Formerly Technical University of Munich, Munich, Germany.
Clinical Academic Group, Molecular and Clinical Sciences Institute, St. George's University of London, London, UK.
Clin Res Cardiol. 2023 Jun;112(6):759-771. doi: 10.1007/s00392-022-02079-y. Epub 2022 Sep 12.
The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is a worldwide non-interventional study of stroke prevention in patients with non-valvular AF.
52,080 patients with newly diagnosed AF were prospectively enrolled from 2010 to 2016. 4121 (7.9%) of these patients were recruited in DACH [Germany (n = 3567), Austria (n = 465) and Switzerland (n = 89) combined], and 47,959 patients were from 32 countries in other regions worldwide (ORW). Hypertension was most prevalent in DACH and ORW (85.3% and 75.6%, respectively). Diabetes, hypercholesterolaemia, carotid occlusive disease and vascular disease were more prevalent in DACH patients vs ORW (27.6%, 49.4%, 5.8% and 29.0% vs 21.7%, 40.9%, 2.8% and 24.5%). The use of non-vitamin K antagonist oral anticoagulants (NOACs) increased more in DACH over time. Management of vitamin K antagonists was suboptimal in DACH and ORW (time in therapeutic range of INR ≥ 65% in 44.6% and 44.4% of patients or ≥ 70% in 36.9% and 36.0% of patients, respectively). Adjusted rates of cardiovascular mortality and MI/ACS were higher in DACH while non-haemorrhagic stroke/systemic embolism was lower after 2-year follow-up.
Similarities and dissimilarities in AF management and clinical outcomes are seen in DACH and ORW. The increased use of NOAC was associated with a mismatch of risk-adapted anticoagulation (over-and-undertreatment) in DACH. Suboptimal control of INR requires educational activities in both regional groups. Higher rates of cardiovascular death in DACH may reflect the higher risk profile of these patients and lower rates of non-haemorrhagic stroke could be associated with increased NOAC use.
全球抗凝剂注册在 FIELD-房颤（GARFIELD-AF）是一个全球性的非介入性研究，预防非瓣膜性房颤患者的中风。
2010 年至 2016 年期间，前瞻性招募了 52080 例新诊断的房颤患者。其中 4121 例（7.9%）来自 DACH 地区[德国（n=3567）、奥地利（n=465）和瑞士（n=89）]，47959 例来自全球其他 32 个国家（ORW）。高血压在 DACH 和 ORW 地区最为普遍（分别为 85.3%和 75.6%）。与 ORW 地区相比，DACH 地区的糖尿病、高胆固醇血症、颈动脉闭塞性疾病和血管疾病更为普遍（分别为 27.6%、49.4%、5.8%和 29.0%；21.7%、40.9%、2.8%和 24.5%）。非维生素 K 拮抗剂口服抗凝剂（NOACs）的使用在 DACH 地区随时间推移而增加。维生素 K 拮抗剂的管理在 DACH 和 ORW 地区均不理想（INR 治疗范围时间在 44.6%和 44.4%的患者中≥65%，在 36.9%和 36.0%的患者中≥70%）。调整后的心血管死亡率和 MI/ACS 发生率在 DACH 地区较高，而在 2 年随访后非出血性卒中和系统性栓塞发生率较低。
在 DACH 和 ORW 地区，房颤管理和临床结局存在相似和不同之处。NOAC 使用的增加与 DACH 地区风险适应抗凝治疗的不匹配（过度和治疗不足）有关。INR 控制不佳需要在两个地区组开展教育活动。DACH 地区心血管死亡率较高可能反映了这些患者的风险较高，而非出血性卒中和系统性栓塞发生率较低可能与 NOAC 使用增加有关。
