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.
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