Atrial fibrillation outcomes in patients from Asia and non-Asia countries: insights from GARFIELD-AF
Background Differences in the clinical outcomes and level of risk among Asian versus non-Asian patients with atrial fibrillation (AF) have been sparsely investigated.Objective To provide a contemporary prospective comparison of outcomes for newly diagnosed patients with AF, between Asian and non-Asi...
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BMJ Publishing Group
2025-02-01
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| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/12/1/e003109.full |
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| author | Karen Pieper Xian-hong Fang Kai Sun Ajay K Kakkar Saverio Virdone Shinya Goto Gloria Kayani Zhi-Cheng Jing John Camm Chun-Yan Cheng Tian-Yu Lian Xi-Jie Zhu Xian-Mei Li |
| author_facet | Karen Pieper Xian-hong Fang Kai Sun Ajay K Kakkar Saverio Virdone Shinya Goto Gloria Kayani Zhi-Cheng Jing John Camm Chun-Yan Cheng Tian-Yu Lian Xi-Jie Zhu Xian-Mei Li |
| author_sort | Karen Pieper |
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| description | Background Differences in the clinical outcomes and level of risk among Asian versus non-Asian patients with atrial fibrillation (AF) have been sparsely investigated.Objective To provide a contemporary prospective comparison of outcomes for newly diagnosed patients with AF, between Asian and non-Asian regions.Methods Six Asian countries (China, Japan, India, Singapore, South Korea and Thailand) and 29 countries outside Asia participated in the Global Anticoagulant Registry in the FIELD-AF (GARFIELD-AF) study. Newly diagnosed patients with AF, enrolled between 2010 and 2016, were followed up for≥2 years. The outcome studies were all-cause, cardiovascular and non-cardiovascular mortality, non-haemorrhagic stroke/systemic embolism (SE), major bleeding. The association of geographical region with clinical outcomes (event rates per 100 person-years) were estimated using multivariable Cox models.Results 13 841/52 057 (26.6%) GARFIELD-AF participants were enrolled in Asia. Average age and prevalence of cardiovascular comorbidities were lower than in non-Asian countries and patients at high risk of stroke (ie, CHA2DS2-VASc≥2 excl. sex) were less frequently anticoagulated (60.1% vs 73.2%). Non-vitamin K oral anticoagulant (NOAC) was similar in both regions (∼28%), though Asian patients were more frequently underdosed. Both Asian and non-Asian patients who received NOAC at enrolment experienced lower all-cause mortality and non-haemorrhagic stroke/SE compared with patients on other treatments or none.All-cause mortality, non-cardiovascular mortality and major bleeding were less frequent in patients from Asia versus non-Asia (HR (95% CI): 0.62 (0.39 to 0.99), 0.52 (0.28 to 0.97), 0.58 (0.36 to 0.96), respectively). Associations of moderate-to-severe chronic kidney disease and vascular disease with increased risk of all-cause mortality were stronger in Asian versus non-Asian patients (interaction p values: 0.0250 and 0.0076, respectively). There was notable heterogeneity in oral anticoagulant (OAC) usage within the Asian countries.Conclusions Patients in Asian countries had a lower risk of all-cause mortality and major bleeding compared to the rest of the world. NOAC had evident benefits for reducing mortality and stroke across populations. Further studies on sociocultural impacts on OAC outcomes are needed.Trial registration number ClinicalTrials.gov NCT01090362. |
| format | Article |
| id | doaj-art-1f688434641744f5b68db69907cdcd9b |
| institution | Kabale University |
| issn | 2053-3624 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMJ Publishing Group |
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| series | Open Heart |
| spelling | doaj-art-1f688434641744f5b68db69907cdcd9b2025-02-07T07:40:15ZengBMJ Publishing GroupOpen Heart2053-36242025-02-0112110.1136/openhrt-2024-003109Atrial fibrillation outcomes in patients from Asia and non-Asia countries: insights from GARFIELD-AFKaren Pieper0Xian-hong Fang1Kai Sun2Ajay K Kakkar3Saverio Virdone4Shinya Goto5Gloria Kayani6Zhi-Cheng Jing7John Camm8Chun-Yan Cheng9Tian-Yu Lian10Xi-Jie Zhu11Xian-Mei Li12Thrombosis Research Institute, London, UKDepartment of Cardiology, Guangdong Provincial People`s Hospital, Guangdong Institute of Cardiovascular Diseases, Guangzhou, Guangdong, ChinaInstitute of Clinical Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaThrombosis Research