Baseline Characteristics and 1-Year Follow-Up of Chinese Atrial Fibrillation Patients according to Age: A Registry Study TAO CHEN, M.D., YAN-MIN YANG, M.D., HUI-QIONG TAN, M.D., YAN LIANG, M.D., and JUN ZHU, M.D. From the State Key Laboratory of Cardiovascular Disease, Emergency and Critical Care Centre, Cardiovascular Institute and Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
Background: The prevalence of atrial fibrillation (AF) increases with age, and may lead to complications and reduced quality of life. The aim of this study was to determine the characteristics, management, and prognosis of Chinese AF patients and whether there were differences according to age. Methods: This registry-based study enrolled ambulatory, outpatient clinic, or hospitalized patients with AF in four sites in China. Based on the Birmingham 2009 schema, patients without and with valve lesion were stratified into three groups according to age. Results: Between September 2008 and April 2011, 2,016 patients were enrolled, including 1,606 patients without valve lesion and 410 patients with valve lesion. Compared with the other two groups, patients >74 years of age were more likely to have morbidity and a CHADS2 score >1, and less likely to receive oral anticoagulants and rhythm-control drugs. At the 1-year follow-up, patients >74 years of age were more likely to have died or suffered a cerebrovascular event or systemic embolism. Age as a continuous variable (subdivided hazard ratio [SHR] 0.98, 95% confidence interval [CI] 0.96–1.01, P = 0.29) was not associated with risk of a cerebrovascular event or systemic embolism at 1-year but age ࣙ75 years (SHR 1.73, 95% CI 1.05–2.87, P = 0.03) was an independent risk factor for the outcome at 1-year when all AF patients were included. Conclusions: Elderly AF patients are inadequately studied and treated compared with younger patients. Education on evidence-based management and the design of randomized controlled trials, specifically targeting the elderly, especially the Chinese elderly, should improve the management and prognosis of this frail segment of the AF population. (PACE 2014; 37:1392–1403) atrial fibrillation, Chinese, evidence-based medicine, prognosis, registry
Introduction Atrial fibrillation (AF) is a common disturbance of cardiac rhythm encountered in clinical practice. It was estimated that the agestandardized prevalence of AF in China (ࣙ30 years) was 0.65–0.77% and increased with age.1,2 Furthermore, AF is a major risk factor for stroke, and the incidence of stroke associated with AF increases dramatically with age. For example, the prevalence of stroke was 4.30% in patients younger than 40 years of age, and increased to Conflict of interest: None declared. Address for reprints: Jun Zhu, Emergency Department, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People’s Republic of China. Fax: 86-010-88364591; e-mail: [email protected] Received January 9, 2014; revised April 7, 2014; accepted May 5, 2014. doi: 10.1111/pace.12443
32.86% among AF patients 80 years or older.3 Despite this, the proportion of AF patients on oral anticoagulation therapy was extremely low at approximately 2.7%, and no patient underwent regular monthly monitoring of the international normalized ratio (INR).4 In a case-control study of hospitalized AF patients, only 9.1% received anticoagulant treatment. More than half of patients (56%) received aspirin, but more than onethird of all AF patients (34.6%) did not receive any prophylactic anticoagulant therapy during hospitalization. Only 6.75% of patients with nonvalvular AF and 18.61% of patients with valvular AF received warfarin.3 Thus, it is necessary to clarify the current management of AF patients across the age spectrum to ensure that all patients receive optimal treatment. Considering this, we conducted a registry-based study to provide data about the characteristics, management, and prognosis of Chinese AF patients, especially elderly patients.
