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Original Research (Original Article) 


Ahmed Futaykhan Alanazi et al, 2019;3(7):604–608.

International Journal of Medicine in Developing Countries.

Atrial Fibrillation in patients of Arar, Northern Saudi Arabia

Ahmed Futaykhan Alanazi1*, Abdulaziz Mofareh Alanazi1, Mana Saleh Hadi AlGrad2, Mohammed Mahdi Owiad AlSuliman2, Faisal Saleh Alanazi1, Abdulelah Abdulrhman Alzammam1, Khalid Nadi Alanazi1, Alhanouf Hussein Alahmari3, Adel Turki Alenezi1, Mohammed Abdullah Ali Qurayshah2, Jafar Faraj Alamrad1, Abdulaziz Matar R. Alanazi4

Correspondence to: Ahmed Futaykhan Alanazi

*Faculty of Medicine, Northern Border University, Arar, Saudi Arabia.

Email: ahmmad1899 [at] gmail.com

Full list of author information is available at the end of the article.

Received: 27 January 2019 | Accepted: 09 February 2019


ABSTRACT

Background:

Atrial fibrillation (AF) is defined as an abnormal heart rhythm characterized by the rapid and irregular beating of the atria. High blood pressure and valvular heart disease are the most common alterable risk factors for AF. The current study aimed to assess the causes and risk factors of AF in AF patients in Arar, Northern Saudi Arabia and also to assess the associated morbidity for this condition.


Methodology:

A cross-sectional study was conducted among the patients attending the cardiac center of Arar, Northern Saudi Arabia during the period from 1 March to 31 May 2018. Fifty adult AF subjects aged more than 20 years were included in the study.


Results:

The majority of cases (72%) were males and 68% were aged between 40 to 60 years with a mean age of 49.6 ± 6.4 (range 22–76). Obesity was found in 4% of the cases, but 46% were overweight, and 2% were underweight. The majority of cases (70%) were hypertensive, 64% were diabetic, 16% had heart failure, 4% had valvular heart diseases, 26% had ischemic heart disease, 18% had thyroid dysfunction, 14% had chronic kidney disease, 16% had chronic obstructive pulmonary disease (COPD), and 16% had prior stroke. Smoking was found to be positive in 62% of the cases.


Conclusion:

AF was more prevalent in males than females among the subjects attending the cardiac center of Arar. Overweight, hypertension, diabetes, heart failure, ischemic heart disease, thyroid dysfunction, and COPD were the risk factors associated with morbidity.


Keywords:

Atrial fibrillation, cardiac center, causes, associated morbidity, Arar, Northern Saudi Arabia.


Introduction

Atrial fibrillation (AF) is defined as an abnormal heart rhythmatria. Often, it starts as brief periods of abnormal heart beating which become longer and possibly constant over time. AF is a common cardiac arrhythmia condition and usually complicates the clinical course of other cardiac and non-cardiac diseases. One large review from the United States [1] in 1968 reported that the commonest associated diseases to AF were hypertension (34%) and arteriosclerotic heart disease (23%). This arrhythmia is a major risk factor for cardiovascular events such as stroke, mortality, and coronary artery diseases [2,3]. Individuals with AF have a nearly fivefold increased risk of developing stroke compared with individuals without cardiovascular disease [4]. In 2001, the prevalence of AF was between 1.0 and 1.5% in the developed countries [5,6]. Due to an increased risk of AF with increasing age [7,8] and an aging population, prevalence has increased in recent years and is expected to continue to rise [9]. In the United States, the total number of individuals with AF has been projected to be more than double over the next 50 years [9]. One hypothesis for the increasing incidence is that AF in the majority of people is a vascular disease caused by hypertension, atherosclerosis, and other cardiovascular risk factors, which increase the arterial stiffness and cause diastolic dysfunction and atrial volume overload, resulting in AF.

