Atrial fi brillation in Middle Eastern Arab and South Asian patients hospitalized with acute myocardial infarction: experience from a 20-year Registry in Qatar (1991–2010) Is Breast Cancer the Same Disease in Asian and Western Countries? Epidemiology of ischemic stroke from atrial fibrillation in Dijon, France, from 1985 to 2006 Atrial fibrillation incidence and risk factors in relation to race-ethnicity and the population attributable fraction of atrial fibrillation risk factors: the Multi-Ethnic Study of Atherosclerosis. Increased risk of first-ever stroke in younger patients with atrial fibrillation not recommended for antithrombotic therapy by current guidelines: a population-based study in an East Asian cohort of 22 million people. Atrial fibrillation in patients with heart failure: Role of catheter ablation therapies. Incidence of Stroke or Systemic Embolism in Paroxysmal Versus Sustained Atrial Fibrillation: The Fushimi Atrial Fibrillation Registry Safety of edoxaban, an oral factor Xa inhibitor, in Asian patients with non-valvular atrial fibrillation. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation 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) Secular Trends, Treatments, and Outcomes of Middle Eastern Arab and South Asian Patients Hospitalized With Atrial Fibrillation Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Enalapril Decreases the Incidence of Atrial Fibrillation in Patients With Left Ventricular Dysfunction Insight From the Studies Of Left Ventricular Dysfunction (SOLVD) Trials Vascular disease prevalence and risk factors in a screened Korean male population. Relation of renal function to risk for incident atrial fibrillation in women. Time Trends of Aspirin and Warfarin Use on Stroke and Bleeding Events in Chinese Patients With New-Onset Atrial Fibrillation. Women hospitalized with atrial fibrillation: gender differences, trends and outcome from a 20-year registry in a Middle Eastern country (1991-2010). Antithrombotic Treatment Patterns in Patients with Newly Diagnosed Nonvalvular Atrial Fibrillation: The GLORIA-AF Registry, Phase II. Gender Differences in the Risk of Ischemic Stroke and Peripheral Embolism in Atrial Fibrillation: The AnTicoagulation and Risk factors In Atrial fibrillation (ATRIA) Study Left atrial thrombus resolution in atrial fibrillation or flutter: Results of a prospective study with rivaroxaban (X-TRA) and a retrospective observational registry providing baseline data (CLOT-AF). Non-valvular atrial fibrillation in the elderly; preliminary results from the National AFTER (Atrial Fibrillation in Turkey: Epidemiologic Registry) Study. Heavy alcohol consumption and risk of atrial fibrillation. The Circulatory Risk in Communities Study (CIRCS). Epidemiology and patient outcome after medical emergency team calls triggered by atrial fibrillation.
Background Recent evidence suggests that there are ethnic variations in atrial fi brillation ( AF ) susceptibility and incidence following acute myocardial infa rct ion ( AMI ) . Objectives The aim of this study was to evaluate the incidence and predictors of AF in the setting of AMI in Middle Eastern Arab and South Asian patients and its impact on in-hospital morbidity and mortality . Methods A retrospective analysis of a prospect i ve registry of all patients hospitalized with AMI in the state of Qatar from 1991 through 2010 was made . Clinical characteristics and outcomes of  AMI patients with and without AF  were compared . Sub- analysis according to ethnicity was also performed . Results During the 20-year period ; a total of 12,881 patients were hospitalized with AMI . Of these 5028 were Arabs and 5985 were South Asians . A total of 227 had AF during hospitalization with an overall incidence of 1.8 % ( 156 Arabs ; incidence 3.1 % and 48 South Asians ; incidence 0.8 % ) . The mean age of AF patients was 65 years ( Arabs 69 , South Asians 54 ) . Patients with AF were signifi cantly older and had more cardiovascular co-morbidities than patients without AF , and were more likely to have non-ST elevation AMI on presentation . Patients with AF had signifi cantly higher in-hospital mortality rate ( 20.3 % versus 7.1 % ; P= 0.001 ) and stroke rates ( 1.8 % versus 0.3 % ; P= 0.001 ) when compared to patients without AF . Age was the only independent predictor of AF development in patients with AMI in our study . Conclusions Our study reports variability in the prevalence of AF among AMI patients according to ethnicity using a 20-year registry from a Middle Eastern country . Advancing age was the major independent predictor of AF in our AMI patients . Further prospect i ve studies are required evaluating optimal therapeutic approaches for these high-risk patients in order to reduce the high mortality observed A mini-symposium was held in Montreal , Canada , at the International Surgical Week for the Breast Surgical International in 2007 addressing the question whether breast cancer is the same disease in Asian and Western countries . Numerous investigators from Asian and Western countries presented the epidemiologic and clinical outcome data of women with breast cancer . Although there are significant similarities , the striking difference is that the peak age for breast cancer is between 40 and 50 years in the Asian countries , whereas the peak age in the Western countries is between 60 and 70 years . Also , the incidence of breast cancer in Asia is rising and is associated with increased mortality . In the West , although the incidence is increasing , the mortality rate is definitely decreasing . Future prospect i ve data collection from Asian and Western countries may provide further interesting epidemiologic and outcome data regarding the outcome of women with breast cancer from Asian and Western countries . Background Whether breast cancer is the same disease in Asian and Western countries was the topic of a 2007 Breast Surgery International symposium at International Surgical Week . Methods Participating investigators