ABSTRACT
Introduction@#Although we have known for almost last few years that Atrial fibrillation has been increasing by patients in Mongolia. Atrial fibrillation, the most common sustained chronic arrhythmia, with atrial rates of 200-500 beats per minute in patients. Most patients atrial fibrillation have structural heart disease such us mitral stenosis or regurgitation, acute myocardial infarction, Wolff-Parkinson-White syndrome, thyrotoxicosis, recent cardiothoracic surgery, cardiomyopathy, myocarditis or pulmonary disease. Atrial Fibrillation increases the risk of stroke, thromboemboli and mortality of adults with structural heart disease [4]. The symptoms most frequently reported by patients with atrial fibrillation is a rapid, irregullar heartbeat, chest pain, shortness of breath, lightheadedness and dizziness.@*Goal@#For that reason we decided to research patients with atrial fibrillation who are treated by the inpatient cardiology department of General hospital of defense and Law Enforcement between 2010-2014 years.@*Conclusion@#</br> 1. The hospitalized patients are observed only 6 cases of atrial fibrillation in 2010 years, even though the prevalence of atrial fibrillation has been increasing 75 cases in 2014 years, as a result it developed 30% during 4 years in hospitalized patients </br> 2. CHA2DS2-VАSc score was high risk of stroke /62.5% of them /most patients with both paroxysmal and chronic atrial fibrillation should be anticoagulated to reduce the occurrence of thromboemboli </br> 3. HAS-BLЕD score has became highest rick of bleeding /32.7% of all patients. For the reason we should be select correctly drugs for patients an anticoagulation treatment and they are controled INR every month
ABSTRACT
Diabetes mellitus (DM) is a very common medical disorder and a major health problem in North Africa including Libya. DM is associated with an increase in the risk of stroke and hospitalization. Objectives: To estimate the importance of DM as a stroke risk factor among people living in Libyan community. Methodology: The study was community based descriptive cross-sectional study used CHADS2 Questionnaire, as well a local Libyan classification of stroke risk factors called Community Stroke Risk Classification (CSRC). Area: North Africa (North of Libya, the capital Tripoli). Time: Five years from 2010-2014. Population: Sampling was done from a large cohort of individuals living in the community, 7497 individuals were screened looking for risk factors of stroke. Results: The prevalence of DM among our participants (7497 individuals) was 39% (2908 patients), among males and females was 54.1% and 45.9% respectively (P =0.0001). Among different age groups, males have higher rates compared to females except in very young (10-19) and very old (>80) where females dominated. The male to female ratio among total population screened was 21%: 17.8% (1573:1335 respectively). DM prevalence increased with age, with higher rates among age over 40 (P <0.0001). 53% of DM patients had hypertension (1538 patients), 21.3% had Congestive Heart Failure (CHF) (618 patients), 13% had Atrial Fibrillation (AF) (382 patients), 22% had Transient Ischemic Attach (TIA) (643 patients), 12.3% had Prior Stroke (PS) (359 patients), All those risk factors accompanying DM increased with age increase (P<0.0001). 100% of DM patients had risk of stroke on CHADS2 and CSRC scores, which mainly concentrated in intermediate and high scores. Conclusion: DM is a major risk factor of stroke among Libyan population and had very high risk scores in CHADS2 and CSRC.
