| ObjectiveAtrial fibrillation (AF) is one of the most common arrhythmias, which can increase the incidence of stroke and heart failure and affect the patients’s quality of life obviously. The aim of this investigation is to analyze the distribution of the gender, age, AF type, etiology, treatment and other epidemic characteristics of patients with AF in the local area based on the data from Qilu hospital and to provide references for the preventation and treatment of AF.MethodsWe made a retrospective study of the medical records of the AF patients in Qilu hospital from January 1st,2010 to June 30th,2015. Then all the data was analyzed by SPSS statistics software. Results1. A total of 2587 cases with AF were enrolled, the mean age of which was 65.78±13.33 (from 18-year-old to 98-year-old). The ratio of male and female patients was 1.20:1.2. The basic trend of case data:(1) All patients were divided into 8 group according to their age:<20,20-29,30-39,40-49,50-59,60-69,70-79,≥80. The proportion of each group was 0.08%,0.73%,2.55%,8.43%,19.17%,26.48%,26.71%,15.85%, which shows that the constituent ratio increases firstly and then decreases following the age. And patients above 60y accounted for half of all patients. (2) The ratio of male and female patients had little change as time goes on. On the whole, the number of male patients is larger than female patients. (3) The ratio of the elderly patients (> 65-year-old) decreased from the year of 2010 to the year of 2015.3. The type of atrial fibrillation:we classified AF into 3 types according to its duration: paroxysmal atrial fibrillation, persistent atrial fibrillation, and permanent atrial fibrillation. Paroxysmal AF accounted for 43.76%, persistent AF was 24.28%, and permanent AF was 31.96%. AF can also be classified into 3 types according to its cause. Valvular atrial fibrillation accounted for 19.91%, Non-valvular Atrial Fibrillation was 75.64%, and isolated AF was 4.45%.4. The causes and associated conditions of AF:advanced age 53.30%, hypertension 42.67%, coronary heart disease 40.78%, rheumatic valvular disease 17.86%, diabetes mellitus 12.68%, cardiomyopathy 4.29%, COPD 4.21%, idiopathic AF 4.45%, hyperthyroidism 4.10%,congenital heart disease 2.47%, pulmonary heart disease 1.01%.5. The risk factors of AF associated cerebral ischemic stroke:the effect of advanced age(≥75-year-old), diabetes mellitus, hypertention, valvular heart disease/after valve replacement, hypertrophic cardiomyopathy, obvious overweight (BMI≥26kg/m2), dyslipidemia(triglyceride≥2.26mmol/L, or LDL-C≥4.14mmol/L) on AF associated cerebral ischemic stroke was analyzed. The result showed that both advanced age and hypertention were significantly relevant with the incidence of associated cerebral ischemic stroke.6. Prevention of thromboembolism:(1) Usage of oral anticoagulants in different departments:the rate of the usage of oral anticoagulants in department of cardiovascular surgery was 57.26%, which was the highest in all departments we had investigated. The second ones were cardiovasology department, emergency department, ICU, and neurology department. (2) Options of antithrombotic therapy:in general,43.18% of AF patients used antiplatelet agents,24.04% used anticoagulants including newer oral anticoagulants such as rivaroxaban and dabigatran), and 6.61% used both. Antiplatelet agents were the main options in paroxysmal atrial fibrillation and persistent atrial fibrillation patients. The rate of the usage of both antiplatelet drugs and antiplatelet drugs combined with anticoagulants was higher in paroxysmal AF patients than in persistent AF patients. However, the rate of the usage of anticoagulants was higher in persistent AF patients than in paroxysmal AF patients. (3) The effect of antithrombotic therapy on the incidence of cerebral ischemic stroke:we compared the effect of 3 kinds of antithrombotic therapies including antiplatelet agents, anticoagulants and antiplatelet agents combined with anticoagulants on the incidence of cerebral ischemic stroke. The results showed that compared with patients without any antithrombotic therapy, anticoagulants and antiplatelet drugs combined with anticoagulants could reduce the incidence rate of cerebral ischemic stroke significantly. But antiplatelet agents by themselves could not reduce the incidence rate of cerebral ischemic stroke significantly. Compared with anticoagulants, antiplatelet drugs combined with anticoagulants could not reduce the incidence rate of cerebral ischemic stroke significantly.7. Rate control and rhythm control of AF therapy:in general,52.18% of AF patients were treated by rate control therapy,19.40% were treated by pharmacological agents for cardioversion and preventing AF,0.23% used electrical cardioversion, and 11.71% used catheter ablation. (1) Paroxysmal AF:56.89% of paroxysmal AF patients were treated by rate control therapy, mainly using beta andrenergic receptor blockers. 27.83% were treated by pharmacological agents for cardioversion and preventing AF, mainly using amiodarone.0.35% used electrical cardioversion, and 14.31% used catheter ablation. (2) Persistent AF:48.18% of paroxysmal AF patients were treated by rate control therapy,12.71% were treated by pharmacological agents for cardioversion and preventing AF,0.14% used electrical cardioversion, and 9.71% used catheter ablation. (3) The effect of AF type on the treatment plan:We compared the effect of different AF types on the treatment plan including rate control therapy, pharmacological agents for cardioversion and preventing AF and catheter ablation. Our results indicated that the difference of the treatment plan in different AF types was significant. The rate of the usage of both rate control and rhythm control therapy in paroxysmal AF was higher than that in persistent AF.Conclusion1. The distribution of gender and age, AF type, causes and associated conditions, and treatment plan of patients with AF in the local areas is similar to other domestic and foreign reports. What’s more, we find that the percentage of elderly patients in hospital has been declining year by year, which reflects that the patients with cardiovascular diseases are in general getting younger in average age.2. The rate of the use of thromboembolism prevention in AF patients is rather lower at present. The level of the prevention of thromboembolism has not met expectations.3. The rate of the usage of rate control in AF patients is much higher than that of rhythm control. Moreover, the importance of catheter ablation has been paid more attention. |
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