1、 Management of Atrial Fibrillation：Update in the EBM proofChangSheng Ma Department of Cardiology, Beijing Anzhen Hospital Capital Medical University, P.R. ChinaPrevalence of AF is increasingAdults with AFib(millions)Year2.082.262.442.66 2.943.333.804.784.345.16 5.425.61% 363753YearProportion Aged 80
2、 YrGo: JAMA, 2001： 2370Miyasaka.Circulation.2006:119Year2.04.06.08.010.012.014.016.02000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050Adults with AFib(millions)5.110.28.412.115.9Prevalence of AF is increasingPrevalence %AgePrevalence of AF:the Rotterdam studyHeerinaga.Eur Heart J,2006,9496808 pt
3、s., F/U 6.9 yrs， prevalence 5.5%Incidence AgeIncidence of AF:the Rotterdam studyHeerinaga.Eur Heart J,2006,9496808 pts., F/U 6.9 yrs， Incidence 9.9Identified AF： the tip of the icebergv14802 pts aged 65 or over， randomized to systemic screening and opportunistic screeningSystemic screening group:986
4、6 pts.Opportunistic screening group: 4936 pts.vF/U 12 monsRate of new AF case in systemic screening 1.63%，Rate of new AF case in opportunistic screening 1.04%Fitzmaurice.BMJ.2007,383Risk for stroke increased in lone AFJahangir. Circulation. 2007:3050Meta-analysis:antithrombotic therapy of AFHart.Ann
5、 Intern Med,2007,857trial pts RR reduced(%)Warfarin vs Placebo 6 2900 64ASA vs Placebo 8 4876 22Warfarin vs ASA 12 12963 39Real world of warfarin in the elderly13.1%4.7%The first 90 days associated with major hemorrhage21% pts withdrawn warfarin for safety issueThe higher risk of stroke, the higher incidence of major hemorrhageHylek. Circulation.2007,2689 HR for ICH was 4.06 for AsiansAsians were at greater risk for warfarin-ralated ICHShen. JACC.2007:309
