Clinical characteristics and 12-month outcomes of patients with valvular and non-valvular atrial fibrillation in Kenya

Temu, Tecla M; Lane, Kathleen A.; Shen, Changyu; Ng’ang'a, Loise; Akwanalo, Constantine; Chen, Peng Sheng; Emonyi, Wilfred; Heckbert, Susan R.; Koech, Myra; Manji, I; Vatta, Matteo; Velázquez, Eric J.; Wessel, Jennifer; Kimaiyo, Sylvester; Inui, Thomas S.; Bloomfield, Gerald S.

doi:10.1371/journal.pone.0185204

Cited by 15 publications

(35 citation statements)

References 23 publications

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“…Hypertension was the most frequently reported risk factor for AF, and the most prevalent, affecting at least one in three patients with AF . This is consistent with the global picture that shows that hypertension is the most common medical condition associated with AF, present in about 30% to 75% of patients with AF .…”

Section: Discussionsupporting

confidence: 86%

“…In three studies, the prevalence of obesity was 48.1% (body mass index [BMI] ≥ 25), 5.5% (BMI ≥ 30), and 6.4% (BMI ≥ 35) . In most studies, about 20% of patients had cardiomyopathy as the underlying etiologic factor . Valvular heart disease was common in patients with AF, with rates ranging from 12.3% to 44.4% .…”

Section: Resultsmentioning

confidence: 99%

“…In more than half of studies about two thirds of patients with AF were in heart failure . Stroke was a common complication in patients with AF; most studies reported that 10% to 15% of patients with AF had a current or a past history of stroke, with rates varying between 2.4% and 33.8% (Figure and Table S3). Peripheral embolism was much less common with prevalence rates of less than 5% .…”

Section: Resultsmentioning

confidence: 99%

“…Few studies reported primary mortality data in patients with AF, most of them lacking information on the time of follow‐up. In a study in Cameroon, during a mean follow‐up was 318 ± 124 days, 29.5% of patients with AF died, with the death being from cardiovascular origin in 55.7% of cases .…”

Section: Resultsmentioning

confidence: 99%

“…The mortality in patients with AF in SSA seems to be high, according to the few studies that reported on this outcome . For instance, at about 1 year of follow‐up, approximately 15% and 30% of patients with AF had died, in studies in Botswana and Cameroon, respectively.…”

Section: Discussionmentioning

confidence: 99%

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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: Discussionsupporting

confidence: 86%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Noubiap

Nyaga²

2019

Cardiovasc electrophysiol

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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

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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.

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Atrial Fibrillation in Africa—An Under-Reported and Unrecognized Risk Factor for Stroke: A Systematic Review

Jacobs

Hulst

Adeoye

et al. 2019

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Over three-quarters of deaths from cardiovascular disease and diabetes occur in low-and middle-income countries, which include many African countries. Global studies showed that the prevalence of the cardiac arrhythmia atrial fibrillation (AF) appeared to be lower in Africa. A systematic search of PubMed and African Journals Online was conducted to determine the prevalence of AF and associated stroke risk factors in Africa and to quantify the need for screening. The publications search yielded a total of 840 articles of which 41 were included. AF was often not identified as the disease of primary interest with its own risks. Data on prevalence in the general population was scarce. The prevalence of stroke risk factors showed a large variation between studies, as well as within clustered subpopulations. AF in Africa is under-reported in published reports. The study types and populations are highly heterogeneous, making it difficult to draw a definitive conclusion on AF prevalence.

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Clinical characteristics and 12-month outcomes of patients with valvular and non-valvular atrial fibrillation in Kenya

Cited by 15 publications

References 23 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

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

Atrial Fibrillation in Africa—An Under-Reported and Unrecognized Risk Factor for Stroke: A Systematic Review

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