Analysis of global risk factors in the global burden of diseases 2010 study showed that high blood pressure is the number 1 risk factor globally (increasing from the fourth position in 1990), accounting for 7% of all global the disability-adjusted life year. High body mass index ranks sixth in the global list, ascending from the 10th position in 1990. Deaths attributable to hypertension increased by 28.8% from 1990 to 2010, whereas deaths attributable to obesity increased by 71.7% in 2018. Thus, it appears that the increase in AF burden potentially could be linked to risk factors such as hypertension and obesity at a global level. High blood pressure and valvular heart disease are the most common alterable risk factors for AF. Other heart-related risk factors include heart failure, coronary artery disease, cardiomyopathy, and congenital heart disease. In the developing countries, valvular heart disease often occurs as a result of rheumatic fever, lung-related risk factors, which include chronic obstructive pulmonary disease (COPD), obesity, and sleep apnea, and other factors, which include excessive alcohol intake, tobacco smoking, diabetes mellitus (DM), and thyrotoxicosis. A few people with AF have no manifestations and are uninformed of their condition until the point when it’s found amid by a physical examination. The individuals who do have AF indications may encounter signs and manifestations, for example, palpitations, which are impressions of a dashing, awkward, unpredictable heartbeat, weakness, reduced ability to exercise, fatigue, lightheadedness, shortness of breath, and chest pain. Aspirin and warfarin have been the backbones of treatment for stroke prevention in individuals with AF [10], while anticoagulation with warfarin is more effective than aspirin in stroke prevention [11,12].


Subjects and Methods

A cross-sectional study was conducted on 50 adult AF subjects aged more than 20 years in Arar city, Saudi Arabia. The study was conducted during the period from 1 March to 31 May 2018. A systematic sampling technique was employed for the study by including every second AF case attending the center and diagnosed by the physicians. Data were collected from the patients by filling the questionnaire which provided the data of socio-demographic characteristics such as age, sex, smoking status, and certain types of diseases that may be a cause, risk factor or complication to the condition such as hypertension, diabetes, heart failure, valvular heart diseases, ischemic heart disease, thyroid dysfunction, chronic kidney disease, COPD, and prior stroke. Also, the Smoking and alcohol drinking condition were included in the collected data.

Informed consent was obtained from all participants. Statistical Package for the Social Sciences (SPSS), V.16 (SPSS Inc., Chicago, Illinois) was used to analyze the data. The results were displayed as counts and percentages.


Results

Table 1 illustrates the findings of AF cases attending the cardiac center of Arar, Northern Saudi Arabia. The total number of cases was 50 patients. The majority of cases (72%) were males, most of the cases (68%) were between 40 and 60 years old, 16% were between 20 and 39 years old, and another 16% ware more than 60 years old with a mean age (±SD) 49.6 ± 6.4 (range 22–76), respectively. Obesity was found in 4% of the cases, 46% were overweight, 48% have a normal weight, and 2% were underweight. The majority of the cases (70%) were hypertensive, 64% were diabetic, 16% had heart failure, 4% had valvular heart diseases, 26% had ischemic heart disease, 18% had thyroid dysfunction, 14% had chronic kidney disease, 16% had chronic COPD, and 16% had prior stroke. Smoking was found to be positive in 62% of the cases, and there was no alcohol drinker.


Discussion

AF or A-fib is an abnormal heart rhythm characterized by the rapid and irregular beating of the atria [13]. Often it starts as brief periods of abnormal beating, which becomes longer and possibly constant over time [14]. It is the most common cardiac rhythm disorder, accounting for one-third of hospitalizations for cardiac disturbances [15,16] and associated with increased risk of morbidity and mortality [17]. AF is a global health care problem with evidence suggesting an increasing prevalence and incidence worldwide [18,19]. A systematic review of worldwide population-based studies (n = 184) estimated that the number of individuals with AF in 2010 was 33.5 million. The prevalence of AF varies with age and sex. AF is present in 0.12%–0.16% of those younger than 49 years, in 3.7%–4.2% of those aged 60–70 years, and in 10%–17% of those aged 80 years or older. Also, it occurs more frequently in males, with a male to female ratio of 1.2:1 [20]. This is a cross-sectional study conducted among 50 AF cases attending the cardiac center of Arar, Northern Saudi Arabia. Age is an important risk factor for the development of new-onset AF; our study reported that AF was more prevalent at age group 40–60 years old by 68% and only 16% older than 60 years. In Riyadh, Saudi Arabia, another study conducted among 152 cases with AF reported the mean age to be 66 years (SD = 10.4); the majority of them (49%) were 61–74 years old, 26% were 51–60 years old, 20% were more than 75 years old, and only 5% were less than 50 years old [21]. In an observational hospital-based study carried amongst indoor patients of AF in Bihar, India, by Vidya et al. [22] reported that the mean age of the patients was 47 years and the majority of patients were aged between 51 and 60 years (48%). However, another study revealed a mean age of 45.4 years, with most (51%) aged < 50 years and only 16.3% were older than 60 years [23]. Furthermore, a study of patients with AF done at a tertiary care hospital in Gujarat, India, revealed that most (46%) patients with AF were between the age of 31 and 40 years, 31% were between 41 and 50 years, and 15% were between the age of 15 and 30 years [24].

