Effect of age on treatment, trends and outcome of patients hospitalized with atrial fibrillation: insights from a 20-years registry in a middle-eastern country (1991–2010)

Background: Most studies on atrial fibrillation (AF) epidemiology, treatment, and outcomes have included mainly Caucasians patients. The world literature on AF in other ethnicities is very limited particularly in the elderly. Aims: The aim of this study was to compare the clinical characteristics, treatment and outcome of elderly and younger patients hospitalized with AF in a Middle-Eastern country and examine the trends of AF etiologies over a 20-year period. Methods: A retrospective analysis of a prospective registry of all patients hospitalized with AF in Qatar from 1991 through 2010 was made. Patients were divided into three groups; group 1: patients ≦50 years old, group 2: patients between 51 and 70 years old, and group 3: patients >70 years old. Clinical characteristics, management, and outcomes of AF patients were compared according to age. Results: Between the year 1991 and the end of 2010, a total 3848 consecutive patients were admitted with AF. One thousand three hundred and forty-five patients were ≦50 years, 1759 were between 51 and 70 years and 744 patients were >70 years old. Elderly patients were more likely to have hypertension and chronic renal impairment. There was a higher prevalence of associated coronary artery disease and aortic stenosis in elderly patients with a lower left ventricular ejection fraction than the younger age groups. A lower use of anticoagulation in the elderly group was observed but there was no underuse of other evidence-based medications. The older AF patients had significantly higher in-hospital mortality and stroke rates with no significant changes in mortality trends over the 20 years of study. An increasing trend of the associated acute coronary syndromes, hypertension and diabetes mellitus prevalence was observed in the elderly group. Conclusion: Anticoagulation remains underutilized in elderly patients with AF despite proven efficacy and increasing trends of cardiovascular comorbidities. The current study underscores the urgent need for prospective studies to investigate warfarin contraindications, relative warfarin efficacy and bleeding risks in our region to help guide healthcare providers in warfarin prescribing in this frail patient population and consequently reduce the risk of AF-related disabling strokes and mortality.