Cardiology and Cardiovascular Surgery Department, Doha, Qatar.
Aging Clin Exp Res. 2012 Dec;24(6):682-90. doi: 10.3275/8757. Epub 2012 Nov 26.
Most studies on atrial fibrillation (AF) epidemiology, treatment, and outcomes have included mainly Caucasians patients. The world literature on AF in other ethnicities is very limited particularly in the elderly.
The aim of this study was to compare the clinical characteristics, treatment and outcome of elderly and younger patients hospitalized with AF in a Middle-Eastern country and examine the trends of AF etiologies over a 20-year period.
A retrospective analysis of a prospective registry of all patients hospitalized with AF in Qatar from 1991 through 2010 was made. Patients were divided into three groups; group 1: patients ≤50 years old, group 2: patients between 51 and 70 years old, and group 3: patients >70 years old. Clinical characteristics, management, and outcomes of AF patients were compared according to age.
Between the year 1991 and the end of 2010, a total 3848 consecutive patients were admitted with AF. One thousand three hundred and forty-five patients were ≤50 years, 1759 were between 51 and 70 years and 744 patients were >70 years old. Elderly patients were more likely to have hypertension and chronic renal impairment. There was a higher prevalence of associated coronary artery disease and aortic stenosis in elderly patients with a lower left ventricular ejection fraction than the younger age groups. A lower use of anticoagulation in the elderly group was observed but there was no underuse of other evidence-based medications. The older AF patients had significantly higher in-hospital mortality and stroke rates with no significant changes in mortality trends over the 20 years of study. An increasing trend of the associated acute coronary syndromes, hypertension and diabetes mellitus prevalence was observed in the elderly group.
Anticoagulation remains underutilized in elderly patients with AF despite proven efficacy and increasing trends of cardiovascular comorbidities. The current study underscores the urgent need for prospective studies to investigate warfarin contraindications, relative warfarin efficacy and bleeding risks in our region to help guide healthcare providers in warfarin prescribing in this frail patient population and consequently reduce the risk of AF-related disabling strokes and mortality.
大多数关于心房颤动（AF）的流行病学、治疗和结局的研究主要纳入了白种人患者。关于其他种族人群 AF 的世界文献非常有限，尤其是在老年人中。
本研究旨在比较中东国家老年和年轻 AF 住院患者的临床特征、治疗和结局，并检查 20 年来 AF 病因的趋势。
对 1991 年至 2010 年期间在卡塔尔住院的所有 AF 患者进行前瞻性登记的回顾性分析。患者分为三组：组 1：≤50 岁患者，组 2：51-70 岁患者，组 3：>70 岁患者。根据年龄比较 AF 患者的临床特征、管理和结局。
在 1991 年至 2010 年底期间，共有 3848 例连续患者因 AF 住院。1345 例患者≤50 岁，1759 例患者在 51-70 岁之间，744 例患者>70 岁。老年患者更可能患有高血压和慢性肾功能不全。与年轻年龄组相比，老年患者更易发生冠状动脉疾病和主动脉狭窄。老年组抗凝治疗的使用率较低，但其他循证药物的使用率并不低。老年 AF 患者的住院死亡率和卒中发生率较高，但在研究的 20 年中，死亡率趋势没有明显变化。在老年组中，与急性冠状动脉综合征、高血压和糖尿病相关的患病率呈上升趋势。
尽管抗凝治疗在 AF 老年患者中的疗效已得到证实，且心血管合并症的趋势呈上升趋势，但抗凝治疗的使用率仍然较低。本研究强调迫切需要进行前瞻性研究，以调查我们地区华法林的禁忌证、相对华法林疗效和出血风险，以帮助指导医疗保健提供者在这个脆弱患者群体中开具华法林处方，从而降低 AF 相关致残性卒中和死亡率的风险。
