TY - JOUR
T1 - Impact of gender on event rates at 1-year in patients with newly diagnosed non-valvular atrial fibrillation
T2 - Contemporary perspective from the GARFIELD-AF registry
AU - GARFIELD-AF Investigators
AU - Camm, A. John
AU - Accetta, Gabriele
AU - Mahmeed, Wael Al
AU - Ambrosio, Giuseppe
AU - Goldhaber, Samuel Z.
AU - Haas, Sylvia
AU - Jansky, Petr
AU - Kayani, Gloria
AU - Misselwitz, Frank
AU - Oh, Seil
AU - Oto, Ali
AU - Raatikainen, Pekka
AU - Steffel, Jan
AU - Eickels, Martin Van
AU - Kakkar, Ajay K.
AU - Bassand, Jean Pierre
AU - Fitzmaurice, David A.
AU - Goto, Shinya
AU - Hacke, Werner
AU - Mantovani, Lorenzo G.
AU - Pieper, Karen S.
AU - Turpie, Alexander G.G.
AU - Gersh, Bernard J.
AU - Luciardi, Hector Lucas
AU - Gibbs, Harry
AU - Brodmann, Marianne
AU - Cools, Frank
AU - Barretto, Antonio Carlos Pereira
AU - Connolly, Stuart J.
AU - Spyropoulos, Alex
AU - Eikelboom, John
AU - Corbalan, Ramon
AU - Hu, Dayi
AU - Nielsen, Jørn Dalsgaard
AU - Ragy, Hany
AU - Le Heuzey, Jean Yves
AU - Darius, Harald
AU - Keltai, Matyas
AU - Kakkar, Sanjay
AU - Sawhney, Jitendra Pal Singh
AU - Agnelli, Giancarlo
AU - Koretsune, Yukihiro
AU - Díaz, Carlos Jerjes Sánchez
AU - ten Cate, Hugo
AU - Atar, Dan
AU - Stepinska, Janina
AU - Panchenko, Elizaveta
AU - Lim, Toon Wei
AU - Jacobson, Barry
AU - Mntla, P.
PY - 2017/3/1
Y1 - 2017/3/1
N2 - Objectives: Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) explored the impact of gender, risk factors and anticoagulant (AC) treatment on 1-year outcomes in patients with nonvalvular atrial fibrillation (NVAF). Design: GARFIELD-AF is a prospective noninterventional registry. Setting: Investigator sites (n=1048) are representative of the care settings/locations in each of the 35 countries. Participants: Patients ≥18yrs with newly diagnosed (≤6 weeks' duration) NVAF and ≥1 investigatordetermined stroke risk factors. Main outcome measures: Event rates per 100 person-years were estimated from the Poisson model and HRs and 95% CIs calculated. Results: Of 28 624 patients (women 44.4%; men 55.6%) enrolled, there were more elderly (≥75 years) women (46.9%) than men (30.4%). All-cause mortality rates per 100 person-years (95% CI) for women and men were 4.48 (4.12 to 4.87) and 4.04 (3.74 to 4.38), respectively, stroke/systemic embolism (SE) (1.62 (1.41 to 1.87) and 1.17 (1.01 to 1.36)) and major bleeding (0.93 (0.78 to 1.13) and 0.79 (0.66 to 0.95)). After adjustment for baseline risk factors in treated and untreated patients, HRs (95% CI) for women (relative to men) for stroke/SE rates were 1.3-fold higher in women (HR 1.30 (1.04 to 1.63)), and similar for major bleeding (1.13 (0.85 to 1.50)) and all-cause mortality (1.05 (0.92 to 1.19)). Antithrombotic treatment patterns in men and women were almost identical. 63.8% women and 62.9% men received AC antiplatelets. Relative to no AC treatment, the reduction in stroke/SE rates with AC treatment was greater (p=0.01) in men (HR 0.45 (0.33 to 0.61)) than women 0.77 (0.57 to 1.03). All-cause mortality reduction with AC treatment was similar (women: 0.65 (0.54 to 0.77); men: 0.57 (0.48 to 0.68)). The risk of major bleeding when treated with AC versus no AC was 2.33 (1.41 to 3.84) in men and 1.86 (1.16 to 2.99) in women (p value=0.53). Conclusions: Women have a higher risk of stroke/SE and the reduction in stroke/SE events rates with AC treatment is less in women than in men.
AB - Objectives: Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) explored the impact of gender, risk factors and anticoagulant (AC) treatment on 1-year outcomes in patients with nonvalvular atrial fibrillation (NVAF). Design: GARFIELD-AF is a prospective noninterventional registry. Setting: Investigator sites (n=1048) are representative of the care settings/locations in each of the 35 countries. Participants: Patients ≥18yrs with newly diagnosed (≤6 weeks' duration) NVAF and ≥1 investigatordetermined stroke risk factors. Main outcome measures: Event rates per 100 person-years were estimated from the Poisson model and HRs and 95% CIs calculated. Results: Of 28 624 patients (women 44.4%; men 55.6%) enrolled, there were more elderly (≥75 years) women (46.9%) than men (30.4%). All-cause mortality rates per 100 person-years (95% CI) for women and men were 4.48 (4.12 to 4.87) and 4.04 (3.74 to 4.38), respectively, stroke/systemic embolism (SE) (1.62 (1.41 to 1.87) and 1.17 (1.01 to 1.36)) and major bleeding (0.93 (0.78 to 1.13) and 0.79 (0.66 to 0.95)). After adjustment for baseline risk factors in treated and untreated patients, HRs (95% CI) for women (relative to men) for stroke/SE rates were 1.3-fold higher in women (HR 1.30 (1.04 to 1.63)), and similar for major bleeding (1.13 (0.85 to 1.50)) and all-cause mortality (1.05 (0.92 to 1.19)). Antithrombotic treatment patterns in men and women were almost identical. 63.8% women and 62.9% men received AC antiplatelets. Relative to no AC treatment, the reduction in stroke/SE rates with AC treatment was greater (p=0.01) in men (HR 0.45 (0.33 to 0.61)) than women 0.77 (0.57 to 1.03). All-cause mortality reduction with AC treatment was similar (women: 0.65 (0.54 to 0.77); men: 0.57 (0.48 to 0.68)). The risk of major bleeding when treated with AC versus no AC was 2.33 (1.41 to 3.84) in men and 1.86 (1.16 to 2.99) in women (p value=0.53). Conclusions: Women have a higher risk of stroke/SE and the reduction in stroke/SE events rates with AC treatment is less in women than in men.
UR - http://www.scopus.com/inward/record.url?scp=85014587482&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2016-014579
DO - 10.1136/bmjopen-2016-014579
M3 - Article
C2 - 28264833
AN - SCOPUS:85014587482
SN - 2044-6055
VL - 7
JO - BMJ Open
JF - BMJ Open
IS - 3
M1 - e014579
ER -