ABSTRACT
Congestive Heart failure (CHF) is a very common medical disorder and a major health problem in Libya. CHF is associated with an increase in the risk of stroke and hospitalization. Objectives: To estimate and describe the main risk factors and complications of CHF among people with a particular interest in Libyan community. Methodology: This project is classified as a community based descriptive cross-sectional study using the CHADS2 questionnaire as well as the local Libyan classification called the Community Stroke Risk Classification (CSRC). Area; North Africa (North of Libya, the capital Tripoli). Time; five years from 2010-2014 Population: Convenient sampling was done from a large cohort of individuals living in the Libyan community. 7497 individuals were screened for risk factors of stroke. CHF was one such factor which was studied in detail among the sample population and was diagnosed by taking detailed histories (including treatment), medical examinations and previous hospital confirmations. Results: The prevalence of CHF among our participants (7497 individuals) was 15.2% (1139 patients) among the sample population as a total with males and females being 51.2% and 48.8% respectively (P=0.87). Among different age groups, females had higher rates than the males except for age interval from 60 to 79 where males had higher rates. The male to female ratio among the total population screened for CHF was 7.8%: 7.4% (583:556 respectively with males being higher). CHF prevalence increased with the progress of age, with higher rates among age groups of over 40 (P <0.0001). 68.3% of CHF patients had hypertension (778 patients), 54.3% had DM (618 patients), 38.7% had transient ischemic attach (TIA) (441 patients), 27.2% had atrial fibrillation (AF) (310 patients), 25.9% had prior stroke (PS) (295 patients), All of these risk factors accompanying CHF increased with age (P<0.0001). 99.92% of CHF patients had risk points of stroke in CHADS2 scores (0.08% had no risk points), from whom 27.1% had intermediate scores (1-2 Risk Points) and 72.9% had high scores (≥3 risk points) (P<0.0001). Results of the CSRC scores showed that 99.91% had risk factors of stroke (0.09% had no risk factors), from whom 29.5% had intermediate scores (1-2 Risk Factors) and 70.5% had high scores (≥3 risk factors) (P<0.0001). Conclusion: CHF is a major risk factor of stroke among the Libyan population in North Africa of whom had very high CHADS2 risk scores. These scores are defined as a combination of six different risk points; 0 points being low risk, 1-2 being intermediate, and a score of 3 or more risk points is defined as being high risk. CHF appeared to dominate the high scores (≥3 risk points). Almost all CHF patients had risk factors of stroke on the CSRC scoring system of whom expressed intermediate and high scores with a significant proportion of high scores (≥3 risk factors of stroke). Hypertension, DM, AF and being aged of over 40 years were very important risk factors contributing to CHF. Both genders of male and female had similar chances of developing CHF in the Libyan community. CHADS2 & CSRC classification scores are very useful and simple tools to be used to classify and describe the risk factors of stroke in populations living within a community.
ABSTRACT
Objective To investigate the predictive value of CHADS2 and CHA2DS2-VASc score in left atrial (LA) or left atrial appendage (LAA) thrombus in patients with non-valvular atrial fibrillation (AF). Methods A total of 164 consecu?tive non-valvular AF patients confirmed by transesophageal echocardiography (TEE) were included in this study, and were divided into two groups, LA/LAA thrombus group and non LA/LAA thrombus group. The previous history was recorded in two groups of patients. Their CHADS2 and CHA2DS2-VASC scores were calculated based on the general data of two groups. The laboratory examinations and TEE indexes were compared between two gropes. Results Of all patients, the rate of LA/LAA thrombus was 19.5%. The CHADS2 and CHA2DS2-VASC scores were significantly higher in LA/LAA thrombus group than those of non LA/LAA thrombus group (2.1±1.3 vs 1.0±0.9, 3.4±1.8 vs 1.9±1.4,P<0.01). There were 13(11.9%) and 5 (8.8%) patients showed LA/LAA thrombus under low-moderate risk in the two score systems, respectively. Multivariate logis?tic regression analysis showed that CHADS2 score≥2 points(OR=3.735, 95%CI:1.508-9.251, P=0.004) and CHA2DS2-VASc score ≥2 points (OR=5.104, 95%CI:1.586-16.425, P=0.006) were independent risk factors of LA/LAA thrombus. ROC curve showed that AUC of CHADS2 and CHA2DS2-VASc scores to predict LA/LAA thrombus were 0.731 (95%CI:0.630-0.832, P<0.001) and 0.742 (95%CI:0.640-0.843, P<0.001), respectively. Conclusion CHADS2 and CHA2DS2-VASC score ≥2 points are independent risk factors of LA/LAA thrombus in patients with non-valvular atrial fibrillation. The pre?dictive values of both score systems are moderate. There are also LA/LAA thrombus in low-moderate risk patients when us?ing the two score systems, and with the increased risk stratification, the rate of LA/LAA thrombus is increased.
