Clinical characteristics and prognostic factors of atrial fibrillation at a tertiary center of Pakistan – From a South-Asian perspective – A cross-sectional study

Abstract

Background There is lack of large data from South-Asian region on atrial fibrillation and it is imperative that clinical presentation, prognostic factors, management pursued, and outcomes are known for this part of the world. Once collective evidence for the region is known, region-specific guidelines can be laid forward. Objectives To evaluate clinical characteristics and prognostic factors of atrial fibrillation at a tertiary care center of Pakistan. Methods This was a retrospective study conducted at a tertiary care center of Pakistan. Period of study ranged from July–December 2018. All hospitalized patients who were admitted with atrial fibrillation as a primary or associated diagnosis were enrolled. Results A total of 636 patients were enrolled. The mean age was 68.5 ± 12 years and 49.5% (315) were male. 90.6% of the patients were admitted via emergency room. Majority (59.9%) had previously known AF and 40% developed new-onset AF during the hospital stay. Hypertension was the most common co-morbid condition (85.4%) followed by Diabetes Mellitus (40.1%). At least 9% had rheumatic heart disease. The median CHA 2 DS 2 VASc and HASBLED scores were 4 and 2 respectively. More than one-third of patients had sepsis as a primary diagnosis (36.8%). The in-hospital mortality of patients with atrial fibrillation was 6.7%. Patients with new-onset AF had higher mortality. Sepsis and stroke were independently associated with a higher mortality. There was no significant difference in median CHA 2 DS 2 VASc and HASBLED scores for patients with new-onset and previously known AF. On discharge, 83% of the eligible patients received oral anticoagulation. Conclusion There was higher prevalence of chronic co-morbid conditions in the studied population leading to a higher CHA 2 DS 2 VASC Score. Sepsis and stroke were independently associated with higher in-hospital mortality.

Detection of Atrial High-Rate Episodes in Patients with Cardiac Implantable Electronic Devices — a Multicenter Experience from Pakistan: A Cross-Sectional Study

“…The commonest indication for implant was AV Block 60.5 % (98) out of which majority of study participants had complete AV block while others were implanted for 2:1 AV block. AV block was followed by left ventricular systolic dysfunction 25.3% (41), sinus node dysfunction 16% (26), chronic bifascicular and trifascicular block 4.3% (7). Out of the studied population, 58% (n=94) participants were pacemaker dependent and 35.8% (n=58) had the rate response feature turned on.…”

“…4,5 Prior literatures also reports a higher risk of AF with certain comorbid conditions namely hypertension, diabetes mellitus, and hyperlipidemia. 6,7 However, the primary limitation of these earlier studies has been the preexistence of AF in the study population, and we know that prior AF is a dominant harbinger of more AF. 8 It is evident from prior studies that the occurrence of AF may result in cerebrovascular accident (CVA).…”

Electrophysiology practice in low- and middle-income countries: An updated review on access to care and health delivery

“… 40 , 41 A study from Pakistan showed a prevalence of 6.5% among acute medical admissions, pointing toward the underestimated burden in African countries. 42 A subgroup analysis from the Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) Registry showed regional disparities in the prevalence of AF, anticoagulation strategies, and risk factors. 43 The investigation concluded there was a lower prevalence of AF in LMICs compared to HICs.…”

Statement from the Asia Summit: Current state of arrhythmia care in Asia

“…Pakistan is the fifth largest country in the world by population, with 242 million people 35 . Unfortunately, there are no national data available, but coronary heart disease and associated risk factors and infectious disease are likely the largest health issues in Pakistan 36,37 . Arrhythmias are likely the third major cardiovascular problem behind coronary artery disease and heart failure.…”

“…35 Unfortunately, there are no national data available, but coronary heart disease and associated risk factors and infectious disease are likely the largest health issues in Pakistan. 36,37 Arrhythmias are likely the third major cardiovascular problem behind coronary artery disease and heart failure. SVT, followed by AF (mainly because of rheumatic heart disease), and bradycardia are the three most important arrhythmia issues in Pakistan.…”