Guideline-directed medical therapies for comorbidities among patients with atrial fibrillation: results from GARFIELD-AF.

Autor:	Camm AJ; Cardiology Clinical Academic Group Molecular & Clinical Sciences Institute, St. George's University of London, London, UK., Steffel J; University of Zurich, Zurich, Switzerland., Virdone S; Thrombosis Research Institute, London, UK., Bassand JP; Thrombosis Research Institute, London, UK.; University of Besançon, Besançon, France., Fox KAA; Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK., Goldhaber SZ; Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA., Goto S; Tokai University, Kanagawa, Japan., Haas S; Formerly Department of Medicine, Technical University of Munich, Munich, Germany., Turpie AGG; McMaster University, Hamilton, Canada., Verheugt FWA; Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands., Misselwitz F; Actimed Therapeutics, Berkshire, UK., Herreros RC; Pontificia Universidad Católica de Chile, Santiago, Chile., Kayani G; Thrombosis Research Institute, London, UK., Pieper KS; Thrombosis Research Institute, London, UK., Kakkar AK; Thrombosis Research Institute, London, UK.
Jazyk:	angličtina
Zdroj:	European heart journal open [Eur Heart J Open] 2023 May 19; Vol. 3 (3), pp. oead051. Date of Electronic Publication: 2023 May 19 (Print Publication: 2023).
DOI:	10.1093/ehjopen/oead051
Abstrakt:	Aims: This study aimed to identify relationships in recently diagnosed atrial fibrillation (AF) patients with respect to anticoagulation status, use of guideline-directed medical therapy (GDMT) for comorbid cardiovascular conditions (co-GDMT), and clinical outcomes. The Global Anticoagulant Registry in the FIELD (GARFIELD)-AF is a prospective, international registry of patients with recently diagnosed non-valvular AF at risk of stroke (NCT01090362). Methods and Results: Guideline-directed medical therapy was defined according to the European Society of Cardiology guidelines. This study explored co-GDMT use in patients enrolled in GARFIELD-AF (March 2013-August 2016) with CHA 2 DS 2 -VASc ≥ 2 (excluding sex) and ≥1 of five comorbidities-coronary artery disease, diabetes mellitus, heart failure, hypertension, and peripheral vascular disease ( n = 23 165). Association between co-GDMT and outcome events was evaluated with Cox proportional hazards models, with stratification by all possible combinations of the five comorbidities. Most patients (73.8%) received oral anticoagulants (OACs) as recommended; 15.0% received no recommended co-GDMT, 40.4% received some, and 44.5% received all co-GDMT. At 2 years, comprehensive co-GDMT was associated with a lower risk of all-cause mortality [hazard ratio (HR) 0.89 (0.81-0.99)] and non-cardiovascular mortality [HR 0.85 (0.73-0.99)] compared with inadequate/no GDMT, but cardiovascular mortality was not significantly reduced. Treatment with OACs was beneficial for all-cause mortality and non-cardiovascular mortality, irrespective of co-GDMT use; only in patients receiving all co-GDMT was OAC associated with a lower risk of non-haemorrhagic stroke/systemic embolism. Conclusion: In this large prospective, international registry on AF, comprehensive co-GDMT was associated with a lower risk of mortality in patients with AF and CHA 2 DS 2 -VASc ≥ 2 (excluding sex); OAC therapy was associated with reduced all-cause mortality and non-cardiovascular mortality, irrespective of co-GDMT use. Clinical Trial Registration: Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362. Competing Interests: Conflict of interest: A.J.C. has received institutional grants and personal fees from Bayer, Boehringer Ingelheim, BMS/Pfizer, and Daichi Sankyo. J.S. has received consultant and/or speaker fees from Abbott, Alexion, AstraZeneca, Bayer, Berlin-Chemie, Biosense Webster, Biotronik, Boehringer Ingelheim, Boston Scientific, BMS, Daiichi Sankyo, Medscape, Medtronic, Menarini, Merck/MSD, Organon, Pfizer, Saja, Servier, and WebMD. He reports ownership of Swiss EP and CorXL. K.A.A.F. has received grants and personal fees from Bayer/Janssen and AstraZeneca. S.Z.G. has received research support from Bayer, BMS, Boston Scientific, BTG, EKOS, Janssen, NHLBI, and Pfizer and has consultancy with Pfizer. S.G. has received a quality fee from the American Heart Association and received a steering committee fee from Duke University. S.H. has received personal fees from Bayer, BMS, Daiichi Sankyo, Pfizer, and Sanofi, outside the submitted work. A.G.G.T. has received personal fees from Bayer Healthcare, Janssen Pharmaceutical Research & Development LLC, Astellas, Portola, and Takeda. F.W.A.V. has received grants from Bayer Healthcare and personal fees from Bayer Healthcare, BMS/Pfizer, Daiichi Sankyo, and Boehringer Ingelheim. K.S.P. has consultancy with Johnson & Johnson, Element Science, Artivion, and Novartis. A.K.K. has received grants and personal fees from Bayer AG, Sanofi, and Anthos Therapeutics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Databáze:	MEDLINE
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