2014年9月3日

GARFIELD-AF

◎GARFIELD-AF Registryのデータが不適切な抗血栓剤使用を示す

◎GARFIELD-AF Registryのデータが不適切な抗血栓剤使用を示す

AsiaNet 57709
共同JBN 0922 (2014.9.3)

【バルセロナ(スペイン)2014年9月3日PRN=共同JBN】
*2014年欧州心臓学会(ESC)会議でのGARFIELD-AF Registryの報告は毎日の臨床行為における脳卒中のリスクがある患者の治療、治療結果についての知見を提供する-

革新的で中立的な学術研究計画である「Global Anticoagulant Registry in the FIELD-Atrial Fibrillation(GARFIELD-AF))」で募集された約1万2500人の患者のデータは、心房細動(AF)患者の脳卒中予防戦略が非ビタミンKアンタゴニスト経口抗血液凝固(NOAC)療法を使う抗血液凝固の新時代への移行にもかかわらずいまなお最適以下にとどまっていることを示している。今週2014年ESC会議で報告されたこの結果は、毎日の臨床行為における治療パターンが証拠に基づく指針とは合致していないこと、抗血液凝固剤の不適切な使用、不十分な使用が患者にとっての悪い結果と関連していることを示している。

GARFIELD-AFは英ロンドンの血栓研究所(Thrombosis Research Institute, TRI)の支援を受けて国際的な運営委員会が指揮している。AFの治療と患者、臨床医、健康管理プロバイダーにとっての結果の変化を明確にすることを目指す観察研究である。AFについての現存データの大半は対比臨床研究のものであり、その一方で患者と毎日の臨床行為に関わる人々の負担はそれほど理解されていない。人口の最大2%はよくある心拍障害だが脳卒中を含む生命を脅かす合併症に至る恐れがあるAFにかかっている(注1)。AF関連の脳卒中はいまでも主要で増大している臨床的、社会的負担である。

ロンドン・ユニバーシティー・カレッジの外科教授でTRI理事のロード・アジャイ・カッカー氏は「GARFIELD-AFの最新データは革新的な療法の導入がAF患者を治療して脳卒中を予防する方法を変え始めたことを示している。これまでの研究は抗凝血療法が適切に使われると患者の結果が改善できることを示した。しかし、GARFIELD-AFでの毎日の臨床行為の観察は、証拠に基づく最良行為の指針の実行を確保するには抗凝固に適した患者、その最適な管理を含め重要な仕事が残っていることを示唆している」と語っている。

2014年ESC会議のサテライト・シンポジウムでは、計画されていた5グループ中の最初の3グループのうち34カ国で募集された3万1666人のGARFIELD-AF患者についての予備的な治療データが報告された(注2)。2009年にGARFIELD-AFが開始されて以来、Xa要素阻害剤(rivaroxaban、apixaban)と直接血栓阻害剤(dabigatran)を含むNOACに対する規制の承認はビタミンKアンタゴニスト(VKA)の代替として確立された標準ケアを提供することによって処方パターンが変更された。NOACを受けたAF患者の割合はグループ1(2009年12月-2011年10月)の3.1%からグループ3(2013年6月-2014年6月)の26.4%に増加した。しかし、なんらかの抗凝固剤を受けた患者の割合は同じ期間に60.6%から67.5%に増加しただけで、VKAを受けた患者(57.5%から41.1%に減少)より少なかった。

分析時点でAFであると診断された後に最低1年のフォローアップ期間があった1万2448人のプロスペクティブ患者は2014年ESC会議では3回のポスター報告に含まれた。

▽VKAで治療された患者の25%だけが適切な抗凝固管理を達成した(注3)
ESC指針は、患者が最低70%の時間を治療範囲つまり国際正常化率(INR)2.0-3.0で過ごせれば十分に管理されたVKA療法だと見なせることを示している(注4)。

