| Objective1. To investigate the epidemiologic features of hospitalized patients diagnosed with non-valvular atrial fibrillation(NVAF) in Jiangxi province, which include age distribution, risk factors, sex differences and so on.2. To investigate the risk of thromboembolism, the condition of antithrombotic therapy, and the related risk factors for stroke in hospitalized patients diagnosed with NVAF.3. To investigate the clinical characteristics of hospitalized patients diagnosed with NVAF such as the average hospitalization days, inpatient mortality, and the risk factors of inpatient death in order to offer some help for future clinical management of the hospitalized patients with NVAF.Methods The clinical data of the hospitalized patients diagnosed with NVAF from May2011 to December 2013 in the second affiliated hospital of Nanchang University were collected and retrospectively analyzed. The NVAF patients who were hospitalized more than once were only counted for the first hospitalization, the remaining times of hospitalization were not counted. The basic clinical characteristics, comorbidities,thromboembolic/bleeding complications, the condition of antithrombotic therapy, and the in-hospital adverse events were recorded in detail. Statistical analysis were performed for each items. All analyses were performed using the SPSS21.0 statistical software. Normally distributed variables are presented as mean±standard deviation and analyzed by t-test, while the non-normally distributed are presented as median with interquartile range(IQR) and analyzed by Mann-Whitney U-test. Categorical variables are presented as n(%) and analyzed using Chi-square test or a Fisher’s exact test. Univariate and multivariate logistic regression analyses were performed to evaluate the risk factors associated with inpatient death among both males and females. A two-side p < 0.05 was considered statistically significant.Result1. 2442 hospitalized patients with NVAF were enrolled in this retrospective study. 1453 patients hospitalized in the cardiovascular department.The average age of all patients was 70.6±11.3 years old. The average age of female patients was higher than males(71.8±10.4 VS 69.6±11.8; p<0.0001). The ratio of male to female was1.23:1. There was no significant sex differences in clinical characteristics except for age distribution, systolic blood pressure, left ventricular ejection fraction, and smoking status. In the uni-factor analysis of NVAF, the top five risk factors followed by aged(73.9%), hypertension(56.3%), heart failure(35.7%), coronary heart disease(19.1%), and diabetes(9.1%). In addition, the proportion of aged, hypertension,diabetes, and hyperthyroidism were larger in female patients than males while the proportion of coronary heart disease(CAD), cardiomyopathy, and chronic kidney disease(CKD) were lower than male patients(p<0.05).2. CHADS2 and CHA2DS2-VASc scoring methods were used for evaluating the thromboembolic risk of all patients, the results showed that both the median CHADS2 and CHA2DS2-VASc scores were higher in female patients than male patients(p <0.0001). When those patients with CHADS2 of 0 or 1 were further refined using CHA2DS2-VASc score, more female patients were classified into the group of CHA2DS2-VASc ≥ 2(83.4% VS 53.0%; p<0.0001). In other words,female patients had higher risk of thromboembolism than male patients.3. Only 173(7.3%) patients took warfarin prior to admission, this increased to791(33.3%) during hospitalization. Rates of aspirin or clopidogrel use at discharge were 38.9% and 10.7% respectively. No sex differences were evident in the choice of antithrombotic therapy.4. During the hospitalization, ischemic stroke occurred in 283 patients, which accounted for 11.6% of all patients. While intracranial or gastrointestinal bleeding events occurred in 80 patients, which accounted for 3.3% of all patients. Aged,hypertension, and history of ischemic cerebral stroke/transient ischemic attack(TIA)/thromboembolism(TE) were independent risk factors for ischemic stroke in hospitalized patients with NVAF.5. The average hospitalization days of all patients was 10 days, there was no significant difference between male and female patients(p = 0.8). The proportion of patients with more than 10 days of hospitalization accounted for 44.4% of all patients.During the hospitalization, 53 patients(2.2%) died, no significant difference was presented in the inpatient mortality between male and female patients(2.3% VS 2.0%;p=0.58). On multivariate analyses, the risk factors significantly associated with inpatients death in females were previous ischemic stroke/TIA/TE(OR: 2.27; 95% CI:1.43-3.61), peripheral artery disease(PAD)(OR: 5.75; 95% CI: 1.49-22.16) and chronic kidney disease(CKD)(OR: 5.68; 95% CI: 1.46-22.13). Hypertension was found to be associated with a lower risk of inpatient death in females(OR: 0.35; 95%CI: 0.14-0.88). Among males, only age(OR: 1.06; 95% CI: 1.02-1.11) and previous ischemic stroke/TIA/TE(OR: 1.81; 95% CI: 1.25-2.63) were independent predictors of inpatient mortality.Conclusion For patients with NVAF, sex differences existed in the age distribution, risk factor profile, risk of stroke and so on. The average age and risk of stroke of the female patients were higher than male patients, but there was no significant difference between male and female patients in the aspect of antithrombotic therapy or in-hospital mortality. The medical history of ischemic stroke/TIA/TE was independent risk factor of inpatient death for both male and female hospitalized patients with NVAF. In addition, PAD and CKD were also two independent risk factors of inpatient death for female patients, while older age was another independent predictor of inpatient death for male patients in addition to the medical history of ischemic stroke/TIA/TE. |
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