Atrial Fibrillation among Patients Admitted to the Department of Internal Medicine in a Tertiary Care Centre: A Descriptive Cross-sectional Study

Shah, Surendra Prasad; Sah, Ram; Panthi, Sagar; Shah, Rakesh; Acharya, Rochana; Neupane, Durga; Puri, Reecha; Poudel, Sulaksha; Basnet, Lila Bahadur

doi:10.31729/jnma.7858

Cited by 2 publications

(3 citation statements)

References 24 publications

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“…[9][10][11][12] Our study shows male preponderance of 60.75% as compared to other various study done in our country which showed female preponderance as the studies have included both valvular and nonvolvular AF and as in our country as Rheumatic heart disease involving mitral valve is the most common cause of valvular AF and the common in female patients. [13][14][15][16][17] The mean CHA 2 DS 2 -VaSc and HAS-BLED score were 2.44±1.2 and 1.51±1.4 , respectively showing higher risk of stroke in the study population which were which were similar to other various study Kerala AF registry , Multicenter study in Thailand ,report from the euro heart survey on AF. 10,12,18 The type of atrial fibrillation in ours study as in order with 37.99% had permanent AF followed by 25.31% had paroxysmal AF, 16.45 % had persistent AF, Long standing persistent in 11.39% and first episode in 8.86 % similar to the various other study where permanent AF followed by paroxysmal AF and persistent AF accounts for majority of the type of AF.…”

Section: Discussionsupporting

confidence: 86%

“…only with warfarin ) varied from 9.6 % to 25.3 %. 7,8,16,17 The reason behind the increasing use of oral anticoagulant with NOACS is that with the increase availability of Novel anticoagulants such as rivaroxaban and dabigatran as national level pharmaceutical company produces it in recent years and as this study was done in tertiary cardiac center patients whom were mostly managed by cardiologist with adoption of the current recommended guidelines.…”

Section: Discussionmentioning

confidence: 99%

“…6 The scenario in Nepal has been depicted by two studies conducted by Dhungana et al assessing the risk profile and the need for oral Nepalese Heart Journal 2023; Vol. 20(2), [13][14][15][16][17] anticoagulants with risk predicting CHADS2 score > 2. 7,8 These two studies showed that among patients with NVAF only 18.9 %and 25.3% of patients were using anticoagulant (warfarin) respectively.…”

Section: Introductionmentioning

confidence: 99%

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Antithrombotic Adherence to guideline-directed therapy and risk profile among Non-Valvular Atrial fibrillation patients

Sherpa,

Adhikari,

Prajapati

et al. 2023

Nepalese Heart J.

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Introduction: Patients with Atrial fbrillation (AF) are at fivefold higher risk for Ischemic stroke than in the general population. Although the current therapeutic guidelines recommend the use of anticoagulants for thromboembolic prophylaxis in patients with nonvalvular AF (NVAF) with additional risk factor(s) for stroke, the global registry data show non-adherence to guidelines for the management of stroke in diferent regions of the world. The current study conducted at the tertiary referral cardiac center of Nepal for addressing the risk profle of stroke based on the current risk scores and the use of antithrombotic agents NVAF patients. Methodology: This was a descriptive observational cross sectional study conducted at Shahid Gangalal National Heart Centre (SGNHC), Kathmandu, Nepal from December 2020 to June 2020 which included patients with Nonvalvular AF. The main objective of the study was to study the clinical characteristics, stroke risk profle based on CHA ₂DS₂-VaSc score and risk of bleeding based on HAS-BLED score and the patterns of use of antithrombotic agents in NVAF patients. Results: A total of 79 cases of NVAF were included with 48(60.8%) males and 31(39.2%) females. The mean CHA₂DS₂-VaSc and HAS-BLED score were 2.44±1.2 and 1.51±1.4 respectively. The majority patients 38% had permanent AF followed by 25.5% had paroxysmal AF. Majority of patients were symptomatic with 67.1% presented with palpitation while 32.9% presented with shortness of breath (SOB). Based on the European Heart Rhythm Association (EHRA) AF related symptoms score, 41.8% had EHRA 2a and 2b while 1.3% had EHRA 4 score. The use of anticoagulants in patients with Nonvalvular AF was 41.6%, with NOACS in 33 % and warfarin used in 8.9% cases. The majority of patients 51.8% of study population were using anti-platelet agents with aspirin in 49.3 % and clopidogrel in 2.5 % cases while no medication in 6.3% of cases. Although 70.8% patients had CHA₂DS₂-VaSc score of 2 or more but the use of anticoagulants was only 58.9% with 46.4% NOACS and 12.5% using warfarin among this group of patients. Conclusion: Although the use of anticoagulant with NOACS in patients with higher risk of stroke is increasing, it is still underused in the majority of cases .There is a need of nationwide AF registry and the need of adoption of the current recommended guidelines to increase use of Anticoagulants in patients with Nonvalvular AF patients for the prevention of stroke .

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Antithrombotic Adherence to guideline-directed therapy and risk profile among Non-Valvular Atrial fibrillation patients

Sherpa,

Adhikari,

Prajapati

et al. 2023

Nepalese Heart J.

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Prevalence of Atrial Fibrillation in Semiurban Nepal: Result From a Community‐Based Cross‐Sectional Screening

Koju Shrestha,

Bista,

Shakya

et al. 2024

Cardiology Research and Practice

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Background: Atrial fibrillation (AF) is a common morbid arrhythmia that can cause thromboembolic events such as stroke. Despite advancements in diagnostic technologies, a significant number of AF patients may remain undetected and undiagnosed, and these asymptomatic patients possess sufficient risk of cardioembolic stroke. Identifying such patients through appropriate screening techniques and timely initiation of systemic anticoagulation therapy is essential to prevent such life‐threatening complications.Objectives: The objectives of this study encompass screening of AF among residents of the Dhulikhel Municipality and identifying its prevalence, along with evaluation of stroke risk and use of antithrombotic therapy in patients confirmed with AF.Methods: All residents of four wards of Dhulikhel Municipality, aged 50 years and above (n = 2048), underwent one‐time electrocardiogram (ECG) screening using a portable 12‐lead ECG machine. The cardiologist checked the cardiogram, and suspected AF cases were referred to the hospital for further evaluation and appropriate management. They were followed up to find out information on disease confirmation and management.Results: Out of 2048 participants, AF was detected in 16 participants, resulting in an overall prevalence of 0.78% (CI 0.4%–1.3%). The prevalence of AF was highest (2.98%) in population aged 80 years and above. Among individuals with AF, the median age was 71.5 (66.3–79.5) years, 50.0% were male and 75.0% had high stroke risk as indicated by a CHA2DS2‐VASc score ≥ 2. Among these patients, only 41.66% were treated with oral anticoagulants (OACs), while 58.34% were treated either with single or dual antiplatelet therapy (DAPT).Conclusion: This study provided important insight into the prevalence of AF at the community level. Many AF patients were at high risk of stroke, but the OAC use was less than 50%. Screening of AF needs to be carried out on a larger scale in Nepal for early detection and timely management of the disease.

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Atrial Fibrillation among Patients Admitted to the Department of Internal Medicine in a Tertiary Care Centre: A Descriptive Cross-sectional Study

Cited by 2 publications

References 24 publications

Antithrombotic Adherence to guideline-directed therapy and risk profile among Non-Valvular Atrial fibrillation patients

Antithrombotic Adherence to guideline-directed therapy and risk profile among Non-Valvular Atrial fibrillation patients

Prevalence of Atrial Fibrillation in Semiurban Nepal: Result From a Community‐Based Cross‐Sectional Screening

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