from China , Taiwan , India , Japan , South Korea , Sweden , Canada , and the United States were asked beforeh and to provide data on the epidemiology and treatment outcome of women in their countries . Results Comparisons of the epidemiologic and clinical outcome data of women with breast cancer  showed significant similarities , but the striking difference is that the peak age is between 40 and 50 years in Asian countries , but is between 60 and 70 years in Western countries . The incidence of breast cancer in Asia is rising and is associated with increased mortality . In the West , although the incidence is also increasing , the mortality rate is definitely decreasing . Discussion Future prospect i ve data collection from Asian and Western countries may provide further interesting epidemiologic and outcome data regarding the outcome of women with breast cancer from Asian and Western countries Background : Atrial fibrillation ( AF ) is strongly associated with age , and epidemiologic studies are needed to evaluate the impact of both aging of the population and the use of anticoagulant therapy in patients with AF on the incidence of cardioembolic stroke with AF ( CE/AF stroke ) . Methods : We evaluated trends in incidence rates , risk factors , prestroke therapy , and survival in CE/AF stroke from a prospect i ve population -based registry , from 1985 to 2006 . Results : A total of 3,064 ischemic  strokes , including 572 ( 18.7 % ) CE/AF strokes , were recorded . Over the 22 years , a decrease in the incidence of overall CE/AF stroke was noted ( incidence rate ratio 0.9858 , 95 % confidence interval [ CI ] 0.9731–0.9986 ; p = 0.03 ) . We observed a higher prevalence of previous AF , previous myocardial infa rct ion , and patients aged > 70 years in CE/AF stroke ( p < 0.0001 ) whereas hypercholesterolemia was more prevalent in other ischemic strokes ( p = 0.003 ) . A significant increase in the use of anticoagulants and antiplatelet agents  was noted , and was particularly pronounced for CE/AF stroke with previous AF . For CE/AF stroke , survival rates were 72 % at 1 month ( 95 % CI 0.68–0.76 ) , 52 % at 1 year ( 95 % CI 0.48–0.56 ) , and 43 % at 2 years ( 95 % CI 0.39–0.48 ) , and remained lower than those of other ischemic stroke . Conclusions : The decrease in the incidence of cardioembolic/atrial fibrillation stroke in our study was probably due to a slight increase in the utilization of antithrombotic therapy in patients with atrial fibrillation , but the use of such therapies will have to increase further because of the expected aging of the population in coming years . AF = atrial fibrillation ; CE = cardioembolic ; CI = confidence interval ; IRR = incidence rate ratios PURPOSE We studied incident atrial fibrillation ( AF ) in the prospect i ve community-based Multi-Ethnic Study of Atherosclerosis ( MESA ) . Reportedly , non-Hispanic blacks ( NHBs ) have a lower AF burden compared with their non-Hispanic white ( NHW ) counterparts . Information on the epidemiology of AF in Hispanic and Asian population s is much more limited . METHODS We excluded participants with a history of AF at enrollment . A total of 6721 MESA participants were monitored for the first AF event ascertained according to hospital discharge International Classification of Diseases , Ninth Revision , codes . Age- and sex-adjusted incidence rates ( IRs ) of AF were calculated per 1000 person-years of observation . IR ratios were calculated using NHWs as the reference group . Age- and sex-adjusted population attributable fractions ( PAFs ) of established modifiable AF risk factors were ascertained . RESULTS In the MESA cohort , 47.2 % was male ; at baseline , 25.7 % had hypertension ; 12.5 % had diabetes . Three hundred five incident hospitalized AF events occurred over a mean follow-up of 7.3 years . Age- and sex-adjusted IRs and IR ratios showed that overall AF incidence was significantly lower among Hispanics , NHBs and Chinese compared with NHWs ( all P < .001 ) . Among participants 65 years of age or greater , Hispanics , Chinese , and blacks had significantly lower AF incidence than NHWs ( all P ≤ .01 ) , but IRs were similar among participants under age 65 years . The PAF for smoking was 27 % among NHBs but lower among other race-ethnic groups . Among NHWs , the PAF for hypertension was 22.2 % , but this was higher among NHBs ( 33.1 % ) , Chinese ( 46.3 % ) , and Hispanics ( 43.9 % ) . CONCLUSIONS Overall , the incidence of hospitalized AF was significantly lower in Hispanics , NHBs , and Chinese than in NHWs . A larger proportion of AF events appear to be attributable to hypertension among nonwhite population s compared with NHWs OBJECTIVE To assess the risk of first-ever ischemic stroke in younger patients with atrial fibrillation ( AF ) who have none of the CHA2DS2-VASc ( congestive heart failure , hypertension , age ≥75 years , diabetes mellitus , previous stroke/transient ischemic attack , vascular disease , age 65 - 74 years , sex category [ female sex ] ) risk factors ( excluding female sex ) by using the National Health Insurance research data base in Taiwan . PATIENTS AND METHODS From 22,842,778 insured people , we identified 24,612 hospitalized patients with newly diagnosed AF between January 1 , 2002 , and December 31 , 2004 , as the AF group and r and omly selected 98,448 age- and sex-matched persons without AF as the non-AF group . Both groups were followed up until December 31 , 2010 , to estimate ischemic stroke incidences in relation to other stroke risk factors . RESULTS During a follow-up period of 89,468 person-years , the stroke rate was higher in patients with AF than in those without AF ( 5.79 per 100 person-years vs 2.25 per 100 person-years ) . The higher prevalence of CHA2DS2-VASc comorbidities ( heart failure , hypertension , diabetes , coronary artery disease , and peripheral artery disease ) in patients with AF further increased the stroke risk . In 790 patients with AF aged 30 to 55 years who had none of