Atrial fibrillation among adults with heart failure in sub-Saharan Africa — prevalence, incidence and all-cause mortality: a systematic review and meta-analysis protocol

Agbor, Valirie Ndip; Aminde, Léopold Ndemnge; Tianyi, Frank-Leonel; Mbanga, Clarence; Petnga, Saint-Just; Ditah, Chobufo; Noubiap, Jean Jacques

doi:10.1136/bmjopen-2018-022320

Cited by 7 publications

(11 citation statements)

References 26 publications

(28 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Atrial fibrillation (AF) is the commonest cardiac arrhythmia, and a global public health problem associated with high rates of hospitalisation, disability, and complications such as heart failure, cardiomyopathy, and cardio-embolic events like stroke [1][2][3][4]. The incidence and prevalence of AF have been on a rise globally especially in high-income European countries [1,5].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and associated factors of undiagnosed atrial fibrillation among end-stage renal disease patients on maintenance haemodialysis: a cross-sectional study

AlAwwa

Al-Hindi

Alfraihat

et al. 2020

BMC Cardiovasc Disord

View full text Add to dashboard Cite

Background: Atrial fibrillation (AF) is the most prevalent sustained arrhythmia worldwide and it aggravates cardiovascular morbidity and mortality; however, this is largely under-diagnosed. Moreover, among end-stage renal disease patients on haemodialysis, AF is substantially more common and serious. The researchers conducted this study to assess the prevalence of, and the factors correlated with AF in Jordanian haemodialysis patients. Methods: In a cross-sectional analysis conducted from October 2018 to February 2019 in four tertiary hospitals, the researchers enrolled all consenting patients aged 18 years or older who were on haemodialysis for at least three months prior to the study. We screened for AF clinically by pulse palpation, precordial auscultation, by an automated blood pressure monitor and an electrocardiogram. The researchers reported qualitative variables as counts and frequencies, while continuous variables were summarised using the mean or median where necessary. We used multiple logistic regression with backward selection to identify independent risk factors of AF. Results: A total of 231 patients were enrolled; mean age was 54.8 ± 15.6 years (from 20 to 86), and 44.3% of them were women. The prevalence of AF was found to be 7.8% (95% CI, 4.8-12.2), with no gender disparity. Age (adjusted odds ratio [AOR] = 1.05; 95% CI, 1.01-1.10; p = 0.031), history of ischaemic heart disease (AOR = 3.74; 95% CI, 1.09-12.34; p = 0.033), history of smoking (AOR = 0.15; 95% CI, 0.02-0.60; p = 0.019), and low interdialytic weight gain (AOR = 0.50: 95% CI, 0.25-0.91; p = 0.031) were independently correlated to AF.

show abstract

Section: Introductionmentioning

confidence: 99%

Prevalence and associated factors of undiagnosed atrial fibrillation among end-stage renal disease patients on maintenance haemodialysis: a cross-sectional study

AlAwwa

Al-Hindi

Alfraihat

et al. 2020

BMC Cardiovasc Disord

View full text Add to dashboard Cite

show abstract

“…The short-term mortality rates we observed in Tanzania are much higher than what has been reported in Kenya [4] , and are also much higher than what has been reported outside of SSA: recent studies from the United States, Canada, and Europe reported thirty-day mortality rates between 0 and 15% 36. , [37] , 38. , 39.…”

Section: Discussionmentioning

confidence: 99%

The prevalence, management, and thirty-day outcomes of symptomatic atrial fibrillation in a Tanzanian emergency department

