Antithrombotic prescribing patterns and the outcomes among patients diagnosed with atrial fibrillation in Nepal: a multicentric registry based study.

Thesis Report.

ABSTRACT: Atrial fibrillation (AF) is a supra ventricular tachyarrhythmia with uncoordinated atrial activation which might lead to serious consequences like stroke. In Nepal, researches regarding management of AF and antithrombotic therapy for stroke prophylaxis are lacking. This study was an attempt to evaluate the baseline characteristics prescription pattern of rate/rhythm and antithrombotic medications in AF cardiac specialty center of Nepal. This is observational retrospective hospital based study conducted in at Manmohan Cardio thoracic vascular and transplant center (MCVTC), Kathmandu Nepal. In this study, we retrospectively reviewed and followed the medical records of patient with AF admitted between 1stBaisakh 2072(14th April 2014) to 32ndShrawan 2074(16th August 2017). We have included all patient diagnosed with both valvular and non valvular AF. The patient diagnosed with atrial flutter was discarded. We reviewed medical record of total 362 patients with AF. The mean age (+SD) of the patient was 59.22 +18.22, with 40.3%male. Total 58% had non valvular AF and 42% had valvular AF. The mean (+ SD) CHADS2score during admission was found to be 1.23(+1.18) and 37.6% had CHADS2score >2. Similarly mean (+ S.D) CHA2DS2-VASc score was 2.32(+1.64). 56.2% of male patients had high CHA2DS2-VASc score (> 2) and in female 29.3% had high CHA2DS2-VASc score (> 3). The mean + (S.D) HAS-BLED value without labile INR during admission and at discharge was 1.12(+ .87) and 1.11(+ .89) respectively. In management of AF rate control therapy was mostly preferred than rhythm control (48.1% vs 2.2%). In total lone anticoagulant was prescribed 142(40.9%) and patients lone antiplatelet148 (42.9%) in discharged. In non valvular AF (with CHA2DS2-VASc score> 2) anticoagulant was prescribe in 27.78% and 25.6% in male and female respectively. The suboptimal use of antithrombotic indicated need of local guidelines for treatment of AF or adherence to the international guidelines in practice.