Clinical Profile of Atrial Fibrillation in Tertiary Hospital in Central Nepal
Introduction: Atrial fibrillation is common cardiac arrhythmia in elderly causing morbidity and mortality.
Methods: A cross-sectional study was conducted in College of Medical Sciences Teaching Hospital from August 2013 to Jul 2016. All in-patients diagnosed with atrial fibrillation were included.
Results: Two hundred five patients were studied from August 2013 to July 2016. Mean age was 63.95 ±16.5 years. There were 105 (51.2%) male and 100(48.8%) female. There were 154(75.1%) nonvalvular and 51 (24.9%) valvular causes for atrial fibrillation. Common presentations were SOB (41%), palpitations (27.8%), stroke (16.1%), fatigability (1.5%), abdominal pain (1.9%), chest pain (2.9%), pneumonia (1%), limb pain (0.5%) and severe bleeding (2.4%). For valvular causes, common lesions were disease of mitral valve (90 %) in isolation or mixed with aortic valve (23.5%). Warfarin was used in 32(62.7%) with mean INR of 2.038 ± 0.6. Seventeen (53.1% ) had INR below 2. In nonvalvular cases, types were paroxysmal (55.2%), persistant(34.4%) and permanent(10.4%). Elderly age, hypertension(30.5%), ischemic heart disease(13.6%), dilated cardiomyopathy(14.9%) , degenerative multivalvular heart disease(14.9%) , atrial septal defect(3.9%), lung cancer(2.3%), mitral valve prolapsed (0.6%), hyperthyroidism(1.9%), alcoholism (0.6%) , and pericardial effusion(1.2%) were common risk factors. CHADS(2) calculated 2 or more were in 98(63.6%) patients. Warfarin was used in 39 patients(25.3%) and 103 patients(66.9%) received aspirin in CHADS(2) score 2 or more. Mean INR in nonvalvular AF was 1.5 ±0.4.
Conclusions: Atrial fibrillation is a common arrhythmia as a result of valvular or nonvalvular origin. Common presentations were shortness of breath, palpitations and stroke. Common risk factors were old age, hypertension and heart failure. Warfarin is underused in nonvalvular causes in our settings.
Keywords: atrial fibrillation; valvular; nonvalvular; warfarin underuse.
2. Gutierrez C, Blanchard DG. Diagnosis and Treatment of Atrial Fibrillation. American family physician. 2016;94(6):442-52. [PubMed]
3. Allessie M, Ausma J, Schotten U. Electrical, contractile and structural remodeling during atrial fibrillation. Cardiovascular research. 2002;54(2):230-46. [PubMed]
4. Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH, et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. European heart journal. 2012;33(21):2719-47. [PubMed │ DOI]
5. Fuster V, Ryden LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, et al. [Guidelines for the management of patients with atrial fibrillation. Executive summary]. Revista espanola de cardiologia. 2006;59(12):1329. [PubMed │ DOI]
6. Lane DA, Lip GY. Use of the CHA(2)DS(2)-VASc and HAS-BLED scores to aid decision making for thromboprophylaxis in nonvalvular atrial fibrillation. Circulation. 2012;126(7):860-5. [PubMed │ DOI]
7. Fauchier L, Philippart R, Clementy N, Bourguignon T, Angoulvant D, Ivanes F, et al. How to define valvular atrial fibrillation? Archives of cardiovascular diseases. 2015;108(10):530-9. [PubMed │ DOI]
8. Gautam MP GS, GuruPrasad S. Subramanyam G, Ghimire U. A study of the clinical profile of a trial fibrillation in a tertiary care superspeciality referral center in central Nepal. Journal of College of Medical Sciences-Nepal. 2012;8:9-16. [DOI]
9. Sharma SK, Verma SH. A clinical evaluation of atrial fibrillation in RHD.. J Asssoc Physicians India. 2015;63:22-5. [PubMed]
10. Dhakal M, Dhakal OP, Nandy P. Epidemiology and Clinical Presentation of Patients with Atrial Fibrillation from a Tertiary care Hospital of East Sikkim: an Observational Study. Journal of Evolution of Medical and Dental Sciences. Journal of Evolution of Medical and Dental Sciences 2013;2(20):3554-60. [DOI]
11. Maskey A, Parajuli M, Kohli SC. A study of risk factors of stroke in patients admitted in Manipal Teaching Hospital Pokhara Kathmandu University Medical Journal.2011;36:244-7. [Full Text]
12. January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC, Jr., et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014;130(23):2071-104. [PubMed │DOI]
13. Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S. Epidemiology of atrial fibrillation: European perspective. Clinical epidemiology. 2014;6:213-20. [PubMed│DOI]
14. Bhardwaj R. Atrial fibrillation in a tertiary care institute- a prospective study. Indain Heart Journal. 2012;64:476-8. [Full Text │ DOI]
15. Boriani G, Cimaglia P, Fantecchi E, Mantovani V, Ziacchi M, Valzania C, et al. Non valvular atrial fibrillation : potential clinical implications of the heterozenous definitions used in trials on new oral anticoagulants. J Cardiovasc Med. 2015;16:491-6. [Full Text │ DOI]
