Antithrombotic agents and Risk Profile of Patients with Atrial Fibrillation from Rural Part of Nepal

Introduction: Atrial fibrillation (AF) is an atrial tachyarrhythmia characterized by uncoordinated activation of atria with subsequent impairment of atrial mechanical function. Anticoagulation with warfarin decreases the ischemic stroke risk associated with AF. Although the trends of anticoagulation use and risk profiles of AF is available from different countries, but, there is scarcity of data from Nepal. Hence, the study was carried out to determine the current practices of antithrombotic use in rural Nepal. Methods: A total of 240 patients from January 2012 to September 2014 with and without admitted but diagnosis of atrial fibrillation (AF) were enrolled from Lumbini Medical College, Palpa. Demographic information, clinical history, co-morbid conditions, use of anticoagulants and risk factors for stroke were obtained from questionnaire designated. Clinical examinations were performed along with electrocardiography and echocardiography from each patient. Results: A total of 240 patients, diagnosis with atrial fibrillation (AF) from outpatient or admitted, the mean ranged was 63.3 years (20 to 90). Male: female ratio was 0.84. Majority of patients (60%) were of age >60 years. Mean heart rate was 98 bpm. Among risk factors for AF, hypertension, rheumatic heart disease, systolic and diastolic heart failure, dilated cardiomyopathy, ischemic heart diseases were common underlying problems. Ninety percent of patients had dilated left atrium (>40mm). Among patients with non-valvular AF. 39.1% had CHADS2 score of ≥ 2 who were eligible for oralanticoagulants and 18.9 % patients received it. Out of 44 with rheumatic heart disease and AF, 10(22.7%) patients obtained oral anticoagulants, Conclusions: The findings highlight the need for improved treatments of underlying risk factors to prevent the onset of AF and adequate use of OACs to prevent stroke risk.