Table 1. Findings of AF cases attending the cardiac center of Arar, Northern Saudi Arabia.

Variables Frequency (No.) Percent (%)
Age group
20–39 8 16.0
40–60 34 68.0
>60 8 16.0
Mean age (±SD) 49.6 ± 6.4 (range 22–76)
Gender
Female 14 28.0
Male 36 72.0
BMI group
Underweight 1 2.0
Normal 24 48.0
Overweight 23 46.0
Obese 2 4.0
Mean BMI (±SD) 25.7 ± 2.8 (range 17.0–34.4)
Hypertension
Yes 35 70.0
No 15 30.0
DM
Yes 32 64.0
No 18 36.0
Heart failure
Yes 8 16.0
No 42 84.0
Valvular heart disease
Yes 2 4.0
No 48 96.0
Ischemic heart disease
Yes 13 26.0
No 37 74.0
Thyroid disease
Yes 9 18.0
No 41 82.0
Chronic kidney diseases
Yes 7 14.0
No 43 86.0
COPD
Yes 8 16.0
No 42 84.0
Prior stroke
Yes 8 16.0
No 42 84.0
Current smoking
Yes 31 62.0
No 19 38.0
Current alcohol drinking
No 50 100.0

As regards gender, this study found that the majority of cases were males 72% and only 28 % were females. In the United Arab Emirates, another study reported among cases with AF, 53% were males and 47 % were females [21]. In both Framingham Heart Study and Atherosclerosis risk in communities Study men had a 1.5-fold greater risk of developing AF than women and the lifetime risk of developing AF after the age of 40 in the Framingham cohort was reported to be 26% for men and 23% for women [25,26]. However, studies from India have revealed a slightly higher female preponderance with the reported male: female ratio in the range of 1:1.38,1:1.2, and 1:1.24 [23,24,27]. According to comorbidities, our study reported; hypertension 70%, DM 64%, ischemic heart disease 26%, thyroid disease 18%, heart failure 16%, COPD16%, prior stroke 16%, chronic Kidney diseases 14%, and valvular heart disease 4%. In King Khalid University Hospital, a retrospective review of 65 consecutive patient charts with a diagnosis of AF was performed in order to study the prevalence of associated underlying diseases and it was found that rheumatic heart disease accounts for the majority of cases 31%, followed by cardiomyopathy with 17 %, arteriosclerotic heart disease 12%, and hypertensive heart disease 8% [28]. In Qatar, another study found that hypertension was present in 31.7% and DM was in 27.6% of the AF patients; congestive heart disease (19.5%) and old myocardial infarction (9.6%( were high among AF patients; and valvular heart diseases were significant underlying diseases in AF patient, particularly mitral stenosis (6.8%) and incompetence (4.5%) [29]. Another study reported that among patients with AF, 47% had congestive heart failure, 27.44% had hypertensive heart disease, 21.4% had ischemic heart disease, 17.4% had valvular heart disease, 14.3% had diabetes, and 6.7% had the COPD [30]. A systematic review of the studies reported on the epidemiology of AF in Europe found that AF is frequently associated with cardiac disease and with cardiac/non-cardiac comorbidity. Hypertensive heart disease (22%–36%), coronary heart disease (14%–32%), valvular heart disease (12%–26%), and cardiomyopathy (6%–10%) are the most common illnesses associated with AF, while the most frequent comorbidities are hypertension (67%–76%), heart failure (22%–42%), diabetes (20%–24%), obesity (20%–35%), chronic pulmonary disease (10%–18%), thyroid dysfunction (8%–11%), renal failure (11%–22%), stroke/transient ischemic attack (9%–16%), and neuropsychiatric disturbances (19%) [20]. Our study reported that 62% of cases were currently smoking. Ahmed et al. [31] showed that atrial AF was identified in 9.5% in smokers versus 7.8% in non-smokers (p < 0.001), and smoking was associated with a 15% increased risk of AF during ten years of follow up in 11,047 participants. The Rotterdam study reported a 51% and 49% increased risk of incident AF among current and former smokers, respectively [32]. The Shinken database from Japan also showed that smoking was independently associated with the first appearance of AF in patients in sinus rhythm [33]. The present study had limitation as it was a cross-sectional study and the sample size was small, not sufficient to make inferences. A case-control study should be carried out to determine the risk factors and to measure the strength of association between the AF and other morbidities.


