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Published on: February 26, 2013
Clinical Outcomes in Asymptomatic and Symptomatic Atrial Fibrillation Presentations in GARFIELD-AF: Implications for
Harry Gibbs1, Ben Freedman2, Mårten Rosenqvist3
1The Alfred Hospital, Melbourne, VIC, Australia.
Insights
Asymptomatic atrial fibrillation has similar outcomes and prognosis as symptomatic atrial fibrillation. Anticoagulation therapy effectively reduces stroke and mortality risk in both groups.
Area of Science:
- Cardiology
- Clinical Research
- Epidemiology
Background:
- Asymptomatic atrial fibrillation (AF) is frequently discovered incidentally.
- The prognosis and optimal treatment for asymptomatic AF compared to symptomatic AF remain unclear.
- This study investigates the differences in clinical characteristics, treatment, and outcomes between asymptomatic and symptomatic AF presentations.
Purpose of the Study:
- To compare the clinical profiles, management strategies, and 2-year outcomes of patients with asymptomatic versus symptomatic atrial fibrillation.
- To evaluate the effectiveness of anticoagulation in reducing adverse events in both asymptomatic and symptomatic AF populations.
Main Methods:
- Utilized data from the Global Anticoagulant Registry in the Field-Atrial Fibrillation (GARFIELD-AF) study.
- Included newly diagnosed atrial fibrillation patients with at least one stroke risk factor.
- Assessed patient symptoms, CHA2DS2-VASc scores, anticoagulation patterns, and recorded outcomes including stroke, systemic embolism, all-cause mortality, and bleeding over two years.
Main Results:
- Out of 52,032 eligible patients, 25.4% were asymptomatic.
- No significant differences were observed in the rates of nonhemorrhagic stroke/systemic embolism, all-cause mortality, or bleeding between asymptomatic and symptomatic AF patients.
- Anticoagulation demonstrated comparable reductions in stroke/systemic embolism and all-cause mortality for both asymptomatic and symptomatic AF presentations.
Conclusions:
- Major clinical outcomes are similar for asymptomatic and symptomatic atrial fibrillation.
- Anticoagulation therapy provides comparable benefits in reducing adverse events for both patient groups.
- Opportunistically detected asymptomatic AF likely shares the same prognosis and treatment response as presenting asymptomatic AF.
Background:
Asymptomatic atrial fibrillation is often detected incidentally. Prognosis and optimal therapy for asymptomatic compared with symptomatic atrial fibrillation is uncertain. This study compares clinical characteristics, treatment, and 2-year outcomes of asymptomatic and symptomatic atrial fibrillation presentations.
Methods:
Global Anticoagulant Registry in the Field-Atrial Fibrillation (GARFIELD-AF) is a global, prospective, observational study of newly diagnosed atrial fibrillation with ≥1 stroke risk factors (http://www.clinicaltrials.gov, unique identifier: NCT01090362). Patients were characterized by atrial fibrillation-related symptoms at presentation and the CHA2DS2-VASc score. Two-year follow-up recorded anticoagulation patterns (vitamin K antagonist, direct oral anticoagulants, parenteral therapy) and outcomes (stroke/systemic embolism, all-cause mortality, and bleeding).
Results:
At presentation, of 52,032 eligible patients, 25.4% were asymptomatic and 74.6% symptomatic. Asymptomatic patients were slightly older (72 vs 70 years), more often male (64.2% vs 52.9%), and more frequently initiated on anticoagulation ± antiplatelets (69.4% vs 66.0%). No difference in events (adjusted hazard ratios, 95% confidence interval) for nonhemorrhagic stroke/systemic embolism (1.19, 0.97-1.45), all-cause mortality (1.06, 0.94-1.20), or bleeding (1.02, 0.87-1.19) was observed. Anticoagulation was associated with comparable reduction in nonhemorrhagic stroke/systemic embolism (0.59, 0.43-0.82 vs 0.78, 0.65-0.93) and all-cause mortality (0.69, 0.59-0.81 vs 0.77, 0.71-0.85) in asymptomatic versus symptomatic, respectively.
Conclusions:
Major outcomes do not differ between asymptomatic and symptomatic atrial fibrillation presentations and are comparably reduced by anticoagulation. Opportunistic screening-detected asymptomatic atrial fibrillation likely has the same prognosis as asymptomatic atrial fibrillation at presentation and likely responds similarly to anticoagulation thromboprophylaxis.
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