1. www.tri-london.ac.uk The GARFIELD Registry is funded by an unrestricted research grant from Bayer Pharma AG Closing Remarks Jean-Pierre Bassand, MD, FESC, FACC, FRCP Emeritus Professor of Cardiology University of Besançon France

2. www.tri-london.ac.uk Disclosures None for this presentation

3. www.tri-london.ac.uk Closing Remarks Garfield-AF registry is doing well; first 3 cohorts completed recruitment, 4 th 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. www.tri-london.ac.uk 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. www.tri-london.ac.uk Closing Remarks Risk stratification should focus on truly low risk patients as all the other patients should be anti- coagulated unless contraindication. CHA 2 -DS 2 -VASc score in this regard has a better discriminative power than CHADS 2

6. www.tri-london.ac.uk 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. www.tri-london.ac.uk 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