title: Incidence of Stroke or Systemic Embolism in Paroxysmal Versus Sustained Atrial Fibrillation: The Fushimi Atrial Fibrillation Registry One-year cardiovascular event rates in Japanese outpatients with myocardial infarction, stroke, and atrial fibrillation. -Results From the Japan Thrombosis Registry for Atrial Fibrillation, Coronary, or Cerebrovascular Events (J-TRACE).-. Current Status and Time Trends of Oral Anticoagulation Use Among Chinese Patients With Nonvalvular Atrial Fibrillation: The Chinese Atrial Fibrillation Registry Study Hyperuricemia and the risk of ischemic stroke in patients with atrial fibrillation--could it refine clinical risk stratification in AF? Secular Trends, Treatments, and Outcomes of Middle Eastern Arab and South Asian Patients Hospitalized With Atrial Fibrillation Heavy alcohol consumption and risk of atrial fibrillation. The Circulatory Risk in Communities Study (CIRCS). The prevalence, incidence, management and risks of atrial fibrillation in an elderly Chinese population: a prospective study Non-valvular atrial fibrillation in the elderly; preliminary results from the National AFTER (Atrial Fibrillation in Turkey: Epidemiologic Registry) Study. Morphological abnormalities in baseline ECGs in healthy normal volunteers participating in phase I studies Atrial Fibrillation Is a Major Risk Factor for Stroke, Especially in Women: The Jichi Medical School Cohort Study Increased risk of first-ever stroke in younger patients with atrial fibrillation not recommended for antithrombotic therapy by current guidelines: a population-based study in an East Asian cohort of 22 million people. Predictors of major adverse cardiovascular events; results of population based MELEN study with prospective follow-up. Prevalence of atrial fibrillation in an urban population in India: the Nagpur pilot study Effect of age on treatment, trends and outcome of patients hospitalized with atrial fibrillation: insights from a 20-years registry in a middle-eastern country (1991–2010) [Epidemiological survey of atrial fibrillation among Uygur and Han elderly people in Xinjiang Uygur autonomous region]. Hyperuricemia and incident atrial fibrillation in a normotensive elderly population in Taiwan. Gender-specific relationship between serum uric acid level and atrial fibrillation prevalence. Effects of smoking habit on the prevalence of atrial fibrillation in Japanese patients with special reference to sex differences. Time Trends of Aspirin and Warfarin Use on Stroke and Bleeding Events in Chinese Patients With New-Onset Atrial Fibrillation. [The prevalence and distributing feature of atrial fibrillation in Xinjiang Uygur Autonomous Region Kazaks adult population]. Atrial fi brillation in Middle Eastern Arab and South Asian patients hospitalized with acute myocardial infarction: experience from a 20-year Registry in Qatar (1991–2010) Influence of atrial fibrillation on post‐discharge natriuretic peptide trajectory and clinical outcomes among patients hospitalized for heart failure: insights from the ASTRONAUT trial
abstract: Background and Purpose — There is controversy on the relationship of the type of atrial fibrillation ( AF ) to stroke . Although several studies show that patients with paroxysmal AF ( PAF ) have a stroke risk similar to those with persistent or permanent AF , recent studies suggest that PAF is associated with a lower rate of stroke . Limited data on stroke risk associated with PAF are evident in Asian population s. Methods — The Registry Study of Atrial Fibrillation Patients in Fushimi-ku ( Fushimi AF Registry ) is a community-based survey of patients with AF in Fushimi-ku , Kyoto , Japan . Patients were categorized into 2 types of AF : PAF or sustained ( persistent or permanent ) AF . We compared clinical events between PAF  ( n=1588 ) and  sustained AF ( n=1716 ) . Results — Patients with PAF were younger , had less comorbidities , and received oral anticoagulants ( OAC ) less commonly . A lower risk of stroke/systemic embolism during follow-up period in the patients with PAF was consistently observed ( non-OAC users : hazard ratio , 0.45 ; 95 % confidence intervals , 0.27–0.75 ; P<0.01 and OAC users : hazard ratio , 0.59 ; 95 % confidence interval , 0.35–0.93 ; P=0.03 ) . The composite end point of stroke/systemic embolism/all-cause mortality was also lower in PAF , whether among OAC users ( hazard ratio , 0.77 ; 95 % confidence interval , 0.59–0.99 ; P=0.046 ) or non-OAC users ( hazard ratio , 0.59 ; 95 % confidence interval , 0.46–0.75 ; P<0.01 ) . On multivariate analysis , PAF was an independent predictor of lower stroke/systemic embolism risk . Conclusions — In this large cohort of Japanese patients with AF , PAF was independently associated with lower incidence of stroke/systemic embolism than sustained AF . This may aid decision making for anticoagulation , especially in those patients with AF with few stroke risk factors . Clinical Trial Registration — URL : http://www.umin.ac.jp/ctr/index.htm . Unique identifier : UMIN000005834 BACKGROUND There remains uncertainty about the risk of cardiovascular events in stable out patients with a history of myocardial infa rct ion ( MI ) , stroke , and