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Peking University Dayi Hu Sept 16, IHF,Beijing, 2005

Atrial Fibrillation in China. Peking University Dayi Hu Sept 16, IHF,Beijing, 2005. Atrial Fibrillation (AF). The most common significant heart rhythm disturbance Incidence increases with age and the development of structural heart disease Common cause of stroke (10-15% of all strokes)

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Peking University Dayi Hu Sept 16, IHF,Beijing, 2005

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  1. Atrial Fibrillation in China Peking University Dayi Hu Sept 16, IHF,Beijing, 2005

  2. Atrial Fibrillation (AF) • The most common significant heart rhythm disturbance • Incidence increases with age and the development of structural heart disease • Common cause of stroke (10-15% of all strokes) • Associated with significant cardiovascular morbidity and mortality • Tends to recur in at least half the patients being treated with antiarrhythmic drug therapy

  3. 6% PSVT • 6% PVCs • 4% Atrial Flutter • 34% Atrial Fibrillation • 9% SSS • 8% Conduction Disease • 10% VT • 3% SCD AF accounts for 1/3 of all pts discharges with arrhythmia as principal diagnosis 2%VF • 18% Unspecified Baily D. J Am Coll Cardiol. 1992; 19: 41A.

  4. 70% men women 0 1 2 3 4 5 6 7 8 9 10 Higher Mortality Rate In Patients With AF Odds Ratio for Death 1.5-2.2 1.2-1.8 Men, AF Women, AF 50% Percent of subject died in follow-up 30% Men, No AF Women, No AF 10% years Benjamin EJ, Circulation 1998; 946-952

  5. The Framingham Study: Attributable Risk of Stroke 30 AF prevalence Strokes attributable to AF 20 % 10 0 50–59 60–69 70–79 80–89 Age Range (years) Wolf et al. Stroke 1991;22:983-988.

  6. 10 8 6 4 SF-36 score 2 0 General health Physical function Social function Mental health Quality of life: AF vs. CAD vs. healthy controls * * † * * † AF CAD Controls * P<0.05, patients with AF compared to healthy controls † P<0.05, patients with AF compared to those with CAD Higher scores = better QQL Dorian P et al. J Am Coll Cardiol. 2000; 36: 1303-1309.

  7. Prevalence of AF in different countries 5.5% ≥ 50 yrs, USA (CHS), single ECG ≥ 65 yrs, UK, single ECG ≥ 60 yrs, Netherlands, single ECG & medical record ≥ 50 yrs, UK, single ECG ≥ 55 yrs, Netherlands, single ECG ≥ 35 yrs, USA, medical record ≥ 50 yrs, UK, single ECG Review results ≥ 60 yrs, Australia, triennial survey ≥ 40 yrs, Japan, single ECG ≥ 60 yrs, Hong Kong, single ECG ≥ 35 yrs, Denmark, single ECG 25 - 64 yrs, west German, single ECG ≥ 15 yrs, India, single ECG 5.4% 5.1% 3.7% 3.0% 2.8% 2.4% 1.5% 1.3% 1.3% 0.60% 0.28% 0.1% Estimate of prevalence of AF vary based on the characteristics of population studied and how AF is ascertained. Ryder KM, et al. Am J Cardiol 1999; 84: 131R-138R.

  8. Atrial Fibrillation Demographics by Age U.S. populationx 1000 Population with AFx 1000 Population withatrial fibrillation 30,000 20,000 10,000 0 500 400 300 200 100 0 U.S. population <5 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94 >95 Age, yr Adapted from Feinberg WM. Arch Intern Med. 1995;155:469-473.

  9. 25.0 20.0 15.0 10.0 5.0 0 Prevalence of AF is increasing in USA 27.0 30.0 11.1 Number (×10,000) 1984 1994 NEJM 1997 337:1360-1369

  10. Cardiovascular Medicine at the Turn of the Millennium:Triumphs, Concerns, and Opportunities Two new epidemics of cardiovascular disease are emerging: heart failure and atrial fibrillation. Eugene Braunwald NEJM 1997 337:1360-1369

  11. Atrial Fibrillation in China?

  12. Percent of Hospitalization in Patients with AF Is Increasing in China 9.0% 8.16% 7.90% 7.90% 8.0% 7.65% 7.5% 7.0% % of hospitalization 6.5% 6.0% 1999 2000 2001 Average Qi W, et al. Chinese J Cardiol, 2003；31：913-916

  13. The Epidemical Investigation of AF in China Fourteen Natural Populations, 13 Different Provinces

  14. Incidence of AF Stratified by Age and Sex in Chinese Population 7.5 7.4 Men (n=13358) Women (n=15521) 3.6 Rate per 100 2.6 1.4 1.1 0.9 0.5 0.6 0.7 0.3 0.2 30-39 40-49 50-59 60-69 70-79 ≥80 Overall Age Group, y Data collected from 13 natural populations from 14 different provinces across China Hu D, et al. 2004 Chin J Intern Med; in press.

