Skip to main content
SpringerLink
Log in

Effect of age on treatment, trends and outcome of patients hospitalized with atrial fibrillation: insights from a 20-years registry in a middle-eastern country (1991–2010)

  • Original Article
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

Abstract

Background: Most studies on atrial fibrillation (AF) epidemiology, treatment, and outcomes have included mainly Caucasians patients. The world literature on AF in other ethnicities is very limited particularly in the elderly. Aims: The aim of this study was to compare the clinical characteristics, treatment and outcome of elderly and younger patients hospitalized with AF in a Middle-Eastern country and examine the trends of AF etiologies over a 20-year period. Methods: A retrospective analysis of a prospective registry of all patients hospitalized with AF in Qatar from 1991 through 2010 was made. Patients were divided into three groups; group 1: patients ≦50 years old, group 2: patients between 51 and 70 years old, and group 3: patients >70 years old. Clinical characteristics, management, and outcomes of AF patients were compared according to age. Results: Between the year 1991 and the end of 2010, a total 3848 consecutive patients were admitted with AF. One thousand three hundred and forty-five patients were ≦50 years, 1759 were between 51 and 70 years and 744 patients were >70 years old. Elderly patients were more likely to have hypertension and chronic renal impairment. There was a higher prevalence of associated coronary artery disease and aortic stenosis in elderly patients with a lower left ventricular ejection fraction than the younger age groups. A lower use of anticoagulation in the elderly group was observed but there was no underuse of other evidence-based medications. The older AF patients had significantly higher in-hospital mortality and stroke rates with no significant changes in mortality trends over the 20 years of study. An increasing trend of the associated acute coronary syndromes, hypertension and diabetes mellitus prevalence was observed in the elderly group. Conclusion: Anticoagulation remains underutilized in elderly patients with AF despite proven efficacy and increasing trends of cardiovascular comorbidities. The current study underscores the urgent need for prospective studies to investigate warfarin contraindications, relative warfarin efficacy and bleeding risks in our region to help guide healthcare providers in warfarin prescribing in this frail patient population and consequently reduce the risk of AF-related disabling strokes and mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Roger VL, Go AS, Lloyd-Jones DM et al.; American Heart Association Statistics Committee and Stroke Statistics Lam doSubcommittee. Heart disease and stroke statistics-2012 update: a report from the American Heart Association. Circulation 2012; 125: e2–e220.

    PubMed  Google Scholar 

  2. Piccini JP, Hammill BG, Sinner MF et al. Incidence and prevalence of atrial fibrillation and associated mortality among Medicare beneficiaries, 1993–2007. Circ Cardiovasc Qual Outcomes 2012; 5: 85–93.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Benjamin EJ, Levy D, Vaziri SM, D’Agostino RB, Belanger AJ, Wolf PA. Independent risk factors for atrial fibrillation in a population- based cohort. The Framingham Heart Study. JAMA 1994; 271: 840–4.

    Article  CAS  PubMed  Google Scholar 

  4. Salam AM. Managing atrial fibrillation in older people: a comparison of two treatment strategies. J Am Geriatr Soc 2003; 51: 1806–7.

    Article  PubMed  Google Scholar 

  5. Miyasaka Y, Barnes ME, Gersh BJ et al. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation 2006; 114: 119–25.

    Article  PubMed  Google Scholar 

  6. Kurian AK, Cardarelli KM. Racial and ethnic differences in cardiovascular disease risk factors: a systematic review. Ethn Dis 2007; 17: 143–52.

    PubMed  Google Scholar 

  7. Soliman EZ, Alonso A, Goff DC Jr. Atrial fibrillation and ethnicity: the known, the unknown and the paradox. Future Cardiol 2009; 5: 547–56.

    Article  PubMed  Google Scholar 

  8. McKee PA, Castelli WP, McNamara PM, Kannel WB. The natural history of congestive heart failure: the Framingham study. N Engl J Med 1971; 285: 1441–6.

    Article  CAS  PubMed  Google Scholar 

  9. Nomenclature and criteria for diagnosis of ischemic heart disease. Report of the Joint International Society and Federation of Cardiology/World Health Organization task force on standardization of clinical nomenclature. Circulation 1979; 59: 607–9.

