Division of Cardiovascular Diseases, Catholic University School of Medicine, Santiago, Chile.
University of Besançon, Besançon, France.
JAMA Cardiol. 2019 Jun 1;4(6):526-548. doi: 10.1001/jamacardio.2018.4729.
Congestive heart failure (CHF) is commonly associated with nonvalvular atrial fibrillation (AF), and their combination may affect treatment strategies and outcomes.
To assess the treatment strategies and 1-year clinical outcomes of antithrombotic and CHF therapies for patients with newly diagnosed AF with concomitant CHF stratified by etiology (ischemic cardiomyopathy [ICM] vs nonischemic cardiomyopathy [NICM]).
DESIGN, SETTING, AND PARTICIPANTS: The GARFIELD-AF registry is a prospective, noninterventional registry. A total of 52 014 patients with AF were enrolled between March 2010 and August 2016. A total of 11 738 patients 18 years and older with newly diagnosed AF (≤6 weeks' duration) and at least 1 investigator-determined stroke risk factor were included. Data were analyzed from December 2017 to September 2018.
One-year follow-up rates of death, stroke/systemic embolism, and major bleeding were assessed.
Event rates per 100 person-years were estimated from the Poisson model and Cox hazard ratios (HRs) and 95% confidence intervals.
The median age of the population was 71.0 years, 22 987 of 52 013 were women (44.2%) and 31 958 of 52 014 were white (61.4%). Of 11 738 patients with CHF, 4717 (40.2%) had ICM and 7021 (59.8%) had NICM. Prescription of oral anticoagulant and antiplatelet drugs was not balanced between groups. Oral anticoagulants with or without antiplatelet drugs were used in 2753 patients with ICM (60.1%) and 5082 patients with NICM (73.7%). Antiplatelets were prescribed alone in 1576 patients with ICM (34.4%) and 1071 patients with NICM (15.5%). Compared with patients with NICM, use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (72.6% [3439] vs 60.3% [4236]) and of β blockers (63.3% [2988] vs 53.2% [3737]) was higher in patients with ICM. Rates of all-cause and cardiovascular death per 100 patient-years were significantly higher in the ICM group (all-cause death: ICM, 10.2; 95% CI, 9.2-11.1; NICM, 7.0; 95% CI, 6.4-7.6; cardiovascular death: ICM, 5.1; 95% CI, 4.5-5.9; NICM, 2.9; 95% CI, 2.5-3.4). Stroke/systemic embolism rates tended to be higher in ICM groups compared with NICM groups (ICM, 2.0; 95% CI, 1.6-2.5; NICM, 1.5; 95% CI, 1.3-1.9). Major bleeding rates were significantly higher in the ICM group (1.1; 95% CI, 0.8-1.4) compared with the NICM group (0.7; 95% CI, 0.5-0.9).
Patients with ICM received oral anticoagulants with or without antiplatelet drugs less frequently and antiplatelets alone more frequently than patients with NICM, but they received angiotensin-converting enzyme inhibitors/angiotensin receptor blockers more often than patients with NICM. All-cause and cardiovascular death rates were higher in patients with ICM than patients with NICM.
ClinicalTrials.gov Identifier: NCT01090362.
充血性心力衰竭（CHF）通常与非瓣膜性心房颤动（AF）相关，两者的合并可能会影响治疗策略和结局。
评估新诊断的 AF 合并 CHF 患者的抗血栓和 CHF 治疗策略，根据病因（缺血性心肌病 [ICM] 与非缺血性心肌病 [NICM]）分层。
设计、设置和参与者：GARFIELD-AF 登记处是一项前瞻性、非干预性登记研究。2010 年 3 月至 2016 年 8 月期间共纳入 52014 例 AF 患者。共纳入 11738 例年龄≥18 岁、新诊断的 AF（≤6 周）且至少有 1 项研究者确定的卒中危险因素的患者。数据分析于 2017 年 12 月至 2018 年 9 月进行。
评估 1 年死亡率、卒中/全身性栓塞和主要出血的发生率。
采用泊松模型和 Cox 风险比（HR）及 95%置信区间估计人群中每 100 人年的发生率。
人群的中位年龄为 71.0 岁，52013 例患者中，22987 例（44.2%）为女性，52014 例患者中，31958 例（61.4%）为白人。在 11738 例 CHF 患者中，4717 例（40.2%）为 ICM，7021 例（59.8%）为 NICM。两组之间口服抗凝药和抗血小板药物的处方并不平衡。ICM 患者中有 2753 例（60.1%）和 NICM 患者中有 5082 例（73.7%）使用了口服抗凝药加或不加抗血小板药物。ICM 患者中有 1576 例（34.4%）和 NICM 患者中有 1071 例（15.5%）单独使用抗血小板药物。与 NICM 患者相比，ICM 患者更常使用血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（72.6%[3439 例]与 60.3%[4236 例]）和β受体阻滞剂（63.3%[2988 例]与 53.2%[3737 例]）。全因和心血管死亡的发生率在 ICM 组明显更高（全因死亡：ICM 组 10.2%（95%CI，9.2-11.1）；NICM 组 7.0%（95%CI，6.4-7.6）；心血管死亡：ICM 组 5.1%（95%CI，4.5-5.9）；NICM 组 2.9%（95%CI，2.5-3.4））。与 NICM 组相比，ICM 组的卒中/全身性栓塞发生率有升高趋势（ICM 组 2.0%（95%CI，1.6-2.5）；NICM 组 1.5%（95%CI，1.3-1.9））。主要出血的发生率在 ICM 组明显更高（1.1%（95%CI，0.8-1.4）），与 NICM 组（0.7%（95%CI，0.5-0.9））相比。
与 NICM 患者相比，ICM 患者更常使用口服抗凝药加或不加抗血小板药物，而较少单独使用抗血小板药物，但 ICM 患者更常使用血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂。与 NICM 患者相比，ICM 患者的全因和心血管死亡发生率更高。
ClinicalTrials.gov 标识符：NCT01090362。
