Prevalence, Risk Factors and Pharmacological Treatment of Atrial Fibrillation in Older Hospitalized Patients in Vietnam

Tu Ngoc Nguyen, Vu Thanh Huyen, Thanh Xuan Nguyen, Thang Pham, Sarah Nicole Hilmer, Robert Graham Cumming


Background. The evidence about prevalence of atrial fibrillation (AF) in Vietnam is very limited. This study aims to investigate the prevalence of AF, its associated factors and pharmacological treatment in older patients in Vietnam.The secondary aim is to investigate the impact of frailty on the pharmacological treatment of AF.

Methods. We used data from a study of the prevalence of frailty in older hospitalised patients at the National Geriatric Hospital in Hanoi, Vietnam. Consecutive patients aged ≥60 years were recruited from 4/2015 to 10/2015.

Results. A total of 461 patients was recruited (56.8% female, mean age 76.2±8.9). The prevalence of AF was 3.9% (18 patients). Amongst patients with AF, the most common medical conditions were hypertension (72.2%), followed by stroke (55.6%), heart failure (50.0%), type2 diabetes (44.4%). Living alone (OR=10.2, 95%CI 1.5–70.1), having a habit of using vitamins at home (OR=3.8, 95%CI 1.1–13.4), having heart failure (OR=31.3, 95%CI 9.6–101.8), and having type 2 diabetes (OR=3.5, 95%CI 1.2–10.7) were associated with the presence of AF on admission. All patients with AF had a high risk of stroke (CHA2DS2-VASc score≥2) and 72.2% of them had a high risk of bleeding with anticoagulant medications (HAS-BLED score≥3). Only 22.2% were anticoagulated on admission and 22.2% upon discharge, with no difference between frail and non-frail patients.

Conclusions. The prevalence of AF among older hospitalised patients in Vietnam is similar to that reported in other countries. Anticoagulation for stroke prevention was underused, without any significant difference between frail and non-frail patients.


atrial fibrillation; prevalence; Vietnam; risk factors; frailty


Rahman F, Kwan GF, Benjamin EJ. Global epidemiology of atrial fibrillation. Nature Reviews Cardiology. 2014;11(11):639-54. DOI: 10.1038/nrcardio.2014.118.

Friberg J, Buch P, Scharling H, Gadsbøll N, Jensen GB. Rising rates of hospital admissions for atrial fibrillation. Epidemiology. 2003;14(6):666-72. DOI: 10.1097/01.ede.0000091649.26364.c0

Wellens HJJ, Smith Jr SC. Current issues in atrial fibrillation management. ACC Cardiosource Review Journal. 2006;15(12):3-6.

Patel NJ, Deshmukh A, Pant S, Singh V, Patel N, Arora S, et al. Contemporary trends of hospitalization for atrial fibrillation in the united states, 2000 through 2010 implications for healthcare planning. Circulation. 2014;129(23):2371-9. DOI: 10.1161/CIRCULATIONAHA.114.008201.

Chugh SS, Blackshear JL, Shen W-K, Hammill SC, Gersh BJ. Epidemiology and natural history of atrial fibrillation: clinical implications. Journal of the American College of Cardiology. 2001;37(2):371-8. DOI:10.1016/S0735-1097(00)01107-4.

Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, et al. Prevalence of Diagnosed Atrial Fibrillation in Adults. JAMA: The Journal of the American Medical Association. 2001;285(18):2370-5. DOI:10.1001/jama.285.18.2370.

Sturm JW, Davis SM, O'Sullivan JG, Vedadhaghi ME, Donnan GA. The Avoid Stroke as Soon as Possible (ASAP) general practice stroke audit. The Medical journal of Australia. 2002;176(7):312-6. Epub 2002/05/16.

Bang A, McGrath NM. The incidence of atrial fibrillation and the use of warfarin in Northland, New Zealand stroke patients. New Zealand Medical Journal. 2011;124(1343):28-32.

