Risk profiles and antithrombotic treatment of patients newly diagnosed with atrial fibrillation at risk of stroke: perspectives from the international, observational, prospective GARFIELD registry

PLoS One. 2013 May 21;8(5):e63479. doi: 10.1371/journal.pone.0063479. Print 2013.


Background: Limited data are available on the characteristics, clinical management, and outcomes of patients with atrial fibrillation at risk of stroke, from a worldwide perspective. The aim of this study was to describe the baseline characteristics and initial therapeutic management of patients with non-valvular atrial fibrillation across the spectrum of sites at which these patients are treated.

Methods and findings: The Global Anticoagulant Registry in the FIELD (GARFIELD) is an observational study of patients newly diagnosed with non-valvular atrial fibrillation. Enrollment into Cohort 1 (of 5) took place between December 2009 and October 2011 at 540 sites in 19 countries in Europe, Asia-Pacific, Central/South America, and Canada. Investigator sites are representative of the distribution of atrial fibrillation care settings in each country. Cohort 1 comprised 10,614 adults (≥18 years) diagnosed with non-valvular atrial fibrillation within the previous 6 weeks, with ≥1 investigator-defined stroke risk factor (not limited to those in existing risk-stratification schemes), and regardless of therapy. Data collected at baseline included demographics, medical history, care setting, nature of atrial fibrillation, and treatments initiated at diagnosis. The mean (SD) age of the population was 70.2 (11.2) years; 43.2% were women. Mean±SD CHADS2 score was 1.9±1.2, and 57.2% had a score ≥2. Mean CHA2DS2-VASc score was 3.2±1.6, and 8,957 (84.4%) had a score ≥2. Overall, 38.0% of patients with a CHADS2 score ≥2 did not receive anticoagulant therapy, whereas 42.5% of those at low risk (score 0) received anticoagulant therapy.

Conclusions: These contemporary observational worldwide data on non-valvular atrial fibrillation, collected at the end of the vitamin K antagonist-only era, indicate that these drugs are frequently not being used according to stroke risk scores and guidelines, with overuse in patients at low risk and underuse in those at high risk of stroke.

Trial registration: ClinicalTrials.gov TRI08888.

Trial registration: ClinicalTrials.gov NCT01090362.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Atrial Fibrillation / complications
  • Atrial Fibrillation / diagnosis*
  • Atrial Fibrillation / drug therapy*
  • Contraindications
  • Female
  • Fibrinolytic Agents / therapeutic use*
  • Humans
  • Male
  • Molecular Sequence Data
  • Prospective Studies
  • Randomized Controlled Trials as Topic
  • Registries*
  • Risk Factors
  • Stroke / drug therapy
  • Stroke / etiology*
  • Vitamin K / antagonists & inhibitors


  • Fibrinolytic Agents
  • Vitamin K

Associated data

  • GENBANK/TRI08888
  • ClinicalTrials.gov/NCT01090362

Grant support

The GARFIELD Registry is sponsored by the Thrombosis Research Institute, London, UK. Funding of the registry is provided through an educational research grant from Bayer Pharma AG, Berlin, Germany. The funding source had no involvement in the data collection, data analysis, or data interpretation. The authors had full access to all the data, and the corresponding author had final responsibility for the decision to submit for publication.