Publication: Acil Servise Atriyal Fibrilasyonla Başvuran Hastalarda Risk Faktörlerinin Araştırılması
Abstract
Amaç: Atriyal fibrilasyon (AF), aritmiler arasında en sık görülendir. AF, morbidite ve mortalite açısından sürekli takip edilmesi gereken ve multidisipliner yaklaşım ihtiyacı olan bir hastalıktır. Çalışmamızda acil servise başvuran ve AF tanısı alan hastalarda alt tipler arasında AF risk faktörlerini araştırmayı amaçladık. Hastalar ve Yöntem: Ocak 2016-Aralık 2020 tarihleri arasında acil servise başvuran ve AF tanısı alan hastalar çalışmaya dahil edildi. Çalışma, tek merkezde ve retrospektif olarak yapıldı. AF tanılı hastalar klinik alt tiplerine göre dört gruba ayrıldı:1)Yeni Tanı AF, 2)Paroksismal AF, 3)Persistant (ısrarcı) AF ve 4)Permanent (kalıcı) AF. Acil servise dışarıdan ölü olarak olarak getirilen, 18 yaş altı olan , yeterli bilgilerine ulaşılamayan ve AF tanı kriterlerini karşılamayan hastalar çalışmaya dahil edilmedi. Veriler IBM SPSS V23 ile analiz edildi. Bulgular ve Tartışma: Çalışmaya alınan 216 hastanın 119 (%55,1)'u kadındı ve hastaların yaş ortalaması 67,79 (20-94) idi. Hastaların 51 (%23,6)'inde yeni tanı AF, 54 (%25)'ünde paroksismal AF, 3 (%1,3)'ünde persistant AF ve 108 (%50)'inde kalıcı AF vardı. Risk faktörleri arasında en sık görülen hastalık hipertansiyon (HT,%74) iken, bunu kalp yetmezliği (KY,%52,8), koroner arter hastalığı (KAH,%43), kronik böbrek yetmezliği (KBY,%24,5) ve kalp kapak hastalığı (%10,2) izledi. HT, KY, KBY ve kalp kapak hastalığı kalıcı AF'de diğer alt tiplere göre daha yüksek oranda saptandı. Kardiyoembolik olayların engellenmesinde varfarin (vitamin-K-antagonist) kullanımı paroksismal ve kalıcı AF'de benzerken yeni tanı AF'si olanlarda düşüktü. Kapak hastalığı olanların büyük çoğunluğunda varfarin kullanımı mevcuttu. Yeni nesil oral antikogülan (YOAK) kullanımı son yıllarda yaygınlaşmakta olup alt tipler arasında paroksismal AF'de kullanılma oranı daha yüksekti. Sol ventrikül ejeksiyon fraksiyonu (LVEF) daha düşük, sol atriyum (LA) çapı daha yüksek olanlarda kalıcı AF görülme oranı daha fazlaydı. Hastaların %61'ine acil serviste hız kontrolü veya ritm kontrol tedavisi uygulanmıştı. Çalışmamızda alt tipler arasında uygulanmış olan hız ve ritm kontrol stratejileri literatürle benzerdi. Hastaların %31,5'i hastaneye yatırılmıştı. Mortalite oranı %3,7 idi. Sonuç: Acil servise AF tanısı ile başvuran hastalarda kadın cinsiyet daha fazlaydı ve AF alt tipleri arasında kalıcı AF'de yaş ortalaması daha yüksekti. Hipertansiyon, AF'de en sık rastlanan risk faktörüydü ve kalıcı AF'de görülme oranı daha yüksekti. Sigara kullanımı yeni tanı AF'de daha yüksek oranda görülmekteydi. Kalıcı AF'de sol ventrikül ejeksiyon fraksiyonu daha düşük ve sol atriyum çapı daha yüksekti. Sonuç olarak AF'de genel yaklaşım biliniyor olsa da AF'nin alt tipleri hakkındaki veriler sınırlıdır ve çalışmalar devam etmektedir. Anahtar Sözcükler: Acil servis, atriyal fibrilasyon, atriyal fibrilasyon alt tipleri, risk faktörleri
Aim: When carciac arrhythmias come to mention, Atrial Fibrilation (AF) is the most common cardiac arrhythmia disease. Because of AF's high risk of morbidity and mortality, it needs more than one discipline for follow up purposes. Our aim in this study, to investigate risk factors among clinical subtypes of AF in patients who diagnosed with AF in emergency department. Patients and Methods: Patients who were included in this study, people who admitted to emergency department and diagnosed with AF in between January 2016 and December 2020. The study was retropective and performed in our center only. Patients who diagnosed with AF were divided into four groups according to their clinical subtypes: 1) Newly Diagnosed AF, 2) Paroxysmal AF, 3) Persistent AF, and 4) Permanent AF. Patients who are under the age 18, deceased before admitting to emergency department, did not have sufficient information about their medical history and did not meet diagnostic criteria for AF were excluded from study. Data were analyzed with IBM SPSS V23. Results and Discussion: From patients who admitted to emergency department and diagnosed with AF in between January 2016 and December 2020, 216 patients were met the criteria of the study. 