of Chlorophyll-a Algorithms Considering Different Trophic Statuses and Optimal Bands

Numerous algorithms have been proposed to retrieve chlorophyll-a concentrations in Case 2 waters; however, the retrieval accuracy is far from satisfactory. In this research, seven algorithms are assessed with different band combinations of multispectral and hyperspectral bands using linear (LN), quadratic polynomial (QP) and power (PW) regression approaches, resulting in altogether 43 algorithmic combinations. These algorithms are evaluated by using simulated and measured datasets to understand the strengths and limitations of these algorithms. Two simulated datasets comprising 500,000 reflectance spectra each, both based on wide ranges of inherent optical properties (IOPs), are generated for the calibration and validation stages. Results reveal that the regression approach (i.e., LN, QP, and PW) has more influence on the simulated dataset than on the measured one. The algorithms that incorporated linear regression provide the highest retrieval accuracy for the simulated dataset. Results from simulated datasets reveal that the 3-band (3b) algorithm that incorporate 665-nm and 680-nm bands and band tuning selection approach outperformed other algorithms with root mean square error (RMSE) of 15.87 mg·m−3, 16.25 mg·m−3, and 19.05 mg·m−3, respectively. The spatial distribution of the best performing algorithms, for various combinations of chlorophyll-a (Chla) and non-algal particles (NAP) concentrations, show that the 3b_tuning_QP and 3b_680_QP outperform other algorithms in terms of minimum RMSE frequency of 33.19% and 60.52%, respectively. However, the two algorithms failed to accurately retrieve Chla for many combinations of Chla and NAP, particularly for low Chla and NAP concentrations. In addition, the spatial distribution emphasizes that no single algorithm can provide outstanding accuracy for Chla retrieval and that multi-algorithms should be included to reduce the error. Comparing the results of the measured and simulated datasets reveal that the algorithms that incorporate the 665-nm band outperform other algorithms for measured dataset (RMSE = 36.84 mg·m−3), while algorithms that incorporate the band tuning approach provide the highest retrieval accuracy for the simulated dataset (RMSE = 25.05 mg·m−3)