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Atrial Fibrillation Cases Filling Hospital Beds

Hospitalizations for heartbeat woes nearly tripled between 1985 and 1999, report says.

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WEDNESDAY, July 30, 2003 (HealthDayNews) -- More Americans are being hospitalized for the heartbeat abnormality called atrial fibrillation, which is bad news not only for them but also for the country's public health system, federal experts report.

Hospital stays in which atrial fibrillation was a factor nearly tripled between 1985 and 1999, rising from 787,750 to nearly 2.3 million, says a report in the July 28 online issue of Circulation.

Hospitalizations in which atrial fibrillation was the primary diagnosis went up at a lesser, but still impressive, rate in the same period, from 154,086 to 376,487, says study author Dr. George A. Mensah, chief of cardiovascular health programs at the U.S. Centers for Disease Control and Prevention.

At this rate, the annual number of hospital admissions related to atrial fibrillation will increase to more than 3.3 million by 2025, Mensah predicts.

Atrial fibrillation is a loss of coordinated contraction between the upper chambers of the heart, known as the atria, and the lower chambers, known as the ventricles. The atria fail to beat forcefully enough, so they don't eject enough blood. Clots can form in the remaining blood, eventually entering the bloodstream and blocking an artery in the heart or brain, causing a heart attack or stroke.

Age is a leading risk factor for atrial fibrillation. It is also common in people who have high blood pressure, congestive heart failure and diabetes, and in those who have had heart attacks.

Mensah and his colleagues got their numbers from the National Hospital Discharge Survey, which is done annually. One significant aspect of the results is that more than half the people who were hospitalized were 75 or older.

Many of those older people were discharged to nursing homes. That finding, along with an associated prevalence of congestive heart failure in those patients, "presages a staggering burden on the Medicare system and the quality of life for affected persons," the report says.

"What this report says is that atrial fibrillation is becoming more of a public health problem over time," says Dr. Ira S. Nash, an associate professor of medicine at Mount Sinai Hospital in New York City and a spokesman for the American Heart Association.

It is possible for someone to be unaware of atrial fibrillation, but most of the time there are symptoms, Nash says. They include palpitations, a sense that the heart is beating erratically. "But sometimes people just have a decline in their physical abilities, such as the ability to exercise," he says.

Prevention is the priority, according to Mensah, with most efforts aimed at known risk factors such as high blood pressure, diabetes and congestive heart failure -- and women come first in that effort.

"We think there is a need for more aggressive attention to addressing risk factors in women -- especially a focus on high blood pressure -- because we found that women are hospitalized more than men and because women live longer than men," Mensah writes.

Doctors must be alert for the often subtle signs of atrial fibrillation, Mensah says.

"There are many times when an elderly woman goes into the hospital with nonspecific complaints, such as chest discomfort or shortness of breath," he explains. "If an EKG [electrocardiogram] is taken, it will show atrial fibrillation. This always should be taken seriously. We are trying to make clinicians aware of the importance of atrial fibrillation."

Hospitalizations can be reduced by careful training of atrial fibrillation patients on the use of drugs to control heart rhythm and heart rate, he adds.

More information

Your questions about atrial fibrillation are answered by the American Heart Association or the National Heart, Lung, and Blood Institute.

SOURCES: Ira S. Nash, associate professor, medicine, Mount Sinai Hospital, New York City, and spokesman, American Heart Association; George A. Mensah, M.D., chief of cardiovascular health programs, U.S. Centers for Disease Control and Prevention, Atlanta; July 28, 2003, online issue, Circulation
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