atrial fibrillation in Japan . METHODS AND RESULTS In the Japan Thrombosis Registry for Atrial Fibrillation , Coronary , or Cerebrovascular Events ( J-TRACE ) , a nationwide prospect i ve cohort of stable out patients with a history of MI ( n=2,291 ) , stroke ( n=3,554 ) , and /or atrial fibrillation ( n=2,242 ) , 1-year follow-up data were available for 7,513 of 8,087 patients ( follow-up rate : 92.9 % ) . The primary endpoint ( death/MI/stroke ) was reported in 3.53 events per 100 person-years ( 95 % confidence interval [ CI ] : 3.11 - 3.99 ) within 1 year . The rates of all-cause death , death from stroke , and death from MI within 1 year were 1.35 ( 95%CI : 1.10 - 1.65 ) , 0.15 ( 95%CI : 0.08 - 0.27 ) , and 0.06 ( 95%CI : 0.02 - 0.14 ) per 100 person-years , respectively . The rate of non-fatal stroke was 1.85 ( 95%CI : 1.55 - 2.19 ) , while that of non-fatal MI was 0.33 ( 95%CI : 0.21 - 0.49 ) . The rate of non-fatal stroke was highest among stroke patients ( 2.95 ; 95%CI : 2.39 - 3.60 per 100 person-years ) , while that of non-fatal MI was similar across all disease categories . Investigator-decided serious non-fatal bleeding events occurred in 0.21 events ( 95%CI : 0.12 - 0.34 ) per 100 person-years . CONCLUSIONS In this large , nationwide Japanese registry , the highest stroke event rate was seen in patients with a history of stroke Background and Purpose — Reported rates of oral anticoagulation ( OAC ) use have been low among Chinese patients with atrial fibrillation ( AF ) . With improved awareness , changing guidelines , this situation may be changing over time . We aim ed to explore the current status and time trends of OAC use in Beijing . Methods — We used the data set from the Chinese Atrial Fibrillation Registry ( CAFR ) , a prospect i ve , multicenter , hospital-based registry study involving 20 tertiary and 12 nontertiary hospitals in Beijing . A total of 11 496 patients with AF were enrolled from 2011 to 2014 . Results — Seven thous and nine hundred seventy-seven eligible patients were included in this ancillary study . The proportions of OAC use were 36.5 % ( 2268/6210 ) , 28.5 % ( 333/1168 ) , and 21.4 % ( 128/599 ) for patients with CHA2DS2-VASc scores ≥2 , 1 , and 0 , respectively . Persistent AF , history of stroke/transient ischemic attack/peripheral embolism , diabetes mellitus , higher body mass index , and tertiary hospital management were factors positively associated with OAC use , whereas older age , previous bleeding , hypercholesterolemia , and established coronary artery disease were factors negatively associated with OAC use . Among patients with CHADS2 scores ≥2 and CHA2DS2-VASc scores ≥2 , the proportion of OAC use increased from 31.3 % to 64.5 % and 30.2 % to 57.7 % , respectively , from 2011 to 2014 . Variation in OAC  use was substantial among different hospitals . Conclusions — An improvement of OAC use among Chinese patients with AF in Beijing is observed in recent years although only 36.5 % of patients with CHA2DS2-VASc score ≥2 received OAC . However , variations between different hospitals were large , suggesting that better education and awareness are needed to improve efforts for stroke prevention among AF patients . Clinical Trial Registration — URL : http://www.chictr.org.cn/showproj.aspx?proj=5831 . Unique identifier : ChiCTR-OCH-13003729 BACKGROUND Although hyperuricemia has been reported to be a risk factor of stroke , the relationship between hyperuricemia and stroke in patients with atrial fibrillation ( AF ) remains uncertain . The goal of the present study was to investigate whether hyperuricemia could potentially refine clinical risk stratification in AF . METHODS This study used the " National Health Insurance Research Data base " in Taiwan . A total of 7601 AF patients who did not receive antiplatelet agents or oral anticoagulants were identified as the study population . Hyperuricemia was defined as having at least one episode of gout attack necessitating long-term treatment with uric acid-lowering agents . The association between hyperuricemia and ischemic stroke was analyzed . RESULTS During the follow up of 3.0±2.7 years , 1116 patients ( 14.7 % ) experienced ischemic stroke with an annual rate of around 4.9 % . Hyperuricemia significantly predicts stroke , with a hazard ratio ( HR ) of 1.280 after adjusting for CHA2DS2-VASc score and other comorbidities . Among the 376 patients with a CHA2DS2VASc score of 0 , hyperuricemia can further stratify them into 2 groups with different stroke rates ( 7.1 % versus 1.3 % , p=0.020 ) . The adjusted HR of hyperuricemia in predicting ischemic stroke diminished from 7.491 for patients with a CHA2DS2-VASc score of 0 to 1.659 for those with a score of 3 , and became insignificant for patients with a score ≥4 . CONCLUSIONS Hyperuricemia was a significant risk factor of stroke which could potentially refine the clinical risk stratification in AF . It deserves a prospect i ve trial to investigate whether it would change the current strategy for stroke preventions using oral anticoagulants A prospect i ve registry was made of all patients hospitalized with atrial fibrillation ( AF ) in the State of Qatar from 1991 to 2010 .  