ABSTRACT
Objective: To analyze the clinical characteristics and current treating status from atrial ifbrillation (AF) patients with different gender in 20 emergency departments. Methods: A total of 2015 consecutive AF patients from 20 emergency departments nationwide from 2008-11 to 2011-10 were retrospectively investigated. The patients were divided into 2 groups: Female group,n=1104 and Male group,n=911. The baseline clinical characteristics and current treating status were compared between groups, the risk of stroke in non-valvular atrial ifbrillation (NVAF) patients was evaluated by CHADS2 score and the factors affecting walfarin application were studied by Logistic regression analysis. Results: Compared with Male group, Female group had the elder age (69.11 ± 12.96) years vs (67.67 ± 13.63) years,P=0.015, lower body mass index (BMI) (23.24 ± 3.73) kg/m2 vs (23.89 ± 3.47) kg/m2,P=0.000, more patients combining with heart failure (39.7% vs 34.6%,P=0.019), more patients with valvular heart disease (26.6% vs 12.4%,P=0.000). In contrast, Male group had more smokers (41.4% vs 5.1%,P=0.000), more patients combining with coronary artery disease (45.1% vs 39.1%,P=0.007) and more patients with previous history of myocardial infarction (9.5% vs 5.5%,P=0.001). The average CHADS2 score was higher in Female group than Male group (2.0 ± 1.4) vs (1.8 ± 1.4),P=0.008 and the proportion of patients with CHADS2 score ≥2 was higher in Female group than Male group (58.0% vs 51%,P=0.005). There were 407 patients of valvular heart disease with AF and 167 (41%) of them received walfarin treatment including 119 female and 48 male,P=0.713; 1608 NVAF patients with CHADS2 score≥ 2 and 105 of them received anticoagulation therapy including 54 female and 51 male,P=0.636. Conclusion: The clinical characteristics and current treating status are different by gender from AF patients in 20 emergency departments in China.
ABSTRACT
Objective: To evaluate the values of CHADS2 score, CHA2DS2-VASc score, and sel--modified CHA2DS2-VASc-LA2 score in predicting left atrial thrombus (LAT) in patients with non-valvular atrial fibrillation (NVAF). Methods: A total of 203 NVAF patients who underwent transesophageal echocardiography (TEE) examination and cardiac multislice CT scans before AF radiofrequency ablation in our department from June 2007 to June 2012 were included in this study. LAT was detected by TEE in 39 patients (thrombosis group) and not detected in 164 patients (control group). The patients' general condition, medical history, admission examination, CHADS2 score and CHA2DS2-VASc score were subjected to univariate analysis and multivariate logistic regression analysis. Then a new CHA2DS2-VAS-LA2 scoring system was formed by combining le!t atrial volume index (LAVI), recording LAVI ≥32 mL/m2 as 2 points and CHA2DS2-VASc score, which was based on the results of logistic regression analysis. The receiver operating characteristic curve (ROC) was used to compare the values of CHADS2, CHA2DS2-VASc and CHA2DS2-VASc-LA2 scores for predicting LAT formation in NVAF patients. Results: ROC curve analysis showed that CHADS2 score had a low predictive value (AUC [area under the curve] = 0.661, P = 0.002); CHA2DS2-VASc score (AUC=0. 731, P<0. 001) and CHA2DS2-VASc-LA2 score (AUC= 0.771, P<0.001) had middle predictive values. The CHA2DS2-VASc-LA2 scores of the three patients with CHADS2 score being 0 in thrombosis group was increased, and there was no patient in the thrombosis group with CHA2DS2-VAS-LA2 score being 0. Conclusion: Compared with CHADS2 and CHA2DS2-VASc systems, CHA2DS2-VASc-LA2 score has a better performance in predicting LAT in low-risk patients with NVAF. It is also suggested that pre-ablation TEE may be unnecessary f the CHA2DS2-VASc-LA2 score is 0.