©2014 Wiley Periodicals, Inc. 1392
October 2014
PACE, Vol. 37
AGE FACTORS IN AF MANAGEMENT FOR CHINESE
Table I. Baseline Characteristics for AF Patients without a Valve Lesion†
Demographics Female Tobacco use Alcohol use SBP, mean (SD), mmHg DBP, mean (SD), mmHg HR, mean (SD), beats/min AF Type Paroxysmal Persistent Permanent Previous History HF Hypertension Stroke or TIA DM CHADS2 Score 0–1 2–3 4–6
Background: The prevalence of atrial fibrillation (AF) increases with age, and may lead to complications and reduced quality of life. The aim of this study was to determine the characteristics, management, and prognosis of Chinese AF patients and whether there were differences according to age. Methods: This registry-based study enrolled ambulatory, outpatient clinic, or hospitalized patients with AF in four sites in China. Based on the Birmingham 2009 schema, patients without and with valve lesion were stratified into three groups according to age. Results: Between September 2008 and April 2011, 2,016 patients were enrolled, including 1,606 patients without valve lesion and 410 patients with valve lesion. Compared with the other two groups, patients >74 years of age were more likely to have morbidity and a CHADS2 score >1, and less likely to receive oral anticoagulants and rhythm-control drugs. At the 1-year follow-up, patients >74 years of age were more likely to have died or suffered a cerebrovascular event or systemic embolism. Age as a continuous variable (subdivided hazard ratio [SHR] 0.98, 95% confidence interval [CI] 0.96–1.01, P = 0.29) was not associated with risk of a cerebrovascular event or systemic embolism at 1-year but age ࣙ75 years (SHR 1.73, 95% CI 1.05–2.87, P = 0.03) was an independent risk factor for the outcome at 1-year when all AF patients were included. Conclusions: Elderly AF patients are inadequately studied and treated compared with younger patients. Education on evidence-based management and the design of randomized controlled trials, specifically targeting the elderly, especially the Chinese elderly, should improve the management and prognosis of this frail segment of the AF population. (PACE 2014; 37:1392–1403) atrial fibrillation, Chinese, evidence-based medicine, prognosis, registry
Introduction Atrial fibrillation (AF) is a common disturbance of cardiac rhythm encountered in clinical practice. It was estimated that the agestandardized prevalence of AF in China (ࣙ30 years) was 0.65–0.77% and increased with age.1,2 Furthermore, AF is a major risk factor for stroke, and the incidence of stroke associated with AF increases dramatically with age. For example, the prevalence of stroke was 4.30% in patients younger than 40 years of age, and increased to Conflict of interest: None declared. Address for reprints: Jun Zhu, Emergency Department, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People’s Republic of China. Fax: 86-010-88364591; e-mail: [email protected] Received January 9, 2014; revised April 7, 2014; accepted May 5, 2014. doi: 10.1111/pace.12443
32.86% among AF patients 80 years or older.3 Despite this, the proportion of AF patients on oral anticoagulation therapy was extremely low at approximately 2.7%, and no patient underwent regular monthly monitoring of the international normalized ratio (INR).4 In a case-control study of hospitalized AF patients, only 9.1% received anticoagulant treatment. More than half of patients (56%) received aspirin, but more than onethird of all AF patients (34.6%) did not receive any prophylactic anticoagulant therapy during hospitalization. Only 6.75% of patients with nonvalvular AF and 18.61% of patients with valvular AF received warfarin.3 Thus, it is necessary to clarify the current management of AF patients across the age spectrum to ensure that all patients receive optimal treatment. Considering this, we conducted a registry-based study to provide data about the characteristics, management, and prognosis of Chinese AF patients, especially elderly patients.
©2014 Wiley Periodicals, Inc. 1392
October 2014
PACE, Vol. 37
AGE FACTORS IN AF MANAGEMENT FOR CHINESE
Table I. Baseline Characteristics for AF Patients without a Valve Lesion†
Demographics Female Tobacco use Alcohol use SBP, mean (SD), mmHg DBP, mean (SD), mmHg HR, mean (SD), beats/min AF Type Paroxysmal Persistent Permanent Previous History HF Hypertension Stroke or TIA DM CHADS2 Score 0–1 2–3 4–6
