Patterns of clinical presentation of atrial fibrillation in hospitalized patients

Introduction and objectives. The ACC/AHA/ESC 2001 guidelines for the management of atrial fibrillation (AF) establish 4 categories: first episode, paroxysmal, persistent and permanent. The aim of this study was to analyze the frequency of the different clinical patterns of presentation of AF in hospitalized patients. Patients and method. We analyzed the pattern of AF in 300 hospitalized patients, 200 of whom were admitted to the cardiology and 100 to the internal medicine department. We determined the clinical profile and evaluated the factors influencing therapeutic management. Results. The permanent form was present in 30% of the patients admitted to the cardiology department and in 51% if those admitted to the internal medicine department. The first episode pattern was the most frequent in cardiology department patients (41%). In patients hospitalized the in cardiology the percentage use of anticoagulants (57.9% vs. 41%; p < 0.01) and beta blockers was greater than in internal medicine patients, and digitalis use was lower. In the multivariate analysis, admission to the cardiology department was an independent predictor of treatment with beta blockers (OR = 3.8; 95% Cl, 1.3-11.1; p < 0.05), and discharge from the hospital with AF was a predictor of anticoagulant prescription (OR = 4.8; 95% Cl, 2.5-9.2; p < 0.001). Conclusions. a) Atrial fibrillation is an arrhythmia with a heterogeneous clinical pattern that varies depending on the type of care provided; b) on admission to cardiology, only 30% of the patients present with permanent arrhythmia, and the most frequent clinical pattern is first episode; and c) discharge from the hospital with AF was the principal determinant of therapeutic management.