Clinical characteristics , management , and outcomes were compared according to ethnicity ( Middle Eastern Arab vs South Asian ) . During this 20-year period , 2857 Arabs and 548 Asians were hospitalized for AF . Arabs were 9 years older and more likely to have hypertension , diabetes mellitus ( DM ) , chronic renal impairment , and dyslipidemia than the Asians . Valvular heart disease and acute coronary syndromes were more common among Asians , while congestive heart failure was more common in Arabs . The overall inhospital mortality was lower in Asians than that of Arabs , while stroke rates were comparable . There was an increase in the prevalence of DM and hypertension in both the groups in the latter years of the study period , but there was no change in mortality trends . Our findings underscore the need to study AF according to ethnicity BACKGROUND Evidence regarding the relationship between different levels of alcohol consumption and the risk of atrial fibrillation ( AF )  is currently limited in Asian population s. METHODS AND RESULTS Between 1991 and 1995 , a total of 8,602 Japanese men and women aged 30 - 80 years took part in the first examination of the Circulatory Risk in Communities Study ( CIRCS ) , a population -based cohort study in Japanese communities .  An interviewer obtained detailed information on weekly alcohol intake . During the follow-up period , the incidence of AF was ascertained from annual ECG records , the subject 's medical history of AF , and cardiovascular disease surveillance . The hazard ratios ( HRs ) of incident AF and the 95 % confidence intervals ( CIs ) relative to the never-drinking group were calculated with adjustment for potential confounding factors by using the Cox proportional hazard model . During a median follow-up period of 6.4 years , 296 incidents of AF occurred . A higher incidence of AF was observed among participants with an ethanol intake > 69g/day , compared with never-drinkers . Compared with the never-drinkers , the multivariable-adjusted HRs ( CIs ) of past , light ( < 23g/day ) , light-moderate ( 23 - 46g/day ) , moderate ( 46 - 69g/day ) , and heavy ( > 69g/day ) drinkers were 1.30 ( 0.68 - 2.49 ) , 0.89 ( 0.60 - 1.32 ) , 1.19 ( 0.73 - 1.95 ) , 1.36 ( 0.79 - 2.35 ) , and 2.90 ( 1.61 - 5.23 ) , respectively . CONCLUSIONS Heavy alcohol consumption is associated with a higher risk of AF Background There is limited information on prevalent and incident atrial fibrillation in Chinese . We aim ed to investigate the prevalence , incidence , management and risks of atrial fibrillation in an elderly Chinese population . Methods In a population —based prospect i ve study in elderly ( ≥60 years ) Chinese , we performed cardiovascular health examinations including a 12-lead electrocardiogram at baseline in 3,922 participants  and biennially during follow-up in 2,017 participants . We collected information on vital status during the whole follow-up period . Results The baseline prevalence of atrial fibrillation was 2.0 % ( n = 34 ) in 1718 men and 1.6 % ( n = 36 ) in 2204 women . During a median 3.8 years of follow-up , the incidence rate of atrial fibrillation ( n = 34 ) was 4.9 per 1000 person-years ( 95 % confidence interval [ CI ] , 3.4–6.9 ) . In univariate analysis , both the prevalence and incidence of atrial fibrillation were higher with age advancing ( P < 0.0001 ) and in the presence of coronary heart disease ( P ≤ 0.02 ) . Of the 104 prevalent and incident cases of atrial fibrillation , only 1 ( 1.0 % ) received anticoagulant therapy ( warfarin ) . These patients with atrial fibrillation , compared with those with sinus rhythm , had significantly higher risks of all-cause ( n = 261 , hazard ratio [ HR ] 1.87 , 95 % CI , 1.09–3.20 , P = 0.02 ) , cardiovascular ( n = 136 , HR 3.78 , 95 % CI 2.17–6.58 , P < 0.0001 ) and stroke mortality ( n = 44 , HR 6.31 , 95 % CI 2.81–14.19 , P = 0.0003 ) . Conclusions Atrial fibrillation was relatively frequent in elderly Chinese , poorly managed and associated with higher risks of mortality OBJECTIVE This study aim ed at the assessment of the clinical approach to atrial fibrillation ( AF ) in the older population and the consistency with the guidelines based on the records of the multicenter , prospect i ve AFTER ( Atrial Fibrillation in Turkey : Epidemiologic Registry ) study . PATIENTS AND METHODS 2242 consecutive patients admitted to the Cardiology Outpatient Clinics of 17 different tertiary Health Care Centers with at least one AF attack determined on electrocardiographic examination , were included in the study . Among the patients included in the study , 631 individuals aged 75 years and older were analyzed . RESULTS The mean age of the patients was determined as 80.3±4.2 years . The most frequent type of AF in geriatric population was the persistent-permanent type with a percentage of 88 % . 60 % of the patients with AF were female . Hypertension was the most common co-morbidity in patients with AF ( 76 % ) . While in 16 % of patients a history of stroke , transient ischemic attack or systemic thromboembolism was present , a history of bleeding was present in 14 % of the patients . 