Abstract
The prevalence and antithrombotic treatment of atrial fibrillation (AF) in Chinese rural population is not well known. The aim of this study was to investigate the extent to which antithrombotic treatment was prescribed for rural AF patients >60 years. We identified 828 AF patients from 36734 rural residents >60 years in Shanghai China. Our data indicated the overall prevalence rate of AF was 2.3% in rural population >60 years in East China and 38.9% of AF patients underwent antithrombotic therapy, including warfarin (5.9%), aspirin (29.6%), clopidogrel (2.9%) and aspirin combined with clopidogrel (0.5%). Of enrolled subjects, 98.4% had CHA2DS2-VASc score ≥1, 72.0% had HAS-BLED score <3 and 59.2% had CHA2DS2-VASc score ≥2 with HAS-BLED score <3. Missing early detection (34.9%), delay in seeking treatment for asymptomatic AF (25.5%) and doctors’s incomplete inform of AF-related risk of stroke to patients (21.7%) were three dominant causes for failing anticoagulant usage. In conclusion, most AF patients were with a high risk of thrombosis and a low risk of bleeding in China, but a large majority of them failed to take anticoagulants mainly for missing an early screening of AF and lack of awareness on AF for both patients and primary care physicians.
Highlights
Atrial fibrillation (AF) is the most common arrhythmia in the elderly, with a prevalence of 1–2% in Western populations
Anticoagulation treatment was recommended to AF patients by both the European Society of Cardiology (ESC) and the American Heart Association (AHA) guidelines[1,10]
The prevalence of AF in the rural population over 60-years-old in Eastern China. 36734 individuals were randomly investigated in seven rural towns in Shanghai China
Summary
Atrial fibrillation (AF) is the most common arrhythmia in the elderly, with a prevalence of 1–2% in Western populations. A study published in 2008 indicated that more than 97% of Chinese AF patients did not take anticoagulants[2] This finding highlighted a great gap between current guidelines and the clinical management of AF in China. The non-vitamin K antagonist oral anticoagulant (NOAC) has been evaluated in large trials for stroke prevention in AF, which indicated NOAC was non-inferior to warfarin in preventing stroke or systemic embolism, with reducing the risk of life-threatening bleeding[1]. The prevalence of antithrombotic treatment in rural populations in Eastern China has not been estimated and there was no study designed to explore the reasons why most AF patients do not take OAC in China. This study is performed to determine the prevalence of AF in rural populations over 60-years-old in Eastern China and to report the current antithrombotic status of these AF patients. Our study provides data for analyzing the reasons why anticoagulant usage is so low in Chinese AF patients
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