Presentation and management of patients admitted with atrial fibrillation: a review of 291 cases in a regional hospital

• Published in: International journal of cardiology 1995-03, Vol.48 (3), p.271-278
• Main Authors: Lok, Ngai-Sang, Lau, Chu-Pak
• Format: Article
• Language: English
• Subjects: Aged; Amiodarone - therapeutic use; Anticoagulation; Atrial fibrillation; Atrial Fibrillation - diagnosis; Atrial Fibrillation - epidemiology; Atrial Fibrillation - therapy; Biological and medical sciences; Cardiac dysrhythmias; Cardiology. Vascular system; Comorbidity; Digoxin - therapeutic use; Electric Countershock; Emergencies; Epidemiology; Female; Heart; Hong Kong - epidemiology; Hospitalization - statistics & numerical data; Humans; Incidence; Length of Stay - statistics & numerical data; Male; Medical sciences; Thrombolytic Therapy; Treatment Outcome
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/0167-5273(94)02259-L

Two hundred and ninety one patients admitted with atrial fibrillation through the emergency room of a regional hospital in the year 1993 were reviewed to evaluate the presenting features and in-hospital treatment of patients with symptomatic atrial fibrillation. The incidence of atrial fibrillation increased with age (mean age was 73 ± 12 years) and the ratio of female to male was 1.8:1. The commonest presenting features were palpitation (42.3%), dyspnoea (38.1%) and heart failure (16.4%). The most frequently associated cardiac conditions were hypertension (28.9%), atherosclerotic cardiovascular disease (24.7%) and rheumatic heart disease (17.5%). Pulmonary diseases (18.6%), diabetes mellitus (12.7%) and thyrotoxicosis (6.2%) were the principal associated non-cardiac conditions. Thromboembolic complications were found in 15 patients at presentation (5.2%). Cardiac enzyme assessment was investigated in two thirds of the patients (68.1%), while thyroid function test (59.5%) and echocardiography (29.6%) were less commonly investigated. Digoxin was still the most popular drug used for ventricular rate control, and cardioversion was performed in only 6.9% of patients. Antithrombotic therapy was used in 5.8% of patients only although it was clinically indicated in more than half of the patients (52%). Contraindications of anticoagulation were found in 23 patients (7.9%), including a history of gastrointestinal or cerebrovascular bleeding, active bleeding, chronic renal failure and poor drug compliance. The mean hospital stay was 5 ± 4 days, compared to a mean stay of 2.7 days for other medical patients. Fourteen patients (4.8%) died during hospitalisation. The causes of death were septicaemia in 6 patients (42.9%) and cerebrovascular events in 4 patients (28.6%). We conclude that atrial fibrillation is predominately a disease of the elderly female, with significant associated medical problems and a longer hospital stay. There is a general reluctance for using cardioversion and antithrombotic treatment.