37 % of the patients were on warfarin treatment and 60 % of the patients were on aspirin treatment . In 38 % of the patients who were on oral anticoagulant  treatment , INR level was in the effective range . CONCLUSIONS The rate of anticoagulant  use in the elderly with AF was 37 % and considering the reason of this situation was the medication not being prescribed by the physician , one should pay more attention particularly in the field of treatment Background & objectives : Morphological abnormalities in  12-lead electrocardiograms ( ECGs ) are seen in subgroups of healthy individuals like athletes and air-force personnel . As these population s may not truly represent healthy individuals , we assessed morphological abnormalities in ECG in healthy volunteers participating in phase I studies , who are screened to exclude associated conditions . Methods : ECGs from 62 phase I studies analyzed in a central ECG laboratory were pooled . A single drug-free baseline ECG from each subject was review ed by experienced cardiologists .  ECG intervals  were measured on five consecutive beats and morphological abnormalities identified using st and ard guidelines . Results : Morphological abnormalities were detected in 25.5 per cent of 3978 healthy volunteers ( 2495 males , 1483 females ; aged 18 - 76 yr ) ; the presence was higher in males ( 29.3 % vs. 19.2 % in females ; P<0.001 ) . Rhythm abnormalities were the commonest ( 11.5 % ) followed by conduction abnormalities ( 5.9 % ) , axis deviation ( 4 % ) , ST-T wave changes ( 3.1 % ) and chamber enlargement ( 1.4 % ) . Incomplete right bundle branch block ( RBBB ) , short PR interval and right ventricular hypertrophy were common in young subjects ( < 20 yr ) while atrial fibrillation , first degree atrioventricular block , complete RBBB and left anterior fascicular block were more prevalent in elderly subjects ( > 65 yr ) . Prolonged PR interval , RBBB and intraventricular conduction defects were more common in males while sinus tachycardia , short PR interval and non-specific T wave changes were more frequent in females . Interpretation & Conclusions : Morphological abnormalities in ECG are commonly seen in healthy volunteers participating in phase I studies ; and vary with age and gender . Further studies are required to determine whether these abnormalities persist or if some of these disappear on follow up Background Only a few population -based cohort studies have investigated the impact of  atrial fibrillation ( AF ) on stroke in Japan . Methods A total of 10 929 participants ( 4147 men and 6782 women ) were included in this population -based prospect i ve cohort study . Baseline data , including  electrocardiograms ( ECGs )  to ascertain AF status , were obtained from April 1992 through July 1995 in 12 areas in Japan . Cox proportional hazards models were used to analyze the association of AF with stroke . Results A total of 54 participants had AF ( 0.49 % ) . The mean follow-up period was 10.7 years , during which 405 strokes were identified ; 12 of these occurred in participants with AF . The crude incidence of stroke in participants with and without AF was 14.9 and 4.5 per 1000 person-years in men , respectively , and 39.3 and 2.7 per 1000 person-years in women . After adjusting for geographical area , sex , age , smoking status , drinking status , obesity , hypertension , dyslipidemia , and diabetes mellitus , the hazard ratios ( 95 % confidence interval ) of AF in all participants and in male and female participants were 4.11 ( 2.28–7.41 ) , 2.12 ( 0.77–5.84 ) , and 10.6 ( 5.01–22.4 ) , respectively . The population attributable fraction ( PAF ) of stroke caused by AF was 2.2 % ; the PAFs were 1.0 % and 3.6 % in men and women , respectively . Conclusions The present Japanese population -based prospect i ve cohort study showed that AF is a major risk factor for stroke , especially in women OBJECTIVE To assess the risk of first-ever ischemic stroke in younger patients with atrial fibrillation ( AF ) who have none of the CHA2DS2-VASc ( congestive heart failure , hypertension , age ≥75 years , diabetes mellitus , previous stroke/transient ischemic attack , vascular disease , age 65 - 74 years , sex category [ female sex ] ) risk factors ( excluding female sex ) by using the National Health Insurance research data base in Taiwan . PATIENTS AND METHODS From 22,842,778 insured people , we identified 24,612 hospitalized patients with newly diagnosed AF between January 1 , 2002 , and December 31 , 2004 , as the AF group and r and omly selected 98,448 age- and sex-matched persons without AF as the non-AF group . Both groups were followed up until December 31 , 2010 , to estimate ischemic stroke incidences in relation to other stroke risk factors . RESULTS During a follow-up period of 89,468 person-years , the stroke rate was higher in patients with AF than in those without AF ( 5.79 per 100 person-years vs 2.25 per 100 person-years ) . The higher prevalence of CHA2DS2-VASc comorbidities ( heart failure , hypertension , diabetes , coronary artery disease , and peripheral artery disease ) in patients with AF further increased the stroke risk . In 790 patients with AF aged 30 to 55 years who had none of the