Two-year outcomes of UK patients newly diagnosed with atrial fibrillation: findings from the prospective observational cohort study GARFIELD-AF
<strong>Background <br></strong>The outcomes of patients newly diagnosed with atrial fibrillation (AF) following the introduction of direct-acting oral anticoagulants are not well known. <br><strong> Aim <br></strong>To determine the 2-year outcomes of patie...
| Main Authors: | , , , , , , , |
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| Other Authors: | |
| Format: | Journal article |
| Language: | English |
| Published: |
Royal College of General Practitioners
2022
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| _version_ | 1797108705643200512 |
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| author | Apenteng, PN Virdone, S Hobbs, FR Camm, AJ Fox, KA Pieper, KS Kayani, G Fitzmaurice, D |
| author2 | GARFIELD UK investigators* |
| author_facet | GARFIELD UK investigators* Apenteng, PN Virdone, S Hobbs, FR Camm, AJ Fox, KA Pieper, KS Kayani, G Fitzmaurice, D |
| author_sort | Apenteng, PN |
| collection | OXFORD |
| description | <strong>Background <br></strong>The outcomes of patients newly diagnosed with atrial fibrillation (AF) following the introduction of direct-acting oral anticoagulants are not well known.
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Aim <br></strong>To determine the 2-year outcomes of patients newly diagnosed with AF, and the effectiveness of oral anticoagulants in everyday practice.
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Design and setting<br></strong> This was a prospective observational cohort study in UK primary care.
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Method<br></strong> In total, 3574 patients aged ≥18 years with a new AF diagnosis were enrolled. A propensity score was applied using an overlap weighting scheme to obtain unbiased estimates of the treatment effect of anticoagulation versus no anticoagulation on the occurrence of death, non-haemorrhagic stroke/systemic embolism, and major bleeding within 2 years of diagnosis.
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Results <br></strong>Overall, 65.8% received anticoagulant therapy, 20.8% received an antiplatelet only, and 13.4% received neither. During the study period, the overall incidence rates of all-cause mortality, non-haemorrhagic stroke/systemic embolism, and major bleeding were 4.15 (95% confidence interval [CI] = 3.69 to 4.65), 1.45 (95% CI = 1.19 to 1.77), and 1.21 (95% CI = 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 adjusted hazard ratio (aHR) 0.70 (95% CI = 0.53 to 0.93), significantly lower risk of non-haemorrhagic stroke/systemic embolism (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).
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Conclusion <br></strong>The data support a benefit of anticoagulation in reducing stroke and death, without an increased risk of a major bleed in patients with new-onset AF. Anticoagulation treatment in patients at high risk of stroke who are not receiving anticoagulation may further improve outcomes. |
| first_indexed | 2024-03-07T07:32:25Z |
| format | Journal article |
| id | oxford-uuid:bec276ec-2870-489a-ad3d-3ecd6128d47e |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T07:32:25Z |
| publishDate | 2022 |
| publisher | Royal College of General Practitioners |
| record_format | dspace |
| spelling | oxford-uuid:bec276ec-2870-489a-ad3d-3ecd6128d47e2023-01-25T08:46:08ZTwo-year outcomes of UK patients newly diagnosed with atrial fibrillation: findings from the prospective observational cohort study GARFIELD-AFJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:bec276ec-2870-489a-ad3d-3ecd6128d47eEnglishSymplectic ElementsRoyal College of General Practitioners2022Apenteng, PNVirdone, SHobbs, FRCamm, AJFox, KAPieper, KSKayani, GFitzmaurice, DGARFIELD UK investigators*<strong>Background <br></strong>The outcomes of patients newly diagnosed with atrial fibrillation (AF) following the introduction of direct-acting oral anticoagulants are not well known. <br><strong> Aim <br></strong>To determine the 2-year outcomes of patients newly diagnosed with AF, and the effectiveness of oral anticoagulants in everyday practice. <br><strong> Design and setting<br></strong> This was a prospective observational cohort study in UK primary care. <br><strong> Method<br></strong> In total, 3574 patients aged ≥18 years with a new AF diagnosis were enrolled. A propensity score was applied using an overlap weighting scheme to obtain unbiased estimates of the treatment effect of anticoagulation versus no anticoagulation on the occurrence of death, non-haemorrhagic stroke/systemic embolism, and major bleeding within 2 years of diagnosis. <br><strong> Results <br></strong>Overall, 65.8% received anticoagulant therapy, 20.8% received an antiplatelet only, and 13.4% received neither. During the study period, the overall incidence rates of all-cause mortality, non-haemorrhagic stroke/systemic embolism, and major bleeding were 4.15 (95% confidence interval [CI] = 3.69 to 4.65), 1.45 (95% CI = 1.19 to 1.77), and 1.21 (95% CI = 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 adjusted hazard ratio (aHR) 0.70 (95% CI = 0.53 to 0.93), significantly lower risk of non-haemorrhagic stroke/systemic embolism (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). <br><strong> Conclusion <br></strong>The data support a benefit of anticoagulation in reducing stroke and death, without an increased risk of a major bleed in patients with new-onset AF. Anticoagulation treatment in patients at high risk of stroke who are not receiving anticoagulation may further improve outcomes. |
| spellingShingle | Apenteng, PN Virdone, S Hobbs, FR Camm, AJ Fox, KA Pieper, KS Kayani, G Fitzmaurice, D Two-year outcomes of UK patients newly diagnosed with atrial fibrillation: findings from the prospective observational cohort study GARFIELD-AF |
| title | Two-year outcomes of UK patients newly diagnosed with atrial fibrillation: findings from the prospective observational cohort study GARFIELD-AF |
| title_full | Two-year outcomes of UK patients newly diagnosed with atrial fibrillation: findings from the prospective observational cohort study GARFIELD-AF |
| title_fullStr | Two-year outcomes of UK patients newly diagnosed with atrial fibrillation: findings from the prospective observational cohort study GARFIELD-AF |
| title_full_unstemmed | Two-year outcomes of UK patients newly diagnosed with atrial fibrillation: findings from the prospective observational cohort study GARFIELD-AF |
| title_short | Two-year outcomes of UK patients newly diagnosed with atrial fibrillation: findings from the prospective observational cohort study GARFIELD-AF |
| title_sort | two year outcomes of uk patients newly diagnosed with atrial fibrillation findings from the prospective observational cohort study garfield af |
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