    Google Scholar 

  10. Lam DW, LeRoith D. The worldwide diabetes epidemic. Curr Opin Endocrinol Diabetes Obes 2012; 19: 93–6.

    Article  PubMed  Google Scholar 

  11. Lopes RD, Pieper KS, Horton JR et al. Short- and long-term outcomes following atrial fibrillation in patients with acute coronary syndromes with or without ST-segment elevation. Heart 2008; 94: 867–73.

    Article  CAS  PubMed  Google Scholar 

  12. Hylek EM, D’Antonio J, Evans-Molina C, Shea C, Henault LE, Regan S. Translating the results of randomized trials into clinical practice: the challenge of warfarin candidacy among hospitalized elderly patients with atrial fibrillation. Stroke 2006; 37: 1075–80.

    Article  PubMed  Google Scholar 

  13. Bungard TJ, Ghali WA, Teo KK, McAlister FA, Tsuyuki RT. Why do patients with atrial fibrillation not receive warfarin? Arch Intern Med 2000; 160: 41–6.

    Article  CAS  PubMed  Google Scholar 

  14. Go AS, Hylek EM, Borowsky LH, Phillips KA, Selby JV, Singer DE. Warfarin use among ambulatory patients with nonvalvular atrial fibrillation: the anticoagulation and risk factors in atrial fibrillation (ATRIA) study. Ann Intern Med 1999; 131: 927–34.

    Article  CAS  PubMed  Google Scholar 

  15. Lackie CL, Garbarino KA, Pruetz JA. Warfarin therapy for atrial fibrillation in the elderly. Ann Pharmacother 2002; 36: 200–4.

    Article  CAS  PubMed  Google Scholar 

  16. Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med 2007; 146: 857–67.

    Article  PubMed  Google Scholar 

  17. Mant J, Hobbs FD, Fletcher K et al.; BAFTA investigators; Midland Research Practices Network (MidReC). Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial. Lancet 2007; 370: 493–503.

    Article  CAS  PubMed  Google Scholar 

  18. SPAF II Investigators. Warfarin versus aspirin for prevention of thromboembolism in atrial fibrillation: Stroke Prevention in Atrial Fibrillation II Study. Lancet 1994; 343: 687–91.

    Google Scholar 

  19. Yamaguchi T. Optimal intensity of warfarin therapy for secondary prevention of stroke in patients with nonvalvular atrial fibrillation: a multicenter, prospective, randomized trial. Japanese Nonvalvular Atrial Fibrillation-Embolism Secondary Prevention Cooperative Study Group. Stroke 2000; 31: 817–21.

    Article  CAS  PubMed  Google Scholar 

  20. Pengo V, Cucchini U, Denas G et al. Lower versus standard intensity oral anticoagulant therapy (OAT) in elderly warfarin-experienced patients with non-valvular atrial fibrillation. Thromb Haemost 2010; 103: 442–9.

    Article  CAS  PubMed  Google Scholar 

  21. Castelino RL, Chen TF, Guddattu V, Bajorek BV. Use of evidence- based therapy for the prevention of cardiovascular events among older people. Eval Health Prof 2010; 33: 276–301.

    Article  PubMed  Google Scholar 

  22. Winkelmayer WC, Fischer MA, Schneeweiss S, Wang PS, Levin R, Avorn J. Underuse of ACE inhibitors and angiotensin II receptor blockers in elderly patients with diabetes. Am J Kidney Dis 2005; 46: 1080–7.

    Article  CAS  PubMed  Google Scholar 

  23. Pappoe LS, Winkelmayer WC. ACE inhibitor and angiotensin II type 1 receptor antagonist therapies in elderly patients with diabetes mellitus: are they underutilized? Drugs Aging 2010; 27: 87–94.

    Article  CAS  PubMed  Google Scholar 

  24. Miyasaka Y, Barnes ME, Bailey KR et al. Mortality trends in patients diagnosed with first atrial fibrillation: a 21-year community- based study. J Am Coll Cardiol 2007; 49: 986–92.