CHA2DS2-VASc comorbidities at baseline and retained a " low risk , " that is , those with a CHA2DS2-VASc score of 0 in men and 1 in women during follow-up , the stroke rate remained considerably higher than that in their non-AF counterparts ( 1.00 per 100 person-years vs 0.25 per 100 person-years ) , with a sex-adjusted hazard ratio of 4.09 ( 95 % CI , 2.97 - 5.62 ) . CONCLUSION This study finds an increased risk of stroke in younger patients with AF who are not recommended for prevention of thromboembolism by current guidelines . Better stroke risk stratification tools are needed to prioritize younger patients with AF for thromboprophylactic therapy in this population OBJECTIVE In healthy persons , cardiovascular risk is the result of multiple interacting risk associates including demographic , clinical , genetic and environmental factors . Several non-invasive tools such as echocardiography , ultrasonography and electrocardiography as well as new biochemical markers were shown to be applicable to predict cardiovascular events . However , implementation of all of these tools has not been tested before . The aim of the study was to evaluate the independent predictors of major adverse cardiovascular events in a prospect i ve population based study , with the use of bioempedance analysis , echocardiography , ultrasonography and ECG . PATIENTS AND METHODS The baseline measurements were conducted on 2230 participants ( 1427 women , 803 men with a mean age of 49 ± 15 ) . The follow-up was done 36 months after the baseline admission via telephone call . Major adverse event was defined as mortality or myocardial infa rct ion or stroke . RESULTS Follow-up data was possible in 1495 participants ( 65 % ) . During the follow-up of 36 months ( 4485 patient years ) , 42 major adverse events occurred ( 0.03 % ) . Among them , 16 were death ( 1 stroke , 2 cancer , 13 cardiac related ) , 12 were stroke and 14 were myocardial infa rct ion . Age , body mass index and atrial fibrillation were independent predictors of major adverse events ; AF being the most powerful ( Odds ratio 10.46 ; 95 % confidence interval [ 1.73 - 63.14 ] ; p = 0.010 ) . CONCLUSIONS Age , lower body mass index and atrial fibrillation were independent predictors of major cardiovascular events in our cohort Objectives Atrial fibrillation ( AF ) is the most common sustained arrhythmia encountered in clinical practice with major public health impact mainly due to the increased risk of stroke . The recent Global Burden of Disease Study reported a lack of prevalence data from India . Our goal was to conduct a pilot study to evaluate the feasibility of assessing AF prevalence and stroke prophylaxis in an urban Indian community . Methods A screening camp was conducted in Nagpur , India , that evaluated adults aged ≥18 years . We collected  demographics , recorded blood pressure , height , weight and the 12-lead electrocardiogram ( ECG ) .  The presence of diabetes and hypertension was recorded by self-reported history . Patients diagnosed with AF were evaluated further to assess aetiology and management . Results Of the total 4077 r and omly selected , community-dwelling adults studied , 0.196 % ( eight patients ) were found to have AF . Mean age of the population was 43.9±14.8 , and 44.5 % were female . The mean age of the patients with AF was 60.5±15.8 years ( five females )  . Rheumatic heart disease was found in five patients with AF . Three patients had history of stroke ( 37.5 % ) and one had peripheral arterial thrombosis . Three patients were on warfarin , but without routine international normalised ratio ( INR ) monitoring . One patient was on aspirin . Five patients were on β-blockers and one on both β-blocker and digoxin . Conclusions The prevalence of AF was low compared with other regions of the world and stroke prophylaxis was underused . A larger study is needed to confirm these findings . This study demonstrates that larger evaluations would be feasible using the community-based techniques employed here Background : Most studies on atrial fibrillation ( AF ) epidemiology , treatment , and outcomes have included mainly Caucasians patients . The world literature on AF in other ethnicities is very limited particularly in the elderly . Aims : The aim of this study was to compare the clinical characteristics , treatment and outcome of elderly and younger patients hospitalized with AF in a Middle-Eastern country and examine the trends of AF etiologies over a 20-year period . Methods : A retrospective analysis of a prospect i ve registry of all patients hospitalized with AF in Qatar from 1991 through 2010 was made . Patients were divided into three groups ; group 1 : patients ≦50 years old , group 2 : patients between 51 and 70 years old , and group 3 : patients > 70 years old .  