PREVALENCE OF ATRIAL FIBRILLATION AND ITS CORRELATES IN HYPERTENSIVE PATIENTS WITHOUT CORONARY HEART DISEASE IN PRIMARY CARE SETTING
Hypertension is a risk factor for atrial fibrillation (AF). Primary prevention of AF in hypertension patients is the ultimate goal of the medical and public health community.
Aim: assess the prevalence and factors associated with AF in hypertensive patients without coronary heart disease (CHD) in primary care setting.
Methods: A cross–sectional study was conducted in January-September 2018. Hypertensive patients 40 years and above visiting primary care clinics during the study period were recruited (n=1121). Exclusion criteria were rheumatic and congenital heart diseases, CHD, thyroid status disorders, and severe somatic diseases. Age, gender, weight, height, waist circumference(WC), body mass index, systolic, diastolic and pulse blood pressure, smoking, diabetes mellitus(DM), total cholesterol and serum creatinine were among potential predictors of AF. Independent associations between the abovementioned factors and AF were studied using multivariate logistic regression analysis. Prevalence estimates and odds ratios (OR) were presented with 95% confidence intervals (CI).
Results: The prevalence of AFwas 4,7% (95% CI: 3,60-6,10). DM (OR=2,80; 95% CI: 1,40-5,58), age 60-69 (OR=4,18; 95% CI: 1,32-13,26), age 70 years and above (OR=27,68; 95% CI: 7,40-103,52) and smoking (OR=5,99; 95% CI: 2,62-13,70) had increased odds of AF compared to the reference categories. Positive associations were also observed between AF and WC (OR=1,07; 95% CI: 1,04-1,10) and height (OR=1,09; 95%: 1,03-1,15) included in the model as continuous variables. Women were less likely to have AF (OR=0,11; 95% CI: 0,04-0,32).
Conclusions: The prevalence of AF among hypertensive patients without CHD in primary care setting was high. DM, age-groups 60-69 years, 70 and above years, smoking, WC and height were positively associated with AF. Women were less likely to have AF. In addition to hypertension control management of modifiable risk factors of AF is required to reduce the prevalence of AF in Kazakhstani hypertensive patients, particularly among men.
Zhenisgul Sh. Tlegenova 1, http://orcid.org/0000-0002-3707-7365
Bekbolat K. Zholdin 1, http://orcid.org/0000-0002-4245-9501
Gulmira Z. Kudaiberdieva 2, http://orcid.org/0000-0003-4099-8816
Ayan S. Abdrakhmanov 3, https://orcid.org/0000-0001-6315-5016
Andrej M. Grjibovski 1, 4-6, http://orcid.org/0000-0002-5464-0498
1 West Kazakhstan Marat Ospanov Medical University, Aktobe, Republic of Kazakhstan;
2 Center of Postgraduate Education and Scientific Research, Bishkek, Kyrgyzstan;
3 Interventional ArrhythmologyDepartment, National Research Cardiac Surgery Center, Astana, Republic of Kazakhstan;
4 Northern State Medical University, Arkhangelsk, Russian Federation;
5 North-Eastern Federal University, Yakutsk, Russian Federation;
6 Al-Farabi Kazakh National University, Almaty, Republic of Kazakhstan
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31. Potpara T.S., Polovina M.M., Marinkovic J.M., Lip G.Y. A comparison of clinical characteristics and long-term prognosis in asymptomatic and symptomatic patients with first-diagnosed atrial fibrillation: the Belgrade Atrial Fibrillation Study // Int J Cardiol. 2013, 168(5), p.4744-4749. doi:10.1016/j.ijcard.2013.07.234
32. Rosenberg M.A., Patton K.K., Sotoodehnia N., Karas M.G., Kizer J.R., Zimetbaum P.J., Chang J.D., Siscovick D., Gottdiener J.S., Kronmal R.A., Heckbert S.R., Mukamal K.J. The impact of height on the risk of atrial fibrillation: the Cardiovascular Health Study // Eur Heart J. 2012, 33(21), p. 2709-17. doi: 10.1093/eurheartj/ehs301