119(55.1%) of patients were female. The mean age of the patients was 67.79 (20-94). The number of patients who diagnosed with AF first time were 51(23.6%). Diagnosed with paroxysmal AF was 54 (25%), persistent AF was 3 (1.3%) and permanent AF was 108 (50%). Hypertensiyon (HT 74%) was the most common disease among the risk factors and followed by heart failure (HF, 52.8%), coronary artery disease (CAD, 43%), chronic kidney failure (CRF, 24.5%) and valvular heart disease (10.2%). Mentioned cardiometabolic risk factors were found more frequently in permanent AF than other subtypes. Warfarin's (vitamine K antagonist) effectiveness on prevention of cardiometabolic events was similar in paroxysmal and permanent AF and was lower in newly diagnosed AF. Majority of patients who have valvular disesase were on warfarins. New generation oral anticoagulants become widespread in recent years and were used for paroxysmal AF more often among subtypes. The patients with low ejection fraction and the patients with increased left atrial diameter were commonly patients with permanent AF. Rate control or rhythm control treatment was applied to 61% of the patients in the emergency department. The strategies we used to treat heart rates and arrhythmias in AF was similar with the literature. 31.5% of the patients were hospitalized.The mortality rate was 3,7%. Conclusion: When we look at the patients who admitted emergency department with the diagnosis AF, female patients count was significantly higher than male patient count. Among subtypes of AF the mean age was higher in permanent AF. Hypertension was seen the most common risk factor in AF and its incidence was higher in permanent AF. When we question medical history in newly diagnosed AF, smoking was standing out in history. Lower left ventricule ejection fraction and increased left atrial diameter were seen more in permanent af. Even the general approach to AF is well known, data on subtypes are limited and studies ongoing. Keywords: Emergency department, atrial fibrillation, atrial fibrillation subtypes, risk factors
Aim: When carciac arrhythmias come to mention, Atrial Fibrilation (AF) is the most common cardiac arrhythmia disease. Because of AF's high risk of morbidity and mortality, it needs more than one discipline for follow up purposes. Our aim in this study, to investigate risk factors among clinical subtypes of AF in patients who diagnosed with AF in emergency department. Patients and Methods: Patients who were included in this study, people who admitted to emergency department and diagnosed with AF in between January 2016 and December 2020. The study was retropective and performed in our center only. Patients who diagnosed with AF were divided into four groups according to their clinical subtypes: 1) Newly Diagnosed AF, 2) Paroxysmal AF, 3) Persistent AF, and 4) Permanent AF. Patients who are under the age 18, deceased before admitting to emergency department, did not have sufficient information about their medical history and did not meet diagnostic criteria for AF were excluded from study. Data were analyzed with IBM SPSS V23. Results and Discussion: From patients who admitted to emergency department and diagnosed with AF in between January 2016 and December 2020, 216 patients were met the criteria of the study. 119(55.1%) of patients were female. The mean age of the patients was 67.79 (20-94). The number of patients who diagnosed with AF first time were 51(23.6%). Diagnosed with paroxysmal AF was 54 (25%), persistent AF was 3 (1.3%) and permanent AF was 108 (50%). Hypertensiyon (HT 74%) was the most common disease among the risk factors and followed by heart failure (HF, 52.8%), coronary artery disease (CAD, 43%), chronic kidney failure (CRF, 24.5%) and valvular heart disease (10.2%). Mentioned cardiometabolic risk factors were found more frequently in permanent AF than other subtypes. Warfarin's (vitamine K antagonist) effectiveness on prevention of cardiometabolic events was similar in paroxysmal and permanent AF and was lower in newly diagnosed AF. Majority of patients who have valvular disesase were on warfarins. New generation oral anticoagulants become widespread in recent years and were used for paroxysmal AF more often among subtypes. The patients with low ejection fraction and the patients with increased left atrial diameter were commonly patients with permanent AF. Rate control or rhythm control treatment was applied to 61% of the patients in the emergency department. The strategies we used to treat heart rates and arrhythmias in AF was similar with the literature. 31.5% of the patients were hospitalized.The mortality rate was 3,7%. Conclusion: When we look at the patients who admitted emergency department with the diagnosis AF, female patients count was significantly higher than male patient count. Among subtypes of AF the mean age was higher in permanent AF. Hypertension was seen the most common risk factor in AF and its incidence was higher in permanent AF. When we question medical history in newly diagnosed AF, smoking was standing out in history. Lower left ventricule ejection fraction and increased left atrial diameter were seen more in permanent af. Even the general approach to AF is well known, data on subtypes are limited and studies ongoing. Keywords: Emergency department, atrial fibrillation, atrial fibrillation subtypes, risk factors
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