Clinical characteristics , management , and outcomes of AF patients were compared according to age . Results : Between the year 1991 and the end of 2010 , a total 3848 consecutive patients were admitted with AF . One thous and three hundred and forty-five patients were ≦50 years , 1759 were between 51 and 70 years and 744 patients were > 70 years old . Elderly patients were more likely to have hypertension and chronic renal impairment . There was a higher prevalence of associated coronary artery disease and aortic stenosis in elderly patients with a lower left ventricular ejection fraction than the younger age groups . A lower use of anticoagulation in the elderly group was observed but there was no underuse of other evidence -based medications . The older AF patients had significantly higher in-hospital mortality and stroke rates with no significant changes in mortality trends over the 20 years of study . An increasing trend of the associated acute coronary syndromes , hypertension and diabetes mellitus prevalence was observed in the elderly group . Conclusion : Anticoagulation remains underutilized in elderly patients with AF despite proven efficacy and increasing trends of cardiovascular comorbidities . The current study underscores the urgent need for prospect i ve studies to investigate warfarin contraindications , relative warfarin efficacy and bleeding risks in our region to help guide healthcare providers in warfarin prescribing in this frail patient population and consequently reduce the risk of AF-related disabling strokes and mortality OBJECTIVE To investigate prevalence of  atrial fibrillation ( AF ) in Uygur and Han elderly population s in Xinjiang Uygur autonomous region ( Xinjiang ) . METHODS Epidemiological survey was conducted among the residents selected through stratified r and om cluster sampling in the southern , northern and eastern Xinjiang . RESULTS The overall AF prevalence among Uygur and Han elderly people was 3.56 % . The crude prevalence of AF was 2.91 % among Uygur elderly people and 4.13 % among Han elderly people . The sex specific prevalence of AF were 3.19 % and 2.61 % among Uygur males and females respectively , and 5.01 % and 3.31 % among Han males and females respectively . The prevalence of valvular AF among Uygur ethnic group was higher than that in Han ethnic group ; the prevalence of non-valvular and isolated AF in Han ethnic group were higher than those in Uygur ethnic group . The compliance  of aspirin and β-blocker medication among Han ethnic group was better than that in Uygur ethnic group . The compliance of warfarin medication was poor in both Uygur ethnic group and Han ethnic group . The prevalence of ischemic stroke were 8.82 % and 0.98 % in Uygur elderly people with or without AF . The prevalence of ischemic stroke were 6.08 % and 0.70 % in Han elderly people with or without AF . CONCLUSION The prevalence of AF in elderly people in Xinjiang is similar to the results from other domestic studies , the prevalence of AF in Han elderly people was higher than that in Uygur elderly peoples BACKGROUND AND AIM Atrial fibrillation ( AF ) is an important cardiovascular disease in the elderly . The association between hyperuricemia and AF is unclear . Therefore , we aim ed to investigate the prospect i ve relationship between uric acid and development of AF in a nationally representative cohort of elderly people . METHODS AND RESULTS A total of 1485 elderly people ( age ≥ 65 yrs ) from the Elderly Nutrition and Health Survey in Taiwan ( 1999 - 2000 ) were without AF on " electrocardiography " at baseline .  Incident AF events ( International Classification of Diseases , Ninth Revision , Clinical Modification , ICD-9-CM : 427.31 ) were identified using data from the National Health Insurance Data set . Hyperuricemia was defined as levels of uric acid > 7.0 mg/dL in men and 6.0 mg/dL in women . A Cox proportional hazards model was used to evaluate the association between hyperuricemia and incident AF . The follow-up period was from 1999 to 2000 to 2008 . During the follow-up period ( median : 9.16 yrs ) , 90 AF events occurred ( 44 in men and 46 in women ) . Older age , elevated systolic blood pressure , being an ex-smoker , and high uric acid were positively associated with incident AF . Hyperuricemia was positively associated with incident AF in normotensive ( age-adjusted hazard ratio ( HR ) : 2.65 and 95 % confidence intervals : 1.05 - 6.69 ) , but not in ( 1.20:0.74 - 1.94 ) hypertensive individuals ( systolic blood pressure ≥130 or diastolic blood pressure ≥85 or using hypertensive medicine ) . A significant association between hyperuricemia and AF ( 3.78 ; 1.24 - 11.59 ) remained after adjusting for other potential confounders among normotensive older persons . CONCLUSION Hyperuricemia is associated with the development of AF in elderly people with normal blood pressure BACKGROUND Although various kinds of cardiovascular risk factors have been reported to be associated with  atrial fibrillation ( AF )  , the relationship between serum uric acid level and AF has not been fully examined . METHODS AND RESULTS Data were collected from a single hospital-based cohort in the Shinken Data base 2004 - 2008 ( n=11,123 ) , and consisted of serum uric acid level for 7,155 patients . The association between serum uric acid level and AF prevalence was evaluated on logistic regression . Uric acid significantly increased the crude AF prevalence in both men and women ( both , P<0.001 ) . The odds ratio ( OR ) and 95 % confidence interval ( 95%CI ) in the highest tertile compared