16. Benjamin EJ, Levy D, Vaziri SM, D'Agostino RB, Belanger AJ, Wolf PA. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. Jama. 1994;271(11):840-4. [PubMed]
17. Andrade J, Khairy P, Dobrev D, Nattel S. The clinical profile and pathophysiology of atrial fibrillation: relationships among clinical features, epidemiology, and mechanisms. Circulation research. 2014;114(9):1453-68. [Pubmed]
18. Im S, II, Chun KJ, Park S-J, Park K-M, Kim JS, On YK. Long-term Prognosis of Paroxysmal Atrial Fibrillation and Predictors for Progression to Persistnt or Chronic Atrial Fibrillation in the Korean Population. Journal of Korean Medical Science. 2015;30(7):895-902. [Full Text │ DOI]
19. Greve AM, Gerdts E, Boman K, Gohlke-Baerwolf C, Rossebø AB, Nienaber CA, et al. Prognostic importance of atrial fibrillation in asymptomatic aortic stenosis: the Simvastatin and Ezetimibe in Aortic Stenosis study. International journal of cardiology. 2013;166(1):72-6. [PubMed │ DOI]
20. Stortecky S, Buellesfeld L, Wenaweser P, Heg D, Pilgrim T, Khattab AA, et al. Atrial Fibrillation and Aortic Stenosis. Circulation: Cardiovascular Interventions. 2013;6(1):77-84. [PubMed│ DOI]
21. Diker E, Aydogdu S, Ozdemir M, Kural T, Polat K, Cehreli S, et al. Prevalence and predictors of atrial fibrillation in rheumatic valvular heart disease. The American journal of cardiology. 1996;77(1):96-8. [PubMed]
22. Vaziri SM, Larson MG, Benjamin EJ, Levy D. Echocardiographic predictors of nonrheumatic atrial fibrillation. The Framingham Heart Study. Circulation. 1994;89(2):724-30. [PubMed]
23. Patel D, Chavda A, Goswami I. Clinical study and etiological evaluation of atrial fibrillation at tertiary care hospital, Jamnagar, Gujarat, India. International journal of scientific research. 2012;1:122-4. [DOI]
24. Gage BF, van Walraven C, Pearce L, Hart RG, Koudstaal PJ, Boode BS, et al. Selecting patients with atrial fibrillation for anticoagulation: stroke risk stratification in patients taking aspirin. Circulation. 2004;110(16):2287-92. [PubMed │ DOI]
25. Manolis AJ, Rosei EA, Coca A, Cifkova R, Erdine SE, Kjeldsen S, et al. Hypertension and atrial fibrillation: diagnostic approach, prevention and treatment. Position paper of the Working Group 'Hypertension Arrhythmias and Thrombosis' of the European Society of Hypertension. Journal of hypertension. 2012;30(2):239-52. [PubMed │ DOI]
26. Solomon MD, Ullal AJ, Hoang DD, Freeman JV, Heidenreich P, Turakhia MP. Cost-effectiveness of pharmacologic and invasive therapies for stroke prophylaxis in atrial fibrillation. Journal of cardiovascular medicine (Hagerstown, Md). 2012;13(2):86-96. [PubMed│ DOI]
27. Wang C, Yang Z, Wang C, Wang Y, Zhao X, Liu L, et al. Significant underuse of warfarin in patients with nonvalvular atrial fibrillation: results from the China national stroke registry. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2014;23(5):1157-63. [PubMed │ DOI]
28. Cohen N, Almoznino-Sarafian D, Alon I, Gorelik O, Koopfer M, Chachashvily S, et al. Warfarin for stroke prevention still underused in atrial fibrillation: patterns of omission. Stroke. 2000;31(6):1217-22.[PubMed]
29. Zareh M, Davis A, Henderson S. Reversal of warfarin-induced hemorrhage in the emergency department. The western journal of emergency medicine. 2011;12(4):386-92. [PubMed]
30. Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Annals of internal medicine. 2007;146(12):857-67. [PubMed]
31. Connolly SJ, Pogue J, Hart RG, Hohnloser SH, Pfeffer M, Chrolavicius S, et al. Effect of clopidogrel added to aspirin in patients with atrial fibrillation. The New England journal of medicine. 2009;360(20):2066-78. [PubMed │ DOI]
32. Connolly S, Pogue J, Hart R, Pfeffer M, Hohnloser S, Chrolavicius S, et al. Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomised controlled trial. Lancet (London, England). 2006;367(9526):1903-12. [PubMed │ DOI]
33. Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, et al. Dabigatran versus warfarin in patients with atrial fibrillation. The New England journal of medicine. 2009;361(12):1139-51. [PubMed │ DOI]
34. Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, Hanna M, et al. Apixaban versus warfarin in patients with atrial fibrillation. The New England journal of medicine. 2011;365(11):981-92. [PubMed │ DOI]
35. Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W, et al. Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation. New England Journal of Medicine. 2011;365(10):883-91. [PubMed │ DOI]
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