Oyediran

Prattipati

Sakita

et al. 2021

African Journal of Emergency Medicine

View full text Add to dashboard Cite

Introduction Data describing atrial fibrillation (AF) care in emergency centres (ECs) in sub-Saharan Africa is lacking. We sought to describe the prevalence and outcomes of AF in a Tanzanian EC. Methods In a prospective, observational study, adults presenting with chest pain or shortness of breath to a Tanzanian EC were enrolled from January through October 2019. Participants underwent electrocardiogram testing which were reviewed by two independent physician judges to determine presence of AF. Participants were asked about their medical history and medication use at enrollment, and a follow-up questionnaire was administered via telephone thirty days later to assess mortality, interim stroke, and medication use. Results Of 681 enrolled patients, 53 (7.8%) had AF. The mean age of participants with AF was 68.1, with a standard deviation (sd) of 21.1 years, and 23 of the 53 (43.4%) being male. On presentation, none of the participants found to have AF reported a previous history of AF. The median CHADS-VASC score among participants was 4 with an interquartile range (IQR) of 2-4. No participants were taking an anticoagulant at baseline. On index presentation, 49 (92.5%) participants with AF were hospitalised with 52 (98.1%) participants completing 30-day follow-up. 18 (34%) participants died, and 5 (9.6%) suffered a stroke. Of the surviving 31 participants with AF and a CHADS-VASC score ≥ 2, none were taking other anti-coagulants at 30 days. Compared to participants without AF, participants with AF were more likely to be hospitalised (OR 5.25, 95% CI 2.10-17.95, p < 0.001), more likely to die within thirty days (OR 1.93, 95% CI 1.03-3.50, p = 0.031), and more likely to suffer a stroke within thirty days (OR 5.91, 95% CI 1.76-17.28, p < 0.001). Discussion AF is common in a Tanzanian EC, with thirty-day mortality being high, but use of evidence-based therapies is rare. There is an opportunity to improve AF care and outcomes in Tanzania.

show abstract

“…By the difference in proportions calculation, a minimum sample size of 331 patients was needed to provide at least 80% power to detect the difference in mortality rates between patients with AF and those without (two-sided test with a 5% level of significance) 18. Our pretest estimation of AF prevalence was 16% 19 20. For the secondary analyses, this sample size was expected to provide at least 10 observations (ie, number of patients with AF or death events) per predictor in the final models to allow good estimates 21 22.…”

Section: Methodsmentioning

confidence: 99%

Atrial fibrillation and mortality in outpatients with heart failure in Tanzania: a prospective cohort study

et al. 2022

View full text Add to dashboard Cite

ObjectiveIn recent years, the prevalence and mortality of heart failure (HF) and other associated cardiovascular diseases have doubled in sub-Saharan Africa (SSA). Studies in high-income countries indicate that HF with concurrent atrial fibrillation (AF) is linked to increased mortality. Our objective was to determine the incidence and clinical outcomes of AF among patients with HF in SSA.DesignA prospective cohort study using data collected between October 2018 and May 2020.SettingOutpatient clinic at a tertiary hospital in Mwanza, Tanzania.Participants303 adult participants (aged ≥18 years) with HF as defined by the European Society of Cardiology guidelines (2016) and 100 adults with HF as defined by clinical criteria alone were enrolled into the study. Patients with comorbid medical condition that had prognosis of <3 months (ie, advance solid tumours, advance haematological malignancies) were excluded.MethodsParticipants were screened for AF, and their medical history, physical examinations and sociodemographic information were obtained. Multivariable logistic regression models were used to examine factors associated with AF incidence. Cox regression models were used to analyse 3-month mortality and its associated risk factors.ResultsWe enrolled 403 participants with HF (mean age 60±19 years, 234 (58%) female). The AF prevalence was 17%. In multivariable models, factors associated with AF were low income, alcohol consumption and longer duration of HF. At the end of the 3-month follow-up, 120 out of 403 (30%) participants died, including 44% (31/70) of those with AF. Higher heart rate on ECG, more severe New York Heart Association HF class, rural residence and anaemia were significantly correlated with mortality.ConclusionAF is common, underdiagnosed and is associated with significant mortality among outpatients with HF in Tanzania (HR 1.749, 95% CI 1.162 to 2.633, p=0.007). Our findings additionally identify tachycardia (>110 bpm, HR 1.879, 95% CI 1.508 to 2.340, p<0.001) as an easily measurable, high-impact physical examination finding for adverse outcomes in patients with HF.

show abstract

Atrial fibrillation among adults with heart failure in sub-Saharan Africa — prevalence, incidence and all-cause mortality: a systematic review and meta-analysis protocol

Cited by 7 publications

References 26 publications

Prevalence and associated factors of undiagnosed atrial fibrillation among end-stage renal disease patients on maintenance haemodialysis: a cross-sectional study

Prevalence and associated factors of undiagnosed atrial fibrillation among end-stage renal disease patients on maintenance haemodialysis: a cross-sectional study

The prevalence, management, and thirty-day outcomes of symptomatic atrial fibrillation in a Tanzanian emergency department

Atrial fibrillation and mortality in outpatients with heart failure in Tanzania: a prospective cohort study

Contact Info

Product

Resources

About