Trends in hospital activity, morbidity and case fatality related to atrial fibrillation in Scotland, 1986--1996.

AIMS: Atrial fibrillation is a common and important cause of cardiovascular morbidity and mortality that may become more prevalent due to an ageing population and more prolonged exposure to predisposing cardiovascular disease states. This study examines recent trends in hospitalizations related to atrial fibrillation in Scotland. METHODS AND RESULTS: Scotland (population 5.1 million) has a well described system for recording hospitalization data. All hospital discharges (and death) can be linked for each individual patient. We examined the period 1986--1996, during which time a total of 103,085 hospitalizations with a principal or secondary diagnosis of atrial fibrillation were recorded. The number of hospitalizations with a principal diagnosis of atrial fibrillation increased threefold from 1869 in 1986 to 5757 in 1996; the number with a secondary diagnosis rose from 3577 to 11,522. Similar increases were seen in the number of patients hospitalized, in those having a 'first-ever' hospitalization and in population hospitalization rates overall. The average age of patients rose, in men from 63.8 (SD 13.2) to 65.0 (13.2) years and in women from 72.2 (12.2) to 73.2 (11.4) years. The proportion of those aged >75 years rose from 33% to 35% in men and from 56% to 60% in women. Average length of stay and case fatality fell during this period, but, because of the overall increase in hospitalizations, atrial fibrillation contributed to a growing proportion of cardiovascular-related bed-days utilized (from 18% to 37% with atrial fibrillation coded in any diagnostic position). CONCLUSION: The number of hospitalizations for atrial fibrillation has increased dramatically (two- to threefold) in recent years. These findings may be due to a real increase in atrial fibrillation prevalence, changing medical practice (e.g. coding or admission thresholds) or both. Consequently, the public health burden of atrial fibrillation is enormous. Moreover, the observed increase in atrial fibrillation-related hospital activity shows no sign of abating.

Trends in hospitalization for heart failure in Scotland, 1990-1996. An epidemic that has reached its peak?

AIMS: Studies in the 1980s and early 1990s showed striking increases in hospitalization rates for heart failure. This report describes contemporary trends in hospitalization for heart failure. METHODS: Scotland (population of 5.1 million) has a well described system for recording details of all hospitalizations. All hospital discharges (and deaths) can be linked to each patient. We examined the period 1990-1996 (158 989 hospitalizations with a principal or secondary diagnosis of heart failure). RESULTS: Compared to 1990, the number of hospitalizations with a principal diagnosis of heart failure increased in men (by 16%) and women (by 12%), although the highest numbers were recorded in 1993 in women (21%) and in 1994 in men (24%). Similar trends were seen for the number of patients hospitalized overall and those having a 'first ever' hospitalization. Hospitalizations with a secondary diagnosis of heart failure increased much more strikingly (by 110% and 60% in men and women, respectively). Re-hospitalization became more common, increasing by 53% and representing 23% of all hospitalizations in 1996. Median length of stay fell (from 9 to 8 days in men and 13 to 10 days in women with a principal diagnosis of heart failure), resulting in 100 877 fewer inpatient days. Heart failure (principal diagnosis) still, however, accounted for 4.2% of all inpatient medicine/geriatric bed-days in 1996. Although inpatient case fatality fell slightly, the total number of deaths due to heart failure (principal diagnosis) increased slightly. CONCLUSIONS: Heart failure continues to be a common cause of hospitalization. The previously reported 'epidemic' of increasing rates of hospitalization for heart failure in Scotland and elsewhere between 1980 and 1990, however, seems to have peaked (in about 1993/4).

Review of the pathologic diagnoses of 2,216 appendectomy specimens.

A retrospective review of 2,216 patients surgically treated for a clinical diagnosis of acute appendicitis was performed. In 80% of cases, histologic acute appendicitis was found; 57% of these patients were male. The rate of normal appendectomy was 16%, and females comprised 68% of that group. The remaining 102 cases (4%) were designated as the alternate diagnosis group. Apart from histologic diagnoses that could be considered variants of normal (57) or acute inflammation (20), the alternate diagnosis group included such entities as neoplasm, parasitic infection, mucocele, and diverticulitis.

A double-blind, crossover trial of mefenamic acid, sulindac and flurbiprofen in rheumatoid arthritis.

A double-blind crossover trial was carried out in 24 patients to compare the effects of mefenamic acid, flurbiprofen, sulindac and placebo. Each drug was given for 2 weeks, the treatment sequence being randomized. Daily doses were 1500 mg mefenamic acid, 150 mg flurbiprofen or 150 mg sulindac. All of the active drugs were significantly superior to placebo in terms of pain score, patients' assessment, articular index of joint tenderness, and duration and severity of morning stiffness. There was improvement in grip strength compared with placebo, but the differences were not statistically significant with sulindac. There was slight reduction in joint circumference but this was only statistically significant in the right hand with flurbiprofen and sulindac. No significant differences were found in technetium uptake in knee joints. The three drugs appeared to be equally effective and tolerated, and no significant differences were noted.

Comparison of sulindac and aspirin in rheumatoid arthritis.

Thirty-one out-patients with rheumatoid arthritis took part in a 10 week double-blind comparison of sulindac (cis-5-fluoro-2-methyl-1-[p-(methylsulphinyl)-benzylidene]-indene-3-acetic acid) 200 mg twice daily and aspirin 3.6 g daily, with a 2-week placebo control period. Both drugs were superior to placebo. The incidence of side-effects was approximately the same on the two drugs, but there was a higher drop-out rate due to side-effects on aspirin.

Comparison of sodium meclofenamate and indomethacin in rheumatoid arthritis.

A double-blind crossover study was conducted in 15 patients with classical definite rheumatoid arthritis to compare the effect of sodium meclofenamate (300 mg daily) with placebo and indomethacin (100 mg daily). Each treatment was administered for 1 week to patients assigned at random to treatment sequences. The active drugs were shown to be significantly superior to placebo. Sodium meclofenamate alone reduced the articular index. Patient preference, however, was in favour of indomethacin.