日常的なモニターと投与量調整を受けるためのVKAに関する患者の必要条件、最適な抗凝固効果を維持することの困難さが抗凝固療法を選ぶ際の重要な考慮点である。NOACは固定投与量で与えられ、予測可能な抗凝固効果をもたらし、モニターの必要はない。VKAによる治療を受けた患者でINRの記録が利用できる5107人のGARFIELD-AF患者のうち25%(n=1301)だけがVKA管理の70%標準を達成した(NIR管理は領域内頻度=FIR=で測定された)。VKA管理が最適以下の患者は脳卒中、大出血事象、死亡に至る可能性が大きい。

▽低リスク患者の5人に2人は指針の勧告に反して抗凝固剤投与を受けている(注5)
CHA2DS2-VAScリスク・スコア(注6)が0のAF患者はESC指針では脳卒中のリスクが低いとみなされ、VKS、NOACによる抗凝固療法の候補ではない(注4)。CHA2DS2-VAScのスコアが0の440人のGARFIELD-AF患者のうち40%は抗凝固剤の投与を受けた(32.4%はVKAを受け、7.6%はNOACを受けた)。またこのデータは、これら低リスク患者にはCHA2DS2-VAScスコアが1以上ないしは1の患者に比べ、あらゆる原因による死亡のリスクがかなり低いことを含め、有害な臨床結果が少ないことも確認し、低リスク患者を抗凝固剤で治療することに反対する指針勧告をサポートしている。

▽高齢患者は抗凝固療法を受けることが多い(注7)
GARFIELD-AF患者の間では、年齢の上昇がより頻繁な経口抗凝固剤の使用、より多くの合併症の発症、脳卒中/全身性塞栓、死亡、大出血事象のリスク上昇に関連していた。65歳以上の患者では心臓血管病による死は主要な死因ではなかった。

▽GARFIELD-AFについて
GARFIELD-AF Registryは独立系の学術研究活動である。Registryは新たに診断された心房細動(AF)患者を観察するマルチセンターによる国際的な予測研究である。Registryは米州、東西欧州、アジア、アフリカ、オーストラリアの35カ国にある少なくとも1000カ所のセンターから登録された5万人の患者を予測研究する。

心房細動に関して現在理解されていることは、比較臨床試験で集められたデータに基づいている。新しい治療の効果と安全性を評価することは重要であるが、これら臨床試験は日常の臨床診療行為ではないので、この疾患に対する実生活上の負担や管理について不確定要素が存在する。GARFIELD-AFはこの患者集団に見られる血栓塞性、出血性の合併症における抗凝固療法の影響について治験の提供を試みる。それは代表的な多様な患者グループ、さらには特徴的な患者集団の治療と臨床的な転帰を改善する可能性のある機会についてより良い理解を提供する。これは医師と医療システムが患者や患者集団に最善の転帰を保証するための技術的進歩を適切に採用することを支援する。

Registryは2009年12月に開始された。GARFIELD-AFプロトコルの4つの重要な設計特性は心房細動について包括的、代表的な説明を確かなものにする。

 *予測され、新たに診断された患者の5つの逐次的集団について、個別の時間周期による比較研究を容易にし、治療と転帰の変化を類型化する。

 *調査対象施設は、慎重に割り当てられた全国的な心房細動医療設置配分の中で無作為に選択されており、登録される患者集団が代表するものとなることを確実にしている。

 *患者登録の選択の偏りを排除するため治療法に関わらず持続的に適格患者を登録する。

 *フォローアップ・データは、診断後最短2年、最長8年間収集され、毎日の臨床診療での治療決定と転帰に関する包括的なデータベースを作成する。

研究対象の患者は過去6週間内に非弁膜性心房細動(AF)と診断され、脳卒中のリスク要因がほかに少なくとも1つあり、そうでなければ脳卒中につながる可能性のある血栓を予防するための抗凝固療法の候補になりうるのである。患者の脳卒中リスク要因を特定するのは、研究者の臨床判断に委ねられる。患者は抗凝固療法を受けるかどうかに関わりなく登録されるので、現在および今後の治療戦略と失敗は個々の患者のリスク特性との関係で適切に理解される。

