Guideline-directed medical therapies for comorbidities among patients with atrial fibrillation: results from GARFIELD-AF
AIMS: This study aimed to identify relationships in recently diagnosed atrial fibrillation (AF) patients with respect to anticoagulation status, use of guideline-directed medical therapy (GDMT) for comorbid cardiovascular conditions (co-GDMT), and clinical outcomes. The Global Anticoagulant Registry...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10246824/ https://www.ncbi.nlm.nih.gov/pubmed/37293139 http://dx.doi.org/10.1093/ehjopen/oead051 |
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author | Camm, Alan John Steffel, Jan Virdone, Saverio Bassand, Jean-Pierre Fox, Keith A A Goldhaber, Samuel Z Goto, Shinya Haas, Sylvia Turpie, Alexander G G Verheugt, Freek W A Misselwitz, Frank Herreros, Ramón Corbalán Kayani, Gloria Pieper, Karen S Kakkar, Ajay K |
author_facet | Camm, Alan John Steffel, Jan Virdone, Saverio Bassand, Jean-Pierre Fox, Keith A A Goldhaber, Samuel Z Goto, Shinya Haas, Sylvia Turpie, Alexander G G Verheugt, Freek W A Misselwitz, Frank Herreros, Ramón Corbalán Kayani, Gloria Pieper, Karen S Kakkar, Ajay K |
author_sort | Camm, Alan John |
collection | PubMed |
description | AIMS: This study aimed to identify relationships in recently diagnosed atrial fibrillation (AF) patients with respect to anticoagulation status, use of guideline-directed medical therapy (GDMT) for comorbid cardiovascular conditions (co-GDMT), and clinical outcomes. The Global Anticoagulant Registry in the FIELD (GARFIELD)-AF is a prospective, international registry of patients with recently diagnosed non-valvular AF at risk of stroke (NCT01090362). METHODS AND RESULTS: Guideline-directed medical therapy was defined according to the European Society of Cardiology guidelines. This study explored co-GDMT use in patients enrolled in GARFIELD-AF (March 2013–August 2016) with CHA(2)DS(2)-VASc ≥ 2 (excluding sex) and ≥1 of five comorbidities—coronary artery disease, diabetes mellitus, heart failure, hypertension, and peripheral vascular disease (n = 23 165). Association between co-GDMT and outcome events was evaluated with Cox proportional hazards models, with stratification by all possible combinations of the five comorbidities. Most patients (73.8%) received oral anticoagulants (OACs) as recommended; 15.0% received no recommended co-GDMT, 40.4% received some, and 44.5% received all co-GDMT. At 2 years, comprehensive co-GDMT was associated with a lower risk of all-cause mortality [hazard ratio (HR) 0.89 (0.81–0.99)] and non-cardiovascular mortality [HR 0.85 (0.73–0.99)] compared with inadequate/no GDMT, but cardiovascular mortality was not significantly reduced. Treatment with OACs was beneficial for all-cause mortality and non-cardiovascular mortality, irrespective of co-GDMT use; only in patients receiving all co-GDMT was OAC associated with a lower risk of non-haemorrhagic stroke/systemic embolism. CONCLUSION: In this large prospective, international registry on AF, comprehensive co-GDMT was associated with a lower risk of mortality in patients with AF and CHA(2)DS(2)-VASc ≥ 2 (excluding sex); OAC therapy was associated with reduced all-cause mortality and non-cardiovascular mortality, irrespective of co-GDMT use. CLINICAL TRIAL REGISTRATION: Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362. |
format | Online Article Text |
