Registry of Atrial Fibrillation in Kerala: A Multicentre cohort study.

Background

Kerala was held up to the world as ‘good health at low cost’. Human development index (HDI) for Kerala is highest in India. Geographically Kerala is situated at the south-west tip of India with an estimated population of 34 million.

Atrial fibrillation (AF) is the most common form of chronic cardiac arrhythmia and its prevalence is likely to increase in the next decades. AF is independently associated with increased risk of stroke and death. AF is associated with a six fold increase in stroke risk, contributing 20-25% of ischaemic stroke in older patients. The incidence of AF doubles with successive age decades after the age of 50 years. Hypertension is the most common comorbidity in AF patients, and globally there has been a steady increase in hypertension prevalence in AF patients from 53% to 83% over the last 20 years.

Very little is known about the prevalence, aetiology and treatment pattern of AF in India and continued data collection through a registry can improve understanding of AF in India. In some rural parts of India, Rheumatic heart disease (RHD) had been reported as the most common factor for AF. In Kerala it has been observed that hypertension is the important factor leading to AF, just like that in the western countries. Though this transition is well appreciated in Kerala, it is not documented through scientific study.

Rationale

Data on Atrial Fibrillation patients from the State of Kerala is lacking. This study will be initiated as state-wide patient registry to document the etiology and socio demographic characteristics of AF patients in the state and the current standard of care as well as short to medium term mortality rate of  AF patients in Kerala.  All patients will be followed up at 30 days, 6 months and 1,2,3,4 and 5 years, for clinical outcome. A database will be created for further scientific study to improve treatment for AF in Kerala.

Clinical Outcome:  Cardiovascular death,

Stroke or transient ischemic attack,

Myocardial infarction,

Peripheral embolism

Hospitalization for arrhythmia,

Hospitalization for: cardiovascular events or intervention, chronic heart failure, acute coronary syndrome.

n  Primary Objective: To evaluate the cardiovascular and non-cardiovascular diseases associated with AF and to assess the socio-demographic characteristics of AF patients.

n  Secondary Objectives:

1.      To estimate the mortality rates among patients with AF in the state.

2.      To estimate the incidence of major adverse cardiac and cerebrovascular  events (MACCE) in patients with AF.