GARFIELD-AF RegistryはBayer Pharma AGから無制限の研究資金供与を受けている。

▽AFの負荷
世界人口の最大2%が心房細動(AF)にかかっている(注1)。欧州の約600万人(注8)、米国の300-500万人(注9、10)、中国の最大800万人がAFにかかっている(注11、12)。その有病率は人口の高齢化とともに2050年には少なくとも倍増する。AFは脳卒中リスクを5倍に増加させる影響を与え、脳卒中全体の5分の1はこの不整脈に起因する。AFに関連する虚血性脳卒中はしばしば致命的であり、生き残こる患者もより高い頻度で重度の身体障害を起こし、ほかの原因による脳卒中患者より再発の可能性が高い。この結果、AF関連の脳卒中によって死亡するリスクは倍増し、医療にかかるコストは50%増加する(注13)。

AFは心房の一部が非協調的な電気信号を発すると時に起こり、心室が非常に速く、不規則に血液を流し、血液を完全に送り出すことができなくなる状態が生じる。その結果、血液は心室にたまり、凝固し、血栓症となるが、これは先進国、発展途上国双方で第1位のキラー要因となっている。血栓が左心房を離れると、身体のほかの部位の動脈、特に脳内の動脈にとどまる可能性がある。致命的な脳卒中の92%は血栓症によって起きる(注15)。AF患者はまた、心不全、慢性疲労、その他心拍上の問題のリスクも高い(注16)。脳卒中は世界的に死亡もしくは長期的な身体障害の主要な原因であり、毎年670万人が死亡(注17)、500万人が終生身体障害となる(注18)。

▽Thrombosis Research Institute(TRI、血栓症研究所)について
TRIは慈善財団であり、血栓症と関連疾患の研究に専心している多くの研究分野にわたる研究所である。TRIの使命は優れた血栓症研究、教育を提供し、血栓症の予防と治療のための新戦略を開発し、それによってケアの質を向上させ、臨床結果を前進させ、健康管理コストを減らすことである。TRIはユニバーシティー・カレッジ・ロンドン(University College London)のPartners Academic Health Science Systemのメンバーである。

(注)
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. 8/22/14. Available at: http://europace.oxfordjournals.org/content/14/11/1553.long

2. Kakkar AJ (2014, August). Introduction and status update of GARFIELD-AF. In AJ Kakkar and J-P Bassand (Co-chairs), Anticoagulation and AF: emerging insights. Symposium conducted at the ESC Congress 2014, Barcelona, Spain.

3. Haas S, Goto S, Fitzmaurice D, et al. International normalized ratio control and 1-year outcomes in patients with newly diagnosed atrial fibrillation: the GARFIELD-AF Registry. Poster session presented at the ESC Congress 2014, Barcelona, Spain.

4. Camm AJ, Lip GY, De Caterina R, et al; ESC Committee for Practice Guidelines (CPG). 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J 2012; 33(21):2719-47. 8/22/14. Available at: http://eurheartj.oxfordjournals.org/content/33/21/2719.full

5. Bassand JP, Goldhaber SZ, Camm J, et al. ‘Truly low-risk’ patients with newly diagnosed non-valvular atrial fibrillation at risk of stroke: 1-year outcomes from the GARFIELD-AF Registry. Poster session presented at the ESC Congress 2014, Barcelona, Spain.

6. Lip GY, Nieuwlaat R, Pisters R, et al. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on atrial fibrillation. Chest 2010; 137:263-72. 8/22/14. Available at: http://journal.publications.chestnet.org/article.aspx?articleid=1086288

7. Bassand JP, Fitzmaurice D, Camm J, et al. Is cardiovascular death a primary driver of mortality in higher age groups of patients with non-valvular atrial fibrillation? Results from the GARFIELD-AF Registry. Poster session presented at the ESC Congress 2014, Barcelona, Spain.

8. The Lancet Neurology. Stroke prevention: getting to the heart of the matter. Lancet Neurol 2010; 9(2):129. 8/22/14. Available at: http://www.atrialfibrillation.org.uk/files/file/Articles_Medical/Lancet%20Neurology-%20getting%20to%20the%20heart%20of%20the%20matter.pdf

9. 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.

