Atrial fibrillation in Sub-Saharan Africa: epidemiology, unmet needs, and treatment options

Stambler, Bruce S.; Ngunga, Leonard

doi:10.2147/ijgm.s84537

Cited by 48 publications

(59 citation statements)

References 67 publications

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“…A review published 4 years ago suggested that there is a dearth of information on the epidemiology of AF in SSA . However, this review was not systematic and did not capture much relevant data.…”

Section: Introductionmentioning

confidence: 99%

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

Noubiap

Nyaga²

2019

Cardiovasc electrophysiol

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This systematic review summarizes the data on the prevalence, risk factors, complications, and management of atrial fibrillation (AF) in sub‐Saharan Africa (SSA). Bibliographic databases were searched from inception to 31 May 2019, to identify all published studies providing data on AF in populations living in SSA. A total of 72 studies were included. The community‐based prevalence of AF was 4.3% and 0.7% in individuals aged ≥40 years and aged ≥70 years, respectively. The prevalence of AF ranged between 6.7% and 34.8% in patients with ischemic stroke, between 9.5% and 46.8% in those with rheumatic heart disease (RHD), between 5% and 31.5% in patients with dilated cardiomyopathy. The main risk factors for AF were hypertension, affecting at least one‐third of patients with AF, and valvular heart disease (12.3%‐44.4%) and cardiomyopathy (~20%). Complications of AF included heart failure in about two thirds and stroke in 10% to 15% of cases. The use of anticoagulation for stroke prevention was suboptimal. Rate control was the most frequent therapeutic strategy, used in approximately 65% to 95% of AF patients, with approximately 80% of them achieving rate control. The management of AF was associated with exorbitant cost. In conclusion, AF seems to have a higher prevalence in the general population than previously thought and is mostly associated with hypertension, cardiomyopathy, and RHD in SSA. It is associated with a high incidence of heart failure and stroke. The management of AF is suboptimal in SSA, especially with a low uptake of oral anticoagulation.

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Section: Introductionmentioning

confidence: 99%

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

Noubiap

Nyaga²

2019

Cardiovasc electrophysiol

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“…Besides, use of oral anticoagulants and not antiplatelets is the recommended treatment for AF in patients at high-risk of stroke, such as those with CHADS 2 scores of 2 or more, according to American Heart Association/European Society of Cardiology guidelines. [9] Considering that stroke related to AF is more disabling and carries greater risks of death and disability,[1516] our findings suggest the need for improved efforts at early detection and appropriate management of AF at primary care settings in SSA.…”

Section: Discussionmentioning

confidence: 99%

Prestroke treatment of stroke risk factors: A cross-sectional survey in central Nigeria

et al. 2016

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Background:Stroke can be prevented with treatments targeted at hypertension, diabetes mellitus, hyperlipidemia and atrial fibrillation, but this is often hampered by under-diagnosis and under-treatment of those risk factors. The magnitude of this problem is not well-studied in sub-Saharan Africa.Materials and Methods:We conducted a cross-sectional survey of stroke patients at a tertiary hospital during January 2010 to July 2013 to determine patient awareness of a pre-existing stroke risk factor and prior use of anti-hypertensive, anti-diabetic, antiplatelet and lipid-lowering agents. We also investigated whether gender and school education influenced patient awareness and treatment of a stroke risk factor prior to stroke.Results:Three hundred and sixty nine stroke patients presented during the study period, of which 344 eligible subjects were studied. Mean age at presentation (±SD) was 55.8 ± 13.7 years, and was not different for men and women. Hypertension, hyperlipidemia, diabetes and atrial fibrillation were prevalent among 83.7%, 26.5%, 25.6% and 9.6% patients respectively. Awareness was high for pre-existing diabetes (81.8%) and hypertension (76.7%), but not for hyperlipidemia (26.4%) and atrial fibrillation (15.2%). Men were better educated than women (p = 0.002), and had better awareness for hyperlipidemia (37.3% versus 13.5%; p = 0.009). Men were also more likely to take drug treatments for a stroke risk factor, but the differences were significant.Conclusions:A high rate of under-diagnosis and under-treatment of hypertension, hyperlipidemia and atrial fibrillation contributes to the stroke burden in sub-Saharan Africa, especially among women. Public health measures including mass media campaigns could help reduce the burden of stroke.

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“…The pulse rates here (result not shown) ranged from 72 to 100/minute; and none was reported as irregular. Atrial fibrillation is not common in African populations, either native on the continent or in the America [19]. There must be a genetic angle to it as African Americans are less encumbered than white Americans [20].…”

Section: Discussionmentioning

confidence: 99%

Rarity of Heart Failure in a Traditional African Population. A Rural Community Based Study

Okeahialam

Agbo²,

Ogbonna³

et al. 2016

ICFJ

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BACKGROUND: Heart failure (HF) is common globally and increases with age. Among Caucasians it affects mainly the elderly, but the middle-aged in Africa. Statistics are usually hospital based, missing those in the population unable to present in hospital for various reasons. Population statistics of HF for sub-Saharan Africa are hardly available. This was to assess the population prevalence of HF in a rural sub-Sahara African community and get a truer picture of HF morbidity.METHODS: Secondary analysis of data from a population study of cardiovascular disease risk factors in rural Nigeria; on self-reported HF as part of general history, physical examination and related laboratory investigations RESULTS: Of the 840 subjects, 231 were men; 8 (0.95%) of whom were in HF (2M, 6F); and aged between 50 to 90 years. All the men were above 65 years while 2 of the women were less than 65 years. Four were hypertensive, 3 had hypertension and diabetes; while 1 the oldest had neither. They all denied tobacco and alcohol use. Most of the affected women were multiparous.CONCLUSION: HF is infrequent in rural Nigeria with a prevalence of 0.95%. Hypertension was a prominent risk factor, with co-morbid diabetes. The absence of tobacco /alcohol history, anaemia and low rate of kidney disease confirms that a constellation of risk factors is required for HF among hypertensives. The earlier presentation and greater involvement of women (in the background of multiparity) supports the notion that repeated pregnancy and child-birth place higher disease burden of hearts of women.

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Atrial fibrillation in Sub-Saharan Africa: epidemiology, unmet needs, and treatment options

Cited by 48 publications

References 67 publications

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

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

Prestroke treatment of stroke risk factors: A cross-sectional survey in central Nigeria

Rarity of Heart Failure in a Traditional African Population. A Rural Community Based Study

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