Levy S, Maarek M, Coumel P, Guize L, Lekieffre J, Medvedowsky JL, et al. Characterization of different subsets of atrial fibrillation in general practice in France: The ALFA study. Circulation. 1999;99(23):3028-35. DOI: 10.1161/01.CIR.99.23.3028.

Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). European heart journal. 2010;31(19):2369-429. DOI: 10.1093/eurheartj/ehq278.

Nguyen TN, Hilmer SN, Cumming RG. Review of epidemiology and management of atrial fibrillation in developing countries. International Journal of Cardiology. 2013;167(6):2412-20. DOI: 10.1016/j.ijcard.2013.01.184.

Hylek EM, Go AS, Chang Y, Jensvold NG, Henault LE, Selby JV, et al. Effect of intensity of oral anticoagulation on stroke severity and mortality in atrial fibrillation. The New England journal of medicine. 2003;349(11):1019-26. DOI: 10.1056/NEJMoa022913.

Waldo AL, Becker RC, Tapson VF, Colgan KJ. Hospitalized patients with atrial fibrillation and a high risk of stroke are not being provided with adequate anticoagulation. Journal of the American College of Cardiology. 2005;46(9):1729-36. DOI:10.1016/j.jacc.2005.06.077

Corvol A, Gulsvik AK, Kuper IMJA, Phylaktou P, Myrstad M, Somme D, et al. Use of anticoagulants for atrial fibrillation in older subjects across different countries: Cyprus, France, Netherlands, Norway. European Geriatric Medicine. 2014;5(1):60-5. DOI: 10.1016/j.eurger.2013.10.013.

Radholm K, Ostgren CJ, Alehagen U, Falk M, Wressle E, Marcusson J, et al. Atrial fibrillation (AF) and co-morbidity in elderly. A population based survey of 85 years old subjects. Archives of Gerontology and Geriatrics. 2011;52(3):e170-e5. DOI: 10.1016/j.archger.2010.10.024

Perera V, Bajorek BV, Matthews S, Hilmer SN. The impact of frailty on the utilisation of antithrombotic therapy in older patients with atrial fibrillation. Age & Ageing. 2009;38(2):156-62. DOI: 10.1093/ageing/afn293.

United Nations Population Fund (UNFPA) in Vietnam. The aging population in Vietnam: current status, prognosis, and possible policy responses. Hanoi, Vietnam: 2011. From Accessed 15/01/2016.

Ha NT, Le NH, Khanal V, Moorin R. Multimorbidity and its social determinants among older people in southern provinces, Vietnam. International Journal for Equity in Health. 2015 May 30;14:50. DOI: 10.1186/s12939-015-0177-8.

Nhung NT, Long TK, Linh BN, Vos T, Huong NT, Anh ND. Estimation of Vietnam national burden of disease 2008. Asia Pac J Public Health. 2014;26(5):527-35. DOI: 10.1177/1010539513510556

Hoang VM, Dao LH, Wall S, Nguyen TK, Byass P. Cardiovascular disease mortality and its association with socioeconomic status: findings from a population-based cohort study in rural Vietnam, 1999-2003. Prev Chronic Dis. 2006;3(3):A89. Epub 2006/06/17.

Islam SM, Purnat TD, Phuong NT, Mwingira U, Schacht K, Froschl G. Non-communicable diseases (NCDs) in developing countries: a symposium report. Global Health. 2014;10:81. DOI: 10.1186/s12992-014-0081-9.

Nguyen HL, Nguyen QN, Ha DA, Phan DT, Nguyen NH, Goldberg RJ. Prevalence of comorbidities and their impact on hospital management and short-term outcomes in Vietnamese patients hospitalized with a first acute myocardial infarction. PloS one. 2014;9(10):e108998. DOI: 10.1371/journal.pone.0108998.

Nguyen T, Do C, Dao N, Le L, Nguyen H, Pham B, et al. Early outcomes of stroke patients associated with atrial fibrillation in Vietnam. International Journal of Stroke. 2015;10:266-7.

