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Open Access Highly Accessed Study protocol

An international longitudinal registry of patients with atrial fibrillation at risk of stroke (GARFIELD): the UK protocol

Patricia N Apenteng1, Ellen T Murray1, Roger Holder1, F D Richard Hobbs2, David A Fitzmaurice1* and UK GARFIELD Investigators and GARFIELD Steering Committee

Author Affiliations

1 Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK

2 Primary Care Health Sciences, University of Oxford, 23-38 Hythe Bridge Street, Oxford, OX1 2ET, UK

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BMC Cardiovascular Disorders 2013, 13:31  doi:10.1186/1471-2261-13-31

Published: 23 April 2013

Abstract

Background

Atrial fibrillation (AF) is an independent risk factor for stroke and a significant predictor of mortality. Evidence-based guidelines for stroke prevention in AF recommend antithrombotic therapy corresponding to the risk of stroke. In practice, many patients with AF do not receive the appropriate antithrombotic therapy and are left either unprotected or inadequately protected against stroke. The purpose of the Global Anticoagulant Registry in the FIELD (GARFIELD) is to determine the real-life management and outcomes of patients newly diagnosed with non-valvular AF.

Methods/design

GARFIELD is an observational, international registry of newly diagnosed AF patients with at least one additional investigator-defined risk factor for stroke. The aim is to enrol 55,000 patients at more than 1000 centres in 50 countries worldwide. Enrolment will take place in five independent, sequential, prospective cohorts; the first cohort includes a retrospective validation cohort. Each cohort will be followed up for 2 years. The UK stands to be a significant contributor to GARFIELD, aiming to enrol 4,582 patients, and reflecting the care environment in which patients with AF are managed. The UK protocol will also focus on better understanding the validity of the two main stroke risk scores (CHADS2 and CHA2DS2VASC) and the HAS-BLED bleeding risk score, in the context of a diverse patient population.

Discussion

The GARFIELD registry will describe how therapeutic strategies, patient care, and clinical outcomes evolve over time. This study will provide UK-specific comprehensive data that will allow a range of evaluations both at a national level and in relation to global data and contribute to a better understanding of AF management in the UK.

Trial registration

ClinicalTrial.gov: NCT01090362

Keywords:
Anticoagulation; Atrial fibrillation; Registry; Stroke; Vitamin K antagonists