Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362.

Periodontal disease as a potential risk factor for low birth weight and reduced maternal haemomglobin levels.

PURPOSE: To investigate the association between maternal periodontal disease and its effect on haemoglobin levels and low birth weight infants. MATERIALS AND METHODS: This observational study included 770 mothers. Data regarding the periodontal status, pregnancy outcome variables, haemoglobin levels (Hb%) and other factors that may contribute to adverse pregnancy outcomes were collected. The data were analysed using the chi-square test and univariate logistic regression analysis. RESULTS: Factors such as literacy (P = 0.002), adverse oral habits (P < 0.001), dental health negligence (P < 0.001), obstetric history (P = 0.001) and Hb% (P < 0.001) showed a significant association with periodontal disease. The study showed only seven mothers had not received antenatal care (ANC), which reflected the awareness of ANC during pregnancy. The reduced haemoglobin levels had an association with the severity of periodontal disease. The univariate logistic regression analysis indicated that mothers with a probing pocket depth (PPD) > 6 mm (OR = 2.21, 95% CI [1.07-4.55], P = 0.032) had a higher risk of giving birth to low birth weight infants. CONCLUSION: Periodontitis significantly influenced low birth weight. The increase in the severity of periodontal disease was associated with an increased rate of pre-term infants. The severity of periodontitis influenced the maternal haemoglobin levels, i.e. more severe peridontitis was associated with lower haemoglobin levels. Severe anaemia and periodontal infection may have an adverse effect on pregnancy and fetal development.