with the lowest one were 3.368 ( 2.478 - 4.578 ) and 1.408 ( 1.169 - 1.695 ) in women and men , respectively . Uric acid was also significantly associated with other various cardiovascular risk factors for AF . Even after the multivariate model was adjusted using these variables , the effect of uric acid on AF was independent in women ( OR , 1.888 ; 95%CI : 1.278 - 2.790 ) , but not in men . CONCLUSIONS Reflecting the composite of various cardiovascular risk factors , serum uric acid level was apparently associated with AF prevalence . The independent association in women might imply some sex-specific mechanisms . The results should be confirmed in prospect i ve studies BACKGROUND Tobacco smoking is a well-known risk factor for cardiovascular disease , but controversial results have been reported regarding its relationship with  atrial fibrillation ( AF ) . Moreover , no study on the relationship between smoking and AF has yet been undertaken in a Japanese context . METHODS AND RESULTS We used data from the Shinken Data base 2004 - 2011 ( men/women , n=10,714/6,803 , respectively ) , which included all new patients attending the Cardiovascular Institute between June 2004 and March 2012 . AF was diagnosed in 1,698 and 598 men and women , respectively . In men , smokers were more prevalent in the AF than in the non-AF group ( 54.5 % vs. 44.7 % ) , whereas in women the prevalence of smokers was similar between AF and non-AF groups ( 14.4 % vs. 15.4 % ) . This discrepancy between the sexes seems to derive from a characteristic distribution pattern of smoking habit in women . After adjustment for various cofactors , smoking was independently associated with AF ( odds ratio 1.54 ; 95 % confidence interval 1.35 - 1.75 ; P<0.001 ) without a significant interaction between sex categories ( P=0.195 ) . CONCLUSIONS Smoking was independently associated with AF without a significant interaction between sex categories among Japanese patients visiting a cardiovascular hospital . Further studies using a prospect i ve cohort design are required to confirm a causal link between smoking and AF in Japanese patients BACKGROUND Much of the clinical epidemiology and treatment patterns for patients with atrial fibrillation ( AF ) are derived from Western population s. Limited data are available on antithrombotic therapy use over time and its impact on the stroke or bleeding events in newly diagnosed Chinese patients with AF . The present study investigates time trends in warfarin and aspirin use in China in relation to stroke and bleeding events in a Chinese population . METHODS We used a medical insurance data base involving > 10 million individuals for the years 2001 to 2012 in Yunnan , a southwestern province of China , and performed time-trend analysis on those with newly diagnosed AF . Cox proportional hazards time-varying exposures were used to determine the risk of stroke or bleeding events associated with antithrombotic therapy among patients with AF . RESULTS Among the r and omly sample d 471,446 participants , there were 1,237 patients with AF , including 921 newly diagnosed with AF , thus providing 4,859 person-years of experience ( 62 % men ; mean attained age , 70 years ) . The overall rate of antithrombotic therapy  was 37.7 % ( 347 of 921 patients ) , with 4.1 % ( 38 of 921 ) on warfarin and 32.3 % ( 298 of 921 ) on aspirin . Antithrombotic therapy was not related to stroke/bleeding risk scores ( CHADS2 [ congestive heart failure , hypertension , age ≥ 75 years , diabetes , stroke ( doubled ) ] score , P = .522 ; CHA2DS2-VASc [ congestive heart failure , hypertension , age ≥ 75 years ( doubled ) , diabetes mellitus , stroke or transient ischemic attack ( doubled ) , vascular disease , age 65 to 74 years , and female sex ] score , P = .957 ; HAS-BLED [ hypertension , abnormal renal/liver function , stroke , bleeding history or predisposition , labile international normalized ratio , elderly ( > 65 years ) , drugs/alcohol concomitantly ] score , P = .095 ) . The use of antithrombotic drugs ( mainly aspirin )  increased in both women and men over time , with the rate of aspirin  increasing from 4.0 % in 2007 to 46.1 % in 2012 in the former , and from 7.7 % in 2007 to 61.9 % in 2012 in the latter ( P for trend for both , < .005 ) . In the overall cohort , the annual stroke rate was approximately 6 % and the annual major bleeding rate was about 1 % . Compared with nonantithrombotic therapy , the hazard ratio for ischemic stroke was 0.68 ( 95 % CI , 0.39 - 1.18 ) for aspirin and 1.39 ( 0.54 - 3.59 ) for warfarin . CONCLUSIONS  Aspirin use increased among Chinese patients newly diagnosed with AF , with no relationship to the patient 's stroke or bleeding risk .  