Institute, London, UKThrombosis Research Institute, London, UKMedicine, Tokai University School of Medicine Graduate School of Medicine, Isehara, JapanThrombosis Research Institute, London, UKDepartment of Cardiology, Guangdong Provincial People`s Hospital, Guangdong Institute of Cardiovascular Diseases, Guangzhou, Guangdong, ChinaCardiology, St Georges Hospital, London, UKDepartment of Cardiology, Guangdong Provincial People`s Hospital, Guangdong Institute of Cardiovascular Diseases, Guangzhou, Guangdong, ChinaDepartment of Cardiology, Guangdong Provincial People`s Hospital, Guangdong Institute of Cardiovascular Diseases, Guangzhou, Guangdong, ChinaDepartment of Cardiology, Guangdong Provincial People`s Hospital, Guangdong Institute of Cardiovascular Diseases, Guangzhou, Guangdong, ChinaDepartment of Cardiology, Guangdong Provincial People`s Hospital, Guangdong Institute of Cardiovascular Diseases, Guangzhou, Guangdong, ChinaBackground Differences in the clinical outcomes and level of risk among Asian versus non-Asian patients with atrial fibrillation (AF) have been sparsely investigated.Objective To provide a contemporary prospective comparison of outcomes for newly diagnosed patients with AF, between Asian and non-Asian regions.Methods Six Asian countries (China, Japan, India, Singapore, South Korea and Thailand) and 29 countries outside Asia participated in the Global Anticoagulant Registry in the FIELD-AF (GARFIELD-AF) study. Newly diagnosed patients with AF, enrolled between 2010 and 2016, were followed up for≥2 years. The outcome studies were all-cause, cardiovascular and non-cardiovascular mortality, non-haemorrhagic stroke/systemic embolism (SE), major bleeding. The association of geographical region with clinical outcomes (event rates per 100 person-years) were estimated using multivariable Cox models.Results 13 841/52 057 (26.6%) GARFIELD-AF participants were enrolled in Asia. Average age and prevalence of cardiovascular comorbidities were lower than in non-Asian countries and patients at high risk of stroke (ie, CHA2DS2-VASc≥2 excl. sex) were less frequently anticoagulated (60.1% vs 73.2%). Non-vitamin K oral anticoagulant (NOAC) was similar in both regions (∼28%), though Asian patients were more frequently underdosed. Both Asian and non-Asian patients who received NOAC at enrolment experienced lower all-cause mortality and non-haemorrhagic stroke/SE compared with patients on other treatments or none.All-cause mortality, non-cardiovascular mortality and major bleeding were less frequent in patients from Asia versus non-Asia (HR (95% CI): 0.62 (0.39 to 0.99), 0.52 (0.28 to 0.97), 0.58 (0.36 to 0.96), respectively). Associations of moderate-to-severe chronic kidney disease and vascular disease with increased risk of all-cause mortality were stronger in Asian versus non-Asian patients (interaction p values: 0.0250 and 0.0076, respectively). There was notable heterogeneity in oral anticoagulant (OAC) usage within the Asian countries.Conclusions Patients in Asian countries had a lower risk of all-cause mortality and major bleeding compared to the rest of the world. NOAC had evident benefits for reducing mortality and stroke across populations. Further studies on sociocultural impacts on OAC outcomes are needed.Trial registration number ClinicalTrials.gov NCT01090362.https://openheart.bmj.com/content/12/1/e003109.full |
| spellingShingle | Karen Pieper Xian-hong Fang Kai Sun Ajay K Kakkar Saverio Virdone Shinya Goto Gloria Kayani Zhi-Cheng Jing John Camm Chun-Yan Cheng Tian-Yu Lian Xi-Jie Zhu Xian-Mei Li Atrial fibrillation outcomes in patients from Asia and non-Asia countries: insights from GARFIELD-AF Open Heart |
| title | Atrial fibrillation outcomes in patients from Asia and non-Asia countries: insights from GARFIELD-AF |
| title_full | Atrial fibrillation outcomes in patients from Asia and non-Asia countries: insights from GARFIELD-AF |
| title_fullStr | Atrial fibrillation outcomes in patients from Asia and non-Asia countries: insights from GARFIELD-AF |
| title_full_unstemmed | Atrial fibrillation outcomes in patients from Asia and non-Asia countries: insights from GARFIELD-AF |
| title_short | Atrial fibrillation outcomes in patients from Asia and non-Asia countries: insights from GARFIELD-AF |
| title_sort | atrial fibrillation outcomes in patients from asia and non asia countries insights from garfield af |
| url | https://openheart.bmj.com/content/12/1/e003109.full |
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