33. Verbeke F., Lindley E., Van Bortel L., Vanholder R., London G., Cochat P., et al. A European Renal Best Practice (ERBP) position statement on the Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline for the management of blood pressure in non-dialysis-dependent chronic kidney disease: an endorsement with some caveats for real-life application // Nephrol Dial Transplant.2014,29(3), p.490-6.doi: 10.1093/ndt/gft321
34. Williams B., Mancia G., Spiering W., AgabitiRosei E., Azizi M., Burnier M., Clement D.L., Coca A., de Simone G., Dominiczak A., Kahan T., Mahfoud F., Redon J., Ruilope L., Zanchetti A., Kerins M., Kjeldsen SE., Kreutz R., Laurent S., Lip GYH., McManus R., Narkiewicz K., Ruschitzka F., Schmieder RE., Shlyakhto E., Tsioufis C., Aboyans V., Desormais I. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension // J Hypertens. 2018, 36(10), p.1953-2041. doi: 10.1097/HJH.0000000000001940
35. World Health Organization. Guide to Physical Measurements (Step 2). WHO STEPS Surveillance. Geneva: World Health Organization; 2008
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15. Gorenek B., Pelliccia A., Benjamin E.J., Boriani G., Cirijns H.J., Fogel R.I., et al. European Heart Rhythm Association (EHRA)/ European Association of Cardiovascular Prevention and Rehabilitation (EACPR) position paper on how to prevent atrial fibrillation endorsed by the Heart Rhythm Society (HRS) and Asia Pacific Heart Rhythm Society (APHRS) // Europace. 2017, 19(2), p.190-225. doi: 10.1093/europace/euw242
16. Haim M., Hoshen M., Reges O., Rabi Y., Balicer R, Leibowitz M., Prospective national study of the prevalence, incidence, management and outcome of a large contemporary cohort of patients with incident non-valvular atrial fibrillation // J Am Heart Assoc. 2015, Jan 21;4(1). : e001486. doi: 10.1161/JAHA.114.001486
17. Hart R.G., Pearce L.A., Aguilar M.I. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation // Ann Intern Med. 2007, 146(12), p.857-867
18. Harvey A., Montezano A.C., Touyz R.M. Vascular biology of ageing-Implications in hypertension // J Mol Cell Cardiol. 2015, 83, p.112-21. doi: 10.1016/j.yjmcc.2015.04.011
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20. Huxley R.R., Lopez F.L., Folsom A.R., Agarwal S.K., Loehr L.R., Soliman E.Z., et al. Absolute and attributable risks of atrial fibrillation in relation to optimal and borderline risk factors: the Atherosclerosis Risk in Communities (ARIC) Study // Circulation. 2011, 123, p.1501–8. doi:10.1161/circulationaha.110.009035
21. International Diabetes Federation Guideline Development Group. Global guideline for type 2 diabetes // Diabetes Res Clin Pract. 2014 Apr; 104(1):1-52.doi: 10.1016/j.diabres.2012.10.001
22. Kirchhof P., Benussi S., Kotecha D., Ahlsson A., Atar D., Casadei B., et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS // Eur Heart J. 2016, 37(38), p.2893-2962. doi: 10.1093/eurheartj/ehw210
23. Ko D., Rahman F., Schnabel R.B., Yin X., Benjamin E.J., Christophersen I.E. Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis // Nat Rev Cardiol. 2016, 13(6), p.321-32. doi: 10.1038/nrcardio.2016
24. Lip G.Y., Nieuwlaat R., Pisters R., Lane D.A., CrijnsH.J. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation // Chest. 2010, 137(2), p. 263-72. doi: 10.1378/chest.09-1584
25. Long M.J., Jiang C.Q., Lam T.H., Xu L., Zhang W.S., Lin J.M., Ou J.P., Cheng K.K. Atrial fibrillation and obesity among older Chinese: the Guangzhou Biobank Cohort Study // Int J Cardiol. 2011, 148(1), p. 48-52. doi: 10.1016/j.ijcard.2009.10.022
26. Mancia G., Fagard R., Narkiewicz K., Redón J., Zanchetti A., Böhm M., et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) // J Hypertens. 2013, 31(7), p.1281-357. doi: 10.1097/01.hjh.0000431740.32696.cc
