A review of the epidemiology of atrial fibrillation in sub‐Saharan Africa

Noubiap, Jean Jacques; Nyaga, Ulrich Flore

doi:10.1111/jce.14222

Cited by 16 publications

(24 citation statements)

References 83 publications

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“…This systematic review has shown that about four in five of all AF are managed via rate-control strategy. These findings are similar to those of one other AF review in this region [122]. This demonstrates that evidenced-based AF rhythm-control strategies with catheter ablations which have been shown to have a survival benefit in AF patients with heart failure as in the CASTLE AF trial and others in a systematic review [127] are unlikely to become routine practice soon in this region.…”

Section: Atrial Fibrillation/atrial Fluttersupporting

confidence: 83%

“…Risk factors of AF are similar in SSA compared to HIC, except the significantly higher prevalence of rheumatic heart disease in SSA (22% ) vs HIC (~2%) in AF patients observed in one large registry, as well as lower rates of ischemic heart disease in SSA (6%) vs HIC (~18%) [41], and high AF prevalence 25% in pericarditis in SSA vs 4.3% seen in pericarditis in HIC [121]. The findings of this systematic review are similar to those of prior reviews in Africa with respect to AF prevalences rates, risk factors, and co-morbidities [8,122]. Despite the relatively lower prevalence of AF in people of African descent, the presence of AF is associated with higher rates of strokes, heart failure, and mortality compared to Caucasians, and Black patients with AF are much younger than patients of other races [123].…”

Section: Atrial Fibrillation/atrial Fluttersupporting

confidence: 76%

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A Systematic Review of the Spectrum of Cardiac Arrhythmias in Sub-Saharan Africa

Yuyun

Bonny

et al. 2020

Global Heart

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Major structural cardiovascular diseases are associated with cardiac arrhythmias, but their full spectrum remains unknown in sub-Saharan Africa (SSA), which we addressed in this systematic review. Atrial fibrillation/atrial flutter (AF/AFL) prevalence is 16-22% in heart failure, 10-28% in rheumatic heart disease, 3-7% in cardiology admissions, but <1% in the general population. Use of oral anticoagulation is heterogenous (9-79%) across SSA. The epidemiology of sudden cardiac arrest/death is less characterized in SSA. Cardiopulmonary resuscitation is challenging, owing to low awareness and lack of equipment for life-support. About 18% of SSA countries have no cardiac implantable electronic devices services, leaving hundreds of millions of people without any access to treatment for advanced bradyarrhythmias, and implant rates are more than 200-fold lower than in the western world. Management of tachyarrhythmias is largely noninvasive (about 80% AF/AFL via rate-controlled strategy only), as electrophysiological study and catheter ablation centers are almost non-existent in most countries. Highlights:-Atrial fibrillation/flutter prevalence is 16-22% in heart failure, 10-28% in rheumatic heart disease, 3-7% in cardiology admissions, and <1% in the general population in sub-Saharan Africa (SSA).-Rates of oral anticoagulation use for CHA2DS2VASC score ≥2 are very diverse (9-79%) across SSA countries.-Data on sudden cardiac arrest are scant in SSA with low cardiopulmonary resuscitation awareness.-Low rates of cardiac implantable electronic devices insertions and rarity of invasive arrhythmia treatment centers are seen in SSA, relative to the high-income countries.

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Section: Atrial Fibrillation/atrial Fluttersupporting

confidence: 83%

Section: Atrial Fibrillation/atrial Fluttersupporting

confidence: 76%

A Systematic Review of the Spectrum of Cardiac Arrhythmias in Sub-Saharan Africa

Yuyun

Bonny

et al. 2020

Global Heart

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“…AF burden is lowest in sub-Saharan Africa [ 29 ], possibly due in part to under-detection and non-recognition. However, it is associated with increased risk of stroke and heart failure [ 3 30 ] and recently, an increase in disability-adjusted life years (DALYs) from AF [ 31 ].…”

Section: Global Af Burden and Country Estimatesmentioning

confidence: 99%

World Heart Federation Roadmap on Atrial Fibrillation – A 2020 Update

et al. 2021

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The World Heart Federation (WHF) commenced a Roadmap initiative in 2015 to reduce the global burden of cardiovascular disease and resultant burgeoning of healthcare costs. Roadmaps provide a blueprint for implementation of priority solutions for the principal cardiovascular diseases leading to death and disability. Atrial fibrillation (AF) is one of these conditions and is an increasing problem due to ageing of the world's population and an increase in cardiovascular risk factors that predispose to AF. The goal of the AF roadmap was to provide guidance on priority interventions that are feasible in multiple countries, and to identify roadblocks and potential strategies to overcome them.Since publication of the AF Roadmap in 2017, there have been many technological advances including devices and artificial intelligence for identification and prediction of unknown AF, better methods to achieve rhythm control, and widespread uptake of smartphones and apps that could facilitate new approaches to healthcare delivery and increasing community AF awareness.In addition, the World Health Organisation added the non-vitamin K antagonist oral anticoagulants (NOACs) to the Essential Medicines List, making it possible to increase advocacy for their widespread adoption as therapy to prevent stroke. These advances motivated the WHF to commission a 2020 AF Roadmap update. Three years after the original Roadmap publication, the identified barriers and solutions were judged still relevant, and progress has been slow.This 2020 Roadmap update reviews the significant changes since 2017 and identifies priority areas for achieving the goals of reducing death and disability related to AF, particularly targeted at low-middle income countries. These include advocacy to increase appreciation of the scope of the problem; plugging gaps in guideline management and prevention through physician education, increasing patient health literacy, and novel ways to increase access to integrated healthcare including mHealth and digital transformations; and greater emphasis on achieving practical solutions to national and regional entrenched barriers. Despite the advances reviewed in this update, the task will not be easy, but the health rewards of implementing solutions that are both innovative and practical will be great.

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“…In this issue of the Journal of Cardiovascular Electrophysiology, Dr Noubiap and Dr Nyaga present a comprehensive review on the epidemiology of AF in sub-Saharan Africa (SSA). 1 They are to be commended for raising awareness of this underserved population with unmet needs. What likely began as a systematic PRISMA based metaanalysis quickly transformed into a descriptive review once the heterogeneity of the population became apparent.…”

mentioning

confidence: 99%

“…Efforts at increasing AF awareness, ambulatory monitoring, anticoagulation, and other therapeutic interventions are growing and gaining widespread attention from both the cardiovascular and general medicine communities. In this issue of the Journal of Cardiovascular Electrophysiology , Dr Noubiap and Dr Nyaga present a comprehensive review on the epidemiology of AF in sub‐Saharan Africa (SSA) . They are to be commended for raising awareness of this underserved population with unmet needs.…”

mentioning

confidence: 99%