Evidence map›Paper›PMID 37169491›Full record

ArticleOpen heart2023

Determinants and clinical outcomes of patients who refused anticoagulation: findings from the global GARFIELD-AF registry.

Patricia Apenteng, Saverio Virdone, John Camm, Keith A A Fox, Jean-Pierre Bassand, Alexander G G Turpie, Seil Oh, Marianne Brodmann, Frank Cools, Antonio C P Barretto and 5 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Open heart, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
0.9field-weighted citation impact, top 24% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 4 citations in OpenAlex.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors at 12 institutions in 9 countries.

Patricia ApentengInstitute of Applied Health Research, University of Birmingham Institute of Applied Health Research, Birmingham, UK p.n.k.apenteng@bham.ac.uk.ORCID 0000-0003-0835-3495
Saverio VirdoneDepartment of Statistics, Thrombosis Research Institute, London, UK.
John CammCardiology, St Georges Hospital, London, UK.
Keith A A FoxCardiology, University of Edinburgh and Royal Infirmary, Edinburgh, UK.
Jean-Pierre BassandDepartment of Cardiology, University of Besançon, Besançon, France.
Alexander G G TurpieDepartment of Medicine, McMaster University, Hamilton, Ontario, Canada.
Seil OhInternal Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of).
Marianne BrodmannDivision of Angiology, Medical University of Graz, Graz, Austria.
Frank CoolsAZ Klina, General Hospital Klina, Brasschaat, Belgium.
Antonio C P BarrettoHospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil.
Jørn NielsenDepartment of Cardiology, University of Copenhagen, Kobenhavn, Denmark.
Sylvia HaasHaemostasis and Thrombosis Research Group, Institute for Experimental Oncology and Therapy Research, Formerly Technical University, Munich, Germany.
Gloria KayaniThrombosis Research Institute, London, UK.
Karen S PieperThrombosis Research Institute, London, UK.
Ajay K KakkarThrombosis Research Institute, London, UK.
Thrombosis Research Institute · GBAZ Klina · BECentre Hospitalier Universitaire de Besançon · FREdinburgh Royal Infirmary · GBHospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo · BRMcMaster University · CAMedical University of Graz · ATSeoul National University Hospital · KRSt George's Hospital · GBTechnical University of Munich · DEUniversity of Birmingham · GBUniversity of Copenhagen · DK

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveThere is a substantial incidence of stroke in patients with atrial fibrillation (AF) not receiving anticoagulation. The reasons for not receiving anticoagulation are generally attributed to clinician's choice, however, a proportion of AF patients refuse anticoagulation. The aim of our study was to investigate factors associated with patient refusal of anticoagulation and the clinical outcomes in these patients.

methodsOur study population comprised patients in the Global Anticoagulant Registry in the FIELD (GARFIELD-AF) registry with CHA

resultsOut of 43 154 AF patients, who were at high risk of stroke, 13 283 (30.8%) did not receive anticoagulation at baseline. The reason for not receiving anticoagulation was unavailable for 38.7% (5146/13 283); of the patients with a known reason for not receiving anticoagulation, 12.5% (1014/8137) refused anticoagulation. Diagnosis in primary care/general practitioner, Asian ethnicity and presence of vascular disease were strongly associated with a higher risk of patient refusal of anticoagulation. Patient refusal of anticoagulation was associated with a higher risk of non-haemorrhagic stroke/SE (adjusted HR (aHR) 1.16 (95% CI 0.77 to 1.76)) but lower all-cause mortality (aHR 0.59 (95% CI 0.43 to 0.80)) compared with patients who received anticoagulation. The GARFIELD-AF mortality score corroborated this result.

conclusionThe data suggest patient refusal of anticoagulation is a missed opportunity to prevent AF-related stroke. Further research is required to understand the patient profile and mortality outcome of patients who refuse anticoagulation.

Indexed as

Atrial FibrillationStrokeAnticoagulantsHumansRegistriesRisk FactorsAnticoagulantsAtrial FibrillationDrug MonitoringStroke

Identifiers

PMID37169491
PMCPMC10410826
OpenAlexW4376135281

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.