the CHA2DS2-VASc comorbidities at baseline and retained a " low risk , " that is , those with a CHA2DS2-VASc score of 0 in men and 1 in women during follow-up , the stroke rate remained considerably higher than that in their non-AF counterparts ( 1.00 per 100 person-years vs 0.25 per 100 person-years ) , with a sex-adjusted hazard ratio of 4.09 ( 95 % CI , 2.97 - 5.62 ) . CONCLUSION This study finds an increased risk of stroke in younger patients with AF who are not recommended for prevention of thromboembolism by current guidelines . Better stroke risk stratification tools are needed to prioritize younger patients with AF for thromboprophylactic therapy in this population Atrial fibrillation ( AF ) represents the most common sustained cardiac arrhythmia in patients with heart failure ( HF ) . AF in HF patients is associated with worsening of symptoms and also results in a substantial increase in mortality . Although HF patients in sinus rhythm have a better outcome than patients with AF , several r and omized studies investigating pharmacological rhythm control versus rate control have shown no advantage of one strategy over the other in terms of patient outcomes . Catheter-based ablation therapy is a newer therapeutic option with a rapidly evolving and changing role in the management of this arrhythmia . In the present review , the authors discuss the epidemiology , pathophysiology and prognostic significance of AF in patients with HF . Exclusively addressed are studies investigating catheter-based ablation for rhythm-control and rate-control therapies in the management of AF in HF patients Background and Purpose — There is controversy on the relationship of the type of atrial fibrillation ( AF ) to stroke . Although several studies show that patients with paroxysmal AF ( PAF ) have a stroke risk similar to those with persistent or permanent AF , recent studies suggest that PAF is associated with a lower rate of stroke . Limited data on stroke risk associated with PAF are evident in Asian population s. Methods — The Registry Study of Atrial Fibrillation Patients in Fushimi-ku ( Fushimi AF Registry ) is a community-based survey of patients with AF in Fushimi-ku , Kyoto , Japan . Patients were categorized into 2 types of AF : PAF or sustained ( persistent or permanent ) AF . We compared clinical events between PAF  ( n=1588 ) and  sustained AF ( n=1716 ) . Results — Patients with PAF were younger , had less comorbidities , and received oral anticoagulants ( OAC ) less commonly . A lower risk of stroke/systemic embolism during follow-up period in the patients with PAF was consistently observed ( non-OAC users : hazard ratio , 0.45 ; 95 % confidence intervals , 0.27–0.75 ; P<0.01 and OAC users : hazard ratio , 0.59 ; 95 % confidence interval , 0.35–0.93 ; P=0.03 ) . The composite end point of stroke/systemic embolism/all-cause mortality was also lower in PAF , whether among OAC users ( hazard ratio , 0.77 ; 95 % confidence interval , 0.59–0.99 ; P=0.046 ) or non-OAC users ( hazard ratio , 0.59 ; 95 % confidence interval , 0.46–0.75 ; P<0.01 ) . On multivariate analysis , PAF was an independent predictor of lower stroke/systemic embolism risk . Conclusions — In this large cohort of Japanese patients with AF , PAF was independently associated with lower incidence of stroke/systemic embolism than sustained AF . This may aid decision making for anticoagulation , especially in those patients with AF with few stroke risk factors . Clinical Trial Registration — URL : http://www.umin.ac.jp/ctr/index.htm . Unique identifier : UMIN000005834 Edoxaban is an oral , reversible , direct factor Xa inhibitor in phase III clinical development for the prevention of stroke in atrial fibrillation ( AF ) . A phase II study was undertaken to evaluate the safety and efficacy of edoxaban in Asian patients with non-valvular AF with CHADS2 score ≥1 . In a multicentre , active-controlled , double-blind edoxaban and open-label warfarin , parallel-group study , a total of 235 patients from four Asian countries were r and omly assigned to edoxaban 30 mg qd , 60 mg qd or warfarin dose adjusted to international normalised ratio of 2 - 3 for three months . The primary endpoint was the incidence of central ly adjudicated all bleeding events ( major , clinical ly relevant non-major and minor ) . Secondary endpoints included thromboembolic events , biomarkers of thrombus formation and all adverse events ( AEs ) . The incidence of all bleeding events ( 95 % CI ) was 20.3 % ( 12.9 , 30.4 ) for edoxaban 30 mg , 23.8 % ( 15.8 , 34.1 ) for edoxaban 60 mg , and 29.3 % ( 20.2 , 40.4 ) for warfarin . A subgroup analysis suggested low body weight ( ≤60 kg ) may affect the incidence of bleeding  events with edoxaban . The incidence of study drug-related AEs was 22 % for edoxaban 30 mg , 29 % for edoxaban 60 mg and 33 % for warfarin . No thromboembolic events occurred in any treatment group . In conclusion , this phase II study found a trend for a reduction in the incidence of all bleeding events in Asian AF patients  with edoxaban 30 mg and 60 mg compared with warfarin . Adverse events were similar between the edoxaban 60-mg and warfarin groups and were lower with the edoxaban 30-mg group During the past three decades , catheter and surgical ablation of  atrial fibrillation ( AF ) have evolved from investigational procedures to their current role as effective treatment options for patients with AF .  