Analysis On Clinical Features Of Hospitalized Patients With Atrial Fibrillation In Single Center

Objective:To know the clinical features of patients with atrial fibrillation(AF) in hospitalization in recent three years,we analyzed the effects of risk factors and on prognosis of AF and on clinical features of patients to evaluate the current therapy and strategy for AF.Method:Single-center retrospective analysis of hospitalized cases was done in the study on hospitalized patients(patient with complete history was collected) from cardio department of The Second Hospital of Tianjin Medical University from 2005 to 2007,and patients who were in hospital more than one times in the study periods were considered as one case.Basic clinical features,discharge diagnosis, echocardiography findings and laboratory examinations,treatment and prognosis were clearly recorded.AF patients were divided into different groups depending on ages,sex,cardiac function,high blood pressure,and coronary artery disease in order to analyze the clinical features of AF patients.Meanwhile,risk factors,prognosis and therapy for AF patients were analyzed as well.Result:1.A total of 5 354 hospitalized patients were selected including 885 AF patients.The average prevalence of AF is 16.5%,and the annual prevalence is 16.6%(290/1 746),16.4%(306/1 862)and 16.8%(355/2 118)respectively,which makes no statistical difference(x~2=0.077,P＞0.05).2.The prevalence of AF in women was more common than that in men(19.0%vs 14.4%,x~2=19.865,P＜0.01).3.Both in men and wemen,the possibility of prevalence of AF was increased as they grew older(P＜0.01).Unlike the patients with vavular and lone AF,the possibility of of nonvalvular AF increased with aging.4.Valvular,nonvalvular and lone AF were 2.3 %,13.4%and 0.8%respectively.The prevalence rate of nonvalvular AF was significantly higher than the other two(x~2=451.750 & 643.397 respectively,P＜0.01). 5.The proportion of AF increased as the cardiac function classification increased (9.4%vs 16.8%vs 29.7%vs 41.3%,P＜0.01).Meanwhile,left atria diameter and left ventricular mass(P＜0.01) also increased,and the ejection fraction in patients decreased.6.According to different blood pressure grades,the rate of AF in patients make no statistical difference(x~2=3.730,P＞0.05),but according to course≤5 years, 6～9 years and＞10 years,the proportion of AF increased gradually(11.2%vs 14.8% vs 21.6%,x~2=37.228,P＜0.01).7.The course of coronary heart desease showed that the proportion of AF increased as the history lasted for a longer time(14,4%vs 22.4%vs 27.1%,x~2=39.391,P＜0.01).Patients with old myocardial infarction(OMI) was higher than those with acute myocardial infarction(AMI)(x~2=16.322,P＜0.001). And anterior wall of AMI to have AF than inferior wall(x~2=6.171,P＜0.01),but it makes no difference for the OMI group(P＞0.05).8.It was shown by multivariate analysis that the age,rheumatic heart disease,heart failure,left atrial enlargement and decreased ejection fraction were the independent risk factors of AF.9.Among all the AF patients:(1) there are 418 male patients and 467 females(sex ratio 1:1.12).(2) The proportion of paroxysmal,persistent and permanent AF was 46.2%,17.7%and 36.1%respectively.(3) The proportion of rheumatic heart disease,OMI,heart failure disease,cardiomyopathy,anemia and stroke on chronic AF patients was significantly higher than that on paroxysmal AF,but the proportion of coronary heart disease,AMI, hyperthyroidism and sick sinus syndrome on paroxysmal AF patients was higher. However it make no statistical difference on in-hospital mortality for both paroxysmal and chronic AF patients(x~2=2.551,P＞0.05).(5) As the duration of AF extended,the possibility of paroxysmal AF on patients was decreased gradually,but there was no statistical difference for the stroke patient and died patients(P＞0.05). Heart failure and age were the independent risk factors for paroxysmal AF developing to chronic AF.(6) Among all the patients with stroke,the proportion of patients with aging,chronic AF,coronary heat disease,hypertension and diabetes was higher than that in patients without brain stroke,but it made no statistical difference in gender and left atrial diameter(P＞0.05).(7) Heart failure and age were the independent risk factors which might lead to death during hospitalization.(8) 8.0%patients with atrial fibrillation initiated with Warfarin therapy and 80.3%patients applied antiplatelet therapy.The use of antiplatelet therapy,β-blockers,calcium antagonists,class IC andⅢantiarrhythmic drugs and radiofequency ablation was more frequent on patients with paroxysmal atrial fibrillation than that on chronic AF patients.Whereas,Warfarin, digitalis and diuretics was widely used on patients with chronic atrial fibrillation.Conclusions:1.The clinical features of age,etiology,types of AF,stroke which were considered as risk factors and prognosis to AF patients were almost the same as the references.2.The course of hypertension had an greater effect on AF than its classification.3.There was direct ratio between AF and the degree of HF.4.It was the independent risk factor that age,rheumatic heart disease,heart failure,left atrial enlargement and decreased ejection fraction might be caused with AF in hospitalized patients.5.The restruction of LA was more obvious as the course of AF increaseing. 6.Age and hear failure was the independent risk factors which might cause chronic AF in patients with paroxysmal AF,even death of patients during hospitalization.7. There was more cases of stroke in patients with chronic AF rather than in paroxysmal AF.8.Currently,rate control was considered as the primary therapy strategy for patients with paroxysmal or chronic atrial fibrillation,whereas Warfarin anticoagulation was usually used as the secondary therapeutic options.