Abstract
Atrial fibrillation is a common cardiac arrhythmia in elderly causing morbidity and mortality. A cross-sectional descriptive study was conducted in College of Medical Sciences Teaching Hospital from August 2013 to July 2016. All in-patients diagnosed with atrial fibrillation were included. Total 205 patients were studied. There were 154 (75.1%) nonvalvular and 51 (24.9%) valvular causes for atrial fibrillation. Common presentations were shortness of breath 84 (41%), palpitations 57 (27.8%) and stroke 38 (24.6 %). For valvular causes, common lesion was of mitral valve (90%). 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%), persistent (34.4%) and permanent (10.4%). Common risk factors were heart failure 87 (56.5%), old age (>75 years) 66 (42.8%), hypertension 47 (30.5%), dilated cardiomyopathy 23 (14.9%), degenerative multivalvular heart disease 23 (14.9%) and ischemic heart disease (13.6%). CHADS(2) calculated 2 or more were in 98 (63.6%) patients. Warfarin was used in 39 (25.3%) and aspirin was used in 103 (66.9%) patients in CHADS(2) score 2 or more. Mean INR in nonvalvular AF was 1.5 ±0.4. Atrial fibrillation occurred as a result of valvular or nonvalvular origin. Common presentations were shortness of breath, palpitations and stroke. Common risk factors in nonvalvular atrial fibrillation were old age, hypertension and heart failure. Warfarin was underused in nonvalvular cases in our setting.
Highlights
Atrial fibrillation is a common cardiac arrhythmia in elderly causing morbidity and mortality
Anticoagulants are prescribed for all valvular Atrial fibrillation (AF) and in nonvalvular AF if CHADS(2) score is 2 or more.[6, 7]
Warfarin was used in only 39 patients (25.3%) and aspirin was used in 103 (66.9%)
Summary
Atrial fibrillation is a common cardiac arrhythmia in elderly causing morbidity and mortality. Atrial fibrillation (AF) is the common sustained cardiac arrhythmia in elderly people.[1] It is characterised by uncontrolled atrial activation with subsequent impaired atrial mechanical functions.[2,3] Valvular AF is related to rheumatic valvular heart disease (predominantly mitral stenosis) or prosthetic heart valves.[4] Nonvalvular AF consisted of rhythm disturbance in absences of such conditions.[5] Anticoagulants are prescribed for all valvular AF and in nonvalvular AF if CHADS(2) score is 2 or more.[6, 7]. The condition is common in elderly in Nepalese population. This rhythm disturbances increase mortality and increase morbidity by precipitating heart failure (HF) and cardioembolic stroke and various thromboembolic conditions.[8,9,10,11]
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