Surgical ablation of AF , using either st and ard , minimally invasive , or hybrid techniques , is available in most major hospitals throughout the world . Catheter ablation of AF is even more widely available , and is now the most commonly performed catheter ablation procedure . In 2007 , an initial Consensus Statement on Catheter and Surgical AF Ablation was developed as a joint effort of the Heart Rhythm Society ( HRS ) , the European Heart Rhythm Association ( EHRA ) , and the European Cardiac Arrhythmia Society (ECAS).1 The 2007 document was also developed in collaboration with the Society of Thoracic Surgeons ( STS ) and the American College of Cardiology ( ACC ) . This Consensus Statement on Catheter and Surgical AF Ablation was rewritten in 2012 to reflect the many advances in AF ablation that had occurred in the interim.2 The rate of advancement in the tools , techniques , and outcomes of AF ablation continue to increase as enormous research efforts are focused on the mechanisms , outcomes , and treatment of AF . For this reason , the HRS initiated an effort to rewrite and up date this Consensus Statement . Reflecting both the worldwide importance of AF , as well as the worldwide performance of AF ablation , this document is the result of a joint partnership between the HRS , EHRA , ECAS , the Asia Pacific Heart Rhythm Society ( APHRS ) , and the Latin American Society of Cardiac Stimulation and Electrophysiology ( Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia [ SOLAECE ] ) . The purpose of this 2017 Consensus Statement is to provide a state-of-the-art review of the field of catheter and surgical ablation of AF and to report the findings of a writing group , convened by these five international societies . The writing group is charged with defining the indications , techniques , and outcomes of AF ablation procedures . Included within this document are recommendations pertinent to the design of clinical trials in the field of AF ablation and the reporting of outcomes , including definitions relevant to this topic . The writing group is composed of 60 experts representing 11 organizations : HRS , EHRA , ECAS , APHRS , SOLAECE , STS , ACC , American Heart Association ( AHA ) , Canadian Heart Rhythm Society ( CHRS ) , Japanese Heart Rhythm Society ( JHRS ) , and Brazilian Society of Cardiac Arrhythmias ( Sociedade Brasileira de Arritmias Cardiacas [ SOBRAC ] ) . All the members of the writing group , as well as peer review ers of the document , have provided disclosure statements for all relationships that might be perceived as real or potential conflicts of interest . All author and peer review er disclosure information is provided in Appendix A and Appendix B. In writing a consensus document , it is recognized that consensus does not mean that there was complete agreement among all the writing group members . Surveys of the entire writing group were used to identify areas of consensus concerning performance of AF ablation procedures and to develop recommendations concerning the indications for catheter and surgical AF ablation . These recommendations were systematic ally balloted by the 60 writing group members and were approved by a minimum of 80 % of these members . The recommendations were also subject to a 1-month public comment period . Each partnering and collaborating organization then officially review ed , commented on , edited , and endorsed the final document and recommendations . The grading system for indication of class of evidence level was adapted based on that used by the ACC and the AHA.3,4 It is important to state , however , that this document is not a guideline . The indications for catheter and surgical ablation of AF , as well as recommendations for procedure performance , are presented with a Class and Level of Evidence ( LOE ) to be consistent with what the reader is familiar with seeing in guideline statements . A Class I recommendation means that the benefits of the AF ablation procedure markedly exceed the risks , and that AF ablation should be performed ; a Class IIa recommendation means that the benefits of an AF ablation procedure exceed the risks , and that it is reasonable to perform AF ablation ; a Class IIb recommendation means that the benefit of AF ablation is greater or equal to the risks , and that AF ablation may be considered ; and a Class III recommendation means that AF ablation is of no proven benefit and is not recommended . The writing group review ed and ranked evidence supporting current recommendations with the weight of evidence ranked as Level A if the data were derived from high- quality evidence from more than one r and omized clinical trial , meta-analyses of high- quality r and omized clinical trials , or one or more r and omized clinical trials corroborated by high- quality registry studies . The writing group ranked available evidence as Level B-R when there was moderate- quality evidence from one or more r and omized clinical trials , or meta-analyses of moderate- quality r and omized clinical trials . Level B-NR was used to denote moderate- quality evidence from one or more well- design ed , well-executed nonr and omized studies , observational studies , or registry studies . This design ation was also used to denote moderate- quality evidence from meta-analyses of such studies . Evidence was ranked as Level C-LD when the primary source of the recommendation was r and omized or nonr and omized observational or registry studies with limitations of design or execution , meta-analyses of such studies , or physiological or mechanistic studies of human subjects . Level C-EO was defined as expert opinion based on the clinical experience of the writing group . Despite a large number of authors , the participation of several societies and professional organizations , and the attempts of the group to reflect the current knowledge in the field adequately , this document is not intended as a guideline . Rather , the group would like to refer to the current guidelines on AF management for the purpose of guiding overall AF management strategies.5,6 This consensus document is specifically focused on catheter and surgical ablation of AF , and summarizes the opinion of the writing group members based on an extensive literature review as well as their own experience . It is directed to all health care professionals who are involved in the care of patients with AF , particularly those who are caring for patients who are undergoing , or are being considered for , catheter or surgical ablation procedures for AF , and those