Risk Factors, Co-Morbidities and Treatment of In-Hospital Patients with Atrial Fibrillation in Bulgaria

Medicina (Kaunas). 2018 May 25;54(3):34. doi: 10.3390/medicina54030034.


Background and objectives: Atrial fibrillation (AF) is the most common arrhythmia worldwide and a major risk factor for cardiovascular complications. Our study aimed to investigate the prevalence, risk factors, demographics, co-morbidities and treatment of AF among in-hospital Bulgarian patients.

Materials and methods: A cross-sectional study including 1027 consecutive patients (n = 516, 50.2% males) with a mean age of 67.6 ± 11.3 years, hospitalized for any reason from 1 May until 31 December 2016 in one of the largest internal clinics in Bulgaria, was carried out.

Results: Atrial fibrillation was diagnosed in 634 (61.7%) patients. The prevalence of modifiable AF risk factors was as follows: heart failure, 98.9%; arterial hypertension (HTN), 93.5%; valvular heart disease, 40.9%; chronic lung disease, 26.7%; type 2 diabetes mellitus, 24.9%; thyroid disease, 16.9%; and ischemic heart disease, 11.2%. Univariate logistic regression analysis identified the following risk factors with strongest impact on AF: left ventricular ejection fraction <40% (odds ratio (OR) = 1.951, 95% confidence interval (CI) 1.208⁻3.151), valvular heart disease (OR = 1.926, 95% CI 1.134⁻3.862), left ventricular ejection fraction 40⁻49% (OR = 1.743, 95% CI 1.248⁻3.017), HTN (OR = 1.653, 95% CI 1.092⁻3.458). History of ischemic stroke was present in 14.4% of the patients with AF. Oral antithrombotic drugs were prescribed to 85.7%: direct oral anticoagulants to 37.9%, vitamin K antagonists to 43.2%, and antiplatelets to 4.6%. Heart rate control medications and antiarrhythmics were prescribed to 75.4% and 40.2%, respectively.

Conclusions: Atrial fibrillation was highly prevalent among our study population. Reduced and mid-range left ventricular ejection fraction, valvular heart disease, and HTN were the risk factors with the strongest association with AF. Although a large number of our AF patients were administered antithrombotic treatment, the prescription rate of oral anticoagulants should be further improved.

Keywords: atrial; embolic; fibrillation; in-hospital; prevention; risk.

MeSH terms

  • Aged
  • Atrial Fibrillation / epidemiology*
  • Atrial Fibrillation / physiopathology
  • Bulgaria / epidemiology
  • Comorbidity
  • Cross-Sectional Studies
  • Female
  • Heart Valve Diseases / epidemiology*
  • Heart Valve Diseases / physiopathology
  • Humans
  • Hypertension / epidemiology*
  • Hypertension / physiopathology
  • Inpatients / statistics & numerical data*
  • Logistic Models
  • Male
  • Middle Aged
  • Odds Ratio
  • Prevalence
  • Risk Factors
  • Stroke Volume