Journal Mobile

U Haq, GYH Lip
Journal Issue: 
Volume 39: Issue 3: 2009




There  are  established  differences  in  cardiovascular  disease  in different racial groups. Worldwide, the literature regarding the clinical epidemiology of atrial fibrillation (AF) in non-white populations is scarce.
To  document  the  clinical  epidemiology  of  AF  among  hospital admissions  to  two  teaching  hospitals  in  Karachi,  Pakistan,  over  a  two-month period and to describe the clinical features and management of these patients.
3,766 acute medical admissions, of whom 245 (6.5%) had AF.
Of 245 patients with AF, clinical notes of 24 were lost in the system. Of the  remaining  221  patients  with AF  (107  males;  mean  age  66  years),  22%  were Afghani Muslims, 3% Indians, 1% white and the rest were Pakistani with unknown country  of  origin.  The  most  common  associated  medical  conditions  were hypertension (54%), valvular heart disease (54%) and ischaemic heart disease (IHD,47%). The most common presenting complaints in female patients were palpitations (51%) and anxiety (35%). In males, the most common symptoms were palpitations (46%),  chest  pain  (35%)  and  anxiety  (27%). Among  male  patients,  100%  had  an electrocardiogram  (ECG),  93%  an  X-ray,  89%  echocardiography  and  49%  thyroid function testing. Direct current (DC) cardioversion was attempted in 8%. Of the male admissions with AF, 64% were taking aspirin, while 75% were anticoagulated in hospital and 40% of patients were discharged on anticoagulants with cessation documented  in  14%.  Beta  blockers  and  amiodarone  were  prescribed  in  74%  and 19% of male cases respectively. In females, 100% had an ECG, 76% chest X-rays and 81%  had  echocardiography  proposed. Thyroid  function  tests  were  done  in  46%  of cases, and DC cardioversion was attempted in 11%. Of the female AF patients, 70% were anticoagulated in hospital and 48% went home on anticoagulants. Cessation of  warfarin  was  documented  in  27%  of  female  patients,  and  beta  blockers  and amiodarone were prescribed in 80% and 26% respectively.
Among acute medical admissions to hospital in Pakistan the prevalence  of AF  was  6.5%.  Consistent  with  previous  similar  surveys  in  mainly Western (Caucasian)  populations,  standard  investigations  in  this  cohort  were  inadequate and there was underuse of anticoagulation (with a high cessation rate).