Two-year outcomes of UK patients newly diagnosed with atrial fibrillation: findings from the prospective observational cohort study GARFIELD-AF

Patricia Apenteng, Saverio Virdone, Richard Hobbs, A. John Camm, Keith A.A Fox, Karen S Pieper, Gloria Kayani, David Fitzmaurice, GARFIELD UK investigators

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Abstract

Background: Outcomes of patients newly diagnosed with atrial fibrillation (AF) in the post-vitamin K antagonist only era are not well known.

Aim: To determine the two-year outcomes of patients newly diagnosed with AF, and the effectiveness of oral anticoagulants in everyday practice.

Design & Setting: Observational prospective cohort study in UK primary care.

Method: 3574 patients aged ≥18 years with a new AF diagnosis were enrolled. We applied a propensity score using an overlap weighting scheme to obtain unbiased estimates of the treatment effect of anticoagulation vs no anticoagulation on the occurrence of death, non-haemorrhagic stroke/systemic embolism(SE) and major bleeding within 2 years of diagnosis.

Results: Overall, 65.8% received anticoagulant therapy, 20.8% received an antiplatelet only; 13.4% received neither. During the study period, the overall incidence rates (95% CI) of all-cause mortality, non-haemorrhagic stroke/SE, and major bleeding were 4.15 (3.69 to 4.66), 1.45 (1.19 to 1.77), and 1.21 (0.97 to 1.50) per 100 person-years respectively. Anticoagulation treatment compared with no anticoagulation treatment was associated with significantly lower all-cause mortality aHR 0.70 (95% CI 0.53 to 0.93), significantly lower risk of non-haemorrhagic stroke/SE (aHR 0.39 [95% CI 0.24 to 0.62]) and a non-significant higher risk of major bleeding (aHR 1.31 [(95% CI 0.77 to 2.24]).

Conclusions: Our data support a benefit of anticoagulation in reducing stroke and death, without an increased risk of a major bleed among patients with new onset AF. Anticoagulation of the group of patients at high risk of stroke not receiving anticoagulation may further improve outcomes.
Original languageEnglish
Article number0548
Pages (from-to)E693-E701
JournalBritish Journal of General Practice
Volume72
Issue number723
Early online date18 Feb 2022
DOIs
Publication statusPublished - 16 May 2022

Keywords

  • (physical)
  • Cancer
  • Clinical
  • Clinical (general)
  • Diagnosis
  • Epidemiology
  • Health promotion and prevention
  • Prevention
  • Research methods
  • Screening

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