Abstract
Background: 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.
Objectives: 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.
Subjects: 3,766 acute medical admissions, of whom 245 (6.5%) had AF.
Results: 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.
Conclusion: 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).
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