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Improving the quality of life and reducing sudden cardiac death by limiting the impact of heart rhythm disturbances.
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Dr. Ajay Kakkar
Ajay Kakkar(United Kingdom)
List of Authors: Ajay Kakkar, On Behalf Of The Garfield Registry Investigators1 - Thrombosis Research Institute, London, United Kingdom
The Global Anticoagulant Registry in the Field (Garfield) is an observational registry of patients with newly diagnosed AF and one or more additional risk factor for stroke. Purpose: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is a major risk factor for thromboembolic stroke and death. The incidence increases with age. Clinical trials have shown that antithrombotic therapy with oral anticoagulation (OAC) using vitamin K antagonists (VKAs) or with acetylsalicylic acid reduces the risk of thromboembolic events and mortality, but many patients do not receive evidence-based treatment. Clinical trials often enrolled prevalent rather than new VKA users, and tight control of the international normalized ratio (INR) in the trial setting may overestimate OAC performance. Therefore, global, real-life data in routine practice are needed on AF management, VKA dosing, and time within the therapeutic INR range, among newly diagnosed AF patients at risk for stroke. The Global Anticoagulant Registry in the Field (Garfield) is an observational registry of patients with newly diagnosed AF and one or more additional risk factor for stroke. The aim of this study is to determine the management and outcomes of such patients in clinical practice. Methods: The Garfield Registry is a prospective/partly retrospective multicentre study of approximately 50,000 patients enrolled as 5 sequential prospective cohorts and 1 retrospective validation cohort at more than 1000 sites in more than 50 countries worldwide. Men and women aged ≥18 years diagnosed with non-valvular AF within the previous 6 weeks are eligible for inclusion; patients with a transient cause for AF, which is reversible, are excluded, along with those in whom follow-up is not possible. The Registry is anticipated to take place over 6 years; it started in December 2009, and will comprise 4 years for recruitment and 2 years for follow-up of each patient. Clinical sites were selected randomly and patients enrolled consecutively, regardless of whether they started OAC therapy. Sites are representative of AF care settings on a geographical basis and include hospitals, anticoagulation clinics, and a broad spectrum of general practitioners. Endpoints include stroke, transient ischaemic attack, systematic embolization, pulmonary embolism, myocardial infarction, major haemorrhage, medication adherence, hospitalization, mortality, and INR control for patients on VKAs. Results: Data, including anticoagulant treatment strategies, will be presented for the retrospective validation cohort of 5000 patients and for the first prospective cohort. Conclusion: Garfield will provide real-world validated and rigorously assessed data on AF treatment and outcomes globally.
Clinical Registry Highlight I - Risk and treatment reality
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