Conclusion

The present study targeted AF subjects attending the cardiac center of Arar, Northern Saudi Arabia. The study found that AF was more prevalent in males than females and the prevalence is particularly in patients aged 40–60 years; overweight, hypertension, diabetes, heart failure, ischemic heart disease, thyroid dysfunction, and COPD were associated with morbidity. Prior cerebrovascular stroke was found in the considerable percentage of cases. Large-scale case-control study is recommended to determine the exact risk factors. Community screening depending upon patient history and ECG is also recommended to discover undiagnosed cases to protect them against the further complications of this condition.


List of Abbreviations

AFAtrial fibrillation
COPDChronic obstructive pulmonary disease
DMDiabetes mellitus
SPSSStatistical Package for the Social Sciences

Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Informed consent was obtained from all the participants.


Ethical approval

The research was done under the supervision of the Faculty of Medicine, Northern Border University, Arar, Saudi Arabia.


Author details

Ahmed Futaykhan Alanazi1, Abdulaziz Mofareh Alanazi1, Mana Saleh Hadi AlGrad2, Mohammed Mahdi Owiad AlSuliman2, Faisal Saleh Alanazi1, Abdulelah Abdulrhman Alzammam1, Khalid Nadi Alanazi1, Alhanouf Hussein Alahmari3, Adel Turki Alenezi1, Mohammed Abdullah Ali Qurayshah2, Jafar Faraj Alamrad1, Abdulaziz Matar R. Alanazi4

  1. Faculty of Medicine, Northern Border University, Arar, Saudi Arabia
  2. Internal Medicine Department, King Abdulaziz University, King Khaled Hospital, Najran, Saudi Arabia
  3. King Khalid University, Abha, Saudi Arabia
  4. Medical Intern, Northern Border University, Arar, Saudi Arabia

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How to Cite this Article
Pubmed Style

Alanazi AF, Alanazi AM, AlGrad MSH, AlSuliman MMO, Alanazi FS, Alzammam AA, Alanazi KN, Alahmari AH, Alenezi AT, Qurayshah MAA, Alamrad JF, Alanazi AMR, . Atrial Fibrillation in patients of Arar, Northern Saudi Arabia. IJMDC. 2019; 3(7): 604-608. doi:10.24911/IJMDC.51-1548377897


Web Style

Alanazi AF, Alanazi AM, AlGrad MSH, AlSuliman MMO, Alanazi FS, Alzammam AA, Alanazi KN, Alahmari AH, Alenezi AT, Qurayshah MAA, Alamrad JF, Alanazi AMR, . Atrial Fibrillation in patients of Arar, Northern Saudi Arabia. http://www.ijmdc.com/?mno=27856 [Access: August 20, 2019]. doi:10.24911/IJMDC.51-1548377897


AMA (American Medical Association) Style

Alanazi AF, Alanazi AM, AlGrad MSH, AlSuliman MMO, Alanazi FS, Alzammam AA, Alanazi KN, Alahmari AH, Alenezi AT, Qurayshah MAA, Alamrad JF, Alanazi AMR, . Atrial Fibrillation in patients of Arar, Northern Saudi Arabia. IJMDC. 2019; 3(7): 604-608. doi:10.24911/IJMDC.51-1548377897