January CT, Wann LS, Alpert JS, Calkins H, Cleveland Jr JC, Cigarroa JE, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: A report of the American college of cardiology/American heart association task force on practice guidelines and the heart rhythm society. Circulation. 2014 Dec 2;130(23):2071-104. DOI: 10.1161/CIR.0000000000000040.

Pisters R, Lane DA, Nieuwlaat R, De Vos CB, Crijns HJGM, Lip GYH. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: The euro heart survey. Chest. 2010;138(5):1093-100. DOI: 10.1378/chest.10-0134.

Hilmer SN, Perera V, Mitchell S, Murnion BP, Dent J, Bajorek B, et al. The assessment of frailty in older people in acute care. Australasian Journal on Ageing. 2009;28(4):182-8. DOI: 10.1111/j.1741-6612.2009.00367.x

Perera V, Bajorek BV, Matthews S, Hilmer SN. The impact of frailty on the utilisation of antithrombotic therapy in older patients with atrial fibrillation. Age and Ageing. 2009;38(2):156-62. doi: 10.1093/ageing/afn293.

Rose M, Pan H, Levinson MR, Staples M. Can frailty predict complicated care needs and length of stay? Internal Medicine Journal. 2014;44(8):800-5. DOI: 10.1111/imj.12502.

Osborne C, Charles A, Hare A, Shipway D. Frailty predicts length of hospital stay in urology patients. European Urology, Supplements. 2015;14(2):e658. DOI: 10.1016/S1569-9056(15)60651-0

Mitchell SJ, Hilmer SN, Murnion BP, Matthews S. Hepatotoxicity of therapeutic short-course paracetamol in hospital inpatients: Impact of ageing and frailty. Journal of Clinical Pharmacy and Therapeutics. 2011;36(3):327-35. DOI: 10.1111/j.1365-2710.2010.01193.x.

Bennett A, Gnjidic D, Gillett M, Carroll P, Matthews S, Johnell K, et al. Prevalence and impact of fall-risk-increasing drugs, polypharmacy, and drug-drug interactions in robust versus frail hospitalised falls patients: A prospective cohort study. Drugs and Aging. 2014;31(3):225-32. DOI: 10.1007/s40266-013-0151-3.

Lubitz SA, Benjamin EJ, Ellinor PT. Atrial Fibrillation in Congestive Heart Failure. Heart Failure Clinics. 2010;6(2):187-200. DOI: 10.1016/j.hfc.2009.11.001.

Menezes AR, Lavie CJ, DiNicolantonio JJ, O'Keefe J, Morin DP, Khatib S, et al. Atrial fibrillation in the 21st century: A current understanding of risk factors and primary prevention strategies. Mayo Clinic Proceedings. 2013;88(4):394-409. DOI: 10.1016/j.mayocp.2013.01.022

Okumura J, Wakai S, Umenai T. Drug utilisation and self-medication in rural communities in Vietnam. Social Science and Medicine. 2002;54(12):1875-86. DOI: 10.1016/S0277-9536(01)00155-1

Vanga SR, Vacek JL, Good M, Nath J, Bommana S, Nagarajan DV, et al. Deficiency of 25-hydroxy cholecalciferol worsens the risk factor profile but confers protection against atrial fibrillation-the vitamin-D paradox? Circulation. 2011;124(21).

Nguyen HM, Cihlar V. Differences in Physical Fitness and Subjectively Rated Physical Health in Vietnamese and German Older Adults. Journal of Cross-Cultural Gerontology. 2013;28(2):181-94. DOI: 10.1007/s10823-013-9195-4.

Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. The Lancet Neurology. 2009;8(4):355-69. DOI: 10.1016/S1474-4422(09)70025-0.

Shewan L, Coats A, Henein M. Requirements for ethical publishing in biomedical journals. International Cardiovascular Forum Journal. 2015;2(2). DOI: 10.17987/icfj.v2i1.4.


Copyright (c) 2016 Tu Ngoc Nguyen, Vu Thanh Huyen, Thanh Xuan Nguyen, Thang Pham, Sarah Nicole Hilmer, Robert Graham Cumming

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.