GARFIELD-AF Registry Data Providing New Real-World Insights on Treatment Options for Patients With Atrial Fibrillation (AF) Will Be Featured at ESC Congress 2015

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Thrombosis Research Institute

20 Aug, 2015, 05:00 GMT

LONDON, August 20, 2015 /PRNewswire/ --

-- A satellite symposium and four GARFIELD-AF presentations will demonstrate how antithrombotic treatment patterns are evolving in the real-world and the impact on clinical outcomes in newly diagnosed AF patients --   

New analyses from the Global Anticoagulant Registry in the Field - Atrial Fibrillation (GARFIELD-AF) will be presented at ESC Congress 2015 to be held in London, United Kingdom, from August 29 to September 2, 2015. Real-world insights into current therapy choices for patients with newly diagnosed AF will provide physicians with a better understanding of how the introduction of non-vitamin K antagonist oral anticoagulants (NOACs) is impacting care and clinical outcomes generally as well as within distinctive populations.

Real-world data from over 40,000 patients will be presented at a satellite symposium, and at one platform and three poster presentations:

Anticoagulation and atrial fibrillation (AF): real life data from the GARFIELD-AF Registry  

  • Satellite Symposium: Sponsored by the Thrombosis Research Institute (TRI)  
  • Saturday, 29th  August 2015, 15:30-17:00, Madrid - Village 4

An expert faculty will discuss the design of GARFIELD-AF in the context of the value that registries bring to clinical research. They will also present the latest data on treatment and outcomes in the global population and in specific patient subgroups.  

Vitamin K antagonist control in Eastern and Southeastern Asia (3278) 

  • Oral session: Thrombosis and coagulation: advances in science
  • Monday 31st August, 2015, 11:37, Tunis - Village 7

A comparison of the distribution of international normalized ratio (INR) values in patients receiving a vitamin K antagonist (VKA) for newly diagnosed AF in countries in Eastern and Southeastern Asia with that for patients in other countries represented in GARFIELD-AF.

Patterns of uptake of non-vitamin K antagonist oral anticoagulants in Europe: an analysis from the GARFIELD-AF registry (P1513) 

  • Poster session 2: Miscellaneous
  • Sunday 30th August 2015, 08:30-12:30, poster area

A comparison of temporal changes in NOACs uptake in patients with newly diagnosed AF in nine European countries.

Evolving antithrombotic treatment patterns in patients with newly diagnosed atrial fibrillation in GARFIELD-AF (P4404) 

  • Poster session 5: Atrial fibrillation and anticoagulation
  • Monday 31st August, 2015, 14:00-18:00, poster area

Evolving patterns of antithrombotic therapy in patients with newly diagnosed AF analysed by baseline characteristics and risk scores for stroke and major bleeding.

Stroke, major bleeding and mortality in newly diagnosed atrial fibrillation with moderate-to-severe chronic kidney disease: results from GARFIELD-AF (P5598) 

  • Poster session 6: Stroke
  • Tuesday 1st September 2015, 08:30-12:00, poster area

A comparison of outcomes following real-world anticoagulant treatment in patients with AF and moderate-to-severe chronic kidney disease (CKD) versus those with AF and no/mild CKD.

These presentations will enhance the breadth and depth of the understanding of the importance of stroke prevention in AF, and ultimately will help to develop strategies for improving patient outcomes worldwide. Baseline data for more than 40,000 patients indicates that, currently, the management of many newly diagnosed patients is not consistent with evidence-based guidelines, with patients inappropriately receiving anticoagulants or being under-treated with anticoagulants, despite the increasing availability of NOACs. The impact of sub-optimal management strategies on patient outcomes suggests a cause for ongoing concern.

About the GARFIELD-AF Registry  

GARFIELD-AF is an independent academic research initiative, led by an international steering committee under the auspices of the Thrombosis Research Institute (TRI), London, United Kingdom.

It is an international observational, multicentre, study of patients with newly diagnosed AF. It will follow 57,000 patients from at least 1,000 centres in 35 countries in the Americas, Eastern and Western Europe, Asia, Africa and Australia. Nearly 45,000 patients were recruited in four sequential cohorts between December 2009 and July 2015. The fifth and final cohort began recruiting at the beginning of August 2015.

Contemporary understanding of AF is based on data gathered in controlled clinical trials. Whilst essential for evaluating the efficacy and safety of new treatments, these trials are not representative of everyday clinical practice and, hence, uncertainty persists about the real-life burden and management of this disease. GARFIELD-AF seeks to provide insights into the impact of anticoagulant therapy on thromboembolic and bleeding complications seen in this patient population. It will provide a better understanding of the potential opportunities for improving care and clinical outcomes amongst a representative and diverse group of patients and across distinctive populations. This should help physicians and healthcare systems to appropriately adopt innovation to ensure the best outcomes for patients and populations.

The registry started in December 2009. Four key design features of the GARFIELD-AF protocol ensure a comprehensive and representative description of AF, these are:

  • Five sequential cohorts of prospective, newly-diagnosed patients, facilitating comparisons of discrete time periods and describing the evolution of treatments and outcomes.
  • Investigator sites that are selected randomly within carefully assigned national AF care setting distributions, ensuring that the enrolled patient population is representative.
  • Enrolment of consecutive eligible patients regardless of therapy to eliminate potential selection bias.
  • Follow-up data captured for a minimum of 2 and up to 8 years after diagnosis, to create a comprehensive database of treatment decisions and outcomes in everyday clinical practice.

