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Closing Remarks

Closing Remarks. Jean-Pierre Bassand, MD, FESC, FACC, FRCP Emeritus Professor of Cardiology University of Besançon France. Disclosures. None for this presentation. Closing Remarks. Garfield-AF registry is doing well; first 3 cohorts completed recruitment, 4 th cohort has started

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Closing Remarks

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  1. Closing Remarks Jean-Pierre Bassand, MD, FESC, FACC, FRCP Emeritus Professor of Cardiology University of Besançon France

  2. Disclosures • None for thispresentation

  3. Closing Remarks • Garfield-AF registry is doing well; first 3 cohorts completed recruitment, 4th cohort has started • Gradual increase in the uptake of NOACs over the course of the first 3 cohorts, particularly but not only factor Xa inhibitors • Still many patients remain inadequately treated, low risk patients are overtreated and high risk patients undertreated

  4. Closing Remarks • In this context anticoagulation with VKA remains a challenge as FIR or TTR is often suboptimal. Inadequate control of coagulation is associated with higher risk of death, stroke and bleeding complications: the triple penalty • Remarkable consistency in efficacy and safety across NOACs: class effect FIR=frequency in range

  5. Closing Remarks • Risk stratification should focus on truly low risk patients as all the other patients should be anti-coagulated unless contraindication. • CHA2-DS2-VASc score in this regard has a better discriminative power than CHADS2

  6. Closing Remarks • Obesity is a risk factor for many CV disease including VTE, CAD, hypertension … • But it also emerges as a risk factor for AF though not included in the currently available risk scores. Garfield may help clarify the situation. • Monitoring of VKA is less adequate in obese patients than in non obese. FIR inversely related to BMI> 30%

  7. Closing Remarks • Preventing a second stroke is still a challenging situation, even in the era of NOACs • The growing burden of AF on the population and on the health care systems, understanding the reasons why a still sizeable proportion of patients are undertreated are among the future challenges that we will be confronted to

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