• Medientyp: E-Artikel
  • Titel: Management and 1‐Year Outcomes of Patients With Newly Diagnosed Atrial Fibrillation and Chronic Kidney Disease: Results From the Prospective GARFIELD‐AF Registry
  • Beteiligte: Goto, Shinya; Angchaisuksiri, Pantep; Bassand, Jean‐Pierre; Camm, A. John; Dominguez, Helena; Illingworth, Laura; Gibbs, Harry; Goldhaber, Samuel Z.; Goto, Shinichi; Jing, Zhi‐Cheng; Haas, Sylvia; Kayani, Gloria; Koretsune, Yukihiro; Lim, Toon Wei; Oh, Seil; Sawhney, Jitendra P. S.; Turpie, Alexander G. G.; van Eickels, Martin; Verheugt, Freek W. A.; Kakkar, Ajay K.; Fitzmaurice, David A.; Hacke, Werner; Mantovani, Lorenzo G.; Misselwitz, Frank; [...]
  • Erschienen: Ovid Technologies (Wolters Kluwer Health), 2019
  • Erschienen in: Journal of the American Heart Association
  • Umfang:
  • Sprache: Englisch
  • DOI: 10.1161/jaha.118.010510
  • ISSN: 2047-9980
  • Schlagwörter: Cardiology and Cardiovascular Medicine
  • Zusammenfassung: <jats:sec xml:lang="en"> <jats:title>Background</jats:title> <jats:p xml:lang="en"> Using data from the <jats:styled-content style="fixed-case">GARFIELD</jats:styled-content> ‐ <jats:styled-content style="fixed-case">AF</jats:styled-content> (Global Anticoagulant Registry in the <jats:styled-content style="fixed-case">FIELD</jats:styled-content> –Atrial Fibrillation), we evaluated the impact of chronic kidney disease ( <jats:styled-content style="fixed-case">CKD</jats:styled-content> ) stage on clinical outcomes in patients with newly diagnosed atrial fibrillation ( <jats:styled-content style="fixed-case">AF</jats:styled-content> ). </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Methods and Results</jats:title> <jats:p xml:lang="en"> <jats:styled-content style="fixed-case">GARFIELD</jats:styled-content> ‐ <jats:styled-content style="fixed-case">AF</jats:styled-content> is a prospective registry of patients from 35 countries, including patients from Asia (China, India, Japan, Singapore, South Korea, and Thailand). Consecutive patients enrolled (2013–2016) were classified with no, mild, or moderate‐to‐severe <jats:styled-content style="fixed-case">CKD</jats:styled-content> , based on the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative guidelines. Data on <jats:styled-content style="fixed-case">CKD</jats:styled-content> status and outcomes were available for 33 024 of 34 854 patients (including 9491 patients from Asia); 10.9% (n=3613) had moderate‐to‐severe <jats:styled-content style="fixed-case">CKD</jats:styled-content> , 16.9% (n=5595) mild <jats:styled-content style="fixed-case">CKD</jats:styled-content> , and 72.1% (n=23 816) no <jats:styled-content style="fixed-case">CKD</jats:styled-content> . The use of oral anticoagulants was influenced by stroke risk (ie, post hoc assessment of <jats:styled-content style="fixed-case">CHA</jats:styled-content> <jats:sub>2</jats:sub> <jats:styled-content style="fixed-case">DS</jats:styled-content> <jats:sub>2</jats:sub> ‐ <jats:styled-content style="fixed-case">VAS</jats:styled-content> c score), but not by <jats:styled-content style="fixed-case">CKD</jats:styled-content> stage. The quality of anticoagulant control with vitamin K antagonists did not differ with <jats:styled-content style="fixed-case">CKD</jats:styled-content> stage. After adjusting for baseline characteristics and antithrombotic use, both mild and moderate‐to‐severe <jats:styled-content style="fixed-case">CKD</jats:styled-content> were independent risk factors for all‐cause mortality. Moderate‐to‐severe <jats:styled-content style="fixed-case">CKD</jats:styled-content> was independently associated with a higher risk of stroke/systemic embolism, major bleeding, new‐onset acute coronary syndrome, and new or worsening heart failure. The impact of moderate‐to‐severe <jats:styled-content style="fixed-case">CKD</jats:styled-content> on mortality was significantly greater in patients from Asia than the rest of the world ( <jats:italic>P</jats:italic> =0.001). </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Conclusions</jats:title> <jats:p xml:lang="en"> In <jats:styled-content style="fixed-case">GARFIELD</jats:styled-content> ‐ <jats:styled-content style="fixed-case">AF</jats:styled-content> , moderate‐to‐severe <jats:styled-content style="fixed-case">CKD</jats:styled-content> was independently associated with stroke/systemic embolism, major bleeding, and mortality. The effect of moderate‐to‐severe <jats:styled-content style="fixed-case">CKD</jats:styled-content> on mortality was even greater in patients from Asia than the rest of the world. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Clinical Trial Registration</jats:title> <jats:p xml:lang="en"> <jats:styled-content style="fixed-case">URL</jats:styled-content> : <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://www.clinicaltrials.gov">http://www.clinicaltrials.gov</jats:ext-link> . Unique identifier: <jats:styled-content style="fixed-case">NCT</jats:styled-content> 01090362. </jats:p> </jats:sec>
  • Beschreibung: <jats:sec xml:lang="en">
    <jats:title>Background</jats:title>
    <jats:p xml:lang="en">
    Using data from the
    <jats:styled-content style="fixed-case">GARFIELD</jats:styled-content>

