| Objective: Atrial fibrillation(AF) is the most common encountered arrhythmia in clinic with a high prevalence. In recent years, great changes have taken place in the etiology spectrum and epidemiology characteristics of AF. AF is an independent risk factor of ischemic stroke. Oral warfarin can efficiently reduce the incidence of stroke, but only a small part of them with high risk factors of stroke is treated regularly by anticoagulation. The purpose of this study it to analysis the clinical data of inpatients with AF thereby the clinical characteristics and the strategies of anticoagulation therapy.Methods: 572 inpatients with AF( An Zhen hospital, from April 2002 till July 2003) were involved in this study. All patients with AF were diagnosed by electrocardiogram or Holter monitoring. Paroxysmal AF is defined as returning to sinus rhythm spontaneously. Persistent AF is defined as reversing to sinus rhythm by pharmacological therapy or electrical cardioversion. Results 1. 215/572(37.6%) patients with vavular AF and 357/572(62.4%) patients with nonvalvular AF. 29.8%(n=171) were older than 70 years old. 31.6% of the patients with nonvalvular AF were coronary heart disease; 28.3% were hypertension; 3.4% were hypertrophic myocardial disease; 1.4% were congenital heart disease; 4.2% were sick sinus syndrome; 8.4 % were hyperthyroidism; 15.4% were isolated fibrillation. The age distribution of the AF group: 0.9% of the patients(n=5) were less than 30 years old; 4.9% (n=28)of the patients were 30～40 years old;14%(n=80) of the patients were 41～50 years old; 22.6%(n=129) were 51～60 years old; 27.8%(n=159) were 61～70 years old. Among 543 patients with ultrasonic record on left atrium, 70.2%(n=381 ) had an enlarged left atrium; 22.8% had a decreased left ventricle ejection fraction(LVEF), 4.7% of the patients with a significant decrease by a less than 35% LVEF; 18.1% with a mild or moderate decreased LVEF. Among all the patients, 41.6%(n=238) were paroxysmal AF; 58.4%(n=334) were persistant AF. 2. The incidence of embolism was 23.7%(n=136) of all the enrolled patients with AF, including 16.8% stroke (n=96).There were 15.6% patients of nonvalvular AF with stroke(n=56). Logistic multivariate regression analysis of the risk factors related to stroke in patients of nonvalvular AF suggested that ages≥75years old, hepertension, peripheral thrombosis and heart failure were the independent high risk factors of stroke.3. Among all the enrolled patients with AF, there were 238 paients with paroxysmal AF and 334 patients with persistant artial fibrillation. There were 32 patients with both paroxysmal AF and stroke and 64 patients with both persistant AF and stroke. There were no statistical difference in ages ,sex, diabetes, hypertension and LVEF<40%. There is non-significent difference in the incidence of stroke between persistant AF and paroxysmal AF(P=0.089). 4.The prevalence rate of stroke was 16.3% in the 165 patients with asprin therapy. While the prevalence rate of stroke was 9.2% in the 217 patients with warfarin therapy. There was a significant difference in the prevalence rate of stroke between the two groups (P=0.041). 123 patients with valvular heart disease accepted warfarin therapy . 94 patients with high risk factors of the 268 patients with nonvalvular AF accepted warfarin therapy .The incidence of hemorrage was 42 among all the patients with AF including 22 cases related to warfarin. Logistic regression analysis showed that the high risk factors related to warfarin was chronic hepatic disease, SHP≥160mmHg and Age≥70y. Conclusion: Nonvalvular AF has become the major cause of AF. The incidence of AF rises with aging. The high risk factors of stroke in patients with AF are hypertension, age≥75y, heart failure, peripheral thrombosis. Anticoagulation therapy is important to patients with paroxysmal AF. Chronic hepatic desease, SHP≥160mmHg and age≥70y, are high risk factors of bleeding complications with warfarin therapy. |
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