10. 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. 8/22/14. Available at: http://www.ajconline.org/article/S0002-9149(13)01288-5/fulltext

11. 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. 8/22/14. Available at: https://www.jstage.jst.go.jp/article/jea/18/5/18_JE2008021/_pdf

12. Hu D, Sun Y. Epidemiology, risk factors for stroke, and management of atrial fibrillation in China. JACC 2008; 52(10):865-8. 8/22/14. Available at: http://www.sciencedirect.com/science/article/pii/S0735109708021141

13. 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. 8/22/14. Available at: http://eurheartj.oxfordjournals.org/content/early/2010/09/25/eurheartj.ehq278.full

14. National Heart, Lung, and Blood Institute. What is Atrial Fibrillation? 8/22/14. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/af/af_what.html

15. Thrombosis Research Institute. About Thrombosis. 8/22/14. Available at: http://www.tri-london.ac.uk/about-us

16. 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

17. World Health Organization. The top 10 causes of death. Fact sheet Nia310. Updated May 2014. 8/22/14. Available at: http://www.who.int/mediacentre/factsheets/fs310/en/

18. World Heart Federation. The global burden of stroke. 8/22/14. Available at: http://www.world-heart-federation.org/cardiovascular-health/stroke/

ソース:GARFIELD-AF

さらに詳しい情報はhttp://www.tri-london.ac.uk/garfield を参照。

▽メディア問い合わせ先
Emily Chu
echu@tri-london.ac.uk
+44(0)207-351-8300 ext. 3383


Data From Global Atrial Fibrillation Registry Show Antithrombotic Agents Not Optimally Used to Prevent Stroke

PR57709

BARCELONA, Spain, Sept. 3, /PRN=KYODO JBN/ —

— GARFIELD-AF Registry presentations at ESC CONGRESS 2014 provide insight into
treatment and outcomes of patients at risk of stroke in everyday clinical
practice —

Data from nearly 12,500 patients enrolled in the Global Anticoagulant Registry
in the FIELD-Atrial Fibrillation (GARFIELD-AF), an innovative, independent
academic research initiative, have illustrated that stroke prevention
strategies for atrial fibrillation (AF) patients remain sub-optimal despite the
transition to a new era of anticoagulation featuring non-vitamin K antagonist
oral anticoagulant (NOAC) therapies. The findings, presented this week at ESC
Congress 2014, show that treatment patterns in everyday clinical practice are
not consistent with evidence-based guidelines, and that inappropriate use and
under-use of anticoagulant therapy is associated with worse outcomes for
patients.

GARFIELD-AF is led by an international steering committee under the auspices of
the Thrombosis Research Institute (TRI), London, UK. It is an observational
study designed to clarify evolving AF treatments and outcomes for patients,
clinicians and healthcare providers. Most existing data about AF have come from
controlled clinical trials, whilst the burden on patients and populations in
everyday clinical practice is less well understood. Up to 2% of the population
has AF,[1] a common heart rhythm disorder that can lead to life-threatening
complications, including stroke. Despite the availability of highly effective
preventive treatments, AF-related stroke remains a major and increasing
clinical and societal burden.

"The latest data from GARFIELD-AF illustrate that the introduction of
innovative therapies has begun to alter the way AF patients are treated to
prevent stroke," said Professor Lord Ajay Kakkar, Professor of Surgery at
University College London and Director of the TRI. "Previous research has
demonstrated that patient outcomes can be improved when anticoagulant therapy
is used appropriately. However, observations of everyday clinical practice in
GARFIELD-AF suggest that important work remains to be done to ensure the
implementation of evidence-based best practice, including the selection of
suitable patients for anticoagulation and their optimal management."

Preliminary treatment data for 31,666 GARFIELD-AF patients enrolled in 34
countries during the first three of five planned cohorts were presented in an
ESC Congress 2014 satellite symposium.[2] Since the initiation of GARFIELD-AF
in 2009, regulatory approval for NOACs including factor Xa inhibitors
(rivaroxaban, apixaban) and a direct thrombin inhibitor (dabigatran) has
altered prescribing patterns by providing an alternative to vitamin K
antagonists (VKAs), the established standard of care. The proportion of AF
patients receiving a NOAC has increased from 3.1% during cohort 1 (December
2009-October 2011) to 26.4% during cohort 3 (June 2013-June 2014). However, the
proportion of patients receiving any anticoagulant only increased from 60.6% to
67.5% in the same period, as fewer patients received a VKA (57.5% to 41.1%).