ABSTRACT
Stroke associated with non-valvular atrial fibrillation (NVAF) is one of the most important subtypes of ischemic stroke, and its importance is becoming even more apparent in an aging population. To assess the risk of stroke associated with NVAF, the CHADS2 and CHA2DS2-VASc scores are mainly used. Such scores can be used to predict the recurrence and prognosis of ischemic stroke. In addition, new oral anticoagulants (NOACs) and devices are being evaluated in the prevention of stroke associated with NVAF in addition to treatment with the conventional oral anticoagulant, warfarin. Since clinical experience with NOACs is not globally sufficient, a cautious approach is needed.
Subject(s)
Aging , Anticoagulants , Atrial Fibrillation , Prognosis , Recurrence , Stroke , WarfarinABSTRACT
Objective To perform a systematic review and meta-analysis of the predictive abilities of CHADS2 and CHA2DS2-VASc in stroke and thromboembolism risk stratification of atrial fibrillation (AF) patients. Methods We searched PubMed and EMBASE for Eng-lish-language literature on comparisons of the diagnostic performance between CHADS2 and CHA2DS2-VASc in predicting stroke, or sys-temic embolism, in AF. We then assessed the quality of the included studies and pooled the C-statistics and 95%confidence intervals (95%CI). Results Eight studies were included. It was unsuitable to perform a direct meta-analysis because of high heterogeneity. When analyzed as a continuous variable, the C-statistic ranged from 0.60 to 0.80 (median 0.683) for CHADS2 and 0.64-0.79 (median 0.673) for CHA2DS2-VASc. When analyzed as a continuous variable in anticoagulation patients, the subgroup analysis showed that the pooled C-statistic (95%CI) was 0.660 (0.655-0.665) for CHADS2 and 0.667 (0.651-0.683) for CHA2DS2-VASc (no significant difference). For non-anticoagulation patients, the pooled C-statistic (95%CI) was 0.685 (0.666-0.705) for CHADS2 and 0.675 (0.656-0.694) for CHA2DS2-VASc (no significant differ-ence). The average ratio of endpoint events in the low-risk group of CHA2DS2-VASc was less than CHADS2 (0.41%vs. 0.94%, P＜0.05). The average proportion of the moderate-risk group of CHA2DS2-VASc was lower than CHADS2 (11.12%vs. 30.75%, P＜0.05). Conclu-sions The C-statistic suggests a similar clinical utility of the CHADS2 and CHA2DS2-VASc scores in predicting stroke and thromboem-bolism, but CHA2DS2-VASc has the important advantage of identifying extremely low-risk patients with atrial fibrillation, as well as classi-fying a lower proportion of patients as moderate risk.
