Abstract
Introduction
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia with an estimated global prevalence of 37.574 million cases (0.51% of the world population) 1
AF has a heterogeneous clinical presentation and can be asymptomatic. It is often associated with heart disease but may occur in patient with no other detectable cardiac disease.1
By convention, the term "nonvalvular AF" is restricted to cases in which the rhythm disturbance occurs in the absence of mitral valve disease, a prosthetic heart valve or mitral valve repair.6
AF has significant morbidity and mortality due to the occurrence of both hemodynamic impairment and thromboembolic events.
The hemodynamic impairment and rhythm disturbances may be symptomatic and can lead to a decrease in the quality of life. However, most of the mortality and functional impairment associated with AF is due to ischemic stroke and other systemic emboli. The frequency of ischemic stroke and systemic embolism in patients with nonvalvular AF is approximately 5% per year that is about 2 to 7 times the rate for patient without AF. 2
Mortality in AF patient is double that of patients in normal sinus rhythm this islinked with the severity of the underlying heart disease.3
The risk of stroke and systemic embolism in patients with AF is determined by patient risk factors. Risk factors for stroke and systemic embolism in patient with nonvalvular AF are a history of previous stroke of transient ischemic attacks (TIA), a history of hypertension, left ventricular dysfunction (LVD) or congestive heart failure (CHF), age (over 75years), diabetes mellitus and coronary artery disease.4
Patients without any of these risk factors i.e. lone AF, have a more favourable prognosis, In the Framingham heart study, patient with rheumatic heart disease and AF had a 17- fold increased risk of stroke compared with age matched controls and the attributed risk was 5 time greater than in those with non-rheumatic AF.5
The aim of the present was to study the epidemiology AND clinical profile of nonvalvular atrial fibrillation
References
- Benjamin EJ , Wolf PA , D’Agostino RB , et al . Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation 1998;98:946–52.doi:10.1161/01.cir.98.10.946 Abstract/FREE Full TextGoogle Scholar
- Wolf PA , Abbott RD , Kannel WB . Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 1991;22:983–8.doi:10.1161/01.STR.22.8.983 Abstract/FREE Full TextGoogle Scholar
- Lip GYH , Freedman B , De Caterina R , et al . Stroke prevention in atrial fibrillation: Past, present and future. Thromb Haemost 2017;117:1230–9.doi:10.1160/TH16-11-0876 Google Scholar
- BaiY , Wang YL , Shantsila A , et al . The global burden of atrial fibrillation and stroke: a systematic review of the clinical epidemiology of atrial fibrillation in Asia. Chest 2017;152:810–20.doi:10.1016/j.chest.2017.03.048 Google Scholar
- Soman CR ,Kutty VR , Safraj S , et al . All-cause mortality and cardiovascular mortality in Kerala state of India: results from a 5-year follow-up of 161,942 rural community dwelling adults. Asia Pac J Public Health 2011;23:896–903.doi:10.1177/1010539510365100 Cross Ref PubMed Web of Science Google Scholar
- Thankappan KR, Shah B , Mathur P, et al. Risk factor profile for chronic non-communicable diseases: results of a community-based study in Kerala, India. Indian J Med Res 2010;131:53–63.PubMed Google Scholar
- Larsen TB, Skjoth F, Nielsen PB, Kjaeldgaard JN, Lip GY. Comparative effectiveness and safety of non‐vitamin K antagonist oral anticoagulants and warfarin in patients with atrial fibrillation: propensity weighted nationwide cohort study. BMJ. 2016; 353:i3189.Google Scholar
- Yao X, Abraham NS, Sangaralingham LR, Bellolio MF, McBane RD, Shah ND, Noseworthy PA. Effectiveness and safety of dabigatran, rivaroxaban, and apixaban versus warfarin in nonvalvular atrial fibrillation. J Am Heart Assoc. 2016; 5:e003725. doi: 10.1161/JAHA.116.003725. Google Scholar
- Goto S, Zhu J, Liu L, Oh BH, Wojdyla DM, Aylward P, Bahit MC, Gersh BJ, Hanna M, Horowitz J, Lopes RD, Wallentin L, Xavier D, Alexander JH; ARISTOTLE Investigators . Efficacy and safety of apixaban compared with warfarin for stroke prevention in patients with atrial fibrillation from East Asia: a subanalysis of the apixaban for reduction in stroke and other thromboembolic events in atrial fibrillation (ARISTOTLE) trial. Am Heart J. 2014; 168:303–309.Google Scholar
- Hori M, Connolly SJ, Zhu J, Liu LS, Lau CP, Pais P, Xavier D, Kim SS, Omar R, Dans AL, Tan RS, Chen JH, Tanomsup S, Watanabe M, Koyanagi M, Ezekowitz MD, Reilly PA, Wallentin L, Yusuf S; RE‐LY Investigators . Dabigatran versus warfarin: effects on ischemic and hemorrhagic strokes and bleeding in Asians and non‐Asians with atrial fibrillation. Stroke. 2013; 44:1891–1896.Google Scholar
- Wong KS, Hu DY, Oomman A, Tan RS, Patel MR, Singer DE, Breithardt G, Mahaffey KW, Becker RC, Califf R, Fox KA, Berkowitz SD, Hacke W, Hankey GJ; Executive Steering Committee, ROCKET AF Study Investigators . Rivaroxaban for stroke prevention in East Asian patients from the ROCKET AF trial. Stroke. 2014; 45:1739–1747.Google Scholar
- Graham DJ, Reichman ME, Wernecke M, Hsueh YH, Izem R, Southworth MR, Wei Y, Liao J, Goulding MR, Mott K, Chillarige Y, MaCurdy TE, Worrall C, Kelman JA. Stroke, bleeding, and mortality risks in elderly Medicare beneficiaries treated with dabigatran or rivaroxaban for nonvalvular atrial fibrillation. JAMA Intern Med. 2016; 176:1662–1671.Google Scholar
Corresponding Author
Dr Nuvvula Siva Krishna MD; (DM)
DOI: https://dx.doi.org/10.18535/jmscr/v11i8.11