The 12,448 prospective patients with at least one year of follow up data after
AF diagnosis at the time of analysis were included in the three posters
presented at ESC Congress 2014.

Only 25% of patients treated with VKAs achieve adequate anticoagulation
control[3]

The ESC guidelines suggest that patients can be considered well managed on VKA
therapy if they spend at least 70% of their time in the therapeutic range, i.e.
with an international normalized ratio (INR) of 2.0-3.0.[4]
The requirement for patients on VKA to undergo routine monitoring and dose
adjustment, and the difficulty of maintaining the optimal anticoagulant effect,
are an important consideration when choosing between anticoagulant therapies.
NOACs are given at fixed doses and exert a predictable anticoagulant effect
without the need for monitoring.
Of the 5107 GARFIELD-AF patients treated with VKAs and with INR recordings
available, only 25% (n=1301) met the 70% standard for VKA control (with INR
control measured as frequency in range (FIR)).
Patients whose VKA control was sub-optimal were significantly more likely to
suffer a stroke, a major bleeding event, and death.


2 in 5 low-risk patients receive anticoagulation against guideline
recommendations[5]

AF patients with a CHA2DS2-VASc risk score[6] of 0 are considered by the ESC
guidelines to be at low risk of stroke and are not candidates for anticoagulant
therapy with either a VKA or a NOAC.[4]
Of the 440 GARFIELD-AF patients with a CHA2DS2-VASc score of 0, 40% received an
anticoagulant (32.4% received a VKA and 7.6% received a NOAC).
The data also confirmed that these low-risk patients tended to have fewer
adverse clinical outcomes, including a substantially lower risk of all-cause
death, compared to patients with CHA2DS2 greater than or equal to 1, supporting
the guideline recommendation against treating low-risk patients with
anticoagulant therapy.


Older patients are more likely to receive anticoagulant therapy[7]

Amongst GARFIELD-AF patients, increasing age was associated with more frequent
oral anticoagulant use, a greater incidence of co-morbidities and higher risks
of stroke/systemic embolism, death and major bleeding events.
In patients aged 65 or over, cardiovascular death was not the primary cause of
mortality.


About GARFIELD-AF

The GARFIELD-AF Registry is an independent academic research initiative. The
registry is an observational, multicentre, international prospective study of
patients with newly diagnosed AF.  It will prospectively follow 50,000 patients
from at least 1000 centres in 35 countries in the Americas, Eastern and Western
Europe, Asia, Africa and Australia.

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:

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 have been diagnosed with non-valvular AF within the past 6
weeks and have at least one additional risk factor for stroke, and as such, are
potential candidates for anticoagulant therapy to prevent blood clots leading
to stroke. It is left to the investigator’s clinical judgment to identify a
patient’s stroke risk factor(s), which are not 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.

The burden of AF

Up to 2% of the global population has AF.[1] Around 6 million people in
Europe[8], 3-5 million people in the United States[9],[10] and up to 8 million
people in China have AF.[11],[12] It is estimated that its prevalence will at
least double by 2050 as the 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 in association 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%.[13]

AF occurs when parts of the atria emit uncoordinated electrical signals that
cause the chambers to pump too quickly and irregularly, not allowing blood to
be pumped out completely.[14] As a result, blood may pool, clot and lead to
thrombosis, which is the number one killer in both the developed and developing
world. If a blood clot leaves the left atrium, it could potentially lodge in an
artery in other parts of the body, particularly in 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 thromboses.[15] People with AF also are at high risk for heart
failure, chronic fatigue and other heart rhythm problems.[16] Stroke is a major
cause of death and long-term disability worldwide – each year 6.7 million
die[17] and 5 million sufferers are left permanently disabled.[18]

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 System.

