Document Detail

Stroke prevention in elderly patients with atrial fibrillation.
MedLine Citation:
PMID:  12188065     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The prevalence of atrial fibrillation increases with age. Atrial fibrillation has been shown to be a significant risk factor for stroke in the elderly. Anticoagulation is effective in preventing stroke in geriatric patients with atrial fibrillation, yet many elderly patients with atrial fibrillation are not anticoagulated. OBJECTIVES: This study aims to determine the prevalence of atrial fibrillation in an inpatient population of a geriatric unit and explores the usage of anticoagulants in those patients diagnosed with atrial fibrillation. METHODS: Consecutive admissions to a geriatric unit were screened with an electrocardiogram to establish a diagnosis of atrial fibrillation. Those with atrial fibrillation were evaluated for risk factors for stroke and for contraindications for anticoagulation. Documentation of reasons for withholding anticoagulation was also examined. RESULTS: Five hundred and six consecutive inpatient admissions were screened. Fifty-six patients had atrial fibrillation (11.1%). Forty of these were known cases of atrial fibrillation whereas sixteen were newly diagnosed. There were 22 (39.3%) males and 34 (60.7%) females. The mean age was 83.3 years (S.D. 6.8). The four most common risk concomitant factors for stroke were age above 75 years (54, 96.4%), hypertension (41, 73.2%), congestive cardiac failure (28, 50%), and a history of strokes (20, 35.7%). Fifty-five (98.2%) patients had at least two other concomitant risk factors for stroke. On discharge, only nine (16.1%) out of 56 patients were anticoagulated. Anticoagulation was withheld because of contraindications in 44 (78.6%) patients and because of patients' objection to anticoagulation in 3 (5.3%) patients. The two most common reasons for withholding anticoagulation were the risk of recurrent falls (18, 38.3%) and peptic ulcer disease (15, 31.9%). CONCLUSIONS: The prevalence rate of atrial fibrillation in elderly inpatients was found to be 11.1%. Most of the elderly with atrial fibrillation had multiple concomitant risk factors for stroke and would benefit from anticoagulant therapy. However, in the majority, anticoagulation was withheld because of contraindications (78.6%) and patients' objection to anticoagulation (5.3%).
S J W Lew; J K H Lim
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Singapore medical journal     Volume:  43     ISSN:  0037-5675     ISO Abbreviation:  Singapore Med J     Publication Date:  2002 Apr 
Date Detail:
Created Date:  2002-08-21     Completed Date:  2002-10-16     Revised Date:  2009-11-03    
Medline Journal Info:
Nlm Unique ID:  0404516     Medline TA:  Singapore Med J     Country:  Singapore    
Other Details:
Languages:  eng     Pagination:  198-201     Citation Subset:  IM    
Geriatric Unit, Changi General Hospital, Singapore.
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MeSH Terms
Aged, 80 and over
Anticoagulants / therapeutic use*
Aspirin / therapeutic use*
Atrial Fibrillation / complications,  drug therapy*,  epidemiology
Platelet Aggregation Inhibitors / therapeutic use*
Risk Factors
Stroke / etiology,  prevention & control*
Warfarin / therapeutic use*
Reg. No./Substance:
0/Anticoagulants; 0/Platelet Aggregation Inhibitors; 50-78-2/Aspirin; 81-81-2/Warfarin

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