Title: A Study of Incidence, Clinical Features, Risk Factor Profile and Prognosis of Atrial Fibrillation in Hospitalised Elderly Patients

Authors: Dr R. Santha Prabu, Dr N. Chidambaram, Dr S. Periyasamy, Dr K. Haynes Raja

 DOI:  https://dx.doi.org/10.18535/jmscr/v4i11.34

Abstract

Atrial fibrillation is the commonest sustained disorder of cardiac rhythm. Epidemiological studies shows that atrial fibrillation is fairly uncommon in people aged under 50 years but is found in 0.5% of people around 60 years and increases to 8.8% at around 80 yrs. This study is taken up to understand the Incidence, Clinical Features, Risk Factor profile and prognosis of Atrial Fibrillation in Hospitalised Elderly patients.

METHODS: This is a descriptive study conducted among the patients with various types of cardiac dysarrhythmia admitted in RMMCH. 100 patients were evaluated as per the history, general physical examination, systemic examination. Blood sugar, fasting lipid profile, serum electrolytes, fasting thyroid profile, 12 lead ECG and 2D Transthoracic echocardiography.

RESULTS: In our study, Atrial Fibrillation was the most common dysarrhythmia found in 19 patients. 16 patients (84%) belonged to 60 - 70 years age group. There were 8 (42%) males and 11(58%) females. Palpitation was the most common (100%) and Limb weakness was the least common (10%) clinical feature. Rheumatic Heart disease was found to be the most common risk factor seen in 9 (47%) patients. Mitral Stenosis with Mitral Regurgitation was the most common valvular abnormality seen in the 5 (55%) Rheumatic Heart Disease patients. Other important risk factors include Hypertension and Hyperthyroidism each accounting for 4 (21%) patients.  Among the 19 patients of Atrial Fibrillation, rate control was achieved in 16 (85%) patients and full recovery in the rest.

CONCLUSION: In our study, most patients belonged to 60 – 70 yrs age group with female predominance. Palpitation was found to be the most common clinical feature. Rheumatic Heart disease was found to be the most common risk factor in our study and Mitral Stenosis with Mitral Regurgitation was the most common valvular abnormality among them. Among the Atrial Fibrillation patients, rate control was achieved in 16 patients and full recovery in the rest suggesting a good prognosis. Alcohol consumption induced atrial fibrillation and Hyperthyroidism were found to be the fully reversible causes of Atrial Fibrillation.

Key Words: Atrial Fibrillation, Rheumatic Heart Disease, Hyperthyroidism.

References

1.      Benjamin EJ, Chen PS, Bild DE et al.  Prevention of atrial fibrillation: report from a National Heart, Lung, and Blood Institute Work shop.  Circulation.  2009; 119:606–618.

2.      Schnabel RB, Sullivan LM et al,.  Development  of a risk score for atrial fibrillation (Framingham Heart Study): a community-based cohort study. Lancet.  2009;373:739–745

3.      Lloyd-Jones DM, Wang TJ, Leip EP, Larson MG, Levy D, Vasan RS, D'Agostino RB, Massaro JM, Beiser A, Wolf PA, Benjamin EJ. Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation.  2004; 110: 1042–1046.

4.      Heeringa J, Van Der Kuip DA, Hofman  A, Kors JA, van Herpen G, Stricker BH, Stijnen T, Lip GY, Witteman JC. Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam Study. Eur Heart J.2006; 27: 949–953.

5.      Curt D Furberg, Bruce M. Psaty, Teri Manolio, Pentti M. Rautaharju;  Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study) The American Journal of Cardiology  74 (3):236-41·  September 1994.

6.      Epidemiology of Arrhythmias and Conduction Disorders in Older Adults Grant V. Chow, M.D., Joseph E. Marine, M.D., and Jerome L. Fleg, M.D. Clin Geriatric Med. 2012 Nov; 28(4): 539–553.

7.      Symptoms and Functional Status of Patients With Atrial Fibrillation State of the Art and Future Research Opportunities Michiel Rienstra, MD, PhD; Steven A. Lubitz, MD, MPH Circulation. 2012;125:2933-2943

8.      Rajdatt Deore, MD; AmitVora, MD, DM, Epidemiology and risk factor of atrial fibrillation in India. J. Preventive Cardiology Vol.3, No. 3, 2014

9.      Hypertension and cardiac arrhythmia: a review of the epidemiology, pathophysio-logy and clinical implications. Yiu KHTse HF. J Hum Hypertens. 2008 Jun;22(6):380-8

10.  A reevaluation of atrial fibrillation in thyrotoxicosis.Agner T, Almdal T, Thorsteinsson B, Agner E Dan Med Bull. 1984 Apr; 31(2):157-9.

11.  Bartalena L, Hennemann G. Graves’ Disease: Complications. [Updated 2014 Feb 12]. In: De Groot LJ, Chrousos G, Dungan K, et al., editors. Endotext. South Dartmouth (MA): 

Corresponding Author

Dr R. Santha Prabu

Post Graduate, Department of General Medicine,

Rajah Muthiah Medical College and Hospital, Annamalai University, Annamalai Nagar – 608002