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the general population and in high-risk groups: the ECHOES study. Europace
2012; 14(11):1553-9. 8/22/14. Available at:
http://europace.oxfordjournals.org/content/14/11/1553.long

2. Kakkar AJ (2014, August). Introduction and status update of GARFIELD-AF. In
AJ Kakkar and J-P Bassand (Co-chairs), Anticoagulation and AF: emerging
insights. Symposium conducted at the ESC Congress 2014, Barcelona, Spain.

3. Haas S, Goto S, Fitzmaurice D, et al. International normalized ratio control
and 1-year outcomes in patients with newly diagnosed atrial fibrillation: the
GARFIELD-AF Registry. Poster session presented at the ESC Congress 2014,
Barcelona, Spain.

4. Camm AJ, Lip GY, De Caterina R, et al; ESC Committee for Practice Guidelines
(CPG). 2012 focused update of the ESC Guidelines for the management of atrial
fibrillation: an update of the 2010 ESC Guidelines for the management of atrial
fibrillation. Developed with the special contribution of the European Heart
Rhythm Association. Eur Heart J 2012; 33(21):2719-47. 8/22/14. Available at:
http://eurheartj.oxfordjournals.org/content/33/21/2719.full

5. Bassand JP, Goldhaber SZ, Camm J, et al. ‘Truly low-risk’ patients with
newly diagnosed non-valvular atrial fibrillation at risk of stroke: 1-year
outcomes from the GARFIELD-AF Registry. Poster session presented at the ESC
Congress 2014, Barcelona, Spain.

6. Lip GY, Nieuwlaat R, Pisters R, et al. Refining clinical risk stratification
for predicting stroke and thromboembolism in atrial fibrillation using a novel
risk factor-based approach: the Euro Heart Survey on atrial fibrillation. Chest
2010; 137:263-72. 8/22/14. Available at:
http://journal.publications.chestnet.org/article.aspx?articleid=1086288

7. Bassand JP, Fitzmaurice D, Camm J, et al. Is cardiovascular death a primary
driver of mortality in higher age groups of patients with non-valvular atrial
fibrillation? Results from the GARFIELD-AF Registry. Poster session presented
at the ESC Congress 2014, Barcelona, Spain.

8. The Lancet Neurology. Stroke prevention: getting to the heart of the matter.
Lancet Neurol 2010; 9(2):129. 8/22/14. Available at:
http://www.atrialfibrillation.org.uk/files/file/Articles_Medical/Lancet%20Neurology-%20getting%20to%20the%20heart%20of%20the%20matter.pdf


9. 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.

10. 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. 8/22/14. Available at:
http://www.ajconline.org/article/S0002-9149(13)01288-5/fulltext

11. 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. 8/22/14. Available at:
https://www.jstage.jst.go.jp/article/jea/18/5/18_JE2008021/_pdf

12. Hu D, Sun Y. Epidemiology, risk factors for stroke, and management of
atrial fibrillation in China. JACC 2008; 52(10):865-8. 8/22/14. Available at:
http://www.sciencedirect.com/science/article/pii/S0735109708021141

13. 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. 8/22/14. Available at:
http://eurheartj.oxfordjournals.org/content/early/2010/09/25/eurheartj.ehq278.full


14. National Heart, Lung, and Blood Institute. What is Atrial Fibrillation?
8/22/14. Available at:
http://www.nhlbi.nih.gov/health/dci/Diseases/af/af_what.html

15. Thrombosis Research Institute. About Thrombosis. 8/22/14. Available at:
http://www.tri-london.ac.uk/about-us

16. 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


17. World Health Organization. The top 10 causes of death. Fact sheet Nia310.
Updated May 2014. 8/22/14. Available at:
http://www.who.int/mediacentre/factsheets/fs310/en/

18. World Heart Federation. The global burden of stroke. 8/22/14. Available at:
http://www.world-heart-federation.org/cardiovascular-health/stroke/

Source: GARFIELD-AF

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

Media Contact
Emily Chu
echu@tri-london.ac.uk
+44(0)207-351-8300 ext. 3383