To Study the Clinical Profile of Atrial Fibrillation in Elderly Patients A One Year Cross Sectional Study at Kles Dr Prabhakar Kore Hospital & MRC, Belgaum

Abstract

Background and objectives The frequency of AF is increasing as the population ages, and therefore, knowledge of the clinical spectrum is essential. This study was aimed to explore the clinical profile of atrial fibrillation in elderly patients. Methodology The present one year cross-sectional study was done under the Department of Medicine, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum. A total of 50 elderly patients (age > 65 years) who presented with atrial fibrillation were included in the study. Patients were subjected to clinical examination, electrocardiogram and 2D echocardiography. The annual stroke risk as assessed based on CHADS2 score and CHA2DS2-VASc score. Results Majority of the patients were males (78%). The male to female ratio was 3.54:1. Past history of hypertension, diabetes mellitus and HD were present in 64%, 62% and 58% of patients respectively. Palpitations were noted as commonest symptom (78%) followed by breathlessness (66%), chest pain (50%), swelling of feet (42%), fainting (20%) and PND (2%). On examination 36% of the patients each had raised JVP and pedal oedema. The other signs included hepatojugular reflex (32%), left parasternal heave (22%) and murmurs (40%). Lipid profile revealed maximum patients with abnormal LDL (84%) followed by abnormal HDL (54%), raised total cholesterol (54%) and triglycerides (28%). The biochemical profile revealed majority of the patients with raised blood urea nitrogen (90%) followed by raised serum creatinine (50%) and hence very low creatinine clearance was observed in patients (94%). ECG showed most of the patients had abnormal rate (64%), ischaemic changes (62%),left axis deviation (38%) and left ventricular hypertrophy (26%). On X-ray, most of the patients had LVH (36%) followed by LVH with LAE (24%), LAE (14%) and LAE+RVH (14%). The 2D echocardiographic findings revealed 50% of the patients had ejection fraction of < 60%, 39% of the patients had dilated left atrium, 31% of the patients had dilated left ventricle, Thickened mitral valve was noted in 20% and calcification in 26%. Aortic valve calcification was present in 58% of the patients. Most of the patients had complications of CCF (36%) followed by CVA (6%) and cor pulmonale (4%). Hypertension is the commonest etiology(64%) and other etiologies or associations include Diabetes Mellitus(62%), cardiomyopathy(42%), ischaemic heart disease(30%), rheumatic heart disease(10%), COPD(6%), surgical stress(4%), chronic kidney disease(4%) and hypothyroidism(4%). Majority of the patients presented were subjected to rate control (82%) than rhytm control(24%) and were being treated with antiplatelets (86%) and anticoagulants (50%). History of cardioversion was present in only (6%). The annual stroke risk based on CHADS2 score showed maximum patients (38%) with intermediate risk of thromboembolic event and CHA2DS2-VASc score revealed moderate to high risk of stroke in maximum patients (88%). Conclusion and interpretation Atrial fibrillation has differences in its clinical presentation and management across elderly age group.