ABSTRACT
BACKGROUND AND PURPOSE: The CHADS2 (an acronym for congestive heart failure, hypertension, age > or =75 years, diabetes mellitus, and prior stroke or transient ischemic attack or thromboembolism) score is a widely used system for estimating the risk of stroke in patients with atrial fibrillation. However, how the CHADS2 score is related to stroke severity and outcome in patients with strokes due to atrial fibrillation has not yet been elucidated. METHODS: We enrolled patients with atrial fibrillation who visited our stroke center within 7 days after the onset of acute ischemic stroke between October 2002 and September 2008. CHADS2 scores were categorized into three groups: 0 points, low risk; 1 or 2 points, intermediate risk; and 3-6 points, high risk. Poor neurological state was defined as follows: a National Institutes of Health Stroke Scale (NIHSS) score of > or =2, and a modified Rankin Scale (mRS) score of > or =3 at discharge. Mortality information was ascertained as at December 2008. RESULTS: A cohort of 298 patients with atrial-fibrillation-related stroke was included in this study. A high-risk CHADS2 score at admission was a powerful predictor of poor neurological outcome [for NIHSS: odds ratio (OR), 4.17; 95% confidence interval (CI), 1.76-9.87; for mRS: OR, 2.97; 95% CI, 1.23-7.16] after controlling for all possible confounders. In addition, a high-risk CHADS2 score was an independent predictor of all causes of death during the follow-up [hazard ratio (HR), 3.01; 95% CI, 1.18-7.65] and vascular death (HR, 12.25; 95% CI, 1.50-99.90). CONCLUSIONS: Although the CHADS2 score was originally designed to distinguish patients with a future risk of stroke, our study shows that it may also be used to predict poor neurological outcome after atrial-fibrillation-related stroke.
Subject(s)
Humans , Atrial Fibrillation , Cause of Death , Cohort Studies , Diabetes Mellitus , Follow-Up Studies , Heart Failure , Hypertension , Ischemic Attack, Transient , Odds Ratio , StrokeABSTRACT
La fibrilación auricular (FA) es el factor de riesgo más importante para eventos tromboembólicos (ETE). El objetivo del presente estudio fue determinar la prevalencia de FA en pacientes con marcapasos definitivo (MCD), el porcentaje de anticoagulación y la prevalencia de ETE. El objetivo secundario fue determinar el nivel de conocimiento relacionado con las indicaciones de anticoagulación oral (AO) en pacientes con FA. Estudio descriptivo y retrospectivo de una serie consecutiva de pacientes. Se evaluaron factores de riesgo cardiovascular, motivos de indicación del MCD, antecedentes de FA, ETE y régimen de anticoagulación. Para determinar las potenciales causas de no AO, se realizó una encuesta a todos los médicos que habitualmente derivan sus pacientes a nuestro servicio. De 934 pacientes, el 26% (244) presentó FA, con una tasa de AO del 34%. El 77,3% presentaban un score CHADS2 ³2, solo el 2% presentó contraindicaciones para AO y la prevalencia de ETE fue del 9%. El 63% de los médicos contestó la encuesta. El 41% conocían el score CHADS2, el 33% pudo describir los parámetros clínicos que evalúa y un 23% respondieron correctamente el puntaje necesario para indicar AO. Se detectó una baja tasa de anticoagulación oral en pacientes con FA y MCD, con una elevada prevalencia de ETE y un sorprendente desconocimiento por parte de los médicos tratantes de las recomendaciones actuales de tratamiento.
Atrial Fibrillation (AF) is the most important risk factor for stroke and thromboembolic events (TE). The aims of this study were to determine the prevalence of AF among patients with permanent pacemakers (PPM), the percentage of anticoagulated patients and the prevalence on TE in this population. The secondary purpose was to determine the level of knowledge about indications of anticoagulation for AF patients. This was a descriptive and retrospective study on a consecutive series of patients referred for PPM implantation. Cardiovascular risk factors, indications for pacing, prior history of AF, TE and anticoagulation indication were analyzed. In order to determine possible causes for not indicating anticoagulation, an electronic survey was sent to all doctors that usually refer patients for PPM implant and follow-up to our clinic. Among 934 patients, 26% (244) presented AF of which 34% were anticoagulated. 77, 3% presented a CHADS2 score of ³2 while only 2% had absolute contraindication for anticoagulation. The prevalence of TE was 9%. More than 60% of the doctors answered the survey. More than 40% acknowledged the CHADS2 score but only 33% were able to recognize all variables included in the score and 23% were able to determine when to indicate anticoagulation properly. A low anticoagulation rate was detected among patients with AF and PPM with a high prevalence of TE and stroke. An extremely low adherence to international guidelines was detected among doctors that usually deal with this sort of patients.