    Article  PubMed  Google Scholar 

  25. Bilato C, Corti MC, Baggio G et al. Prevalence, functional impact, and mortality of atrial fibrillation in an older Italian population (from the Pro.V.A. study). Am J Cardiol 2009; 104: 1092–7.

    Article  PubMed  Google Scholar 

  26. Furberg CD, Psaty BM, Manolio TA, Gardin JM, Smith VE, Rautaharju PM. Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study). Am J Cardiol 1994; 74: 236–41.

    Article  CAS  PubMed  Google Scholar 

  27. Lake FR, Cullen KJ, de Klerk NH, McCall MG, Rosman DL. Atrial fibrillation and mortality in an elderly population. Aust N Z J Med 1989; 19: 321–6.

    Article  CAS  PubMed  Google Scholar 

  28. Go AS, Hylek EM, Phillips KA et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 2001; 285: 2370–5.

    Article  CAS  PubMed  Google Scholar 

  29. Ruo B, Capra AM, Jensvold NG, Go AS. Racial variation in the prevalence of atrial fibrillation among patients with heart failure: the Epidemiology, Practice, Outcomes, and Costs of Heart Failure (EPOCH) study. J Am Coll Cardiol 2004; 43: 429–35.

    Article  PubMed  Google Scholar 

  30. Dang D, Patel R, Haywood LJ. Atrial fibrillation in a multiethnic inpatient population of a large public hospital. J Natl Med Assoc 2004; 96: 1438–44.

    PubMed  PubMed Central  Google Scholar 

  31. Bush D, Martin LW, Leman R, Chandler M, Haywood LJ; NHLBI AFFIRM Investigators. Atrial fibrillation among African Americans, Hispanics and Caucasians: clinical features and outcomes from the AFFIRM trial. J Natl Med Assoc 2006; 98: 330–9.

    PubMed  PubMed Central  Google Scholar 

  32. Novaro GM, Asher CR, Bhatt DL et al. Meta-analysis comparing reported frequency of atrial fibrillation after acute coronary syndromes in Asians versus whites. Am J Cardiol 2008; 101, 506–9.

    Article  PubMed  Google Scholar 

  33. Shen AY, Contreras R, Sobnosky S et al. Racial/ethnic differences in the prevalence of atrial fibrillation among older adults—a crosssectional study. J Natl Med Assoc 2010; 102: 906–13.

    PubMed  Google Scholar 

  34. Meschia JF, Merrill P, Soliman EZ et al. Racial disparities in awareness and treatment of atrial fibrillation: the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Stroke 2010; 41: 581–7.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Sun X, Hill PC, Lowery R et al. Comparison of frequency of atrial fibrillation after coronary artery bypass grafting in African Americans versus European Americans. Am J Cardiol 2011; 108: 669–72.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Adult Cardiology, Heart Hospital, Hamad Medical Corporation (HMC), P.O Box 3050, Doha, Qatar

    Amar M. Salam, Hajar A. AlBinali, Abdul Wahid Al-Mulla, Rajvir Singh & Jassim Al Suwaidi MB, ChB, FACC, FSCAI, FESC

  2. Geriatric Department, Hamad Medical Corporation, Doha, Qatar

    Essa M. Al-Sulaiti

  3. Cardiovascular Surgery Department, USA

    Amar M. Salam, Abdul Wahid Al-Mulla, Rajvir Singh & Jassim Al Suwaidi MB, ChB, FACC, FSCAI, FESC

Authors
  1. Amar M. Salam
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hajar A. AlBinali
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Essa M. Al-Sulaiti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Abdul Wahid Al-Mulla
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rajvir Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jassim Al Suwaidi MB, ChB, FACC, FSCAI, FESC
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jassim Al Suwaidi MB, ChB, FACC, FSCAI, FESC.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Salam, A.M., AlBinali, H.A., Al-Sulaiti, E.M. et al. Effect of age on treatment, trends and outcome of patients hospitalized with atrial fibrillation: insights from a 20-years registry in a middle-eastern country (1991–2010). Aging Clin Exp Res 24, 682–690 (2012). https://doi.org/10.1007/BF03654850

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03654850

Key words

Search

Navigation