involved in research in the field of AF ablation . This statement is not intended to recommend or promote catheter or surgical ablation of AF . Rather , the ultimate judgment regarding care of a particular patient must be made by the health care provider and the patient in light of all the circumstances presented by that patient . The main objective of this document is to improve patient care by providing a foundation of knowledge for those involved with catheter ablation of AF . A second major objective is to provide recommendations for design ing clinical trials and reporting outcomes of clinical trials of AF ablation . It is recognized that this field continues to evolve rapidly . As this document was being prepared , further clinical trials of catheter and surgical ablation of AF were under way 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 prospect i ve 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 thous and 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 prospect i ve 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 A prospect i ve registry was made of all patients hospitalized with atrial fibrillation ( AF ) in the State of Qatar from 1991 to 2010 .  Clinical characteristics , management , and outcomes were compared according to ethnicity ( Middle Eastern Arab vs South Asian ) . During this 20-year period , 2857 Arabs and 548 Asians were hospitalized for AF . Arabs were 9 years older and more likely to have hypertension , diabetes mellitus ( DM ) , chronic renal impairment , and dyslipidemia than the Asians . Valvular heart disease and acute coronary syndromes were more common among Asians , while congestive heart failure was more common in Arabs . The overall inhospital mortality was lower in Asians than that of Arabs , while stroke rates were comparable . There was an increase in the prevalence of DM and hypertension in both the groups in the latter years of the study period , but there was no change in mortality trends . Our findings underscore the need to study AF according to ethnicity AIMS We aim ed to investigate the prevalence and incidence of atrial fibrillation ( AF )  in a large European population -based study . METHODS AND RESULTS The study is part of the Rotterdam study , a population -based prospect i ve cohort study among subjects aged 55 years and above . The prevalence at baseline was assessed in 6808 participants .  Incidence of AF was investigated during a mean follow-up period of 6.9 years in 6432 persons . We identified 376 prevalent and 437 incident cases . Overall prevalence was 5.5 % , rising from 0.7 % in the age group 55 - 59 years to 17.8 % in those aged 85 years and above . The overall incidence rate was 9.9/1000 person-years . The incidence rate in the age group 55 - 59 years was 1.1/1000 person-years , rose to 20.7/1000 person-years in the age group 80 - 84 years and stabilized in those aged 85 years and above . Prevalence and incidence were higher in men than in women . The lifetime risk to develop AF at the age of 55 years was 23.8 % in men and 22.2 % in women . CONCLUSION In this prospect i ve study in a European population , the prevalence and incidence of AF increased with age and were higher in men than in women . The high lifetime risk to develop AF was similar to North American epidemiological data Background Atrial fibrillation ( AF ) is frequently encountered in patients with heart failure ( HF ) and is also a predictor of morbidity and mortality in this population . Recent experimental studies have shown electrical and structural atrial remodeling with increased fibrosis in animals with HF and have suggested a preventive effect of ACE inhibitors ( ACEi ) on the development of AF . To verify the hypothesis that ACEi prevent the development of AF in patients with HF , we conducted a retrospective analysis of the patients from the Montreal Heart Institute ( MHI ) included in the Studies Of Left Ventricular Dysfunction ( SOLVD ) . Methods and Results Clinical charts were review ed and serial ECGs interpreted by a single cardiologist blinded to drug allocation . Patients with AF or flutter on the baseline ECG were excluded . Baseline characteristics were obtained from the SOLVD data bases . The mean follow‐up was 2.9±1.0 years . Of the 391 patients r and omly assigned at MHI , 374 were in sinus rhythm at the time of r and om assignment , with 186 taking enalapril and 188 taking placebo .  Baseline characteristics were similar in the two groups except for a higher incidence of previous myocardial infa rct ion in the enalapril group . Fifty‐five patients had AF during the follow‐up : 10 ( 5.4 % ) in the enalapril group and 45 ( 24 % ) in the placebo group ( P<0.0001 ) . By Cox multivariate analysis , enalapril was the most powerful predictor for risk reduction of AF ( hazard ratio , 0.22 ; 95 % CI , 0.11 to 0.44 ; P<0.0001 ) . Conclusions Treatment with the ACEi enalapril markedly reduces the risk of development of atrial fibrillation in patients with left ventricular dysfunction . ( Circulation . 2003;107:2926‐2931 . BACKGROUND Vascular diseases , such as carotid artery stenosis ( CAS ) , abdominal aortic aneurysm ( AAA ) , and peripheral arterial occlusive disease ( PAD ) of the lower limb , are common in elderly men . These diseases have not been thoroughly reported in Eastern countries as well as in Western countries . We compare the prevalence rates in Korea with previous reports , and evaluate correlations between known risk factors and these conditions in this population . MATERIAL S AND METHODS From November 2008 to December 2012 , elderly men ( ≥65 years ) were r and omly referred from the Incheon Federation of the Korean Senior Citizens ' Association , which is one of the major organizations representing retired individuals in Korea .  CAS was defined as ≥50 % of internal CAS , AAA was defined as ≥3 cm aortic diameter , and PAD of the lower limb was defined as an ankle brachial index ≤0.9 . RESULTS The average age was 72.14 ± 5.15 years .  