November 29, 2022

– The GARFIELD registry, a multicentre international registry of patients newly diagnosed with atrial fibrillation at risk of stroke (Ajay KAKKAR, London)

The presentation of important clinical registries has been a key feature of these esc 2011 sessions as illustrated by the first data from the garfield registry presented by a jk car this registry aims to describe real-life treatment patterns and it assesses outcomes of 55,000 patients with newly diagnosed atrial fibrillation and at least one additional risk factor

For stroke the key message from garfield baseline characteristics of the first 10,000 patients are that newly presenting patients with atrial fibrillation using contemporary risk scores over 80% are at risk of thromboembolic stroke that we know how to identify these patients clearly we know that only a small proportion of them some 25% have a concern about bleeding

Risk and we know that the cominis risk factor driving stroke risk is indeed hypertension overall we find that about two-thirds of patients at high risk which ever score you use chads2 or trans vasc are receiving anticoagulation to prevent their stroke that means one-third or not and the most common reason why patients are not receiving anticoagulation is the choice

Of their physician even though esc guidelines on atrial fibrillation were published last year many new developments have occurred and a special session was organized during esc 2011 to review the new evidence for example in the field of catheter ablation the first key message is that catheter ablation is no longer an experimental study it’s really beyond that stage

And we can offer an effective and safe treatment option for patients with atrial fibrillation now the guidelines from 2010 have recommended it as a class 2 recommendation and we gather more and more evidence from randomized control trials that this is even stronger to be recommended much stronger than we have assessed so far because the alternative of algorithmic

Medication is also not that successful on that safe so it have been now head-to-head comparisons and edge of ablation has shown in different patient groups to be a very effective and safe procedure for those patients aristotle is a new piece of evidence demonstrating that new drugs such as factor 10a antagonists and direct thrombin inhibitors are better than vitamin

K antagonists in this international trial patients with atrial fibrillation and one additional risk factor were randomly assigned to receive either a new oral 10a inhibitor apixaban 5 milligrams twice daily or warfarin we have found in this 18,000 patient trial that that this dose of apixaban an oral factor 10a inhibitor as an alternative to warfarin and compared

To warfarin was both more effective 21 percent relative risk reduction in total stroke in safer a 31 percent reduction in in major bleeding we are presenting this afternoon also data that shows that a fix event is advantageous irrespective on our control so although the event rates who are lower in the european countries still the benefit of apixaban was consistent

So therefore i mean the same conclusions can be drawn concerning the european perspective as for the global perspective

Transcribed from video
ESC TV 2011 – Atrial fibrillation By European Society of Cardiology