CLINICAL-PATTERN AND COMPLICATIONS OF NONVALVULAR ATRIAL-FIBRILLATIONIN ELDERLY AND NONELDERLY PATIENTS

Three hundred patients with nonvalvular atrial fibrillation were hospi talized between 1988 and 1995, representing 2% of hospital admissions in this period. Two hundred six patients had paroxysmal atrial fibrill ation, associated with structural heart disease in 67% of the cases (p atients' age greater than or equal to 65 years in 60%) and not associa ted with heart disease in 33% (patients' age greater than or equal to 65 years in 36%). Ninety-four patients had chronic atrial fibrillation , associated with structural heart disease in 79% of the cases (patien ts' age greater than or equal to 65 years in 51%) and not associated w ith structural heart disease in 21% (patients' age greater than or equ al to 65 years in 40%). In patients with paroxysmal atrial fibrillatio n, the most common underlying heart disease was ischemic heart disease , either in patients <65 years (prevalence = 49%) or greater than or e qual to 65 years (prevalence = 82%). In patients aged <65 years with c hronic atrial fibrillation, the most common underlying heart disease w as cardiomyopathy (prevalence = 44%), whereas in patients aged greater than or equal to 65 years, the most common heart disease was ischemic heart disease (prevalence = 42%). Among patients aged <65 years, syst emic hypertension was present in 20% of the patients with paroxysmal a trial fibrillation without structural heart disease, in 41% of patient s with paroxysmal atrial fibrillation and heart disease, in 50% of pat ients with chronic atrial fibrillation without structural heart diseas e, and in 42% of patients with chronic atrial fibrillation and heart d isease. Among patients aged greater than or equal to 65 years, systemi c hypertension was present in 60% of the patients with paroxysmal atri al fibrillation without structural heart disease, in 52% of patients w ith paroxysmal atrial fibrillation and heart disease, in 63% of patien ts with chronic atrial fibrillation without structural heart disease, and in 53% of patients with chronic atrial fibrillation and heart dise ase. Overall 32 out of 300 patients (11%) had a history of previous th romboembolic complications (transient ischemic attacks in 50%, stroke in 44%, systemic embolism in 6%), and these complications occurred eve n in patients without structural heart disease (2% of patients with pa roxysmal atrial fibrillation <65 years, 8% of patients with paroxysmal atrial fibrillation greater than or equal to 65 years, 8% of patients with chronic atrial fibrillation <65 years, and 50% of patients with chronic atrial fibrillation greater than or equal to 65 years). In con clusion, in a selected in-hospital population, nonvalvular atrial fibr illation (either paroxysmal or chronic) is more frequently associated with structural heart disease, particularly ischemic heart disease. Hy pertension is quite common in these patients, especially in those aged greater than or equal to 65 years. Thromhoembolic complications may o ccur even in atrial fibrillation without structural heart disease, and their prevalence is particularly high in elderly subjects with chroni c atrial fibrillation.