id | pubmed-10246824 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-102468242023-06-08 Guideline-directed medical therapies for comorbidities among patients with atrial fibrillation: results from GARFIELD-AF Camm, Alan John Steffel, Jan Virdone, Saverio Bassand, Jean-Pierre Fox, Keith A A Goldhaber, Samuel Z Goto, Shinya Haas, Sylvia Turpie, Alexander G G Verheugt, Freek W A Misselwitz, Frank Herreros, Ramón Corbalán Kayani, Gloria Pieper, Karen S Kakkar, Ajay K Eur Heart J Open Original Article AIMS: This study aimed to identify relationships in recently diagnosed atrial fibrillation (AF) patients with respect to anticoagulation status, use of guideline-directed medical therapy (GDMT) for comorbid cardiovascular conditions (co-GDMT), and clinical outcomes. The Global Anticoagulant Registry in the FIELD (GARFIELD)-AF is a prospective, international registry of patients with recently diagnosed non-valvular AF at risk of stroke (NCT01090362). METHODS AND RESULTS: Guideline-directed medical therapy was defined according to the European Society of Cardiology guidelines. This study explored co-GDMT use in patients enrolled in GARFIELD-AF (March 2013–August 2016) with CHA(2)DS(2)-VASc ≥ 2 (excluding sex) and ≥1 of five comorbidities—coronary artery disease, diabetes mellitus, heart failure, hypertension, and peripheral vascular disease (n = 23 165). Association between co-GDMT and outcome events was evaluated with Cox proportional hazards models, with stratification by all possible combinations of the five comorbidities. Most patients (73.8%) received oral anticoagulants (OACs) as recommended; 15.0% received no recommended co-GDMT, 40.4% received some, and 44.5% received all co-GDMT. At 2 years, comprehensive co-GDMT was associated with a lower risk of all-cause mortality [hazard ratio (HR) 0.89 (0.81–0.99)] and non-cardiovascular mortality [HR 0.85 (0.73–0.99)] compared with inadequate/no GDMT, but cardiovascular mortality was not significantly reduced. Treatment with OACs was beneficial for all-cause mortality and non-cardiovascular mortality, irrespective of co-GDMT use; only in patients receiving all co-GDMT was OAC associated with a lower risk of non-haemorrhagic stroke/systemic embolism. CONCLUSION: In this large prospective, international registry on AF, comprehensive co-GDMT was associated with a lower risk of mortality in patients with AF and CHA(2)DS(2)-VASc ≥ 2 (excluding sex); OAC therapy was associated with reduced all-cause mortality and non-cardiovascular mortality, irrespective of co-GDMT use. CLINICAL TRIAL REGISTRATION: Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362. Oxford University Press 2023-05-19 /pmc/articles/PMC10246824/ /pubmed/37293139 http://dx.doi.org/10.1093/ehjopen/oead051 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Original Article Camm, Alan John Steffel, Jan Virdone, Saverio Bassand, Jean-Pierre Fox, Keith A A Goldhaber, Samuel Z Goto, Shinya Haas, Sylvia Turpie, Alexander G G Verheugt, Freek W A Misselwitz, Frank Herreros, Ramón Corbalán Kayani, Gloria Pieper, Karen S Kakkar, Ajay K Guideline-directed medical therapies for comorbidities among patients with atrial fibrillation: results from GARFIELD-AF |
title | Guideline-directed medical therapies for comorbidities among patients with atrial fibrillation: results from GARFIELD-AF |
title_full | Guideline-directed medical therapies for comorbidities among patients with atrial fibrillation: results from GARFIELD-AF |
title_fullStr | Guideline-directed medical therapies for comorbidities among patients with atrial fibrillation: results from GARFIELD-AF |
title_full_unstemmed | Guideline-directed medical therapies for comorbidities among patients with atrial fibrillation: results from GARFIELD-AF |
title_short | Guideline-directed medical therapies for comorbidities among patients with atrial fibrillation: results from GARFIELD-AF |
title_sort | guideline-directed medical therapies for comorbidities among patients with atrial fibrillation: results from garfield-af |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10246824/ https://www.ncbi.nlm.nih.gov/pubmed/37293139 http://dx.doi.org/10.1093/ehjopen/oead051 |
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