Georges Pompidou Hospital, René Descartes University, 75908 Paris cedex, France.
University of Besançon, 25000 Besançon, France; Thrombosis Research Institute, London SW3 6LR, UK.
Arch Cardiovasc Dis. 2018 Dec;111(12):749-757. doi: 10.1016/j.acvd.2018.03.012. Epub 2018 Jun 1.
GARFIELD-AF is a non-interventional worldwide study of adults with atrial fibrillation.
To analyse the characteristics of the 1399 patients recruited in France from August 2010 to July 2015, their 1-year outcomes and healthcare resource utilization.
Patients aged ≥18 years with newly diagnosed atrial fibrillation (≤6 weeks' duration) and ≥1 stroke risk factor were eligible. Patient demographics, medical history and antithrombotic treatment were recorded at baseline. The incidences of stroke/systemic embolism, major bleeding, all-cause mortality, cardiovascular and non-cardiovascular mortality, new acute coronary syndrome and congestive heart failure were recorded during a 1-year follow-up.
The median age was 76.0 years; 44.5% of patients were female. The median CHADS-VASc and HAS-BLED scores were 4.0 and 2.0, respectively. At diagnosis, 78.9% of patients received anticoagulant therapy±antiplatelet therapy; more patients received vitamin K antagonists (VKAs; 46.0%) than direct oral anticoagulants (DOACs; 32.9%). The median proportion of time in the therapeutic range for VKAs was 65.6%. Between 2010 and 2015, anticoagulant prescription increased, driven by the growing use of DOACs±antiplatelet therapy (1.1% to 50.0%), whereas prescription of VKAs±antiplatelet therapy decreased (74.4% to 32.3%). All-cause mortality was the most frequent event (6.75 per 100 person-years). Risk-adjusted event rates for France showed that stroke/systemic embolism and all-cause mortality occurred more frequently than in GARFIELD-AF overall, whereas the rates of major bleeding were similar. In terms of healthcare resource utilization, the highest cost was associated with inpatients.
Patients enrolled in France had higher rates of mortality and stroke/systemic embolism than in GARFIELD-AF overall. Conversely, the risk of major bleeding was not higher.
GARFIELD-AF 是一项在全球范围内开展的针对成人房颤患者的非干预性研究。
分析 2010 年 8 月至 2015 年 7 月期间在法国招募的 1399 例患者的特征、1 年结局和医疗资源利用情况。
入选患者为年龄≥18 岁、新诊断为房颤（发病时间≤6 周）且至少存在 1 项卒中危险因素。患者基线时的人口统计学特征、既往史和抗栓治疗情况均被记录。1 年随访期间，记录卒中/全身性栓塞、大出血、全因死亡率、心血管和非心血管死亡率、新发急性冠脉综合征和充血性心力衰竭的发生率。
中位年龄为 76.0 岁，44.5%的患者为女性。中位 CHADS-VASc 和 HAS-BLED 评分分别为 4.0 和 2.0。诊断时，78.9%的患者接受抗凝治疗±抗血小板治疗，其中接受维生素 K 拮抗剂（VKA）治疗者多于直接口服抗凝剂（DOAC）治疗者（46.0%比 32.9%）。VKA 的治疗范围内时间中位数为 65.6%。2010 年至 2015 年，抗凝治疗处方增加，主要是由于 DOAC 联合抗血小板治疗的使用增加（1.1%增至 50.0%），而 VKA 联合抗血小板治疗的处方减少（74.4%减至 32.3%）。全因死亡率是最常见的事件（100 人年 6.75 例）。风险调整后，法国的卒中/全身性栓塞和全因死亡率高于 GARFIELD-AF 总体，而大出血发生率相似。就医疗资源利用而言，住院患者的费用最高。
法国入组患者的死亡率和卒中/全身性栓塞发生率高于 GARFIELD-AF 总体，而大出血风险并未增加。