CAS  was detected in 116 subjects ( 7.2 % ) , AAA  was detected in 52 subjects ( 3.2 % ) , and PAD was detected in 79 subjects ( 4.9 % ) . On multivariate analysis , octogenarian status and coronary artery disease were significantly associated with CAS and current smoking was significantly associated with PAD ( P < 0.001 ) . CONCLUSIONS The Korean prevalence rates of CAS and PAD in this study are similar to previous reports . The prevalence of AAA in Korea is lower compared with western reports , but higher than previous Asian reports . It is presently necessary to conduct major clinical studies throughout Asian countries to prepare for a rapid increase in the prevalence of major vascular diseases in Asia Few prospect i ve studies have explored the association between renal function and risk for  incident atrial fibrillation ( AF ) in apparently healthy population s. A total of 24,746 women participating in the Women 's Health Study who were free of cardiovascular disease and AF and provided blood sample s at baseline were prospect ively followed for incident AF from 1993 to 2010 . AF events were confirmed by medical chart review . Estimated glomerular filtration rate ( eGFR ) was calculated from baseline creatinine using the Chronic Kidney Disease Epidemiology ( CKD-EPI ) equation . Cox models were used to estimate hazard ratios and 95 % confidence intervals ( CIs ) for incident AF across eGFR categories controlling for AF risk factors . During a median of 15.4 years of follow-up , 786 incident AF events occurred . The multivariate-adjusted hazard ratios for incident AF across eGFR categories ( < 60 , 60 to 74.9 , 75 to 89 , and ≥90 ml/min/1.73 m(2 ) ) were 1.36 ( 95 % CI 1.00 to 1.84 ) , 0.90 ( 95 % CI 0.71 to 1.14 ) , 0.99 ( 95 % CI 0.84 to 1.18 ) and 1.00 , respectively , without evidence of a linear association ( P for trend = 0.48 ) . Similarly , there was no significant curvilinear association ( quadratic p = 0.10 ) in multivariate analysis across categories . Compared to women with eGFRs ≥60 ml/min/1.73 m(2 ) , the 1,008 women with eGFRs < 60 ml/min/1.73 m(2 ) had a multivariate-adjusted hazard ratio for AF of 1.39 ( 95 % CI 1.04 to 1.86 , p = 0.03 ) . In conclusion , no significant linear or curvilinear relation was observed between incident AF and less severe impairment of renal function in this large prospect i ve cohort of women . However , a significant elevation in AF risk was observed at a threshold eGFR of < 60 ml/min/1.73 m(2 ) BACKGROUND Much of the clinical epidemiology and treatment patterns for patients with atrial fibrillation ( AF ) are derived from Western population s. Limited data are available on antithrombotic therapy use over time and its impact on the stroke or bleeding events in newly diagnosed Chinese patients with AF . The present study investigates time trends in warfarin and aspirin use in China in relation to stroke and bleeding events in a Chinese population . METHODS We used a medical insurance data base involving > 10 million individuals for the years 2001 to 2012 in Yunnan , a southwestern province of China , and performed time-trend analysis on those with newly diagnosed AF . Cox proportional hazards time-varying exposures were used to determine the risk of stroke or bleeding events associated with antithrombotic therapy among patients with AF . RESULTS Among the r and omly sample d 471,446 participants , there were 1,237 patients with AF , including 921 newly diagnosed with AF , thus providing 4,859 person-years of experience ( 62 % men ; mean attained age , 70 years ) . The overall rate of antithrombotic therapy  was 37.7 % ( 347 of 921 patients ) , with 4.1 % ( 38 of 921 ) on warfarin and 32.3 % ( 298 of 921 ) on aspirin . Antithrombotic therapy was not related to stroke/bleeding risk scores ( CHADS2 [ congestive heart failure , hypertension , age ≥ 75 years , diabetes , stroke ( doubled ) ] score , P = .522 ; CHA2DS2-VASc [ congestive heart failure , hypertension , age ≥ 75 years ( doubled ) , diabetes mellitus , stroke or transient ischemic attack ( doubled ) , vascular disease , age 65 to 74 years , and female sex ] score , P = .957 ; HAS-BLED [ hypertension , abnormal renal/liver function , stroke , bleeding history or predisposition , labile international normalized ratio , elderly ( > 65 years ) , drugs/alcohol concomitantly ] score , P = .095 ) . The use of antithrombotic drugs ( mainly aspirin )  increased in both women and men over time , with the rate of aspirin  increasing from 4.0 % in 2007 to 46.1 % in 2012 in the former , and from 7.7 % in 2007 to 61.9 % in 2012 in the latter ( P for trend for both , < .005 ) . In the overall cohort , the annual stroke rate was approximately 6 % and the annual major bleeding rate was about 1 % . Compared with nonantithrombotic therapy , the hazard ratio for ischemic stroke was 0.68 ( 95 % CI , 0.39 - 1.18 ) for aspirin and 1.39 ( 0.54 - 3.59 ) for warfarin . CONCLUSIONS  Aspirin use increased among Chinese patients newly diagnosed with AF , with no relationship to the patient 's stroke or bleeding risk .  Warfarin use was very low . Given the health-care burden of AF and its complications , our study has major implication s for health-care systems in non-Western countries , given the global burden of this common arrhythmia BACKGROUND Most of the published research on atrial fibrillation ( AF ) is limited to studies in the developed world and included mainly Caucasian patients . Data about women with AF among other ethnicities is very limited . OBJECTIVES The aim of this study was to compare the clinical characteristics , treatment and outcome of women to men hospitalized with AF in a middle-eastern country . METHODS Retrospective analysis of prospect i ve registry of all patients hospitalized with AF in Qatar from 1991 through 2010 was made . Clinical characteristics , management , and outcomes of AF patients were compared according to gender . RESULTS During the 20-years period ; 1417 women and 2432 men were hospitalized for AF . Women were 5 years older and more likely to have diabetes mellitus , hypertension , and chronic renal impairment and were also less likely to be current smokers and to have ischemic heart disease and impaired left ventricular function when compared to men . There was no gender preference in the use of anticoagulation . The prevalence of concomitant ischemic heart disease and hypertension increased , while the prevalence of valvular heart disease and heart failure decreased among patients hospitalized with AF over the study period . In-hospital mortality and stroke rates were comparable between the two groups . CONCLUSIONS Women hospitalized with atrial fibrillation were older in age and had higher prevalence of co-morbid cardiovascular risk factors compared to men whereas , mortality and stroke rates were comparable BACKGROUND The Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation ( GLORIA-AF ) was design ed to provide prospect ively collected information on patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke , with the aim of addressing treatment patterns and questions of effectiveness and safety . METHODS AND RESULTS In this predefined analysis from GLORIA-AF , the baseline characteristics and initial antithrombotic management of the first 10,000 patients in Phase II of this large Registry Program are presented . Overall , 32.3 % of patients received vitamin K antagonists ( VKAs ) and 47.7 % received non-VKA oral anticoagulants ( NOACs ) , while 12.3 % received antiplatelet treatment and 7.6 % did not receive any antithrombotic treatment . Among patients with CHA2DS2-VASc score ≥2 , 6.7 % received no antithrombotic treatment and 10.0 % received aspirin . In Europe , treatment with dabigatran was as common as treatment with VKAs ( 38.8 % and 37.8 % , respectively ) . More than half of the patients were treated with NOACs ( 52.4 % ) , while antiplatelet treatment was given to 5.7 % , and 4.1 % did not receive any antithrombotic treatment . In North America , treatment with dabigatran  ( 25.0 % ) was as common as with VKAs ( 26.1 % ) , but overall NOAC use was more common ( 52.1 % ) than with VKAs ( 26.1 % ) ; however , 14.1 % received antiplatelet treatment , while 7.6 % received no antithrombotic treatment . In Asia , treatment with VKAs ( 31.9 % ) was more prevalent than NOACs ( 25.5 % ) , but antiplatelet treatment was given to 25.8 % , and 16.9 % did not receive any antithrombotic treatment . In Asia , only 60.7 % of patients with high stroke risk received oral anticoagulants ( OACs ) . Paroxysmal atrial fibrillation and minimally symptomatic ( or asymptomatic ) patients were often undertreated with OACs . CONCLUSION In this analysis , OAC use was high in Europe and North America , with overall NOAC use higher than VKA use . A considerable percentage of high-risk patients in North America still received antiplatelet treatment or were untreated , while Asian patients had a high proportion of aspirin use and nontreatment Background —Previous studies provide conflicting results about whether women are at higher risk than men for thromboembolism in the setting of atrial fibrillation ( AF ) . We examined data from a large contemporary cohort of AF patients to address this question . Methods and Results —We prospect ively studied 13 559 adults with AF and recorded data on patients ’ clinical characteristics and the occurrence of incident hospitalizations for ischemic stroke , peripheral embolism , and major hemorrhagic events through search ing vali date d computerized data bases and medical record review . We compared event rates by patient sex using multivariable log-linear regression , adjusting for clinical risk factors for stroke , and stratifying by warfarin use . We identified 394  ischemic stroke and peripheral embolic events during 15 494 person-years of follow-up off warfarin . After multivariable analysis , women had higher annual rates of thromboembolism off warfarin than did men ( 3.5 % versus 1.8 % ; adjusted rate ratio [ RR ] , 1.6 ; 95 % CI , 1.3 to 1.9 ) . There was no significant difference by sex in 30-day mortality after thromboembolism ( 23 % for both ) . Warfarin use was associated with significantly lower adjusted thromboembolism rates for both women and men ( RR , 0.4 ; 95 % CI , 0.3 to 0.5 ; and RR , 0.6 ; 95 % CI , 0.5 to 0.8 , respectively ) , with similar annual rates of major hemorrhage ( 1.0 % and 1.1 % , respectively ) . Conclusions —Women are at higher risk than men for AF-related thromboembolism off warfarin . Warfarin therapy appears be as effective in women , if not more so , than in men , with similar rates of major hemorrhage . Female sex is an independent risk factor for thromboembolism and should influence the decision to use anticoagulant therapy in persons with AF BACKGROUND Data on left atrial/left atrial appendage ( LA/LAA ) thrombus resolution after non-vitamin K antagonist ( VKA ) oral anticoagulant treatment are scarce . The primary objective of X-TRA was to explore the use of rivaroxaban for the resolution of LA/LAA thrombi in patients with nonvalvular atrial fibrillation ( AF ) or atrial flutter , with the CLOT-AF registry providing retrospective data after st and ard-of-care therapy in this setting . METHODS X-TRA was a prospect i ve , single-arm , open-label , multicenter study that investigated rivaroxaban treatment for 6 weeks for LA/LAA thrombus resolution in patients with nonvalvular AF or atrial flutter and LA/LAA thrombus confirmed at baseline on a transesophageal echocardiogram ( TEE ) .  