Morbidity and mortality in 229 elderly patients with nonrheumatic atrial fibrillation. A five-year follow-up.
| Autor: | Bordin P; Department of Medicine, San Daniele del Friuli General Hospital, ASS4 Medio Friuli, Udine. albord@libero.it, Mazzone C, Pandullo C, Goldstein D, Scardi S |
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| Jazyk: | angličtina |
| Zdroj: | Italian heart journal : official journal of the Italian Federation of Cardiology [Ital Heart J] 2003 Aug; Vol. 4 (8), pp. 537-43. |
| Abstrakt: | Background: In the elderly the impact of atrial fibrillation on mortality and morbidity is substantial. Oral anticoagulant therapy reduces the risk of stroke by 70%; nevertheless, it remains largely underused. We evaluated, in a community prospective study, the factors associated with embolic events and death and the feasibility of oral anticoagulant therapy managed by general practitioners. Methods: We enrolled at the Trieste Cardiovascular Center 229 patients aged > or = 65 years with non-rheumatic atrial fibrillation. At baseline, each patient underwent a transesophageal echocardiography and received instructions about oral anticoagulation. Patients were regularly followed by their general practitioner and finally evaluated at the Center. Results: At baseline, the mean age was 73 years, 14% of patients were free of heart disease, 27% had had a previous embolic event, and 33% had an atrial thrombus. After a 5-year follow-up, 85% of the patients had been admitted to hospital, 17% had suffered an embolic event, and 35% were dead. Diabetes and the presence of a low flow in the left atrial appendage were predictive of embolic events. Heart failure, spontaneous echocontrast and aortic plaques were predictive of death. Anticoagulant therapy increased from 14 to 34% but the incidence of major bleeding did not change. The patients on anticoagulant therapy at follow-up constituted the group with the worst cardiovascular profile and embolic rate, but had a lower death rate (19%) compared with those on antiplatelet therapy (32%) and with those without antithrombotic therapy (67%). The hospitalization rates were respectively 78, 83 and 100%. Conclusions: In a group of elderly patients followed by their general practitioner with the support of a specialized cardiologic unit, oral anticoagulant therapy was well tolerated and associated with a significant decrease in mortality and hospitalization. |
| Databáze: | MEDLINE |
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