Management and 1‐Year Outcomes of Patients With Newly Diagnosed Atrial Fibrillation and Chronic Kidney Disease: Results From the Prospective GARFIELD‐AF Registry

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Sylvia Haas¹  Freek W. A. Verheugt²  Helena Dominguez³  Samuel Z. Goldhaber⁴  Gloria Kayani⁵  Zhi‐Cheng Jing⁶  Shinichi Goto⁷  Martin van Eickels⁸  Toon Wei Lim⁹  Seil Oh^1,10  Ajay K. Kakkar^1,11  Pantep Angchaisuksiri^1,12  Jitendra P. S. Sawhney^1,13  Alexander G. G. Turpie^1,14  A. John Camm^1,15  Harry Gibbs^1,16  Yukihiro Koretsune^1,17  Laura Illingworth^1,17  Shinya Goto^1,18  Jean‐Pierre Bassand^1,19 

[1] CAMS Beijing China;Bayer AG Berlin Germany;Bispebjerg‐Frederiksberg Hospital Copenhagen Denmark;Brigham and Women's Hospital and Harvard Medical School Boston MA;Formerly Klinikum rechts der Isar Technical University of Munich Germany;;Fu Wai Hospital State Key Lab of Cardiovascular Disease National Center for Cardiovascular Disease PUMC &Keio University School of Medicine Tokyo Japan;McMaster University Hamilton Canada;National Hospital Organization Osaka National Hospital Osaka Japan;National University Hospital Singapore;Onze Lieve Vrouwe Gasthuis (OLVG) Amsterdam The Netherlands;Ramathibodi Hospital Mahidol University Bangkok Thailand;Seoul National University Hospital Seoul Korea;Sir Ganga Ram Hospital Delhi India;St. George's University of London London United Kingdom;The Alfred Hospital Melbourne Australia;Thrombosis Research Institute London United Kingdom;Tokai University School of Medicine Kanagawa Japan;University of Besançon France;

关键词: atrial fibrillation;    chronic kidney disease;    GARFIELD‐AF registry;    outcomes research;    registry;   

DOI  :  10.1161/JAHA.118.010510

来源: DOAJ

【 摘 要 】

Background Using data from the GARFIELD‐AF (Global Anticoagulant Registry in the FIELD–Atrial Fibrillation), we evaluated the impact of chronic kidney disease (CKD) stage on clinical outcomes in patients with newly diagnosed atrial fibrillation (AF). Methods and Results GARFIELD‐AF is a prospective registry of patients from 35 countries, including patients from Asia (China, India, Japan, Singapore, South Korea, and Thailand). Consecutive patients enrolled (2013–2016) were classified with no, mild, or moderate‐to‐severe CKD, based on the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative guidelines. Data on CKD status and outcomes were available for 33 024 of 34 854 patients (including 9491 patients from Asia); 10.9% (n=3613) had moderate‐to‐severe CKD, 16.9% (n=5595) mild CKD, and 72.1% (n=23 816) no CKD. The use of oral anticoagulants was influenced by stroke risk (ie, post hoc assessment of CHA2DS2‐VASc score), but not by CKD stage. The quality of anticoagulant control with vitamin K antagonists did not differ with CKD stage. After adjusting for baseline characteristics and antithrombotic use, both mild and moderate‐to‐severe CKD were independent risk factors for all‐cause mortality. Moderate‐to‐severe CKD was independently associated with a higher risk of stroke/systemic embolism, major bleeding, new‐onset acute coronary syndrome, and new or worsening heart failure. The impact of moderate‐to‐severe CKD on mortality was significantly greater in patients from Asia than the rest of the world (P=0.001). Conclusions In GARFIELD‐AF, moderate‐to‐severe CKD was independently associated with stroke/systemic embolism, major bleeding, and mortality. The effect of moderate‐to‐severe CKD on mortality was even greater in patients from Asia than the rest of the world. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362.

【 授权许可】

Unknown