Vancouver/ICMJE Style

Alanazi AF, Alanazi AM, AlGrad MSH, AlSuliman MMO, Alanazi FS, Alzammam AA, Alanazi KN, Alahmari AH, Alenezi AT, Qurayshah MAA, Alamrad JF, Alanazi AMR, . Atrial Fibrillation in patients of Arar, Northern Saudi Arabia. IJMDC. (2019), [cited August 20, 2019]; 3(7): 604-608. doi:10.24911/IJMDC.51-1548377897



Harvard Style

Alanazi, A. F., Alanazi, . A. M., AlGrad, . M. S. H., AlSuliman, . M. M. O., Alanazi, . F. S., Alzammam, . A. A., Alanazi, . K. N., Alahmari, . A. H., Alenezi, . A. T., Qurayshah, . M. A. A., Alamrad, . J. F., Alanazi, . A. M. R. & (2019) Atrial Fibrillation in patients of Arar, Northern Saudi Arabia. IJMDC, 3 (7), 604-608. doi:10.24911/IJMDC.51-1548377897



Turabian Style

Alanazi, Ahmed Futaykhan, Abdulaziz Mofareh Alanazi, Mana Saleh Hadi AlGrad, Mohammed Mahdi Owiad AlSuliman, Faisal Saleh Alanazi, Abdulelah Abdulrhman Alzammam, Khalid Nadi Alanazi, Alhanouf Hussein Alahmari, Adel Turki Alenezi, Mohammed Abdullah Ali Qurayshah, Jafar Faraj Alamrad, Abdulaziz Matar R Alanazi, and . 2019. Atrial Fibrillation in patients of Arar, Northern Saudi Arabia. International Journal of Medicine in Developing Countries, 3 (7), 604-608. doi:10.24911/IJMDC.51-1548377897



Chicago Style

Alanazi, Ahmed Futaykhan, Abdulaziz Mofareh Alanazi, Mana Saleh Hadi AlGrad, Mohammed Mahdi Owiad AlSuliman, Faisal Saleh Alanazi, Abdulelah Abdulrhman Alzammam, Khalid Nadi Alanazi, Alhanouf Hussein Alahmari, Adel Turki Alenezi, Mohammed Abdullah Ali Qurayshah, Jafar Faraj Alamrad, Abdulaziz Matar R Alanazi, and . "Atrial Fibrillation in patients of Arar, Northern Saudi Arabia." International Journal of Medicine in Developing Countries 3 (2019), 604-608. doi:10.24911/IJMDC.51-1548377897



MLA (The Modern Language Association) Style

Alanazi, Ahmed Futaykhan, Abdulaziz Mofareh Alanazi, Mana Saleh Hadi AlGrad, Mohammed Mahdi Owiad AlSuliman, Faisal Saleh Alanazi, Abdulelah Abdulrhman Alzammam, Khalid Nadi Alanazi, Alhanouf Hussein Alahmari, Adel Turki Alenezi, Mohammed Abdullah Ali Qurayshah, Jafar Faraj Alamrad, Abdulaziz Matar R Alanazi, and . "Atrial Fibrillation in patients of Arar, Northern Saudi Arabia." International Journal of Medicine in Developing Countries 3.7 (2019), 604-608. Print. doi:10.24911/IJMDC.51-1548377897



APA (American Psychological Association) Style

Alanazi, A. F., Alanazi, . A. M., AlGrad, . M. S. H., AlSuliman, . M. M. O., Alanazi, . F. S., Alzammam, . A. A., Alanazi, . K. N., Alahmari, . A. H., Alenezi, . A. T., Qurayshah, . M. A. A., Alamrad, . J. F., Alanazi, . A. M. R. & (2019) Atrial Fibrillation in patients of Arar, Northern Saudi Arabia. International Journal of Medicine in Developing Countries, 3 (7), 604-608. doi:10.24911/IJMDC.51-1548377897