Warfarin use was very low . Given the health-care burden of AF and its complications , our study has major implication s for health-care systems in non-Western countries , given the global burden of this common arrhythmia OBJECTIVE To investigate the prevalence and distributing feature of  atrial fibrillation ( AF ) in Xinjiang Kazaks adult population . METHODS Four-stage selected r and om sample s aged 30 - 89 years from Tacheng , Yili and Aletai  were analyzed . An epidemical study of AF was performed including inquiring medical history , recording electrocardiogram and auscultation . RESULTS A total of 22 514 adults were surveyed . The prevalence of AF in Xinjiang Kazaks adult population was 0.37 % , which was increasing with aging . The prevalence was higher in men than in women ( 0.5 % vs 0.2 % , P < 0.01 ) . In AF patients , 23 was valvular AF . Ischemic stroke was the most frequent type and the stroke rate in the patients with AF was significantly higher than that without AF ( 6.0 % vs 1.2 % , P < 0.01 ) . CONCLUSIONS The prevalence of AF in Xinjiang Kazaks adult population is lower than the reported national prevalence but patients with AF in this population would not like to take the necessary medicine . Therefore , the control of AF need to be reinforced Background Recent evidence suggests that there are ethnic variations in atrial fi brillation ( AF ) susceptibility and incidence following acute myocardial infa rct ion ( AMI ) . Objectives The aim of this study was to evaluate the incidence and predictors of AF in the setting of AMI in Middle Eastern Arab and South Asian patients and its impact on in-hospital morbidity and mortality . Methods A retrospective analysis of a prospect i ve registry of all patients hospitalized with AMI in the state of Qatar from 1991 through 2010 was made . Clinical characteristics and outcomes of  AMI patients with and without AF  were compared . Sub- analysis according to ethnicity was also performed . Results During the 20-year period ; a total of 12,881 patients were hospitalized with AMI . Of these 5028 were Arabs and 5985 were South Asians . A total of 227 had AF during hospitalization with an overall incidence of 1.8 % ( 156 Arabs ; incidence 3.1 % and 48 South Asians ; incidence 0.8 % ) . The mean age of AF patients was 65 years ( Arabs 69 , South Asians 54 ) . Patients with AF were signifi cantly older and had more cardiovascular co-morbidities than patients without AF , and were more likely to have non-ST elevation AMI on presentation . Patients with AF had signifi cantly higher in-hospital mortality rate ( 20.3 % versus 7.1 % ; P= 0.001 ) and stroke rates ( 1.8 % versus 0.3 % ; P= 0.001 ) when compared to patients without AF . Age was the only independent predictor of AF development in patients with AMI in our study . Conclusions Our study reports variability in the prevalence of AF among AMI patients according to ethnicity using a 20-year registry from a Middle Eastern country . Advancing age was the major independent predictor of AF in our AMI patients . Further prospect i ve studies are required evaluating optimal therapeutic approaches for these high-risk patients in order to reduce the high mortality observed AIMS Change in NT-proBNP level is a common surrogate endpoint in early phase heart failure ( HF ) trials , but whether this endpoint is influenced by atrial fibrillation/flutter ( AFF ) is unclear . METHODS AND RESULTS This analysis included 1358 patients from the ASTRONAUT trial , which r and omized patients hospitalized for HF with EF ≤40 % to aliskiren or placebo in addition to st and ard care .  Patients were stratified by presence of AFF on baseline ECG . NT-proBNP was measured longitudinally by a core laboratory at baseline , 1 month , 6 months , and 12 months . Compared with non-AFF patients , AFF patients experienced greater reduction from baseline in log-transformed NT-proBNP ( interaction P < 0.001 ) , but this difference was not significant after adjustment ( interaction P = 0.726 ) . The ability of aliskiren to lower NT-proBNP during follow-up differed by AFF status ( interaction P = 0.001 ) , with aliskiren  lowering NT-proBNP more than placebo among non-AFF patients only . After adjustment , baseline AFF was not associated with mortality or HF hospitalization at 12 months ( all P ≥ 0.152 ) . CONCLUSION In this hospitalized HF cohort , AFF status did not influence post-discharge NT-proBNP trajectory or clinical outcomes after adjustment for patient characteristics . Aliskiren lowered follow-up NT-proBNP levels in patients without AFF , but had no influence among patients with AFF . This study generates the hypothesis that the ability of a HF trial to meet an NT-proBNP defined endpoint may be influenced by the prevalence of AFF in the population . Because aliskiren did not improve outcomes in patients without AFF , this analysis suggests changes in NT-proBNP induced by investigational therapies may be dissociated from clinical effects
target: : The incidence and prevalence of AF have increased in recent years , although great variability still exists in Asian countries .
  Variability in annual IS risk in patients with AF was apparent between hospital‐ and community‐based studies .
background: BACKGROUND : Our previous review reported great variability in the incidence and prevalence of atrial fibrillation ( AF ) in non‐Western cohorts , especially from Asian countries ; in recent years , epidemiologic studies on AF have been increasingly reported from Asia .
  METHODS : The goal of this up date d systematic review was to present the current knowledge base of AF epidemiology in Asian countries since our previous review .