Clinical pattern and complications of nonvalvular atrial fibrillation in elderly and nonelderly patients

Three hundred patients with nonvalvular atrial fibrillation were hospitalized between 1988 and 1995, representing 2% of hospital admissions in this period. Two hundred six patients had paroxysmal atrial fibrillation, associated with structural heart disease in 67% of the cases (patients' age greater than or equal to 65 years in 60%) and not associated with heart disease in 33% (patients' age greater than or equal to 65 years in 36%). Ninety-four patients had chronic atrial fibrillation, associated with structural heart disease in 79% of the cases (patients' age greater than or equal to 65 years in 51%) and not associated with structural heart disease in 21% (patients' age greater than or equal to 65 years in 40%). In patients with paroxysmal atrial fibrillation, the most common underlying heart disease was ischemic heart disease, either in patients <65 years (prevalence = 49%) or greater than or equal to 65 years (prevalence = 82%). In patients aged <65 years with chronic atrial fibrillation, the most common underlying heart disease was cardiomyopathy (prevalence = 44%), whereas in patients aged greater than or equal to 65 years, the most common heart disease was ischemic heart disease (prevalence = 42%). Among patients aged <65 years, systemic hypertension was present in 20% of the patients with paroxysmal atrial fibrillation without structural heart disease, in 41% of patients with paroxysmal atrial fibrillation and heart disease, in 50% of patients with chronic atrial fibrillation without structural heart disease, and in 42% of patients with chronic atrial fibrillation and heart disease. Among patients aged greater than or equal to 65 years, systemic hypertension was present in 60% of the patients with paroxysmal atrial fibrillation without structural heart disease, in 52% of patients with paroxysmal atrial fibrillation and heart disease, in 63% of patients with chronic atrial fibrillation without structural heart disease, and in 53% of patients with chronic atrial fibrillation and heart disease. Overall 32 out of 300 patients (11%) had a history of previous thromboembolic complications (transient ischemic attacks in 50%, stroke in 44%, systemic embolism in 6%), and these complications occurred even in patients without structural heart disease (2% of patients with paroxysmal atrial fibrillation <65 years, 8% of patients with paroxysmal atrial fibrillation greater than or equal to 65 years, 8% of patients with chronic atrial fibrillation <65 years, and 50% of patients with chronic atrial fibrillation greater than or equal to 65 years). In conclusion, in a selected in-hospital population, nonvalvular atrial fibrillation (either paroxysmal or chronic) is more frequently associated with structural heart disease, particularly ischemic heart disease. Hypertension is quite common in these patients, especially in those aged greater than or equal to 65 years. Thromhoembolic complications may occur even in atrial fibrillation without structural heart disease, and their prevalence is particularly high in elderly subjects with chronic atrial fibrillation.