    <jats:styled-content style="fixed-case">AF</jats:styled-content>
    (Global Anticoagulant Registry in the
    <jats:styled-content style="fixed-case">FIELD</jats:styled-content>
    –Atrial Fibrillation), we evaluated the impact of chronic kidney disease (
    <jats:styled-content style="fixed-case">CKD</jats:styled-content>
    ) stage on clinical outcomes in patients with newly diagnosed atrial fibrillation (
    <jats:styled-content style="fixed-case">AF</jats:styled-content>
    ).
    </jats:p>
    </jats:sec>
    <jats:sec xml:lang="en">
    <jats:title>Methods and Results</jats:title>
    <jats:p xml:lang="en">
    <jats:styled-content style="fixed-case">GARFIELD</jats:styled-content>

    <jats:styled-content style="fixed-case">AF</jats:styled-content>
    is a prospective registry of patients from 35 countries, including patients from Asia (China, India, Japan, Singapore, South Korea, and Thailand). Consecutive patients enrolled (2013–2016) were classified with no, mild, or moderate‐to‐severe
    <jats:styled-content style="fixed-case">CKD</jats:styled-content>
    , based on the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative guidelines. Data on
    <jats:styled-content style="fixed-case">CKD</jats:styled-content>
    status and outcomes were available for 33 024 of 34 854 patients (including 9491 patients from Asia); 10.9% (n=3613) had moderate‐to‐severe
    <jats:styled-content style="fixed-case">CKD</jats:styled-content>
    , 16.9% (n=5595) mild
    <jats:styled-content style="fixed-case">CKD</jats:styled-content>
    , and 72.1% (n=23 816) no
    <jats:styled-content style="fixed-case">CKD</jats:styled-content>
    . The use of oral anticoagulants was influenced by stroke risk (ie, post hoc assessment of
    <jats:styled-content style="fixed-case">CHA</jats:styled-content>
    <jats:sub>2</jats:sub>
    <jats:styled-content style="fixed-case">DS</jats:styled-content>
    <jats:sub>2</jats:sub>

    <jats:styled-content style="fixed-case">VAS</jats:styled-content>
    c score), but not by
    <jats:styled-content style="fixed-case">CKD</jats:styled-content>
    stage. The quality of anticoagulant control with vitamin K antagonists did not differ with
    <jats:styled-content style="fixed-case">CKD</jats:styled-content>
    stage. After adjusting for baseline characteristics and antithrombotic use, both mild and moderate‐to‐severe
    <jats:styled-content style="fixed-case">CKD</jats:styled-content>
    were independent risk factors for all‐cause mortality. Moderate‐to‐severe
    <jats:styled-content style="fixed-case">CKD</jats:styled-content>
    was independently associated with a higher risk of stroke/systemic embolism, major bleeding, new‐onset acute coronary syndrome, and new or worsening heart failure. The impact of moderate‐to‐severe
    <jats:styled-content style="fixed-case">CKD</jats:styled-content>
    on mortality was significantly greater in patients from Asia than the rest of the world (
    <jats:italic>P</jats:italic>
    =0.001).
    </jats:p>
    </jats:sec>
    <jats:sec xml:lang="en">
    <jats:title>Conclusions</jats:title>
    <jats:p xml:lang="en">
    In
    <jats:styled-content style="fixed-case">GARFIELD</jats:styled-content>

    <jats:styled-content style="fixed-case">AF</jats:styled-content>
    , moderate‐to‐severe
    <jats:styled-content style="fixed-case">CKD</jats:styled-content>
    was independently associated with stroke/systemic embolism, major bleeding, and mortality. The effect of moderate‐to‐severe
    <jats:styled-content style="fixed-case">CKD</jats:styled-content>
    on mortality was even greater in patients from Asia than the rest of the world.
    </jats:p>
    </jats:sec>
    <jats:sec xml:lang="en">
    <jats:title>Clinical Trial Registration</jats:title>
    <jats:p xml:lang="en">
    <jats:styled-content style="fixed-case">URL</jats:styled-content>
    :
    <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://www.clinicaltrials.gov">http://www.clinicaltrials.gov</jats:ext-link>
    . Unique identifier:
    <jats:styled-content style="fixed-case">NCT</jats:styled-content>
    01090362.
    </jats:p>
    </jats:sec>
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  • Zugangsstatus: Freier Zugang