Clinical Outcomes in Asymptomatic and Symptomatic Atrial Fibrillation Presentations in GARFIELD-AF: Implications for AF Screening |
| |
| Authors: | Harry Gibbs Ben Freedman Mårten Rosenqvist Saverio Virdone Wael Al Mahmeed Giuseppe Ambrosio A. John Camm Barry Jacobson Carlos Jerjes-Sanchez Gloria Kayani Ali Oto Elizaveta Panchenko Hany Ragy Ajay K. Kakkar |
| |
| Affiliation: | 1. The Alfred Hospital, Melbourne, VIC, Australia;2. Heart Research Institute, Charles Perkins Centre, and Sydney School of Medicine, University of Sydney, Sydney, NSW, Australia;3. Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden;4. Thrombosis Research Institute, London, UK;5. Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates;6. University of Perugia School of Medicine, Perugia, Italy;7. St George''s University of London, London, UK;8. Johannesburg Hospital, University of the Witwatersrand, Johannesburg, South Africa;9. Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Instituto de Cardiologia y Medicina Vascular, TEC Salud, Monterrey, Mexico;10. Hacettepe University, Ankara, Turkey;11. Cardiology Research and Production Center, Moscow, Russia;12. Hayat Hospital, Cairo, Egypt;13. University College London, London, UK |
| |
| Abstract: | BackgroundAsymptomatic atrial fibrillation is often detected incidentally. Prognosis and optimal therapy for asymptomatic compared with symptomatic atrial fibrillation is uncertain. This study compares clinical characteristics, treatment, and 2-year outcomes of asymptomatic and symptomatic atrial fibrillation presentations.MethodsGlobal Anticoagulant Registry in the Field-Atrial Fibrillation (GARFIELD-AF) is a global, prospective, observational study of newly diagnosed atrial fibrillation with ≥1 stroke risk factors (http://www.clinicaltrials.gov, unique identifier: NCT01090362). Patients were characterized by atrial fibrillation-related symptoms at presentation and the CHA2DS2-VASc score. Two-year follow-up recorded anticoagulation patterns (vitamin K antagonist, direct oral anticoagulants, parenteral therapy) and outcomes (stroke/systemic embolism, all-cause mortality, and bleeding).ResultsAt presentation, of 52,032 eligible patients, 25.4% were asymptomatic and 74.6% symptomatic. Asymptomatic patients were slightly older (72 vs 70 years), more often male (64.2% vs 52.9%), and more frequently initiated on anticoagulation ± antiplatelets (69.4% vs 66.0%). No difference in events (adjusted hazard ratios, 95% confidence interval) for nonhemorrhagic stroke/systemic embolism (1.19, 0.97-1.45), all-cause mortality (1.06, 0.94-1.20), or bleeding (1.02, 0.87-1.19) was observed. Anticoagulation was associated with comparable reduction in nonhemorrhagic stroke/systemic embolism (0.59, 0.43–0.82 vs 0.78, 0.65–0.93) and all-cause mortality (0.69, 0.59-0.81 vs 0.77, 0.71-0.85) in asymptomatic versus symptomatic, respectively.ConclusionsMajor outcomes do not differ between asymptomatic and symptomatic atrial fibrillation presentations and are comparably reduced by anticoagulation. Opportunistic screening-detected asymptomatic atrial fibrillation likely has the same prognosis as asymptomatic atrial fibrillation at presentation and likely responds similarly to anticoagulation thromboprophylaxis. |
| |
| Keywords: | Anticoagulation Asymptomatic Atrial fibrillation Symptomatic |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
