Objective: To identify the risk factor profile of Atrial Fibrillation applying CHA2DS2-VASC scoring system Study Design: Descriptive cross-sectional study. Place and Duration of Study: The study was conducted in outdoor patient and emergency departments of Armed Forces Institute of Cardiology/National Institute of Heart Diseases in 4 months duration after approval of synopsis, from Sep 2019 to Dec 2019. Methodology: All patients with symptoms of palpitation and dyspnea were evaluated with detailed history, physical examination, electrocardiogram and 2-D echocardiography for collection of data. Patients who were found with Atrial Fibrillation on electrocardiogram and non-valvular on 2-D echocardiography were enrolled. Detailed History regarding CHA2DS2-VASC scoring system was taken. Patients with age <18 years, those with moderate rheumatic stenos is, hypertrophic cardiomyopathy and Atrial Fibrillation with prosthetic valves were excluded. Data was entered and analyzed with SPSS-23. Results: Out of 100 patients enrolled, frequencies of male and female patients were 60 (60%) and 40 (40%) respectively. The age varied from 25 years to 89 years with a mean age of 64.27 ± 12 years. Maximum number of patients was between 65-74 years (31%). Hypertension (57%) was the most common risk factor after gender followed by age. Frequencies of other risk factors were congestive heart failure (33%), diabetes mellitus (18%), vascular disease (14%) and stroke/TIA/thrombo-embolism (13%). Paroxysmal atrial fibrillation was the most common type of atrial fibrillation observed (67%) followed by persistent atrial fibrillation (31%). The number of patients having CHA2DS2-VASC score 2 and greater than 2 were 76 (76%) and less than 2 were 24%. Conclusion: Our findings highlighted the prevalence of non-modifiable as well as modifiable predictors of thromboembolic phenomena in atrial fibrillation using CHA2DS2-VASC scoring system in our population.

Objective: To determine the frequency of compliance to guideline recommended treatment among patients with STAGE-C or STAGE-D heart failure and LVEF<40%. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Adult cardiology department of AFIC/NIHD, Rawalpindi, from Sept to Dec 2019. Methodology: Eighty Four patients of Heart Failure with reduced LVEF after satisfying inclusion and exclusion criteria were recruited in this study through non-probability consecutive sampling technique. Data was collected from ER and OPD patients through complete history based on demographics (i.e. age and gender), co-morbidities (i.e. diabetes, hypertension, CAD and smoking history), previous EF record measured on 2D-echo, functional improvement of the patients using NYHA dyspnea class and guideline recommended medication history with compliance. The data was analyzed using SPSS version 23. Results: A total of 84 patients of Heart Failure with LVEF = 31.61 ± 7.61% were enrolled out of whom 62 (73.8%) were male and 22 (26.2%) female patients. The mean age of patients was 62.26 ± 9.879 years. About 30 (35.7%) patients were diabetic, 44 (52.4%) were hypertensive, 19 (22.6%) were current smokers, 16 (19%) were ex-smokers and 49 (58.2%) were nonsmokers. Those with history of CAD were (SVCAD=8 (9.5%), DVCAD=14 (16.7%),TVCAD 15 (17.9%). Compliance of patients to treatment was 74 (88.1%) good. Patients presenting with NYHA Class I/II 3 (3.6%)/20 (23.6%) showed significant improvement after medical therapy 34 (40.5%)/30 (35.7%), whereas those with class III/IV did not show significant improvement in functional status. Conclusion: This survey shows that patient’s compliance is relatively goods but patients with NYHA III/IV were receiving suboptimal treatment. Secondly patients presenting with NYHAI/II after medical therapy showed significant improvement in functional status as compared to those with NYHA III/IV. Thereby further actions are needed for improving quality of life and standard of care among HF patients by optimization of treatmentaccording to guidelines.