ACUTE ADMISSIONS WITH ATRIAL-FIBRILLATION IN A BRITISH MULTIRACIAL HOSPITAL POPULATION

To assess the clinical characteristics and management of patients with atrial fibrillation (AF), we performed a prospective survey of all ac ute medical admissions over six months to our hospital. Of 7451 such a dmissions, 245 had AF (110 male, 135 female, mean age 74.4 years). Of these, 213 were Caucasian, 10 black/Afro-Caribbean and 22 Asian. Compl ete data were available for 185 patients. Of these, 82 had newly diagn osed AF, 83 had previous chronic AF and 20 had paroxysmal AF. The main presenting features was dyspnoea, stroke and syncope. A history of is chaemic heart disease was present in 64, heart failure in 46, hyperten sion in 51 and rheumatic heart disease in 13, while 31 had a previous stroke. Chest X-ray showed cardiomegaly and pulmonary oedema in 121 pa tients, but was normal in 28. Echocardiography showed poor cardiac fun ction in eight patients and enlarged left atria in five. Only 28% of t hose with previously diagnosed AF were on anticoagulation. Of the newl y diagnosed patients, only 18% were started on anticoagulants. Cardiov ersion was attempted or planned in only 6%. The primary diagnosis on d ischarge was heart failure in 45, stroke in 24 and myocardial infarcti on in 12. AF remains a common arrhythmia among acute medical admission s and is commonly associated with heart failure and a high mortality. There is still a reluctance to start anticoagulant therapy or to perfo rm cardioversion in such patients.