Direct current conversion and clinical events at 1 year in patients with non-valvular atrial fibrillation. The Global Anticoagulant Registry in the FIELD (GARFIELD)

Abstract

Purpose: To compare baseline characteristics and outcomes of patients with atrial fibrillation (AF) who underwent direct current conversion (DCC+) within 4 months of diagnosis with those who did not (DCC-). Methods: Consecutive patients with newly diagnosed (≤6 weeks) non-valvular AF and ≥1 additional investigator-defined stroke risk factor(s) were enrolled into the GARFIELD Registry at 540 randomly selected, representative sites in 19 countries. 1-year event rates (absolute and adjusted for baseline characteristics and antithrombotic therapy) are reported. Results: Of 10,614 patients, 1440 (13.6%) underwent DCC within 4 months of diagnosis. DCC+ patients were younger, had a higher mean heart rate and a lower prevalence of prior stroke/transient ischaemic attack (Table). DCC+ patients were more likely to have vitamin K antagonist therapy and less likely to have antiplatelet therapy (Table). Clinical events during the first year after diagnosis did not differ between DCC+ and DCC- patients: death (absolute rates 1.2% vs 2.4%; adjusted HR 0.66; 95% CI 0.40-1.11); stroke/systemic embolism (0.9% vs 1.2%; HR 0.86; 95% CI 0.48-1.56); major bleeds (0.4% vs 0.6%; HR 0.77; 95% CI 0.33-1.82). View this table: Baseline characteristics Conclusions: DCC was infrequent in this international registry; one-fifth of these patients did not receive oral anticoagulant therapy. DCC+ patients had different baseline characteristics to those who did not. Outcomes at 1-year were similar.