  15. Difference in Trend between Paroxysmal AF and Persistent AF Hu D, et al. 2004 Chin J Intern Med; in press.

  16. % years Similar trends and relatively lower prevalence of AF in China compared with USA, Australia and UK FHS: the Framingham study. Wolf PA et al. Sroke 1991; 22: 983-988 Australia: Lake FR, et al. Aust NZ Med 1989; 19: 321-326 UK: Hill JD et al. J R Coll Gen Pract 1987; 37: 172-173

  17. ≥ 50 yrs, USA (CHS), single ECG ≥ 65 yrs, UK, single ECG ≥ 60 yrs, Netherlands, single ECG & medical record ≥ 50 yrs, UK, single ECG ≥ 55 yrs, Netherlands, single ECG ≥ 35 yrs, USA, medical record ≥ 50 yrs, UK, single ECG Review results ≥ 60 yrs, Australia, triennial survey ≥ 40 yrs, Japan, single ECG ≥ 60 yrs, Hong Kong, single ECG ≥ 35 yrs, main land, China, single ECG ≥ 35 yrs, Denmark, single ECG 25 - 64 yrs, west German, single ECG ≥ 15 yrs, India, single ECG 5.1% 3.7% 3.0% 2.8% 2.4% 1.5% 1.3% 1.3% 0.77% 0.60% 0.28% 0.1% Prevalence of AF in China and other countries 5.5% 5.4% Patients with AF In China 8 million

  18. Hospitalized Patients with AF in China: Causes and Associated Condition 0 10% 20% 30% 40% 50% 60% 58.1% Advanced age 40.3% Hypertension CAD 34.8% 33.1% CHF 23.9% RVD 7.4% Idiopathic AF caidiomyopathy 5.4% 4.1% Diabetes CAD: coronary artery disease; CHF: congestive heart failure; RVD: rheumatic valve disease Chinese J Cardiol, 2003；31：913-916

  19. Prevalence of Stroke in Chinese Patients with AF 24.81% % 25% 17.5% 20% 12.95% 15% 10% 5% 0 Hu D, 2004 Qi W, 2003 Hu D, 2004 Hu D, et al. 2004 Chin J Intern Med; in press. Random sample of population Qi W, et al. 2003 Chin J Cardiol; 31: 913-916. Case-control study. Hospitalized patients Hu D, et al. 2003 Chin J Intern Med; 42: 157-161. Case-control study. Hospitalized patients

  20. Prevalence of Stroke in Patients with None Valve AF Stratified by Age 30 25 20 Prevalence (%) 15 10 5 0 years >40 40～49 50-59 60～69 70～79 >80 HU D, et al. Chin J Intern Med, 2003; 42: 157-161

  21. Framingham Heart Study: Significant Multivariable Risk for developing AF Male Female 2.1 (1.8-2.5) 2.2 (1.9-2.6) AGE 4.5 (3.1-6.6) 4.2 (4.2-8.4) CHF 1.8 (1.2-2.5) 3.4 (2.5-4.5) VHD 1.4 (1.0-2.0) Prior MI 1.5 (1.2-2.0) 1.4 (1.1-1.8) HTN DM 1.4 (1.0-2.0) 1.6 (1.1-2.2) 0 1 2 3 4 5 6 7 8 9 Benjamin EJ, et al. JAMA, 1994; 271: 840-844

  22. Risk Factors for Stroke in Chinese with Non Vascular AF: A Case-control Study AGE >76 yrs 1.76 (1.08-2.89) Hypertension 1.52 (1.28-1.80) Diabetes 1.39 (1.11-1.76) 1.71 (1.21-2.28) SBP 2.77 (1.25-6.13) LA thrombi 1 2 3 4 5 HU D, et al. Chin J Intern Med, 2003; 42: 157-161

  23. Risk of Stroke: Case-control Study P<0.001 Stroke Control 100 97.7 P=0.009 94.4 75.2 P=0.21 75 % 62.4 66.9 51.9 50 37.6 24.8 21.2 18.8 25 5.6 2.3 0 Lone AF Persistence AF Paroxymal AF None valve AF Control of heart rate Conversion HU D, et al. Chin J Intern Med, 2003; 42: 157-161

  24. AF Treatment – Possible Objectives • Control the ventricular rate • Restore/maintain sinus rhythm • Prevent embolic complications

  25. Controls Warfarin AF Investigators: Meta-analysisWarfarin for Stroke Prevention 8 p < 0.01 6 p < 0.02 p < 0.03 p < 0.001 p < 0.002 Stroke Incidence (%) p > 0.2 4 2 0 AFASAK 58%7–81 SPAF 67%27–85 BAATAF 86%51–96 CAFA 42%-68–80 SPINAF 79%52–90 TOTAL 68%50–79 Risk reduction 95% CI AF Investigators. Arch Intern Med 1994;154:1449-1457.Atwood et al. Herz 1993;18:27-38.

  26. P<0.001 stroke rate Antiplatetet and Anticoagulation showed Significant Lower Stroke in Chinese Hospitalized Patients with AF Anticoagulation 5.5% P<0.001 6.7% Antiplatetet No Therapy 24.2% 0 5% 10% 15% 20% 25% Number of Strokes Prevented Qi W, et al. Chinese J Cardiol, 2003；31：913-916

  27. Treatment of Chinese Hospitalized patients with paroxymal AF Amiodarone 31.0% Cedilanid 29.6% β-Blocker18.3% Propafenone 14.3% Qi W, et al. Chinese J Cardiol, 2003；31：913-916

  28. Treatment of Chinese Hospitalized patients with persistent AF Digoxin β-Blocker CCB Amiodarone Qi W, et al. Chinese J Cardiol, 2003；31：913-916

  29. Prevalence of Antiplatetet and Anticoagulation in Chinese Hospitalized Patients with AF Qi W, et al. Chinese J Cardiol, 2003；31：913-916

  30. Prevalence of Antiplatetet and Anticoagulation in Patients with AF in Chinese Natural Population Hu D, et al. 2004 Chin J Intern Med; in press

  31. Thanks！ Atrial fibrillation in China: A Long Way to Go!

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