Included patients must have been diagnosed with non-valvular AF within the previous 6 weeks and have at least one additional risk factor for stroke; as such they are potential candidates for anticoagulant therapy to prevent blood clots leading to stroke. It is left to the investigator to identify a patient's stroke risk factor(s), which need not be restricted to those included in established risk scores. Patients are included whether or not they receive anticoagulant therapy, so current and future treatment strategies and failures can be properly understood in relation to patients' individual risk profiles.

The GARFIELD-AF Registry is funded by an unrestricted research grant from Bayer Pharma AG (Berlin, Germany).

The burden of AF  

Up to 2% of the global population has AF.[1] Around 6 million people in Europe[2], 3-5 million people in the USA[3],[4] and up to 8 million people in China have AF.[5],[6] It is estimated that its prevalence will at least double by 2050 as the global population ages. AF confers a five-fold increase in the risk of stroke, and one in five of all strokes is attributed to this arrhythmia. Ischaemic strokes associated with AF are often fatal, and those patients who survive are left more frequently and more severely disabled and more likely to suffer a recurrence than patients with other causes of stroke. In consequence, the risk of death from AF-related stroke is doubled and the cost of care is increased by 50%.[7]

AF occurs when parts of the atria emit uncoordinated electrical signals. This causes the chambers to pump too quickly and irregularly, not allowing blood to be pumped out completely.[8] As a result, blood may pool, clot and lead to thrombosis, which is the number one cardiovascular killer in the world.[9] If a blood clot leaves the left atrium, it could potentially lodge in an artery in other parts of the body, including the brain. A blood clot in an artery in the brain leads to a stroke. Ninety-two per cent of fatal strokes are caused by thrombosis.[9] People with AF also are at high risk for heart failure, chronic fatigue and other heart rhythm problems.[10] Stroke is a major cause of death and long-term disability worldwide - each year 6.7 million people die[11] and 5 million are left permanently disabled.[12]

About the TRI  

The TRI is a charitable foundation and multi-disciplinary research institute dedicated to the study of thrombosis and related disorders. TRI's mission is to provide excellence in thrombosis research and education, to develop new strategies to prevent and treat thrombosis and thereby improve quality of care, advance clinical outcomes and reduce healthcare costs. The TRI is a member of University College London Partners' Academic Health Science Network.

For more information, visit http://www.tri-london.ac.uk/garfield.

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1.  Davis RC, Hobbs FD, Kenkre JE, et al. Prevalence of atrial fibrillation in the general population and in high-risk groups: the ECHOES study. Europace 2012; 14(11):1553-9. 6/16/15. Available at: http://europace.oxfordjournals.org/content/14/11/1553.long
2.  The Lancet Neurology. Stroke prevention: getting to the heart of the matter. Lancet Neurol 2010; 9(2):129. 6/16/15. Available at: http://www.atrialfibrillation.org.uk/files/file/Articles_Medical/Lancet%20Neurology-%20getting%20to%20the%20heart%20of%20the%20matter.pdf
3.  Naccarelli GV, Varker H, Lin J, et al. Increasing prevalence of atrial fibrillation and flutter in the United States. Am J Cardiol 2009; 104(11):1534-9.
4.  Colilla S, Crow A, Petkun W, et al. Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S. adult population. Am J Cardiol 2013; 112(8):1142-7. 6/16/15. Available at: http://www.ajconline.org/article/S0002-9149(13)01288-5/fulltext
5.  Zhou Z, Hu D. An epidemiological study on the prevalence of atrial fibrillation in the Chinese population of mainland China. J Epidermiol 2008; 18(5):209-16. 6/16/15. Available at: https://www.jstage.jst.go.jp/article/jea/18/5/18_JE2008021/_pdf
6.  Hu D, Sun Y. Epidemiology, risk factors for stroke, and management of atrial fibrillation in China. JACC 2008; 52(10):865-8. 6/16/15. Available at: http://www.sciencedirect.com/science/article/pii/S0735109708021141
7.  European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery, Camm AJ, Kirchhof P, Lip GY, et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). 8/22/14. Eur Heart J 2010; 31(19):2369-429. 6/16/15. Available at: http://eurheartj.oxfordjournals.org/content/early/2010/09/25/eurheartj.ehq278.full
8.  National Heart, Lung, and Blood Institute. What is Atrial Fibrillation? 6/16/15. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/af/af_what.html
9.  International Society on Thrombosis and Haemostasis. About World Thrombosis Day. Available at: http://www.worldthrombosisday.org/about/
10. American Heart Association. Why Atrial Fibrillation (AF or AFib) Matters. 8/22/14. Available at: http://www.heart.org/HEARTORG/Conditions/Arrhythmia/AboutArrhythmia/Why-Atrial-Fibrillation-AF-or-AFib-Matters_UCM_423776_Article.jsp
11.  World Health Organization. The top 10 causes of death. Fact sheet N°310. Updated May 2014. 6/16/15. Available at: http://www.who.int/mediacentre/factsheets/fs310/en/
12.  World Heart Federation. The global burden of stroke. 6/16/15. Available at: http://www.world-heart-federation.org/cardiovascular-health/stroke/