CLOT-AF retrospectively collected thrombus-related patient outcome data after st and ard-of-care anticoagulant treatment for 3 to 12 weeks in patients with nonvalvular AF or atrial flutter who had LA/LAA thrombi on TEE recorded in their medical file . RESULTS In X-TRA , patients were predominantly ( 95.0 % ) from Eastern European countries . The adjudicated thrombus resolution rate was 41.5 % ( 22/53 modified intention-to-treat [ mITT ] patients , 95 % CI 28.1%-55.9 % ) based on central TEE assessment s. Resolved or reduced thrombus was evident in 60.4 % ( 32/53 mITT patients , 95 % CI 46.0%-73.6 % ) of patients . In CLOT-AF , the reported thrombus resolution rate was 62.5 % ( 60/96 mITT patients , 95 % CI 52.0%-72.2 % ) and appeared better in Western European countries ( 34/50 ; 68.0 % ) than in Eastern European countries ( 26/46 ; 56.5 % ) . CONCLUSION X-TRA is the first prospect i ve , multicenter study examining LA/LAA thrombus resolution with a non-VKA oral anticoagulant in VKA-naïve patients or in patients with suboptimal VKA therapy . Rivaroxaban could be a potential option for the treatment of LA/LAA thrombi OBJECTIVE This study aim ed at the assessment of the clinical approach to atrial fibrillation ( AF ) in the older population and the consistency with the guidelines based on the records of the multicenter , prospect i ve AFTER ( Atrial Fibrillation in Turkey : Epidemiologic Registry ) study . PATIENTS AND METHODS 2242 consecutive patients admitted to the Cardiology Outpatient Clinics of 17 different tertiary Health Care Centers with at least one AF attack determined on electrocardiographic examination , were included in the study . Among the patients included in the study , 631 individuals aged 75 years and older were analyzed . RESULTS The mean age of the patients was determined as 80.3±4.2 years . The most frequent type of AF in geriatric population was the persistent-permanent type with a percentage of 88 % . 60 % of the patients with AF were female . Hypertension was the most common co-morbidity in patients with AF ( 76 % ) . While in 16 % of patients a history of stroke , transient ischemic attack or systemic thromboembolism was present , a history of bleeding was present in 14 % of the patients . 37 % of the patients were on warfarin treatment and 60 % of the patients were on aspirin treatment . In 38 % of the patients who were on oral anticoagulant  treatment , INR level was in the effective range . CONCLUSIONS The rate of anticoagulant  use in the elderly with AF was 37 % and considering the reason of this situation was the medication not being prescribed by the physician , one should pay more attention particularly in the field of treatment BACKGROUND Evidence regarding the relationship between different levels of alcohol consumption and the risk of atrial fibrillation ( AF )  is currently limited in Asian population s. METHODS AND RESULTS Between 1991 and 1995 , a total of 8,602 Japanese men and women aged 30 - 80 years took part in the first examination of the Circulatory Risk in Communities Study ( CIRCS ) , a population -based cohort study in Japanese communities .  An interviewer obtained detailed information on weekly alcohol intake . During the follow-up period , the incidence of AF was ascertained from annual ECG records , the subject 's medical history of AF , and cardiovascular disease surveillance . The hazard ratios ( HRs ) of incident AF and the 95 % confidence intervals ( CIs ) relative to the never-drinking group were calculated with adjustment for potential confounding factors by using the Cox proportional hazard model . During a median follow-up period of 6.4 years , 296 incidents of AF occurred . A higher incidence of AF was observed among participants with an ethanol intake > 69g/day , compared with never-drinkers . Compared with the never-drinkers , the multivariable-adjusted HRs ( CIs ) of past , light ( < 23g/day ) , light-moderate ( 23 - 46g/day ) , moderate ( 46 - 69g/day ) , and heavy ( > 69g/day ) drinkers were 1.30 ( 0.68 - 2.49 ) , 0.89 ( 0.60 - 1.32 ) , 1.19 ( 0.73 - 1.95 ) , 1.36 ( 0.79 - 2.35 ) , and 2.90 ( 1.61 - 5.23 ) , respectively . CONCLUSIONS Heavy alcohol consumption is associated with a higher risk of AF INTRODUCTION  Atrial fibrillation ( AF ) in hospitalized patients may lead to activation of the medical emergency team ( MET ) . We sought to assess the baseline characteristics and outcomes of the patients presenting AF as a cause of MET call activation . METHODS Using a prospect ively constructed MET data base , we retrospectively review ed all patients with AF as a trigger for MET activation between August 2005 and April 2010 . Demographics , principal diagnostic and outcome of these patients were compared with those of a control group of patients matched for age , sex and ward of origin , r and omly selected from the data base . RESULTS We studied 5431 MET calls of which 557 ( 10.3 % ) , in 458 patients were triggered by AF . Mean age for AF patients was 74.8 years , 230 ( 50.2 % ) were female and 271 ( 59.1 % ) were in a surgical ward . 92 ( 20.1 % ) AF patients died in hospital compared with 131 ( 28.6 % ) in the control group . Among the 336 patients without limitations of medical therapy ( LOMT ) , 46 ( 13.7 % ) died in hospital . In total , 46 ( 13.7 % ) patients were transferred to a higher level care ward while 290 ( 86.3 % ) remained on the ward . Only 2 ( 4.3 % ) of these patients died compared with 44 ( 15.2 % ) among those who remained in the general ward ( p=0.03 ) . CONCLUSIONS In our hospital , AF triggers one tenth of MET activations and mortality associated with it is high even when issues of LOMT are excluded . The decreased mortality among patients admitted to a higher level ward suggests that some of these deaths may be avoidable
: The incidence and prevalence of AF have increased in recent years , although great variability still exists in Asian countries .
Variability in annual IS risk in patients with AF was apparent between hospital‐ and community‐based studies .
BACKGROUND : Our previous review reported great variability in the incidence and prevalence of atrial fibrillation ( AF ) in non‐Western cohorts , especially from Asian countries ; in recent years , epidemiologic studies on AF have been increasingly reported from Asia .
METHODS : The goal of this up date d systematic review was to present the current knowledge base of AF epidemiology in Asian countries since our previous review .