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28. Meschia J.F., Bushnell C., Boden-Albala B., Braun L.T., Bravata D.M., Chaturvedi S., Creager M.A., Eckel R.H., Elkind M.S., Fornage M., Goldstein L.B., Greenberg S.M., Horvath S.E., Iadecola C., Jauch E.C., Moore W.S., Wilson J.A. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association.American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Functional Genomics and Translational Biology; Council on Hypertension // Stroke. 2014, 45(12), p. 3754-832. doi: 10.1161/STR.0000000000000046
29. Odutayo A., Wong C.X., Hsiao A.J., Hopewell S., Altman D.G., Emdin C.A. Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: systematic review and meta-analysis // BMJ. 2016, 6; 354:i4482. doi: 10.1136/bmj.i4482
30. Piepoli M.F., Hoes A.W., Agewall S., Albus C., Brotons C., Catapano A.L. et al. ESC Scientific Document Group. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the.European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR) // Eur Heart J. 2016, 37(29), p.2315-2381. doi: 10.1093/eurheartj/ehw106
31. Potpara T.S., Polovina M.M., Marinkovic J.M., Lip G.Y. A comparison of clinical characteristics and long-term prognosis in asymptomatic and symptomatic patients with first-diagnosed atrial fibrillation: the Belgrade Atrial Fibrillation Study // Int J Cardiol. 2013, 168(5), p.4744-4749. doi:10.1016/j.ijcard.2013.07.234
32. Rosenberg M.A., Patton K.K., Sotoodehnia N., Karas M.G., Kizer J.R., Zimetbaum P.J., Chang J.D., Siscovick D., Gottdiener J.S., Kronmal R.A., Heckbert S.R., Mukamal K.J. The impact of height on the risk of atrial fibrillation: the Cardiovascular Health Study // Eur Heart J. 2012, 33(21), p. 2709-17. doi: 10.1093/eurheartj/ehs301
33. Verbeke F., Lindley E., Van Bortel L., Vanholder R., London G., Cochat P., et al. A European Renal Best Practice (ERBP) position statement on the Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline for the management of blood pressure in non-dialysis-dependent chronic kidney disease: an endorsement with some caveats for real-life application // Nephrol Dial Transplant. 2014, 29(3), p.490-6.doi: 10.1093/ndt/gft321
34. Williams B., Mancia G., Spiering W., AgabitiRosei E., Azizi M., Burnier M., Clement DL., Coca A., de Simone G., Dominiczak A., Kahan T., Mahfoud F., Redon J., Ruilope L., Zanchetti A., Kerins M., Kjeldsen S.E., Kreutz R., Laurent S., Lip GYH., McManus R., Narkiewicz K., Ruschitzka F., Schmieder RE., Shlyakhto E., Tsioufis C., Aboyans V., Desormais I. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension // J Hypertens. 2018, 36(10), p.1953-2041. doi: 10.1097/HJH.0000000000001940
35. World Health Organization. Guide to Physical Measurements (Step 2). WHO STEPS Surveillance. Geneva:World Health Organization; 2008
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Тлегенова Ж.Ш., Жолдин Б.К., Кудайбердиева Г.З., Абдрахманов А.С., Гржибовский А.М. Распространенность фибрилляции предсердий и ассоциированные факторы у больных артериальной гипертензией в условиях первичной медико-санитарной помощи // Наука и Здравоохранение. 2019. 2 (Т.21).С. 44-54. Tlegenova Zh.Sh., Zholdin B.K., Kudaiberdieva G.Z., Abdrakhmanov A.S., Grjibovski A.M. Prevalence of atrial fibrillation and its correlates in hypertensive patients without coronary heart disease in primary care setting // Nauka i Zdravookhranenie [Science & Healthcare]. 2019, (Vol.21) 2, pp. 44-54. Тілегенова Ж.Ш., Жолдин Б.К., Кұдайбердиева Г.З., Абдрахманов А.С., Гржибовский А.М. Біріншілік медико-санитарлық көмек беру деңгейінде артериялық гипертензиясы бар науқастардағы жүрекшелер жыбырының таралуы және байланысты факторлары // Ғылым және Денсаулық сақтау. 2019. 2 (Т.21). Б. 44-54.Related publications:
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